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Abstract：
OBJECTIVE: To discuss the optimal treatment options for low grade endometrial stromal sarcoma (LG-ESS).
METHODS: Medical records of consecutive patients with LG-ESS in our institute were collected. The pertinent data, including clinicopathological characteristics, treatment and prognostic information were evaluated.
RESULTS: A total of 153 cases of LG-ESS were included. The 5-year relapse free survival (RFS), overall survival (OS) and survival after relapse (SAR) rates were 66.1%, 95.8% and 82.9%, respectively. Ovary-sparing procedures, positive resection-margins, and myomectomy were the independent adverse factors for relapse (P<0.0001, =0.0041, and =0.0075, respectively). Post-menopause, cervical involvement, and positive lymphovascular space involvement were significantly associated with survival (P<0.0001, =0.0020, and =0.0163, respectively). Distance recurrence and macroscopically residual tumors negatively affected SAR (P=0.0137 and =0.0004, respectively). No benefit was found for lymphadenectomy in terms of both RFS and OS (P=0.1187 and =0.5138, respectively). Initial ovary-sparing procedures and myomectomy had no impact on OS (P=0.0810 and =0.8845, respectively). Adjuvant treatment had a slightly beneficial effect both on OS and SAR.
CONCLUSIONS: Hysterectomy with bilateral salpingo-oophorectomy and complete resection of the macroscopic lesion should be treated as the initial and salvage mainstay treatments for LG-ESS patients. Ovary-sparing procedures could be considered for young women without cervical involvement; however, long-term follow-up should be mandatory. Myomectomy should only be conserved for young patients with a strong desire for future fertility, with fully informed consent; hysterectomy was recommended after the completion of pregnancy and delivery. However, the roles of lymphadenectomy and adjuvant treatment deserve further investigation.
METHODS: Medical records of consecutive patients with LG-ESS in our institute were collected. The pertinent data, including clinicopathological characteristics, treatment and prognostic information were evaluated.
RESULTS: A total of 153 cases of LG-ESS were included. The 5-year relapse free survival (RFS), overall survival (OS) and survival after relapse (SAR) rates were 66.1%, 95.8% and 82.9%, respectively. Ovary-sparing procedures, positive resection-margins, and myomectomy were the independent adverse factors for relapse (P<0.0001, =0.0041, and =0.0075, respectively). Post-menopause, cervical involvement, and positive lymphovascular space involvement were significantly associated with survival (P<0.0001, =0.0020, and =0.0163, respectively). Distance recurrence and macroscopically residual tumors negatively affected SAR (P=0.0137 and =0.0004, respectively). No benefit was found for lymphadenectomy in terms of both RFS and OS (P=0.1187 and =0.5138, respectively). Initial ovary-sparing procedures and myomectomy had no impact on OS (P=0.0810 and =0.8845, respectively). Adjuvant treatment had a slightly beneficial effect both on OS and SAR.
CONCLUSIONS: Hysterectomy with bilateral salpingo-oophorectomy and complete resection of the macroscopic lesion should be treated as the initial and salvage mainstay treatments for LG-ESS patients. Ovary-sparing procedures could be considered for young women without cervical involvement; however, long-term follow-up should be mandatory. Myomectomy should only be conserved for young patients with a strong desire for future fertility, with fully informed consent; hysterectomy was recommended after the completion of pregnancy and delivery. However, the roles of lymphadenectomy and adjuvant treatment deserve further investigation.
摘要：
目的：探讨低级别子宫内膜间质肉瘤（LG-ESS）的最佳治疗方案。
方法：收集我院连续LG-ESS患者的病历。相关数据，包括临床病理特征，评估治疗和预后信息。
结果：共纳入153例LG-ESS。5年无复发生存期（RFS），总生存率(OS)和复发后生存率(SAR)分别为66.1%,95.8%和82.9%，分别。保留卵巢的程序，切缘阳性,和子宫肌瘤切除术是复发的独立不良因素(分别为P<0.0001,=0.0041,和=0.0075).绝经后,宫颈受累,和阳性淋巴血管间隙受累与生存率显着相关（分别为P<0.0001，=0.0020和=0.0163）。距离复发和宏观残留肿瘤对SAR具有负面影响（分别为P=0.0137和0.0004）。在RFS和OS方面，淋巴结清扫术没有发现益处（分别为P=0.1187和0.5138）。最初的保留卵巢手术和子宫肌瘤切除术对OS没有影响（分别为P=0.0810和0.8845）。辅助治疗对OS和SAR都有轻微的有益作用。
结论：对LG-ESS患者，应将双侧附件卵巢切除术和宏观病灶完全切除作为初始和挽救性的主要治疗方法。对于没有宫颈受累的年轻女性，可以考虑保留卵巢；然而，长期随访应该是强制性的.子宫肌瘤切除术应该只保留对未来生育有强烈愿望的年轻患者，在完全知情同意的情况下，建议在完成妊娠和分娩后进行子宫切除术。然而,淋巴结清扫术和辅助治疗的作用值得进一步研究.
方法：收集我院连续LG-ESS患者的病历。相关数据，包括临床病理特征，评估治疗和预后信息。
结果：共纳入153例LG-ESS。5年无复发生存期（RFS），总生存率(OS)和复发后生存率(SAR)分别为66.1%,95.8%和82.9%，分别。保留卵巢的程序，切缘阳性,和子宫肌瘤切除术是复发的独立不良因素(分别为P<0.0001,=0.0041,和=0.0075).绝经后,宫颈受累,和阳性淋巴血管间隙受累与生存率显着相关（分别为P<0.0001，=0.0020和=0.0163）。距离复发和宏观残留肿瘤对SAR具有负面影响（分别为P=0.0137和0.0004）。在RFS和OS方面，淋巴结清扫术没有发现益处（分别为P=0.1187和0.5138）。最初的保留卵巢手术和子宫肌瘤切除术对OS没有影响（分别为P=0.0810和0.8845）。辅助治疗对OS和SAR都有轻微的有益作用。
结论：对LG-ESS患者，应将双侧附件卵巢切除术和宏观病灶完全切除作为初始和挽救性的主要治疗方法。对于没有宫颈受累的年轻女性，可以考虑保留卵巢；然而，长期随访应该是强制性的.子宫肌瘤切除术应该只保留对未来生育有强烈愿望的年轻患者，在完全知情同意的情况下，建议在完成妊娠和分娩后进行子宫切除术。然而,淋巴结清扫术和辅助治疗的作用值得进一步研究.
