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Abstract：
To provide refined prognostic information from large cohorts of women with low-grade or high-grade endometrial stromal sarcoma (ESS).
We performed an observational retrospective cohort analysis of women diagnosed with low-grade or high-grade ESS from the 1998-2013 National Cancer Database. Kaplan-Meier and multivariable accelerated failure time survival analyses were performed to identify prognostic factors after multiple imputation of missing data. Recursive partitioning methods were used to rank prognostic factors in high-grade ESS. Matched cohort analyses were performed to hypothesis-test effects of adjuvant treatments.
We identified 2414 and 1383 women with low-grade or high-grade ESS, respectively. Women with high-grade ESS had markedly decreased survival compared to women with low-grade ESS (five-year survival (95% CI): 32.6 (30.1-35.3%) versus 90.5% (89.3-91.8%), P<0.001). Among women with high-grade ESS, median survival (95% CI) was only 19.9 (17.1-22.1) months. Increased age and tumor size were associated with decreased survival in low-grade ESS. In high-grade ESS, additional negative prognostic factors were distant or nodal metastasis, omission of lymphadenectomy, and pathologically-positive surgical margins (all P<0.001). Use of adjuvant chemotherapy (time ratio (TR) (95% CI): 1.36 (1.17-1.58), P<0.001) and radiotherapy (TR (95% CI): 1.57 (1.32-1.87), P<0.001) were associated with increased survival for high-grade ESS.
The contrasting excellent versus poor prognosis of low-grade versus high-grade ESS, respectively, was confirmed. The best treatment of high-grade ESS is early and complete surgical resection including lymphadenectomy. Adjuvant chemotherapy and radiotherapy may increase survival of women with high-grade ESS.
We performed an observational retrospective cohort analysis of women diagnosed with low-grade or high-grade ESS from the 1998-2013 National Cancer Database. Kaplan-Meier and multivariable accelerated failure time survival analyses were performed to identify prognostic factors after multiple imputation of missing data. Recursive partitioning methods were used to rank prognostic factors in high-grade ESS. Matched cohort analyses were performed to hypothesis-test effects of adjuvant treatments.
We identified 2414 and 1383 women with low-grade or high-grade ESS, respectively. Women with high-grade ESS had markedly decreased survival compared to women with low-grade ESS (five-year survival (95% CI): 32.6 (30.1-35.3%) versus 90.5% (89.3-91.8%), P<0.001). Among women with high-grade ESS, median survival (95% CI) was only 19.9 (17.1-22.1) months. Increased age and tumor size were associated with decreased survival in low-grade ESS. In high-grade ESS, additional negative prognostic factors were distant or nodal metastasis, omission of lymphadenectomy, and pathologically-positive surgical margins (all P<0.001). Use of adjuvant chemotherapy (time ratio (TR) (95% CI): 1.36 (1.17-1.58), P<0.001) and radiotherapy (TR (95% CI): 1.57 (1.32-1.87), P<0.001) were associated with increased survival for high-grade ESS.
The contrasting excellent versus poor prognosis of low-grade versus high-grade ESS, respectively, was confirmed. The best treatment of high-grade ESS is early and complete surgical resection including lymphadenectomy. Adjuvant chemotherapy and radiotherapy may increase survival of women with high-grade ESS.
摘要：
从患有低级别或高级别子宫内膜间质肉瘤（ESS）的大型女性队列中提供精细的预后信息。
我们对1998-2013年国家癌症数据库中诊断为低级别或高级别ESS的女性进行了观察性回顾性队列分析。进行Kaplan-Meier和多变量加速失效时间生存分析，以在多次填补缺失数据后确定预后因素。使用递归划分方法对高级别ESS的预后因素进行排名。进行匹配的队列分析以假设检验辅助治疗的效果。
我们确定了2414和1383名女性患有低年级或高年级ESS，分别。与低等级ESS的女性相比，高等级ESS的女性生存率显着降低（五年生存率（95％CI）：32.6（30.1-35.3％）与90.5％（89.3-91.8％），P<0.001)。在拥有高级ESS的女性中，中位生存期(95%CI)仅为19.9(17.1~22.1)个月.年龄和肿瘤大小的增加与低级别ESS的生存率降低有关。在高级ESS中，其他阴性预后因素是远处或淋巴结转移，省略淋巴结清扫术，手术切缘病理阳性（均P<0.001）。使用辅助化疗（时间比（TR）（95％CI）：1.36（1.17-1.58），P<0.001）和放疗（TR（95％CI）：1.57（1.32-1.87），P<0.001）与高级别ESS的生存率增加有关。
低度与高度ESS的优预后与差预后对比，分别,已确认。高级ESS的最佳治疗方法是早期和完整的手术切除，包括淋巴结清扫术。辅助化疗和放疗可能会增加高度ESS女性的生存率。
我们对1998-2013年国家癌症数据库中诊断为低级别或高级别ESS的女性进行了观察性回顾性队列分析。进行Kaplan-Meier和多变量加速失效时间生存分析，以在多次填补缺失数据后确定预后因素。使用递归划分方法对高级别ESS的预后因素进行排名。进行匹配的队列分析以假设检验辅助治疗的效果。
我们确定了2414和1383名女性患有低年级或高年级ESS，分别。与低等级ESS的女性相比，高等级ESS的女性生存率显着降低（五年生存率（95％CI）：32.6（30.1-35.3％）与90.5％（89.3-91.8％），P<0.001)。在拥有高级ESS的女性中，中位生存期(95%CI)仅为19.9(17.1~22.1)个月.年龄和肿瘤大小的增加与低级别ESS的生存率降低有关。在高级ESS中，其他阴性预后因素是远处或淋巴结转移，省略淋巴结清扫术，手术切缘病理阳性（均P<0.001）。使用辅助化疗（时间比（TR）（95％CI）：1.36（1.17-1.58），P<0.001）和放疗（TR（95％CI）：1.57（1.32-1.87），P<0.001）与高级别ESS的生存率增加有关。
低度与高度ESS的优预后与差预后对比，分别,已确认。高级ESS的最佳治疗方法是早期和完整的手术切除，包括淋巴结清扫术。辅助化疗和放疗可能会增加高度ESS女性的生存率。
