J Gynecol Oncol.  2017 Jul;28(4):e46. 10.3802/jgo.2017.28.e46.

Safety of ovarian preservation in premenopausal women with stage I uterine sarcoma

• Nasioudis
• Chapman-Davis E
• Frey M
• Holcomb K

• KMID: 2413431
• DOI: http://doi.org/10.3802/jgo.2017.28.e46

Abstract

OBJECTIVE
To evaluate the oncologic safety of ovarian preservation (OP) in premenopausal women diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) stage I uterine sarcoma.
METHODS
The National Cancer Institute's Surveillance, Epidemiology, and End Results database was accessed and a cohort of women aged ≤50 diagnosed between 1988-2013 with a sarcoma limited to the uterus was drawn. Based on site-specific surgery codes, women who underwent hysterectomy with or without oophorectomy and did not receive radiation therapy were selected for further analysis. Overall (OS) and cancer-specific (CSS) survival were determined following generation of Kaplan-Meier curves; comparisons were made with the log-rank test. A Cox-proportional hazard model was constructed to control for possible confounders.
RESULTS
A total of 1,482 women were included in the analysis; 800 (54.0%) were diagnosed with leiomyosarcoma (LMS), 520 (35.1%) with low-grade endometrial stromal sarcoma (LG-ESS), and 162 (10.9%) with adenosarcoma (AS). The OP group included 418 women (28.2%). Differences in the rate of OP were noted based on histology (p=0.014), year of diagnosis (p=0.001), patient age (p<0.001) and race (p=0.012). There was no difference in OS (p=0.220) or CSS (p=0.210) between women who had OP and those who did not. Multivariate analysis confirmed that OP was not associated with a worse mortality.
CONCLUSION
In this population-based cohort of women with sarcoma limited to the uterus, OP was not associated with worse oncologic outcomes. OP could be considered for women with LMS, sparing them from the morbidity associated with iatrogenic menopause. No conclusions could be made for those with LG-ESS or AS.

Keyword

Sarcoma; Leiomyosarcoma; Adenosarcoma of the Uterus; Endometrial Stromal Sarcoma; Ovariectomy

MeSH Terms

Adenosarcoma/pathology/*surgery
Adolescent
Adult
Female
Humans
Hysterectomy
Kaplan-Meier Estimate
Leiomyosarcoma/pathology/*surgery
Middle Aged
Neoplasm Staging
*Organ Sparing Treatments
*Ovariectomy
Ovary/*surgery
Premenopause
Proportional Hazards Models
Retrospective Studies
SEER Program
Survival Rate
Tumor Burden
Uterine Neoplasms/pathology/*surgery
Young Adult