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Primary characteristics and outcomes of newly diagnosed low-grade endometrial stromal sarcoma
  1. Evan S Smith1,
  2. Corinne Jansen1,2,
  3. Kathryn M Miller1,
  4. Sarah Chiang3,
  5. Kaled M Alektiar4,
  6. Martee L Hensley5,6,
  7. Jennifer J Mueller1,7,
  8. Nadeem R Abu-Rustum1,7 and
  9. Mario M Leitao Jr1,7
  1. 1Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  5. 5Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  6. 6Department of Medicine, Weill Cornell Medical College, New York, New York, USA
  7. 7Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Mario M Leitao Jr, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA; leitaom{at}


Objective To assess potential predictive variables for nodal metastasis and survival outcomes in patients with newly diagnosed, low-grade endometrial stromal sarcoma.

Methods We performed a single-institution, retrospective analysis of consecutive patients with newly diagnosed, low-grade endometrial stromal sarcoma who presented between January 1, 1980 and December 31, 2019 and underwent hysterectomy at our institution or presented within 3 months of primary surgery elsewhere before recurrence. Patients who presented to our institution only at recurrence were excluded. Patients with <3 months of follow-up were excluded from survival analyses.

Results We identified 127 consecutive patients for analysis. Median age at diagnosis was 48 years (range 19–88 years); 91 (74.6%) of 127 were pre-menopausal; and 74 (58.3%) of 127 had uterine-confined, stage I tumors. Of 56 patients (44.1%) who underwent lymph node sampling, 10 (17.9%) had nodal metastasis. Of the 10 with nodal metastasis, 1 (10%) did not have lymphadenopathy or extra-uterine disease, 4 (40%) had lymphadenopathy only, 1 (10%) had extra-uterine disease only, and 4 (40%) had both. Among the 29 patients without apparent extra-uterine disease or gross lymphadenopathy, there was one occult lymph node metastasis (3.4%). Gross lymphadenopathy at time of surgery was predictive for lymph node metastasis (p<0.001). Median follow-up was 69 months (range 4–336) for the 95 patients included in the survival analyses. The 5-year progression-free survival and disease-specific survival rates were 79.8% and 90.8%, respectively. Patients with stage I tumors had longer progression-free survival than those with stage II–IV disease (p<0.001); there was no difference in disease-specific survival (p=0.63). Post-operative observation versus adjuvant therapy with hormone blockade or radiation therapy did not result in progression-free survival differences for stage I or completely resected stage II–IV disease (p=0.50 and p=0.81, respectively). Similarly, there was no disease-specific survival difference for completely resected stage II–IV disease (p=0.3).

Conclusions Lymph node dissection in patients with low-grade endometrial stromal sarcoma should be reserved for those with clinically suspicious lymphadenopathy. Disease stage correlated with progression-free survival but not disease-specific survival. Post-operative therapy did not improve progression-free survival or disease-specific survival.

  • surgery
  • sarcoma
  • surgical oncology
  • lymphatic metastasis

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors Conceptualization: ESS, ML. Data curation: ESS, CJ, KMM, ML. Formal analysis: ESS, ML. Methodology: ESS, ML. Roles: Writing - original draft: ESS, CJ, ML. Writing - review and editing: all authors. Guarantor: ML.

  • Funding Funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

  • Competing interests Outside the submitted work, ML reports personal fees from JnJ/Ethicon and Takeda, and grants from KCI/Acelity. He is also an ad hoc speaker for Intuitive Surgical, Inc. NRA-R reports grants from Stryker/Novadaq and GRAIL. SC reports personal fees from AstraZeneca. MLH reports “other” from Sanofi and UpToDate, as well as personal fees from GSK, Lilly, Thrive/Exact Sciences, and Research To Practice.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.