Fertility-sparing treatment for low-grade endometrial stromal sarcoma

Area of Science:

• Gynecologic Oncology
• Reproductive Endocrinology
• Surgical Oncology

Background:

• Oncologic outcomes for low-grade endometrial stromal sarcoma (LGESS) with fertility preservation are not well-established.
• This study addresses the prognosis of fertility-sparing surgeries and associated obstetrical outcomes in LGESS patients.

Purpose of the Study:

• To investigate the oncologic and fertility outcomes of fertility-sparing surgery in patients with low-grade endometrial stromal sarcoma.
• To evaluate the impact of ovarian preservation on recurrence and survival in LGESS patients.

Main Methods:

• Retrospective review of 135 patients with primary LGESS treated from February 2012 to June 2019.
• Follow-up until June 1, 2020, to assess fertility and oncologic outcomes, including recurrence and mortality.
• Comparative analysis of outcomes between patients who underwent fertility-sparing surgery versus those who did not, and with versus without ovarian preservation.

Main Results:

• Fertility-sparing surgery (21 patients) and ovarian preservation (42 patients) were performed in 15.6% and 31.1% of LGESS cases, respectively.
• Significantly higher recurrence rates were observed in patients undergoing fertility-sparing surgery (47.6% vs. 15.8%) and ovarian preservation (42.9% vs. 10.8%).
• Fertility-sparing surgery and ovarian preservation increased recurrence risk (HR 3.5 and 5.2, respectively) in the overall cohort and stage I patients, with no increased mortality risk. Seven of nine patients attempting pregnancy achieved live births.

Conclusions:

• Fertility-sparing surgery for LGESS is associated with a significantly elevated risk of recurrence but does not increase mortality.
• Ovarian preservation in LGESS patients also correlates with a higher risk of recurrence.
• For stage I LGESS patients, fertility-sparing surgery demonstrates promising live birth rates, balancing reproductive desires with oncologic risks.