Fertility-sparing treatment for low-grade endometrial stromal sarcoma

Little is known about the oncologic results of patients with low-grade endometrial stromal sarcoma (LGESS) with fertility preservation. This study investigated the prognosis of fertility-sparing surgeries and relevant obstetrical outcomes.

All eligible patients in the study center were retrospectively reviewed if they consented to surgical treatment for primary LGESS from February 2012 to June 2019 in the study center. Follow-up of fertility and oncologic outcomes was carried out until June 1, 2020.

Among 135 patients who underwent surgical therapy for primary uterine LGESS, 21 (15.6%) and 42 (31.1%) underwent fertility-sparing surgery and ovarian preservation, respectively. After a median follow-up of 38.5 (range 5-98) months, differences were detected in the recurrence rates among patients with and without fertility-sparing surgery (47.6% vs 15.8%, p = 0.002) or with and without ovarian preservation (42.9% vs 10.8%, p < 0.001). Fertility-sparing surgery and ovarian preservation significantly increased the risk of recurrence in the entire cohort (hazard ratio [HR] 3.5 and 5.2, 95% confidence interval [CI] 1.6-7.6 and 2.4-11.3, p = 0.002 and < 0.001) and in stage I patients (HR 2.6 and 3.1, 95% CI 1.0-6.4 and 1.3-7.4, p = 0.041 and 0.011). No factor was found to be associated with increased mortality risk. Among the 9 patients who attempted pregnancy, 7 (77.8%) achieved 8 live births. All three advanced-stage patients who underwent fertility-sparing surgery experienced recurrence without successful conception.

Fertility-sparing surgery for LGESS results in a significantly increased risk of recurrence but not mortality and has promising results in terms of live births in stage I patients.