Low-grade endometrial stromal sarcoma: Hormonal aspects

Micheline C. Chu, Gil Mor, Chungyun Lim, Wenxin - Zheng, Vinita Parkash, Peter E. Schwartz

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

Objective. The goal of this work was to determine whether exposure to estrogen following treatment of low-grade endometrial stromal sarcomas affects clinical outcome. Methods. Twenty-two patients with low-grade endometrial stromal sarcomas were reviewed to determine whether they were exposed to exogenous or endogenous estrogen and/or progestins following their diagnosis and whether exposure to these hormones might have influenced their prognosis. Estrogen receptor (ER) α and β and progestin receptor (PR) status were analyzed from paraffin-embedded tissue by immunohistochemistry and ER mRNA was measured in fresh tissue by reverse transcription polymerase chain reaction (RT-PCR). Results. Ten of the twenty-two patients with low-grade endometrial stromal sarcomas developed recurrent disease. Four of five patients (80%) who received estrogen replacement therapy (ERT) recurred. Four of eight patients (50%) with retained ovaries recurred. Eight of the ten specimens available for analysis were positive for ERα, none were positive for ERβ, and 9 of 10 were positive for PR. Four of thirteen patients who received progestins as adjuvant therapy recurred, compared with 6 of 9 patients who did not receive progestins (31% vs 67%). Eight recurrences were treated with progestin therapy and 7 (88%) of them had either stable disease (3/8, 38%) or complete response (4/8, 50%). Conclusions. Our results suggest that ERT may be detrimental in patients with low-grade endometrial stromal sarcoma. Retention of normally functioning ovaries, on the other hand, may not significantly affect the recurrence rate following hysterectomy alone in Stage I patients. The lack of ERβ expression in endometrial stromal sarcomas compared with normal endometrial stromal cells suggests that loss of ERβ may be a marker for malignancy. Progestin therapy should be routinely considered for adjuvant therapy and for the treatment of recurrent endometrial stromal sarcomas.

Original languageEnglish (US)
Pages (from-to)170-176
Number of pages7
JournalGynecologic Oncology
Volume90
Issue number1
DOIs
StatePublished - Jul 2003
Externally publishedYes

Fingerprint

Endometrial Stromal Tumors
Estrogen Receptors
Progestins
Endometrial Stromal Sarcoma
Estrogen Replacement Therapy
Progesterone Receptors
Ovary
Estrogens
Therapeutics
Recurrence
Stromal Cells
Hysterectomy
Paraffin
Reverse Transcription
Immunohistochemistry
Hormones

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Chu, M. C., Mor, G., Lim, C., Zheng, W. ., Parkash, V., & Schwartz, P. E. (2003). Low-grade endometrial stromal sarcoma: Hormonal aspects. Gynecologic Oncology, 90(1), 170-176. https://doi.org/10.1016/S0090-8258(03)00258-0

Low-grade endometrial stromal sarcoma : Hormonal aspects. / Chu, Micheline C.; Mor, Gil; Lim, Chungyun; Zheng, Wenxin -; Parkash, Vinita; Schwartz, Peter E.

In: Gynecologic Oncology, Vol. 90, No. 1, 07.2003, p. 170-176.

Research output: Contribution to journalArticle

Chu, MC, Mor, G, Lim, C, Zheng, W, Parkash, V & Schwartz, PE 2003, 'Low-grade endometrial stromal sarcoma: Hormonal aspects', Gynecologic Oncology, vol. 90, no. 1, pp. 170-176. https://doi.org/10.1016/S0090-8258(03)00258-0
Chu, Micheline C. ; Mor, Gil ; Lim, Chungyun ; Zheng, Wenxin - ; Parkash, Vinita ; Schwartz, Peter E. / Low-grade endometrial stromal sarcoma : Hormonal aspects. In: Gynecologic Oncology. 2003 ; Vol. 90, No. 1. pp. 170-176.
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abstract = "Objective. The goal of this work was to determine whether exposure to estrogen following treatment of low-grade endometrial stromal sarcomas affects clinical outcome. Methods. Twenty-two patients with low-grade endometrial stromal sarcomas were reviewed to determine whether they were exposed to exogenous or endogenous estrogen and/or progestins following their diagnosis and whether exposure to these hormones might have influenced their prognosis. Estrogen receptor (ER) α and β and progestin receptor (PR) status were analyzed from paraffin-embedded tissue by immunohistochemistry and ER mRNA was measured in fresh tissue by reverse transcription polymerase chain reaction (RT-PCR). Results. Ten of the twenty-two patients with low-grade endometrial stromal sarcomas developed recurrent disease. Four of five patients (80{\%}) who received estrogen replacement therapy (ERT) recurred. Four of eight patients (50{\%}) with retained ovaries recurred. Eight of the ten specimens available for analysis were positive for ERα, none were positive for ERβ, and 9 of 10 were positive for PR. Four of thirteen patients who received progestins as adjuvant therapy recurred, compared with 6 of 9 patients who did not receive progestins (31{\%} vs 67{\%}). Eight recurrences were treated with progestin therapy and 7 (88{\%}) of them had either stable disease (3/8, 38{\%}) or complete response (4/8, 50{\%}). Conclusions. Our results suggest that ERT may be detrimental in patients with low-grade endometrial stromal sarcoma. Retention of normally functioning ovaries, on the other hand, may not significantly affect the recurrence rate following hysterectomy alone in Stage I patients. The lack of ERβ expression in endometrial stromal sarcomas compared with normal endometrial stromal cells suggests that loss of ERβ may be a marker for malignancy. Progestin therapy should be routinely considered for adjuvant therapy and for the treatment of recurrent endometrial stromal sarcomas.",
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N2 - Objective. The goal of this work was to determine whether exposure to estrogen following treatment of low-grade endometrial stromal sarcomas affects clinical outcome. Methods. Twenty-two patients with low-grade endometrial stromal sarcomas were reviewed to determine whether they were exposed to exogenous or endogenous estrogen and/or progestins following their diagnosis and whether exposure to these hormones might have influenced their prognosis. Estrogen receptor (ER) α and β and progestin receptor (PR) status were analyzed from paraffin-embedded tissue by immunohistochemistry and ER mRNA was measured in fresh tissue by reverse transcription polymerase chain reaction (RT-PCR). Results. Ten of the twenty-two patients with low-grade endometrial stromal sarcomas developed recurrent disease. Four of five patients (80%) who received estrogen replacement therapy (ERT) recurred. Four of eight patients (50%) with retained ovaries recurred. Eight of the ten specimens available for analysis were positive for ERα, none were positive for ERβ, and 9 of 10 were positive for PR. Four of thirteen patients who received progestins as adjuvant therapy recurred, compared with 6 of 9 patients who did not receive progestins (31% vs 67%). Eight recurrences were treated with progestin therapy and 7 (88%) of them had either stable disease (3/8, 38%) or complete response (4/8, 50%). Conclusions. Our results suggest that ERT may be detrimental in patients with low-grade endometrial stromal sarcoma. Retention of normally functioning ovaries, on the other hand, may not significantly affect the recurrence rate following hysterectomy alone in Stage I patients. The lack of ERβ expression in endometrial stromal sarcomas compared with normal endometrial stromal cells suggests that loss of ERβ may be a marker for malignancy. Progestin therapy should be routinely considered for adjuvant therapy and for the treatment of recurrent endometrial stromal sarcomas.

AB - Objective. The goal of this work was to determine whether exposure to estrogen following treatment of low-grade endometrial stromal sarcomas affects clinical outcome. Methods. Twenty-two patients with low-grade endometrial stromal sarcomas were reviewed to determine whether they were exposed to exogenous or endogenous estrogen and/or progestins following their diagnosis and whether exposure to these hormones might have influenced their prognosis. Estrogen receptor (ER) α and β and progestin receptor (PR) status were analyzed from paraffin-embedded tissue by immunohistochemistry and ER mRNA was measured in fresh tissue by reverse transcription polymerase chain reaction (RT-PCR). Results. Ten of the twenty-two patients with low-grade endometrial stromal sarcomas developed recurrent disease. Four of five patients (80%) who received estrogen replacement therapy (ERT) recurred. Four of eight patients (50%) with retained ovaries recurred. Eight of the ten specimens available for analysis were positive for ERα, none were positive for ERβ, and 9 of 10 were positive for PR. Four of thirteen patients who received progestins as adjuvant therapy recurred, compared with 6 of 9 patients who did not receive progestins (31% vs 67%). Eight recurrences were treated with progestin therapy and 7 (88%) of them had either stable disease (3/8, 38%) or complete response (4/8, 50%). Conclusions. Our results suggest that ERT may be detrimental in patients with low-grade endometrial stromal sarcoma. Retention of normally functioning ovaries, on the other hand, may not significantly affect the recurrence rate following hysterectomy alone in Stage I patients. The lack of ERβ expression in endometrial stromal sarcomas compared with normal endometrial stromal cells suggests that loss of ERβ may be a marker for malignancy. Progestin therapy should be routinely considered for adjuvant therapy and for the treatment of recurrent endometrial stromal sarcomas.

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