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LGESS was based on the International Classification of To the Editor: Endometrial stromal sarcoma (ESS) is a histologic subtype that accounts for approximately 38%of [1] Disease for Oncology, Third Edition. Data involved in this uterine sarcomas. Early and complete surgical resection of ESS is the initial treatment. However, the effect of local treatment modalities for ovarian conservation, lymphadenectomy, and postoperative radiation remains unclear. The International Federation of Gynecology and Obstetrics (FIGO) 2009 system classifies ESS patients with lymph node metastasis as stage IIIC, implying a significant adverse effect of lymph node status on patient prognosis. According to the National Comprehensive Cancer Network, bilateral salpingo-oophorectomy is preferred in low-grade ESS (LGESS), but no evidence supports the choice of lymphadenectomy, and the management of ovaries may be individualized in patients of reproductive age. Over 80% of patients with LGESS are estrogen receptor-positive, and postoperative estrogen blockade is recommended for stages II to IV LGESS. Adjuvant radiotherapy is recommended as a postoperative treatment for patients with stage II disease to reduce local recurrence rates. However, the benefits of lymph node resection after primary surgery (total hysterectomy/bilateral salpingooophorectomy) in nonmetastatic LGESS remain controversial. Moreover, few studies found that oophorectomy and hormone receptor status had no influence on overall survival (OS) and endocrine therapy. Few studies have also suggested that postoperative pelvic radiotherapy did not improve OS in stage I or stage II uterine sarcomas. Because these studies are biased by heterogeneity and small sample sizes, we retrospectively reviewed treatments of patients with LGESS in the surveillance, epidemiology, and end results (SEER) 18 registry database (1973–2015, submission in November 2017) to evaluate the impact of lymphadenectomy, postoperative radiation, and ovarian conservation on survival outcome (5-year OS and 5-year cause-specific survival [CSS]) in LGESS patients.

Survival outcomes of different treatment modalities in patients with low-grade endometrial stromal sarcoma