Abstract
ObjectiveThe Ki-67 index is used to evaluate cell proliferation activity, which is related to tumor progression, metastasis, and prognosis. We aimed to explore the prognostic value of Ki-67 index in endometrial stromal sarcoma and to explore the optimal cut-off value of Ki-67 index for predicting recurrent endometrial stromal sarcoma.MethodsA total of 82 patients with endometrial stromal sarcoma who were treated in our hospital were collected. Clinicopathological data of these patients were retrospectively analyzed. Ki-67 index was detected by the immunohistochemical method. Receiver operating characteristic curve and the Youden index were performed to determine the optimal cut-off value of Ki-67 index for predicting recurrent endometrial stromal sarcoma. The Cox regression was performed to analyze risk factors affecting prognosis of endometrial stromal sarcoma. The Kaplan–Meier method and Log-rank test were performed to analyze the survival of patients.ResultsThe optimal cut-off value of Ki-67 index for predicting recurrent endometrial stromal sarcoma was 35%. The results of univariate analysis showed that high Ki-67 index (≥35%) was statistically significantly bound up with shorter progress free survival and overall survival. The results of multivariate analysis showed that Ki-67 index (P = 0.001) and ovarian preservation (P = 0.040) were independent prognostic factors of progress free survival.ConclusionsA Ki-67 index cut-off of 35% was optimal for predicting recurrent endometrial stromal sarcoma. Ki-67 index may be a useful prognostic marker in endometrial stromal sarcoma.
Highlights
Endometrial stromal sarcoma is a rare malignant tumor derived from endometrial stromal cells, accounting for 1% of all primary uterine malignancies and 7–25% of all uterine mesenchymal tumors [1, 2]
A total of 82 patients with endometrial stromal sarcoma who were treated in our hospital were collected
SD, standard deviation; BMI, body mass index; LG-ESS, low-grade endometrial stromal sarcoma; HG-ESS, high-grade endometrial stromal sarcoma; UUS, undifferentiated uterine sarcoma; ER, estrogen receptor; PR, progesterone receptor. *The stage of one patient was unknown. §One patient accepted vulvar mass resection. #Four patients were lost to follow-up
Summary
Endometrial stromal sarcoma is a rare malignant tumor derived from endometrial stromal cells, accounting for 1% of all primary uterine malignancies and 7–25% of all uterine mesenchymal tumors [1, 2]. Endometrial sarcomas are classified by the latest WHO classification standard into the following three categories: low-grade endometrial stromal sarcoma, high-grade endometrial stromal sarcoma, and undifferentiated. Ki-67 for Predicting Recurrent ESS uterine sarcoma [1]. Low-grade endometrial stromal sarcoma is a hormone-sensitive tumor with an indolent behavior and favorable prognosis. High-grade endometrial stromal sarcoma has poorer prognosis with higher recurrence rate compared with low-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma behaves more aggressively [1, 6]. Recurrences occur in 23–59% of patients with endometrial stromal sarcoma, and 15–25% of these patients die of recurrent disease [6]. Endometrial stromal sarcoma still lacks consensus on the optimal treatment and risk factors related to poor prognosis, owing to its rarity and histopathological diversity. There are no reliable indicators to predict recurrent endometrial stromal sarcoma after treatment. It is necessary to explore potential predictive and prognostic markers of endometrial stromal sarcoma
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