RISK FACTORS FOR ENDOMETRIAL STROMAL SARCOMA: METABOLIC, HORMONAL AND MOLECULAR DETERMINANTS

Resume. Endometrial stromal sarcoma (ESS) accounts for well under one per cent of uterine malignancies, yet its young age distribution and the wide prognostic gap between its subtypes give it a clinical weight out of proportion to its frequency. This review synthesises the evidence published between 2000 and 2025 on the metabolic, hormonal, reproductive and molecular determinants of ESS risk. Obesity and diabetes mellitus are the only determinants quantified with reasonable confidence, with pooled odds ratios of 1.74 (95% CI 1.03–2.93) and 2.28 (95% CI 1.02–5.12) in an analysis of 98 ESS cases. Unopposed oestrogen exposure, tamoxifen therapy and endometriosis recur across the literature without comparable precision, while JAZF1–SUZ12, YWHAE–NUTM2 and BCOR rearrangements define the molecular separation between low-grade and high-grade disease, whose five-year overall survival differs by roughly sixty percentage points. Because several of the implicated exposures are modifiable, risk-factor counselling retains a place even in a tumour this rare. Keywords: endometrial stromal sarcoma; uterine sarcoma; risk factors; obesity; diabetes mellitus; oestrogen exposure; tamoxifen; endometriosis; JAZF1–SUZ12; YWHAE–NUTM2; BCOR

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