A Swedish Nationwide prospective study of oncological and reproductive outcome following fertility-sparing surgery for treatment of early stage epithelial ovarian cancer in young women

Gry Johansen,Pernilla Dahm-Kähler,Kenny A Rodriguez-Wallberg,Angelique Flöter Rådestad,Christian Staf

doi:10.1186/s12885-020-07511-y

Abstract

BackgroundEpithelial ovarian cancer (EOC) is rare in women of reproductive age and fertility-sparing surgery (FSS) may be applied in early stages. The purpose of this study was to investigate the safety and efficacy of FSS for treatment of EOC.MethodsThe Swedish nationwide population-based Quality Register for Gynecological Cancer was used to identify all women 18–40 years of age diagnosed with stage I EOC between 2008 and 2015. Detailed data on surgery, staging, histopathology, and follow-up were extracted and reviewed. Cross-linking of individuals to population-based registries allowed retrieval of data on obstetrical and reproductive outcomes after FSS. Disease-free survival (DFS) and overall survival (OS) rates were compared (Kaplan-Meier method) between women who underwent FSS vs. radical surgery (RS).ResultsIn total 83 women were identified; 36 who had FSS performed and 47 RS. The 5-year OS rate was 92% and no statistical differences between DFS or OS were found between women treated by FSS or RS. The recurrence rate after RS was 13% compared to 6% after FSS. Recurrences were more frequently found in women with stage IC tumor or with histologic subtypes with more aggressive behavior. In the FSS cohort, nine women gave birth to 12 healthy children, all delivered at fullterm. Only one women had received assisted reproductive technology treatment.ConclusionIn this nationwide population-based cohort study natural fertility was maintained after FSS. Specific histologic subtypes showed greater prognostic impact on the oncological outcome than the use of FSS. Recurrences occurred after FSS, but none in the uterus, which questions the need of hysterectomy in young women with EOC.Trial registrationThis article reports the results of a healthcare intervention using the data prospectively registered in the Swedish population-based registries including the Quality Register for Gynecological Cancer, the National Death Register, the Swedish Medical Birth Register, and the National Quality Register for Assisted Reproduction.

Highlights

Epithelial ovarian cancer (EOC) is rare in women of reproductive age and fertility-sparing surgery (FSS) may be applied in early stages
Flowchart and demographics During the study period 83 women aged 18–40 years diagnosed with EOC and with complete data, were identified in the Swedish Quality Register for Gynecological Cancer (SQRGC)
All patients were diagnosed in either stage IA or stage IC, there were no cases of stage IB during the study period

Summary

Introduction

Epithelial ovarian cancer (EOC) is rare in women of reproductive age and fertility-sparing surgery (FSS) may be applied in early stages. Epithelial ovarian cancer (EOC) is rare, but may occur, in women of reproductive age. As EOC’s histological subtypes differ in their malignancy potential, there is no current international consensus about the substages or histologic subtypes and grades at which fertility-sparing surgery (FSS) is considered as safe as radical surgery (RS) for the specific treatment of young women of reproductive age. It has been suggested that the aggressiveness of the disease, rather than the sparing of the ovary and uterus, is what affects the risk of distant metastases [7, 10, 12, 14]

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