Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Population-Based Assessment in the United States [ID 2693178

Abstract

INTRODUCTION: The objective of this study was to assess population-level utilization and outcome of reproductive-aged patients with early epithelial ovarian cancer (EOC) who underwent fertility-sparing surgery (FSS) in the United States. METHODS: This population-based retrospective study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program. The study included 3,027 patients aged less than 50 years with stage I EOC receiving primary surgical therapy from 2007 to 2020. Fertility-sparing surgery was defined as preservation of one ovary and the uterus for unilateral lesion and preservation of the uterus for bilateral lesions. Temporal trend of FSS was assessed with linear segmented regression with log-transformation. Overall survival (OS) associated with FSS was assessed with Cox proportional hazard regression model. RESULTS: A total of 534 (17.6%) patients underwent FSS. At cohort level, the utilization of FSS was 13.4% in 2007 and 21.8% in 2020 (P-trend=.009). Non-Hispanic White individuals (2.8-fold), high-grade serous histology (2.2-fold), and stage IC disease (2.3-fold) had greater than 2-fold increase in FSS utilization during the study period (all, P-trend<.05). After controlling for the measured clinico-pathological characteristics, patients who received FSS had OS comparable to those who had nonsparing surgery (5-year rates, 93.6% versus 92.1%; adjusted hazard ratio, 0.87; 95% CI, 0.57–1.35). This survival association was consistent in high-grade serous (5-year rates, 92.9% versus 92.4%), low-grade serous (100% versus 92.2%), clear cell (97.5% versus 86.1%), mucinous (92.1% versus 86.6%), low-grade endometrioid (95.7% versus 97.7%), and mixed histology (93.3% versus 83.7%) (all, P>.05). In high-grade endometrioid tumor, FSS was associated with decreased OS (5-year rates, 71.9% versus 93.8%; adjusted-hazard ratio 2.90; 95% CI, 1.09–7.67). Among bilateral ovarian lesions, FSS was not associated with OS (5-year rates, 95.8% versus 92.5%; P=.364). CONCLUSION: Nearly one in five reproductive-aged patients with stage I EOC underwent FSS in recent years in the United States. The data suggest that FSS may not adversely affect OS, except for high-grade endometrioid tumors.