Abstract
BackgroundFertility-sparing surgery is indicated for patients with stage I epithelial ovarian cancers. We sought to evaluate the clinical outcomes and oncofertility in a cohort of patients of reproductive age with stage I epithelial ovarian cancer (EOC).MethodsOverall, 108 patients of reproductive age (≤ 40 years) diagnosed with stage I EOC who were treated at Peking Union Medical College Hospital between 1999 and 2013 were included in the study. The Kaplan-Meier model and Cox regression analyses were used for the survival analysis.ResultsThe type of surgery included fertility-sparing surgery (FSS) (48.1%) and radical surgery (RS) (51.9%). After a median follow-up of 83 months, we observed that grade 3 or clear-cell carcinoma was the only independent risk factor for disease-free survival and tumor-specific survival in the multivariate analysis. Patients with grade 3 or clear-cell carcinoma tended to be older than 30 years, have endometriosis, and undergo RS (p < 0.05). Fertility-sparing surgery did not affect disease-free survival or tumor-specific survival among patients of reproductive age with stage I EOC and among high-risk patients with stage IC2-3, grade 3, or clear-cell carcinoma. Thirty-four out of 52 (65.4%) FSS patients attempted to get pregnant. Twenty-eight (82.4%) achieved a successful pregnancy with a full-term delivery.ConclusionsGrade 3 or clear-cell carcinoma was the only independent risk factor for survival of patients of reproductive age with stage I EOC. FSS can be safely performed on patients of reproductive age with grade 1-2, stage I EOC. The safety of FSS for grade 3 and clear-cell carcinoma warrants further investigation.
Highlights
Fertility-sparing surgery is indicated for patients with stage I epithelial ovarian cancers
Patients in the radical surgery (RS) group were more likely to have coexisting endometriosis (p = 0.006), which could be attributed to the higher proportion of clear-cell histology
The distribution of grade 3 and clear-cell carcinoma in stage I epithelial ovarian cancer (EOC) cohort of reproductive age Since grade 3 and clear-cell carcinoma was the only independently significant predictor of Disease-free survival (DFS) and Tumor-specific survival (TSS), we evaluated the correlation of grade 3 and clear-cell carcinoma with age, endometriosis, and surgery type
Summary
Fertility-sparing surgery is indicated for patients with stage I epithelial ovarian cancers. We sought to evaluate the clinical outcomes and oncofertility in a cohort of patients of reproductive age with stage I epithelial ovarian cancer (EOC). Epithelial ovarian cancer (EOC) is the most lethal of malignant ovarian tumors [1]. Clinicians have been reluctant to perform fertility-sparing surgery in certain groups of patients with stage I epithelial ovarian cancers, including those with poorly differentiated tumors or clear-cell carcinomas. Based on current evidence-based medicine, fertility-sparing surgery is indicated for patients. There has been increasing interest in fertility-sparing surgery that does not negatively affect survival for these patients. Most studies have suggested that oncologic and reproductive outcomes of patients who undergo FSS are favorable [6, 7]
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