Pregnancy following fertility-sparing surgery for early-stage ovarian cancer is not associated with poor obstetric outcomes

Abstract

<h3>Objectives:</h3> While ovarian cancer is most frequently diagnosed in postmenopausal women, 10% are diagnosed during reproductive years. As more women delay childbearing, the number of women who have yet to complete their family at the time of diagnosis will increase. Fertility-sparing surgery (FSS) is an important treatment option that can allow women to conceive in the future, though data for obstetric outcomes following FSS are conflicting. We sought to use population-based data to evaluate obstetric outcomes in patients with early-stage ovarian cancer. <h3>Methods:</h3> This is a population based retrospective study of women age 18-45 years with a history of stage IA and IC ovarian cancer reported to the California Cancer Registry (CCR) for the years 2000-2012. CCR data were linked to the 2000-2015 California Office of Statewide Health Planning and Development (OSPHD) birth and discharge datasets to establish a linked database with both oncologic characteristics and obstetric outcomes. Exposure status was defined as ovarian cancer patients who conceived at least 3 months after fertility-sparing surgery (FSS) and delivered after 23 weeks gestational age (GA). The primary outcome was preterm birth, and only the first pregnancy following cancer diagnosis was considered. Secondary outcomes included growth restriction, neonatal morbidity (in the first 30 days) and severe maternal morbidity (SMM) as defined by the CDC. Propensity score was used to match similar women in 2 groups in a 1:2 ratio (when possible) of cases to controls: group 1: Women who conceived at least 1 year prior to their ovarian cancer diagnosis; group 2: healthy controls. Wald statistics and logistic regression were used to evaluate outcomes. <h3>Results:</h3> Of the 1618 patients who were 18-45 years at time of ovarian cancer diagnosis, 36.8% (n=595) had a recorded pregnancy. Of those, 133 conceived following FSS and were primarily Hispanic (36.8%) followed by non-Hispanic White (31.6%) with a median age of 30 (26-34). Ovarian cancer patients who delivered during the study period were less likely to have epithelial histology (57.1% vs 78.3%, <i>P</i><<i>0.001</i>), and less likely to have received chemotherapy (24.1% vs 36.9% P=0.006) compared to those who did not. They were also less likely to have received chemotherapy (26.1% vs 37.0% P=0.017). Propensity score matching based on age, education, insurance status, race, year of diagnosis, income, year of delivery, parity, single vs multiple gestation, and maternal comorbidities (hypertension, gestational and pre-gestational diabetes, preeclampsia, abnormal placentation and chronic renal disease) yielded 156 group 1 controls and 266 group 2 controls. Undergoing ovarian cancer surgery at least 3 months prior to conception was not associated with premature delivery before 37 weeks (OR 1.17, 95% CI 0.60-2.30), delivering a growth restricted infant (<10th %ile OR 1.08 95% CI 0.56-2.10; 5th %ile OR 0.85 95% CI 0.32-2.27), cesarean delivery (OR 1.32, 95% CI 0.86-2.03), severe maternal morbidity (OR 2.03, 95% CI 0.50-8.25), or neonatal morbidity (OR 0.48 95% CI 0.19-1.20). <h3>Conclusions:</h3> In a population-based cohort, patients who conceived at least 3 months following surgery for early-stage ovarian cancer did not have an increased risk of poor obstetric outcomes. These data may aid in shared decision making about FSS for patients with early-stage ovarian cancer.