Survival and pregnancy outcomes of fertility-sparing surgery for ovarian malignant sex cord-stromal tumors: A multicenter retrospective study (176)

Abstract

<b>Objectives:</b> To assess the survival and pregnancy outcomes of fertility-sparing surgery (FSS) in stage I ovarian malignant sex cord-stromal tumors (MSCSTs). <b>Methods:</b> Inverse Probability of Treatment Weighting (IPTW) was performed between the FSS and radical surgery (RS) groups. The Chi-square test and Kaplan-Meier method were used to compare the categorical variables and disease-free survival (DFS). The binary logistic regression analysis and Cox proportional hazards regression analysis were used to identify risk factors related to pregnancy and DFS. <b>Results:</b> A total of 107 patients were included, of whom 54 (50.5%) women underwent FSS, and 53 (49.5%) women underwent RS. After IPTW, 208 patients were obtained, and all of the covariates were well balanced. After a median follow-up time of 50 months (range: 7-156 months), there was no significant difference of DFS between the two groups in both unweighted cohort (p=0.969) or weighted cohort (p=0.792). In the weighted cohort, stage IC (p=0.014), tumor diameter >8 cm (p=0.003), without staging surgery (p=0.003), and no adjuvant chemotherapy (P <0.001) were the four high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully, and the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (p=0.009) was associated with pregnancy. <b>Conclusions:</b> FSS is safe in stage IA and IC MSCSTs with a satisfactory reproductive outcome on the premise of complete staging surgery.