The effect of fertility-sparing surgery on sexuality and global quality of life in women with malignant ovarian germ cell and sex cord stromal tumors: an analysis of the CORSETT database of the AGO study group

Annette Hasenburg,Andreas Du Bois,Bastian Czogalla,Philipp Harter,Michaela Bossart,Theresa Link,Annette Staebler,Jacqueline Keul,Fabian Trillsch,Paul Buderath,Florian Heitz,Susanne Schnittger ,Elena Ioana Braicu ,Helmut Plett ,B Krämer ,Doris Mayr,Alexander Burges,Stefan Kommoss,Pauline Wimberger,Maximilian Klar

doi:10.1007/s00404-021-06019-5

Abstract

PurposeMalignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) are ovarian neoplasms that affect disproportionally young women. Little is known about the impact of surgical and adjuvant management of these patient’s sexual life. This study investigated the effect of fertility-sparing surgery on sexual activity and global quality of life (gQoL) in women with MOGCT and SCST.MethodsCORSETT was an observational, multicenter, mixed retrospective/prospective cohort study of the AGO study group. Women of any age who had been diagnosed with MOGCTs and SCSTs between 2001 and 2011 were asked to complete the Sexual Activity Questionnaire (SAQ) and the EORTC QLQ-C30.ResultsIn total, 355 patients were included. Of these, 152 patients with confirmed histological diagnosis had completed the questionnaires. A total of 106 patients were diagnosed with SCST and 46 with MOGCT.Totally, 83 women (55%) were sexually active. After fertility-sparing surgery, patients had a 2.6 fold higher probability for being sexually active than after non-fertility-conserving treatment (unadjusted odds ratio (OR) 2.6, p = 0.01). After adjustment for age, time since diagnosis, FIGO stage, histology and phase of disease, the OR dropped to 1.8 (p = 0.22).Of the sexually active patients, 35 (42%) reported high levels of discomfort during intercourse; 38% after fertility-sparing; and 58% after non-fertility-sparing surgery (adjusted OR 2.8, p = 0.18).Women with fertility-conserving treatment reported a significantly better global QoL (Fadj 2.1, 6.2 points difference, p = 0.03) but not more pleasure during intercourse than women without fertility-sparing surgery (Fadj 0.4, p = 0.52).ConclusionFertility preserving approaches should be offered to every patient, when oncologically acceptable.

Highlights

PurposeMalignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) are rare ovarian neoplasms that, affect a disproportionally high number of young patients.Extended author information available on the last page of the articleIn a global population-based study on cancer of the ovaries, non-epithelial malignant tumors comprised approximately 5–6% of all ovarian malignancies in Europe [1].MOGCT represents 2–3% of ovarian malignancies [2]
We aimed to investigate the prevalence of fertility-sparing treatment and systemic therapy for patients with MOGCTs and SCTSs among German centers of the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie) study group and the impact of the surgical technique—either fertility sparing or non-fertility sparing—on quality of life and sexuality
Out of 355 MOGCT and SCSCT patients, 168 (47.3%) had completed the Sexual Activity Questionnaire (SAQ) and were included into the study; 65 of those who did not complete the SAQ were not actively declining but had not received the questionnaire; 106 participants were diagnosed with SCST, 46 with MOGCT and 16 with unknown histology (Table 2), resulting in 152 patients to be included in the analysis

Summary

Introduction

PurposeMalignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) are rare ovarian neoplasms that, affect a disproportionally high number of young patients.Extended author information available on the last page of the articleIn a global population-based study on cancer of the ovaries, non-epithelial malignant tumors comprised approximately 5–6% of all ovarian malignancies in Europe [1].MOGCT represents 2–3% of ovarian malignancies [2]. Malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) are rare ovarian neoplasms that, affect a disproportionally high number of young patients. Extended author information available on the last page of the article. In a global population-based study on cancer of the ovaries, non-epithelial malignant tumors comprised approximately 5–6% of all ovarian malignancies in Europe [1]. MOGCT represents 2–3% of ovarian malignancies [2]. They primarily arise in young women between 10 and 30 years of age and represent 70 percent of ovarian tumors in this age group [3]. With an incidence peak in childbearing age, the majority of women may wish to retain their reproductive potential.

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