Abstract
PurposeWe investigated the effect of ovary preserving surgery in early International Federation of Obstetrics and Gynecology (FIGO) stage endometrial cancer patients.MethodsMedical records were retrospectively reviewed for 539 patients who were diagnosed with early stage endometrial cancer between Jan 2006 and Dec 2017. Patients were categorized into ovary preservation and ovary removal groups. Demographics, recurrence free survival (RFS), and five-year overall survival (OS) rate were compared, and the clinical factors affecting survival were evaluated by univariate and multivariate analysis.ResultsThe median follow-up period was 85 months (range, 6–142 months), and the median age was 52.7 years. The mean age was higher in the ovary removal group than in the ovary preservation group (54.4 vs 40.94 years; P < 0.001). The ovary preservation group showed an earlier FIGO stage than the ovary removal group (P = 0.0264). There was a greater incidence of adjuvant chemotherapy administration in the removal group. There were no statistical differences in other baseline characteristics. When comparing the RFS and OS rates, there were no statistical differences between the preservation and removal groups. (recurrence free rate 98.5% vs 92.7%, p = 0.4360, and 5-year survival rate 98.6% vs 93.0%, p = 0.0892, respectively). Endometrioid histology (p = 0.006) and post-operative adjuvant chemotherapy (p = 0.0062) were related to OS, and adjuvant chemotherapy (p < 0.001) and radiotherapy (p = 0.005) were related to RFS.ConclusionsOvary preservation in early stage endometrial cancer is worth considering, as it does not affect survival in early stage endometrial cancer patients.
Highlights
Endometrial cancer has the highest incidence in gynecological cancers in Western countries [1], and the incidence is increasing in Korea [2]
According to the National Comprehensive Cancer Network (NCCN) guidelines, early stage endometrial cancer is treated with total hysterectomy, bilateral salpingooophorectomy, and lymph node dissection, with subsequent staging according to the pathologic report
The Federation of Obstetrics and Gynecology (FIGO) stage was earlier in the ovarian preservation group (P = 0.0264)
Summary
Endometrial cancer has the highest incidence in gynecological cancers in Western countries [1], and the incidence is increasing in Korea [2]. Endometrial cancer has a higher rate of early diagnosis than other gynecologic and solid cancers because symptoms such as irregular bleeding or discharge are detected. According to the National Comprehensive Cancer Network (NCCN) guidelines, early stage endometrial cancer is treated with total hysterectomy, bilateral salpingooophorectomy, and lymph node dissection, with subsequent staging according to the pathologic report. Adjunctive total salpingo-oophorectomy is the standard treatment option, because of the possibility of occult tumor cells in the ovary and the fact that endometrial cancer is advanced by ovarian hormones [4, 5]. Exogenous hormone replacement therapy may relieve these menopausal symptoms but can induce other complications [12, 13]
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