Trends in ovarian conservation and association with survival in premenopausal patients with stage I leiomyosarcoma

Abstract

ObjectiveTo explore trends of ovarian conservation (OCN) over time in young women with early stage leiomyosarcoma (LMS) and examine the association between OCN and survival. MethodsPatients under the age of 50 who were diagnosed with stage I LMS who underwent hysterectomy with and without oophorectomy between 2010 and 2016 were identified in the National Cancer Database (NCDB). Performance of oophorectomy vs. OCN was determined using surgery codes. Trends of OCN were reported. Multivariable regression models were fit to estimate predictors of OCN. An inverse probability of treatment weighted propensity score method was used to examine the association between all-cause mortality and OCN. ResultsOverall, 225 patients (28%) underwent OCN. Rates of OCN decreased from 41.2% (2010) to 14.3% (2016); this finding was consistent across age groups: <35, 35–39, 40–44, and 45–49 years. Race, insurance, and stage did not affect performance of OCN. Women with poorly differentiated tumors were less likely to undergo OCN compared to well-differentiated tumors (aRR 0.59; 95% CI 0.40–0.86). After propensity score weighting, there was no association between OCN and mortality (HR 1.19, 95% CI 0.80–1.77). Five-year survival for the OCN group was 67.1% (95% CI 59.8–75.2%) compared to 72.2% for the oophorectomy group (95% CI 67.2–77.5%). ConclusionsOCN for early stage LMS in premenopausal women has decreased over time. There was no association between OCN and mortality among women with stage I LMS. OCN should be considered in premenopausal women with stage I LMS given the health benefits.