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

Abstract

<h3>Objectives:</h3> Standard therapy for women with leiomyosarcoma (LMS) entails hysterectomy with resection of gross intraabdominal disease. For women with uterine-confined disease, the role of oophorectomy remains controversial. We explored trends over time in ovarian conservation (OC) in young women with LMS and examined the association between ovarian conservation and survival. <h3>Methods:</h3> Patients 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 ovarian conservation was determined using site-specific surgery codes. Trends in performance of OC are reported. Multivariable regression models were fit to estimate predictors of OC in the patient population. An inverse probability of treatment weighted propensity score method was used to examine the association between all-cause mortality and OC. <h3>Results:</h3> A total of 793 patients were identified. Overall, 225 patients (28%) underwent OC. The rate of OC decreased consistently from 41.2% in 2010 to 14.3% in 2016; this finding was consistent across each age group: <35, 35-39, 40-44, and 45-49 years (Figure 1). The rate of ovarian conservation was 29% among White women compared to 26% among BlackBlack women (P=0.24). Ovarian conservation was utilized in 30% of patients with private insurance and 24% of patients with Medicaid or Medicare insurance (P=0.49). Ovarian conservation was utilized in 32% of women with stage IA tumors and 27% of those with stage IB tumors (P=0.19). Women with poorly differentiated tumors were less likely to undergo OC compared to well-differentiated tumors (aRR 0.59; 95% CI 0.40-0.86). After propensity score weighting, there was no association between OC and mortality when compared to oophorectomy (HR 1.19, 95% CI 0.80 - 1.77). The 5-year survival for women who underwent OC with stage IA LMS was 86.6% (95% CI 67.6 - 94.9%) compared to 77.0% for women who underwent oophorectomy (95% CI 58.0 - 88.2%). In stage IB tumors, 5-year survival was 68.4% in the OC group (95% CI 57.4 - 77.2%) compared to 66.8% in the oophorectomy group (95% CI 59.4-73.1%). <h3>Conclusions:</h3> The practice of ovarian conservation for early stage LMS in premenopausal women across all age groups has decreased over time. There was no association between ovarian conservation all-cause mortality among women with stage I LMS. Ovarian conservation should be considered in premenopausal women with LMS that is confined to the uterus given health benefits such as prevention of osteoporosis, cardiovascular disease, and vasomotor symptoms.