Disparities in fertility-sparing surgery in adolescent and young women with stage I ovarian dysgerminoma

Abstract Background The aim of this study was to investigate how much the risks of recurrence and death are increased as a consequence of selecting fertility-sparing surgery (FSS) in young women with epithelial ovarian cancer (EOC). Methods After a central pathological review and search of the medical records from 14 collaborating hospitals, a non-randomized, observational cohort study was conducted between 1987 and 2015, including 1183 women with stage I EOC. Finally, a total of 285 patients with stage I EOC at reproductive age were recruited. Oncologic outcomes were compared between the FSS (N = 101) and radical surgery (RS) group (N = 184) using a propensity score (PS)-matching technique to adjust for relevant risk factors: the age, substage, histological type, grade, CA125 values, ascites cytology, ascites volume, and chemotherapy. Results During 66.0 months (median) of follow-up, 42 patients (14.7%) developed recurrence, and 31 patients (10.9%) died. In the original cohort, there was no significant difference in overall survival (OS) or recurrence-free survival (RFS) between the FSS and RS groups {Log-rank: OS (P = 0.838), RFS (P = 0.377)}. In the PS-matched cohort after adjustment for multiple clinicopathologic factors, there was no significant difference in RFS or OS between the FSS and RS groups {RFS (FSS vs. RS), HR: 1.262 (95% CI: 0.559–2.852), P = 0. 575; OS (FSS vs. RS), HR: 1.206 (95% CI: 0.460–3.163), P = 0.704}. Conclusions After adjustment for clinicopathologic factors, FSS in itself may not worsen the oncologic outcome in young women with early-stage EOC. A large-scale clinical study is necessary to validate the findings.

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Outcomes of fertility-sparing surgery among young women with FIGO stage I clear cell carcinoma of the ovary

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2015.10.022 ◽

2016 ◽

Vol 134 (1) ◽

pp. 49-52 ◽

Cited By ~ 18

Author(s):

Jeong-Yeol Park ◽

Dae-Shik Suh ◽

Jong-Hyeok Kim ◽

Yong-Man Kim ◽

Young-Tak Kim ◽

...

Keyword(s):

Cell Carcinoma ◽

Young Women ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Figo Stage ◽

Stage I ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Carcinoma Of The Ovary

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Outcomes of Surgery Alone and Surveillance Strategy in Young Women With Stage I Malignant Ovarian Germ Cell Tumors

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000702 ◽

2016 ◽

Vol 26 (5) ◽

pp. 859-864 ◽

Cited By ~ 15

Author(s):

Jeong-Yeol Park ◽

Dae-Yeon Kim ◽

Dae-Shik Suh ◽

Jong-Hyeok Kim ◽

Yong-Man Kim ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Germ Cell ◽

Young Women ◽

Disease Free Survival ◽

Stage I ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Bep Chemotherapy

ObjectivesThis study aimed to evaluate the safety of surgery alone followed by surveillance in young women with stage I malignant ovarian germ cell tumor (MOGCT).MethodsA retrospective review was performed on 31 patients with stage I MOGCT who were treated by surgery alone with follow-up.ResultsThe median patient age was 22 years (range, 6–45 years). The histological type was dysgerminoma in 17, immature teratoma in 11, yolk sac tumor in 1, and mixed MOGCT in 2 cases. Seventeen patients were stage IA, 1 was IB, and 13 were IC. All patients underwent fertility-sparing surgery, which involved either unilateral salpingo-oophorectomy or oophorectomy. Additionally, 12 (38.7%) patients underwent cystectomy of the contralateral ovary, but only 1 patient had MOGCT in the contralateral ovary. Twenty (65%) patients underwent a complete staging operation that included peritoneal exploration, biopsy, cytology, and/or omentectomy or omental biopsy; 7 (22.6%) patients who underwent pelvic and para-aortic lymphadenectomy. After a median follow-up time of 137 months (range, 24–268 months), 7 (22.6%) patients had recurrent disease, and underwent secondary surgery followed by chemotherapy with bleomycin, etoposide, and cisplatin (BEP). Six (86%) patients were successfully salvaged, but 1 died of disease progression. The 10-year disease-free survival rate was 77%, but the 10-year overall survival rate was 97%.ConclusionsFertility-sparing surgery alone with surveillance could be a safe treatment strategy. Most recurrence can be successfully salvaged by surgery and BEP chemotherapy and the overall survival is not compromised. Using this strategy, 77.4% of patients may avoid unnecessary BEP chemotherapy.

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Fertility Preservation in Young Women With Cervical Cancer: An Oncologic Dilemma or a New Conception of Fertility Sparing Surgery?

Cancer Investigation ◽

10.3109/07357907.2013.767343 ◽

2013 ◽

Vol 31 (3) ◽

pp. 189-189 ◽

Cited By ~ 13

Author(s):

Salvatore Gizzo ◽

Emanuele Ancona ◽

Tito Silvio Patrelli ◽

Carlo Saccardi ◽

Omar Anis ◽

...

Keyword(s):

Cervical Cancer ◽

Fertility Preservation ◽

Young Women ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Controversies in the management of early endometrial carcinoma: an update

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172301 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2124 ◽

Cited By ~ 1

Author(s):

P. Reddi Rani ◽

Jasmina Begum ◽

K. Sathyanarayana Reddy

Keyword(s):

Developing Countries ◽

Endometrial Carcinoma ◽

Young Women ◽

Genital Tract ◽

Best Practice ◽

Management Strategies ◽

Evidence Based ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Cure Rates

Endometrial carcinoma (EC) is the commonest genital tract malignancy in developing countries and is usually confined to the uterus at the time of diagnosis with excellent prognosis and high cure rates. But the management is associated with lot of controversies like in staging, best surgical approach, extent of lymphadenectomy, adjuvant therapy, fertility sparing surgery in young women etc. A thorough surgical staging is important to determine uterine and extrauterine spread and also understanding of the pathophysiology and management strategies to identify women who are at high risk and tailoring the adjuvant treatment if necessary without increasing the morbidity. This evidence based narrative review conducted by searching Medline (1994- 2015) and other online articles from Pubmed, Google scholar. Articles were selected based on their currency and relevance to the discussion they summarize the current literature to provide an approach to best practice management of early endometrial carcinoma.

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All-Cause Mortality After Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer

Obstetrical & Gynecological Survey ◽

10.1097/ogx.0000000000000508 ◽

2017 ◽

Vol 72 (12) ◽

pp. 713-715

Author(s):

Alexander Melamed ◽

Anthony E. Rizzo ◽

Roni Nitecki ◽

Allison A. Gockley ◽

Amy J. Bregar ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Stage I ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

All Cause Mortality

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Fertility-sparing surgery for the management of young women with embryonal rhabdomyosarcoma of the cervix: A case series

Gynecologic Oncology Reports ◽

10.1016/j.gore.2016.08.004 ◽

2016 ◽

Vol 18 ◽

pp. 4-7 ◽

Cited By ~ 9

Author(s):

Geneviève Bouchard-Fortier ◽

Raymond H. Kim ◽

Lisa Allen ◽

Abha Gupta ◽

Taymaa May

Keyword(s):

Young Women ◽

Case Series ◽

Embryonal Rhabdomyosarcoma ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.8617 ◽

2010 ◽

Vol 28 (10) ◽

pp. 1727-1732 ◽

Cited By ~ 119

Author(s):

Toyomi Satoh ◽

Masayuki Hatae ◽

Yoh Watanabe ◽

Nobuo Yaegashi ◽

Osamu Ishiko ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Clear Cell ◽

Stage I ◽

Healthy Children ◽

Favorable Histology ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Stage Ia ◽

Grade 3

Purpose The objective of this study was to assess clinical outcomes and fertility in patients treated conservatively for unilateral stage I invasive epithelial ovarian cancer (EOC). Patients and Methods A multi-institutional retrospective investigation was undertaken to identify patients with unilateral stage I EOC treated with fertility-sparing surgery. Favorable histology was defined as grade 1 or grade 2 adenocarcinoma, excluding clear cell histology. Results A total of 211 patients (stage IA, n = 126; stage IC, n = 85) were identified from 30 institutions. Median duration of follow-up was 78 months. Five-year overall survival and recurrence-free survival were 100% and 97.8% for stage IA and favorable histology (n = 108), 100% and 100% for stage IA and clear cell histology (n = 15), 100% and 33.3% for stage IA and grade 3 (n = 3), 96.9% and 92.1% for stage IC and favorable histology (n = 67), 93.3% and 66.0% for stage IC and clear cell histology (n = 15), and 66.7% and 66.7% for stage IC and grade 3 (n = 3). Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children. Conclusion Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy.

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