Fertility-sparing surgery for stage II epithelial ovarian carcinoma: Analysis of oncologic outcomes

ObjectiveFertility-sparing surgery is rarely offered for patients with stage II epithelial ovarian carcinoma. The aim of the present study was to evaluate the overall survival of pre-menopausal patients with stage II epithelial ovarian carcinoma who did not undergo hysterectomy.MethodsThe National Cancer Database was accessed, and patients aged ≤40 years without a history of another tumor diagnosed between 2004 and 2015 with a pathological stage II epithelial ovarian carcinoma, who underwent lymphadenectomy and received multi-agent chemotherapy, were identified. Overall survival was compared with the log-rank test after generation of Kaplan–Meier curves. A Cox model was constructed to control for tumor histology.ResultsA total of 185 patients met the inclusion criteria. The rate of uterine preservation was 24.3% (45 patients). Patients who did not undergo hysterectomy were younger (median 32 vs 37 years, p<0.001) and less likely to have high-grade tumors compared with those who underwent hysterectomy. The two groups were comparable in terms of presence of co-morbidities and performance of adequate lymphadenectomy (p>0.05). Median follow-up of the present cohort was 62.3 months (95% CI 53.6 to 71.0) and a total of 22 deaths occurred. There was no difference in overall survival between patients who did and did not undergo hysterectomy (p=0.50; 5-year overall survival rates 87.5% and 91.4%, respectively). After controlling for tumor histology, grade and substage, omission of hysterectomy was not associated with worse survival (HR 0.69, 95% CI 0.22 to 2.12).ConclusionsUterine preservation was not associated with worse survival in this cohort of pre-menopausal patients with stage II epithelial ovarian carcinoma.

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Oncological and Reproductive Outcomes of Fertility-sparing Surgery in Women with Early-stage Epithelial Ovarian Carcinoma: A Multicenter Retrospective Study

Current Medical Science ◽

10.1007/s11596-020-2239-4 ◽

2020 ◽

Vol 40 (4) ◽

pp. 745-752

Author(s):

Jing Chen ◽

Fen-fen Wang ◽

Yan Zhang ◽

Bin Yang ◽

Ji-hui Ai ◽

...

Keyword(s):

Retrospective Study ◽

Ovarian Carcinoma ◽

Early Stage ◽

Epithelial Ovarian Carcinoma ◽

Reproductive Outcomes ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Correction: Oncologic outcomes of uterine preservation for pre-menopausal patients with stage II epithelial ovarian carcinoma

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001747corr1 ◽

2021 ◽

Vol 31 (12) ◽

pp. 1620-1620

Keyword(s):

Ovarian Carcinoma ◽

Epithelial Ovarian Carcinoma ◽

Stage Ii ◽

Oncologic Outcomes ◽

Uterine Preservation

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Fertility-sparing surgery for patients with stage IC2 or IC3 epithelial ovarian carcinoma: any evidence of safety?

Gynecologic Oncology ◽

10.1016/s0090-8258(21)00949-5 ◽

2021 ◽

Vol 162 ◽

pp. S161

Author(s):

Dimitrios Nasioudis ◽

Quetrell Heyward ◽

Emily Ko ◽

Ashley Haggerty ◽

Lori Cory ◽

...

Keyword(s):

Ovarian Carcinoma ◽

Epithelial Ovarian Carcinoma ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Fertility-sparing surgery for patients with stage IC2 or IC3 epithelial ovarian carcinoma: any evidence of safety?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-003115 ◽

2021 ◽

pp. ijgc-2021-003115

Author(s):

Dimitrios Nasioudis ◽

Quetrell D Heyward ◽

Emily M Ko ◽

Ashley F Haggerty ◽

Lori Cory ◽

...

Keyword(s):

Overall Survival ◽

Ovarian Carcinoma ◽

Relapse Rate ◽

Radical Surgery ◽

Tumor Grade ◽

Epithelial Ovarian Carcinoma ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

And Performance ◽

Cumulative Relapse Rate

ObjectiveInvestigate the overall survival of patients with stage IC2/IC3 epithelial ovarian carcinoma undergoing fertility-sparing surgery.MethodsPatients aged <45 years diagnosed between January 2004 and December 2015 with epithelial ovarian carcinoma, who underwent surgical staging and had tumor involving the ovarian surface (IC2), malignant ascites or positive cytology (IC3), were identified in the National Cancer Database. The fertility-sparing surgery group included patients who had preservation of the uterus and the contralateral ovary while the radical surgery group included patients who had hysterectomy with bilateral salpingo-oophorectomy. Overall survival was evaluated following generation of Kaplan–Meier curves while a Cox model was constructed to control for tumor grade and performance of lymphadenectomy. A systematic review of the literature was performed and cumulative relapse rate among patients with IC2/IC3 disease who underwent fertility-sparing surgery was calculated.ResultsA total of 235 cases were identified; 105 (44.7%) patients underwent fertility-sparing surgery. There was no difference in overall survival between the fertility-sparing and radical surgery groups (p=0.37; 5- year overall survival rates 90.2% and 85%, respectively). After controlling for tumor grade and performance of lymphadenectomy, fertility-sparing surgery was not associated with worse overall survival (HR 1.22, 95% CI 0.56, 2.62). A systematic review identified 151 patients with stage IC2/IC3 disease who underwent fertility-sparing surgery. Cumulative relapse rate was 19.3% (n=29) while 12 (6.7%) deaths were reported. Median time to recurrence was 19 (range 1–128.5) months. Tumor recurrence involved the ovary exclusively in 42% (11/26) of patients, while 15% (4/26) had a lymph node, 35% (9/26) a pelvic/abdominal, and 8% (2/26) a distant tumor relapse.ConclusionsIn a large cohort of patients with stage IC2/IC3 epithelial ovarian carcinoma, fertility-sparing surgery was not associated with worse overall survival. However, based on a literature review, relapse rate is approximately 20%.

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