Outcomes After Fertility-sparing Surgery of Early-stage Ovarian Cancer: A Nationwide Population-based Study

Overview

Journal Cancer Med

Specialty Oncology

Date 2024 Apr 12

PMID 38606892

Authors

Chia-Yi Lee

Chun-Ju Chiang

Yi-Jou Tai

Heng-Cheng Hsu

Yu-Li Chen

Ying-Cheng Chiang

Chia-Ying Wu

Wen-Chung Lee

Hsiao-Lin Hwa

Wen-Fang Cheng

Affiliations

Soon will be listed here.

Abstract

Background: Fertility-sparing surgery (FSS) is an alternative choice of young patients who have not completed their family planning and still have fertility needs. The aims of this study were to compare the outcomes of early-stage epithelial ovarian cancer (EOC) patients undergoing FSS and radical comprehensive staging surgery (RCS), and the suitability of FSS.

Methods: A total of 1297 patients aged between 20 and 44 years with newly diagnosed early-stage EOC were recruited from the Taiwan Cancer Registry database between 2009 and 2017. Site-specific surgery codes were used to distinguish patients in FSS group or RCS group. Cancer-specific survival (CSS) was evaluated using Kaplan-Meier method with log-rank test and Cox regression model.

Results: There were 401 and 896 patients in FSS and RCS group. Patients in FSS group were with younger age and mostly had Stage I disease. In contrast, patients in RCS group were older. There were more Stage II, high-grade (Grade 3) disease, and adjuvant chemotherapy in RCS group. Stage and tumor grade were two independent factors correlating with CSS and the type of surgery showed no effect on CSS (HR: 1.09, 95% CI: 0.66-1.77, p = 0.73) in multivariable analysis. In multivariable analysis, the clear cell carcinoma group who underwent FSS demonstrated better CSS compared to those in the RCS group (HR: 0.28, 95% CI: 0.06-0.82, p = 0.04). A total of 17 women who underwent FSS developed second malignancies of the uterine corpus or contralateral ovary.

Conclusion: FSS can be a safe alternative procedure in selected young patients of Stage I EOC who have fertility desire. Endometrial biopsy before or during FSS and regular surveillance to detect recurrence are mandatory for ovarian cancer patients undergoing FSS.

Citing Articles

Outcomes after fertility-sparing surgery of early-stage ovarian cancer: A nationwide population-based study.

Lee C, Chiang C, Tai Y, Hsu H, Chen Y, Chiang Y Cancer Med. 2024; 13(7):e7132.

PMID: 38606892 PMC: 11010646. DOI: 10.1002/cam4.7132.

References

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Fruscio R, Ceppi L, Corso S, Galli F, DellAnna T, DellOrto F . Long-term results of fertility-sparing treatment compared with standard radical surgery for early-stage epithelial ovarian cancer. Br J Cancer. 2016; 115(6):641-8. PMC: 5023783. DOI: 10.1038/bjc.2016.254. View

Nasioudis D, Chapman-Davis E, Frey M, Witkin S, Holcomb K . Could fertility-sparing surgery be considered for women with early stage ovarian clear cell carcinoma?. J Gynecol Oncol. 2017; 28(6):e71. PMC: 5641522. DOI: 10.3802/jgo.2017.28.e71. View

Lee Y, Kim T, Kim M, Kim H, Song T, Kim M . Prognosis of ovarian clear cell carcinoma compared to other histological subtypes: a meta-analysis. Gynecol Oncol. 2011; 122(3):541-7. DOI: 10.1016/j.ygyno.2011.05.009. View

Kurnit K, Sinno A, Fellman B, Varghese A, Stone R, Sood A . Effects of Gastrointestinal-Type Chemotherapy in Women With Ovarian Mucinous Carcinoma. Obstet Gynecol. 2019; 134(6):1253-1259. PMC: 7100606. DOI: 10.1097/AOG.0000000000003579. View

Ledermann J, Raja F, Fotopoulou C, Gonzalez-Martin A, Colombo N, Sessa C . Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24 Suppl 6:vi24-32. DOI: 10.1093/annonc/mdt333. View

Chiang C, Wang Y, Lee W . Taiwan's Nationwide Cancer Registry System of 40 years: Past, present, and future. J Formos Med Assoc. 2019; 118(5):856-858. DOI: 10.1016/j.jfma.2019.01.012. View

Hsieh S, Lau H, Wu H, Hsu H, Twu N, Cheng W . Prognostic Factors of Early Stage Epithelial Ovarian Carcinoma. Int J Environ Res Public Health. 2019; 16(4). PMC: 6406698. DOI: 10.3390/ijerph16040637. View

Fujiwara K, Shintani D, Nishikawa T . Clear-cell carcinoma of the ovary. Ann Oncol. 2016; 27 Suppl 1:i50-i52. DOI: 10.1093/annonc/mdw086. View

10.

Melamed A, Rizzo A, Nitecki R, Gockley A, Bregar A, Schorge J . All-Cause Mortality After Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer. Obstet Gynecol. 2017; 130(1):71-79. DOI: 10.1097/AOG.0000000000002102. View

11.

Shimizu Y, Kamoi S, Amada S, Hasumi K, Akiyama F, Silverberg S . Toward the development of a universal grading system for ovarian epithelial carcinoma. I. Prognostic significance of histopathologic features--problems involved in the architectural grading system. Gynecol Oncol. 1998; 70(1):2-12. DOI: 10.1006/gyno.1998.5051. View

12.

Chen S, Li Y, Qian L, Deng S, Liu L, Xiao W . A Review of the Clinical Characteristics and Novel Molecular Subtypes of Endometrioid Ovarian Cancer. Front Oncol. 2021; 11:668151. PMC: 8210668. DOI: 10.3389/fonc.2021.668151. View

13.

Bentivegna E, Fruscio R, Roussin S, Ceppi L, Satoh T, Kajiyama H . Long-term follow-up of patients with an isolated ovarian recurrence after conservative treatment of epithelial ovarian cancer: review of the results of an international multicenter study comprising 545 patients. Fertil Steril. 2015; 104(5):1319-24. DOI: 10.1016/j.fertnstert.2015.06.008. View

14.

Satoh T, Yoshikawa H . Fertility-sparing surgery for early stage epithelial ovarian cancer. Jpn J Clin Oncol. 2016; 46(8):703-10. DOI: 10.1093/jjco/hyw069. View

15.

Kajiyama H, Shibata K, Mizuno M, Umezu T, Suzuki S, Nawa A . Long-term survival of young women receiving fertility-sparing surgery for ovarian cancer in comparison with those undergoing radical surgery. Br J Cancer. 2011; 105(9):1288-94. PMC: 3241559. DOI: 10.1038/bjc.2011.394. View

16.

Kajiyama H, Suzuki S, Yoshikawa N, Kawai M, Mizuno K, Yamamuro O . Fertility-sparing surgery and oncologic outcome among patients with early-stage ovarian cancer ~propensity score- matched analysis~. BMC Cancer. 2019; 19(1):1235. PMC: 6921416. DOI: 10.1186/s12885-019-6432-4. View

17.

Utada M, Ohno Y, Shimizu S, Hori M, Soda M . Comparison between overall, cause-specific, and relative survival rates based on data from a population-based cancer registry. Asian Pac J Cancer Prev. 2013; 13(11):5681-5. DOI: 10.7314/apjcp.2012.13.11.5681. View

18.

Busca A, Nofech-Mozes S, Olkhov-Mitsel E, Gien L, Bassiouny D, Mirkovic J . Histological grading of ovarian mucinous carcinoma - an outcome-based analysis of traditional and novel systems. Histopathology. 2019; 77(1):26-34. DOI: 10.1111/his.14039. View

19.

Park J, Suh D, Kim J, Kim Y, Kim Y, Nam J . Outcomes of fertility-sparing surgery among young women with FIGO stage I clear cell carcinoma of the ovary. Int J Gynaecol Obstet. 2016; 134(1):49-52. DOI: 10.1016/j.ijgo.2015.10.022. View

20.

Kajiyama H, Shibata K, Mizuno M, Hosono S, Kawai M, Nagasaka T . Fertility-sparing surgery in patients with clear-cell carcinoma of the ovary: is it possible?. Hum Reprod. 2011; 26(12):3297-302. DOI: 10.1093/humrep/der342. View