Fertility preserving surgery for high-grade epithelial ovarian carcinoma confined to the ovary

Dimitrios Nasioudis, Spyridon A Mastroyannis, Ashley F Haggerty, Robert L Giuntoli, Mark A Morgan, Emily M Ko, Nawar A Latif
European Journal of Obstetrics, Gynecology, and Reproductive Biology 2020 January 30, 248: 63-70

OBJECTIVE: To investigate the safety of uterine preservation in patients with high-grade epithelial ovarian carcinoma (EOC).

STUDY DESIGN: The Surveillance, Epidemiology, and End Results database was accessed (1988-2014) and patients aged < = 45 years, diagnosed with an unilateral high-grade non-clear cell EOC confined to the ovary were selected. Based on surgery codes we determined whether hysterectomy was performed. Overall (OS) and cancer-specific survival (CSS) was estimated calculated following generation of Kaplan-Meier curves and compared using the log-rank test. Cox hazard model was constructed to control for possible confounders.

RESULTS: A total of 1039 patients with a median follow-up of 119 months were identified. Rate of uterine preservation was 31.8 %. Patients who had hysterectomy were older (median 41 vs 32 yrs, p < 0.001). Patients with mucinous tumors were less likely to undergo hysterectomy (58.9 %) compared to those with endometrioid (73.9 %) and serous (75.9 %) carcinoma, p < 0.001. There was no difference in CSS between patients who did and did not have hysterectomy, p = 0.70 (5-yr rates were 93.9 % vs 92.2 %, respectively). After controlling for year of diagnosis, tumor histology (serous vs non-serous), disease stage, performance of lymph node dissection (LND) and tumor grade, uterine preservation was not associated with a worse cancer-specific (HR: 1.08, 95 % CI:0.69,1.71) and overall (HR:0.88, 95 % CI: 0.59, 1.32) mortality.

CONCLUSION: In this retrospective cohort of patients with unilateral high-grade non-clear cell EOC confined to the ovary, uterine preservation was not associated with a worse prognosis.

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