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Fertility/Pregnancy
2022-RA-838-ESGO All-cause and cancer-specific mortality after fertility-sparing surgery for stage I epithelial ovarian cancer
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  1. Kirsten Jorgensen1,
  2. Chi-Fang Wu1,
  3. Clare Meernik2,
  4. Roni Nitecki1,
  5. Alexander Melamed3 and
  6. Jose Alejandro Rauh-Hain1
  1. 1Gynecological Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston, TX
  2. 2Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
  3. 3Obstetrics and Gynecology, Division Gynecologic Oncology, New York-Presbyterian/Columbia University Medical Center, New York, NY

Abstract

Introduction/Background To compare all-cause and cancer-specific mortality between women who underwent fertility-sparing (FS) surgery with those who underwent standard surgery for stage I epithelial ovarian cancer.

Methodology A cohort study using data from the California Cancer Registry, identified women ages 18–45 diagnosed with stage IA and IC epithelial ovarian cancer between 2000–2015. Fertility-sparing (FS) surgery was defined as retention of at least one ovary and the uterus. Standard surgery included removal of one or both ovaries, the uterus, and possible additional structures. The primary outcome was survival based on time from diagnosis to death or study completion. Inverse probability of treatment propensity score matching was used to create cohorts balanced on covariates of interest. Survival analysis was conducted with Kaplan-Meier method and Cox proportional hazards modeling.

Results We identified 799 women ages 18–45 diagnosed with stage IA or IC epithelial ovarian cancer between 2000–2015. 265 (33.1%) received FS surgery. There was an increasing trend in FS surgery over the study period (21% in 2000 to 46% in 2015). Before matching, there were significant (P<0.05) differences in age at diagnosis, race/ethnicity, marital status, rurality, tumor size, grade, histology, receipt of chemotherapy and lymph node dissection. Propensity-score matching yielded a matched cohort of 176 women who did and 176 women who did not receive FS surgery, balanced on observed covariates. There were 16 overall deaths in the fertility-sparing cohort (median follow-up, 7.3 years), and 21 deaths in the control cohort (median follow-up, 8.2 years). Fertility-sparing surgery was not associated with increased hazard of overall death (HR 0.8 95% CI 0.4–1.5) or cancer-specific death (HR 1.0 95%CI 0.5–2.4). Small number of deaths limited precision of results.

Conclusion Fertility-sparing surgery was not associated with increased risk of death compared to standard surgery among reproductive-age epithelial ovarian cancer survivors with stage IA or IC disease.

https://doi.org/10.1136/ijgc-2022-ESGO.375

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