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  • Fertility sparing surgery for patients with FIGO stage I clear cell ovarian carcinoma: a database analysis and systematic review of the literature

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Original research
Fertility sparing surgery for patients with FIGO stage I clear cell ovarian carcinoma: a database analysis and systematic review of the literature
  1. Dimitrios Nasioudis1,2,
  2. Lakeisha Mulugeta-Gordon2,
  3. Erin McMinn2,
  4. Melissa K Frey3,
  5. Eloise Chapman-Davis3 and
  6. Kevin Holcomb3
  1. 1 Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
  2. 2 Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3 Division of Gynecologic Oncology, Weill Cornell Medicine, New York, New York, USA
  1. Correspondence to Dr Dimitrios Nasioudis, Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; dimitrios.nasioudis{at}uphs.upenn.edu

Abstract

Objective Fertility sparing surgery for patients with early stage ovarian clear cell carcinoma is controversial. We aimed to investigate the impact of fertility sparing surgery on the oncologic outcomes of young patients with stage I ovarian clear cell carcinoma.

Methods The National Cancer Database was accessed and patients with pathological stage IA or IC ovarian clear cell carcinoma, aged <45 years, were selected. Based on site specific surgery codes, patients who underwent fertility sparing or radical surgery were identified. Overall survival was evaluated following generation of Kaplan–Meier curves, and compared with the log rank test. Multivariate Cox analysis was performed to control for possible confounders. A systematic review of literature of the Pubmed, EMBASE and Web of Science databases was also performed to summarize all reported cases.

Results A total of 57 (35.8%) and 102 (64.2%) patients underwent fertility sparing and radical surgery. There was no difference in overall survival between patients who had fertility sparing and radical surgery (p=0.92); 5 year overall survival rates were 89% and 87.9%, respectively. After controlling for the performance of lymphadenectomy and disease substage, fertility sparing surgery was not associated with worse survival (hazard ratio 0.83, 95% confidence interval 0.30 to 2.32). A systematic review of the literature identified 132 patients with stage I disease who underwent fertility sparing surgery; a total of 20 patients (15.2%) experienced a relapse at a median of 18 months from surgery.

Conclusions In a large cohort of young patients with stage I ovarian clear cell carcinoma, fertility sparing surgery was not associated with worse survival.

  • ovary
  • surgery
  • hysterectomy

https://doi.org/10.1136/ijgc-2020-001716

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    Footnotes

    • Twitter @MelissaFrey2

    • Contributors DN: conception, statistical analysis, critical analysis, and drafting/final editing. LM-G, EM, EC-D, MKF, and KH: critical analysis and drafting/final editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The present study was deemed exempt from institutional review board (IRB) review by the Penn IRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Data acquired by the American College of Surgeons.