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Oncologic outcomes of uterine preservation for pre-menopausal patients with stage II epithelial ovarian carcinoma
  1. Dimitrios Nasioudis1,
  2. Lakeisha Mulugeta-Gordon2,
  3. Erin McMinn2,
  4. Maureen Byrne2,
  5. Emily M Ko1,
  6. Lori Cory1,
  7. Ashley F Haggerty1 and
  8. Nawar A Latif1
  1. 1Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
  2. 2Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, 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 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.

Methods The 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.

Results A 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).

Conclusions Uterine preservation was not associated with worse survival in this cohort of pre-menopausal patients with stage II epithelial ovarian carcinoma.

  • ovarian cancer
  • hysterectomy
  • ovary

Data availability statement

Data may be obtained from a third party and are not publicly available. Data are available from the American College of Surgeons.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data are available from the American College of Surgeons.

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Footnotes

  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors DN: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, visualization, writing - original draft, writing - review and editing. MB, EM, LM-G, LC, AFH, EMK: investigation, methodology, writing - original draft, writing - review and editing. NL: supervision, formal analysis, investigation, methodology, writing - original draft, writing - review and 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.

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