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Original research
Oncologic and pregnancy outcomes after fertility-sparing surgery for stage I, low-grade endometrioid ovarian cancer
  1. Brenna E Swift1,
  2. Allan Covens2,
  3. Victoria Mintsopoulos3,
  4. Carlos Parra-Herran4,
  5. Marcus Q Bernardini1,
  6. Sharon Nofech-Mozes5 and
  7. Liat Hogen1
  1. 1 Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  3. 3 Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4 Department of Anatomy and Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5 Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Liat Hogen, Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada; liat.hogen{at}uhn.ca

Abstract

Objective To evaluate oncologic outcomes in patients with stage I endometrioid ovarian cancer treated with fertility-sparing compared with conventional surgery and to describe reproductive outcomes.

Methods A retrospective cohort study was carried out of patients aged 18–45 with stage I, grade 1 and 2 (low-grade) endometrioid ovarian cancer treated at two cancer centers between July 2001 and December 2019. Clinical and pathologic characteristics were compared using Fisher’s exact test for categorical and the Mann–Whitney U test for continuous variables. Recurrence-free and overall survival were calculated from Kaplan–Meier curves and compared for fertility-sparing and conventional surgery using the log rank test. Pregnancy outcomes are described.

Results There were 230 patients with endometrioid ovarian cancer. After exclusion of patients with stage greater than I and those older than 45 years, there were 31 patients with stage I cancer aged 18–45. Of these patients, 11 (35.5%) underwent fertility-sparing surgery and 20 (64.5%) underwent conventional surgery. The median follow-up was 6.0 years (range 1.8–17.3). The median age was 36 years (range 26–42) in the fertility-sparing group and 42 years (range 35–45) in the conventional surgery group (p=0.001), with no difference in other clinical and pathologic characteristics. The 5-year recurrence-free survival was 90.9% (95% CI 73.9% to 100%) for the fertility-sparing group and 84.0% (95% CI 67.3% to 100%) for the conventional surgery group (p=0.65). The 5-year overall survival was 100% for patients in the fertility-sparing group and 92.6% (95% CI 78.7% to 100%) for patients treated with conventional surgery (p=0.49). Four (12.9%) patients had disease recurrence: three (15%) after conventional surgery and one (9.1%) in the contralateral ovary after fertility-sparing surgery and embryo cryopreservation. After fertility-sparing surgery, seven (63.6%) patients attempted pregnancy, of which five (71.4%) conceived with four (57.1%) using in vitro fertilization. Of the five patients who conceived, there were three spontaneous abortions and five live births.

Conclusion Fertility-sparing surgery appears safe and may be considered in young women with stage I, low-grade endometrioid ovarian cancer when fertility preservation is desired.

  • gynecologic surgical procedures
  • ovarian cancer

Data availability statement

Data are available upon reasonable request. We will provide our data for the reproducibility of this study in other centers if such is requested.

https://doi.org/10.1136/ijgc-2022-003560

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    Data availability statement

    Data are available upon reasonable request. We will provide our data for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • Presented at This work was presented as an abstract at the Society of Gynecologic Oncology Annual Meeting 2022. Abstract presentation: Society of Gynecologic Oncologists Annual Meeting on Women’s Cancer, Phoenix, Arizona, USA; March 18-22, 2022.

    • Contributors BES: Conceptualization, data curation, investigation, methodology, visualization, writing - original draft. AC: Visualization, writing - review & editing. VM: Investigation, writing - review & editing. CP-H: investigation, writing - review & editing. MQB: Writing - review & editing. SN-M: Investigation. LH: Guarantor, conceptualization, methodology, visualization, writing - review & 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.