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Frequency and prediction of deep uterine involvement in advanced high-grade epithelial ovarian cancer: is uterine preservation an option?
  1. Tamar Perri1,2,
  2. Gal Harel1,2,
  3. Tal Dadon2,
  4. Aya Mor-Sasson1,2,
  5. Itai Yagel1,2,
  6. Gilad Ben-Baruch1,2 and
  7. Jacob Korach1,2
  1. 1Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel
  2. 2Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
  1. Correspondence to Dr Tamar Perri, Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; tamarperri{at}


Introduction Hysterectomy is traditionally part of the surgical treatment for advanced high-grade epithelial ovarian carcinomas, although the incidence of uterine involvement has not been fully investigated. Some young patients with advanced high-grade epithelial ovarian carcinomas want uterine preservation. We aimed to determine the frequency of non-serosal (deep) uterine involvement in patients with high-grade epithelial ovarian carcinomas and to establish predictive factors for such involvement.

Methods A retrospective cohort study was performed of 366 consecutive patients with advanced high-grade epithelial ovarian carcinomas who had surgery between January 2012 and December 2019. Data collected included demographic and clinical details, and surgical and pathological reports to determine macroscopic and microscopic deep uterine involvement. The characteristics of the patients with and without deep uterine involvement were compared and univariate and multivariate Cox proportional hazard models were used to assess correlations and determine risk factors.

Results A total of 311 patients were included in the final analysis. The mean age was 62±11.6 years, with 32 (10.3%) being younger than 45. Most (92.3%) had serous carcinoma. Uterine involvement, excluding superficial (serosa-only), was present microscopically in 194 patients (62.4%) but was detected macroscopically at surgery in only 166 patients. Deep involvement was missed at surgery in 28 patients (14.4%), including parametrial involvement (n=18), parametria plus cervix (n=2), cervical involvement (n=3), endometrium (n=3), and myometrium (n=2). Multivariate analysis identified factors associated with deep uterine involvement including residual disease at surgery (HR 2.43, 95% CI 1.13 to 4.48; p=0.004) and CA125 >1000 U (HR 1.8, 95% CI 1.09 to 2.94; p=0.02).

Conclusions The incidence of deep uterine involvement in high-grade epithelial ovarian carcinomas is high. It can be diagnosed in most but not all cases on gross examination at surgery and is associated with residual disease and CA125 >1000 U. Patients who desire uterine preservation should be advised on an individual basis, given these factors and the operative findings.

  • cystadenocarcinoma
  • ascitic fluid
  • gynecologic surgical procedures
  • surgical procedures
  • operative
  • hysterectomy

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  • TP and GH are joint first authors.

  • Contributors Conception or design of the work: TP, JK, GB-B. Acquisition, analysis or interpretation of data: TP, JK, GH, TD, AM-S, IY, GB-B. Drafting the work: TP. Revising it critically for important intellectual content: JK, GH, TD, AM-S, GB-B, IY. Final approval of the version published: TP, JK, GH, TD, AM-S, IY, GB-B. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • 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.

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

  • Data availability statement Data and statistics are available upon reasonable request from

  • Author note This work was performed in partial fulfillment of the M.D. thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.