Fertility-sparing surgery in young women with invasive epithelial ovarian cancer

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Abstract

Objectives

The purpose of this study was to clarify the clinical outcome of patients with stage IA or more advanced epithelial ovarian cancer (EOC) treated with fertility-sparing surgery (FSS).

Methods

After a central pathological review and search of the medical records from multiple institutions, a total of 60 stage I EOC patients treated with FSS were retrospectively evaluated in the current study.

Results

The median age was 30 years (range: 12–40 years). The median follow-up time was 54.7 months (range: 4.8–243.8 months). The stage was IA in 30, IB in one, and IC in 29 patients. Fifty-two patients were alive without relapse and 8 patient experienced recurrences {IA, 2; IB, 1; IC(surface involvement), 1; and IC(positive cytology), 4}. However, all patients with stage IC(capsule rupture) (n = 17) were alive without recurrence. Collectively, there was no significant difference in the overall survival between the stage IA and IC groups (P = 0.256). Moreover, there was no significant difference in DFS and OS between patients with stage IC(capsule rupture) and those with stage IA. In contrast, DFS and OS of the patients with stage IC(surface involvement/positive cytology) were poorer than those of patients with stage IA {OS; P = 0.030, and DFS; P= 0.005, respectively}. Thirteen pregnancies were observed in 9 patients.

Conclusions

FSS may be considered a treatment option in women with stage I EOC, even in those with stage IC(capsule rupture) or more wishing to bear children.

Introduction

Epithelial ovarian carcinoma (EOC) is the leading cause of death from gynecological malignancy.1 The standard surgical treatment for patients with EOC is based on hysterectomy and bilateral salpingo-oophorectomy with peritoneal sampling (peritoneal washing, omentectomy, multiple peritoneal biopsies, and the removal of peritoneal implants) with or without lymph node sampling.2 However, several reports have estimated that 3–17% of all EOCs occur in woman under 40 years of age.3, 4, 5, 6, 7 In these patients, the preservation of reproductive and endocrine functions is crucial. In general, fertility-sparing surgery (FSS) has been adopted in young patients with borderline, germ cell, and stromal tumors and some authors propose this treatment for stage I/grade 1 invasive EOC. However, because of the risk of leaving a microscopic contralateral tumor and thereby compromising curability, most gynecologists are reluctant to perform FSS in all other stage I invasive EOCs. Indeed, on selecting this surgical procedure, there may be a risk that the probability of recurrence and death is increased. The amount of evidence is too small to resolve this point because previous reports frequently involved few patients with multiple histologic tumor types including borderline tumors.

After the central pathological review and scanning of the medical records of multicentric institutions between 1986 and 2006, a total of 60 patients with stage I EOC treated with FSS were enrolled in the present study. In this study, we retrospectively analyzed these cases to clarify the clinical outcome of EOC patients who would usually undergo radical surgery.

Section snippets

Materials and methods

Between January 1986 and December 2006, a total of 1443 patients with EOC were registered and treated by the Tokai Ovarian Tumor Study Group, consisting of Nagoya University Hospital and affiliated hospitals. Data were collected from medical records and clinical follow-up visits. Seventy patients received FSS. Six patients were excluded from this study because of insufficient clinical data or being lost to follow-up immediately after surgery. Among the remaining 64 patients, 4 patients with

Results

The clinical and histological characteristics of the patients studied are illustrated in Table 1. The median age was 30.0 years (range: 12–40 years). The median follow-up time was 54.7 months. All patients were nulliparous. The stage was IA in 30 patients, IB in one, and IC in 29. In stage IC patients, 3 patients were at stage IC(a) {i.e.,IC(surface involvement)}, 17 were at stage IC(b) {i.e.,IC(capsule rupture)}, and 9 were at IC(2) {i.e.,IC(positive cytology)}. Nineteen patients underwent a

Discussion

A lot of young women with early stage EOC wish to preserve fertility without compromising survival. However, the application of conservative management in EOC continues to be controversial in the literature since data concerning such surgical management of EOC are uncommon. Needless to say, it is optimal for FSS to be proposed to young patients with stage I disease, an encapsulated tumor, no invasion of the capsule, a well-differentiated tumor, and negative peritoneal washings along with a

Conflict of interest statement

The all authors declare that there are no conflicts of interest.

References (11)

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