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

Nasioudis, Dimitrios; Mulugeta-Gordon, Lakeisha; McMinn, Erin; Frey, M.K.; Chapman‐Davis, Eloise; Holcomb, Kevin

doi:10.1136/ijgc-2020-001716

Cited by 25 publications

(13 citation statements)

References 33 publications

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“…Large retrospective studies and metaanalyses have found that for stage I epithelial ovarian cancer, fertility-sparing surgery did not appear to compromise disease-free survival (DFS) or overall survival (OS) compared with radical surgery. [76][77][78][79][80][81][82][83][84][85] Although clear cell histology is associated with increased risk of poor outcomes, 83 some studies have shown that even among patients with stage I clear cell, fertility-sparing surgery does not increase risk of relapse or shorten survival compared with radical surgery. 77,78,81,82,85 Large retrospective studies among patients with stage I borderline ovarian tumors have found that recurrence rate and survival is similar for those treated with fertility sparing versus radical surgery.…”

Section: Fertility Sparing Options For Stage I Diseasementioning

confidence: 99%

“…[76][77][78][79][80][81][82][83][84][85] Although clear cell histology is associated with increased risk of poor outcomes, 83 some studies have shown that even among patients with stage I clear cell, fertility-sparing surgery does not increase risk of relapse or shorten survival compared with radical surgery. 77,78,81,82,85 Large retrospective studies among patients with stage I borderline ovarian tumors have found that recurrence rate and survival is similar for those treated with fertility sparing versus radical surgery. [86][87][88][89] In retrospective studies, including multivariate analyses, fertility sparing surgery does not appear to be associated with poorer outcomes (DFS, PFS, OS) compared with more extensive surgery in patients with stage I germ cell tumors and sex-cord stromal tumors.…”

Section: Fertility Sparing Options For Stage I Diseasementioning

confidence: 99%

See 1 more Smart Citation

Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

Armstrong

Alvarez

Bakkum-Gamez³

et al. 2021

Journal of the National Comprehensive Cancer Network

483

356

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Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States and is the country’s fifth most common cause of cancer mortality in women. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. These NCCN Guidelines discuss cancers originating in the ovary, fallopian tube, or peritoneum, as these are all managed in a similar manner. Most of the recommendations are based on data from patients with the most common subtypes─high-grade serous and grade 2/3 endometrioid. The NCCN Guidelines also include recommendations specifically for patients with less common ovarian cancers, which in the guidelines include the following: carcinosarcoma, clear cell carcinoma, mucinous carcinoma, low-grade serous, grade 1 endometrioid, borderline epithelial, malignant sex cord-stromal, and malignant germ cell tumors. This manuscript focuses on certain aspects of primary treatment, including primary surgery, adjuvant therapy, and maintenance therapy options (including PARP inhibitors) after completion of first-line chemotherapy.

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Section: Fertility Sparing Options For Stage I Diseasementioning

confidence: 99%

Section: Fertility Sparing Options For Stage I Diseasementioning

confidence: 99%

Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

Armstrong

Alvarez

Bakkum-Gamez³

et al. 2021

Journal of the National Comprehensive Cancer Network

483

356

View full text Add to dashboard Cite

show abstract

“…Because OCCC is mostly a tumor with poor pathological differentiation, some studies have pointed out the controversy of FSS in OCCC patients [20], while others have suggested that compared with FSS and radical surgery, there is no difference in OS between the two groups of patients, after adjusting for lymph node resection. Moreover, disease staging or FSS did not affect OS [21]. In our survival curve, we can see that the prognosis of patients who underwent intermediate and advanced tumor debulking surgery was signi cantly worse, while there seemed to be no signi cant difference between patients who underwent FSS and complete hysterectomy and bilateral adnexa, as the choice of surgical method was also closely related to disease stage.…”

Section: Discussionmentioning

confidence: 65%

Construction of a prediction model of cancer-specific survival after ovarian clear cell carcinoma surgery

Huang¹,

Li²,

Liu³

et al. 2022

Preprint

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Purpose To construct a nomogram model for predicting postoperative cancer-specific survival (CSS) of patients with ovarian clear cell carcinoma (OCCC) and analyze in detail the risk factors associated with OCCC. Methods The clinical pathological data of 596 OCCC patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Of these patients, 420 were allocated to the training group and 176 patients to the validation group using bootstrap resampling. The nomogram was developed based on the Cox regression model for predicting the cancer-specific survival probability of patients at 3 and 5 years after the operation. The model was evaluated in both the training and validation groups using consistency index, Receiver Operating Characteristic (ROC), and calibration plots. Results The independent risk factors for CSS in OCCC patients included FIGO stage, race, age, tumor laterality, and the log odds of positive lymph nodes (LODDS). The nomograms were established for predicting the 3- and 5-year CSS of patients after operation. The c-index of the nomogram for CSS was 0.786 in the training group and 0.742 in the verification group. AUCs of the 3-year and 5-year ROC curves were 0.818, 0.824 in the training group; and 0.816, 0.808 in the verification group, respectively. Conclusion Based on the real population data, the construction of the CSS prediction model after OCCC surgery has high prediction efficiency, can identify postoperative high-risk OCCC patients, and can be a valuable aid for the tumor staging system.

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“…We report on nine patients who underwent fertility conservation, none of whom experienced recurrent disease after a median follow-up of 95.4 months. The literature is limited with regard to fertility conservation in this patient population: a National Cancer Database analysis of 33 women with stage IA and 24 women with stage IC ovarian clear cell carcinoma found no difference in survival between patients undergoing fertility-sparing surgery versus radical cytoreduction, although lymphadenectomy was deferred in nearly half of the cases 22. A systematic review of 132 patients with stage IA/IC disease undergoing fertility-sparing surgery reported a 15% relapse rate; however, the analysis did not account for whether patients were fully staged 22.…”

Section: Discussionmentioning

confidence: 99%

Management of patients with early-stage ovarian clear cell carcinoma: risk stratification and fertility conservation

Manning‐Geist

Gordhandas

Hodgson

et al. 2022

Int J Gynecol Cancer

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ObjectiveWe sought to describe clinicopathologic and treatment factors associated with oncologic outcomes in patients with early-stage ovarian clear cell carcinoma undergoing complete staging and in a sub-set of these patients undergoing fertility-conserving surgery.MethodsWe retrospectively identified patients with ovarian clear cell carcinoma initially treated at our institution from January 1, 1996 to March 31, 2020. Survival was estimated using Kaplan–Meier curves and compared by log-rank test. Survival-associated variables were identified by Cox proportional hazards regression.ResultsOf 182 patients, mismatch repair and p53 protein expression were assessed by immunohistochemistry on 82 and 66 samples, respectively. There were no significant differences in progression-free survival or overall survival between mismatch repair-deficient (n=6, including 4 patients with Lynch syndrome; 7.3%) and mismatch repair-proficient patients, whereas aberrant p53 expression (n=3; 4.5%) was associated with worse progression-free (p<0.001) and overall survival (p=0.01). Patients with stage IA/IC1 disease had a 95% 5-year overall survival rate (95% CI 88% to 98%); patients with stage IC2/IC3 disease had a similar 5-year overall survival rate (76%; 95% CI 54% to 88%) to that of patients with stage IIA/IIB disease (82%; 95% CI 54% to 94%). There was no difference in 5-year overall survival in patients with stage IA/IC1 undergoing chemotherapy versus observation (94% vs 100%). Nine patients underwent fertility-sparing surgery and none experienced recurrence. Of five patients who pursued fertility, all had successful pregnancies.ConclusionsIn patients with completely staged ovarian clear cell carcinoma, those with stage IA/IC1 disease have an excellent prognosis, regardless of chemotherapy. Aberrant p53 expression may portend worse outcomes. Additional investigation is warranted on the safety of fertility conservation in patients with stage IA/IC1 disease.

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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

Cited by 25 publications

References 33 publications

Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

Construction of a prediction model of cancer-specific survival after ovarian clear cell carcinoma surgery

Management of patients with early-stage ovarian clear cell carcinoma: risk stratification and fertility conservation

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