Fertility sparing surgery vs radical surgery for epithelial ovarian cancer: a meta-analysis of overall survival and disease-free survival

Liu, Denghua; Cai, Jing; Gao, Aiwei; Wang, Zehua; Cai, Lei

doi:10.1186/s12885-020-06828-y

Cited by 36 publications

(35 citation statements)

References 31 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%

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%

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

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“…This conservative treatment is considered in AYAs with a strong desire to preserve fertility and with limited disease and no visible abnormalities during surgery. However, only observational, retrospective series comparing FSS and non-FSS in selected patients are available and controversy about women with high-risk prognostic factors remains [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

Schuurman

Zilver

Samuels

et al. 2021

Cancers

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Fertility-sparing surgery (FSS) is increasingly being offered to women with a gynecological malignancy who wish to preserve fertility. In this systematic review, we evaluate the best evidence currently available on oncological and reproductive outcome after FSS for early stage cervical cancer, epithelial ovarian cancer, and endometrial cancer. An extensive literature search was conducted using the electronic databases Medline (OVID), Embase, and Cochrane Library to identify eligible studies published up to December 2020. In total, 153 studies were included with 7544, 3944, and 1229 patients who underwent FSS for cervical, ovarian, and endometrial cancer, respectively. We assessed the different FSS techniques that are available to preserve fertility, i.e., omitting removal of the uterine body and preserving at least one ovary. Overall, recurrence rates after FSS are reassuring and therefore, these conservative procedures seem oncologically safe in the current selection of patients with low-stage and low-grade disease. However, generalized conclusions should be made with caution due to the methodology of available studies, i.e., mostly retrospective cohort studies with a heterogeneous patient population, inducing selection bias. Moreover, about half of patients do not pursue pregnancy despite FSS and the reasons for these decisions have not yet been well studied. International collaboration will facilitate the collection of solid evidence on FSS and the related decision-making process to optimize patient selection and counseling.

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“…Radical surgery is unlikely to reduce the risk of recurrence of certain histological subtypes 32 . In a previous study, there was no signi cant difference in overall survival between stage I and radical surgery in EOC 33 . Prognosis may be more related to the natural history of the disease and the cancer type rather than to the speci c type of surgery 34 .…”

Section: Discussionmentioning

confidence: 75%

Nomogram for Predicting Postoperative Cancer-specific Early Death in Patients with Epithelial Ovarian Cancer based on the SEER Database: A Large Cohort Study

Zhang

Zhu

2021

Preprint

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Background: Ovarian cancer is a common gynecological malignant tumor. Poor prognosis is strongly associated with early death, but there is no effective tool to predict this. This study aimed to construct a nomogram for predicting cancer-specific early death in ovarian cancer patients.Methods: Our study used data from the Surveillance, Epidemiology, and End Results (SEER) database of ovarian cancer patients registered from 1988 to 2016. Important independent prognostic factors were determined by univariate and multivariate logistic regression and LASSO Cox regression. Several risk factors were considered in constructing the nomogram. Nomogram discrimination and calibration were evaluated using C-index, internal validation, and receiver operating characteristic (ROC) curves.Results: A total of 4769 patients were included. Patients were assigned to the training set (n = 3340; 70%) and validation set (n = 1429; 30%). Based on the training set, eight variables were shown to be significant factors for early death and were incorporated in the nomogram: AJCC (American Joint Committee on Cancer) stage, residual lesion size, chemotherapy, serum CA125 level, tumor size, number of lymph nodes examined, surgery of primary site, and age. The C-indices and ROC curves showed that the nomogram had better predictive ability than the AJCC staging system and good clinical practicability. Internal validation based on validation set showed good consistency between predicted and observed values for early death. Conclusions: Compared with predictions made using AJCC stage or residual lesion size, the nomogram was able to provide more robust predictions for early death in ovarian cancer patients.

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Fertility sparing surgery vs radical surgery for epithelial ovarian cancer: a meta-analysis of overall survival and disease-free survival

Cited by 36 publications

References 31 publications

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

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

Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

Nomogram for Predicting Postoperative Cancer-specific Early Death in Patients with Epithelial Ovarian Cancer based on the SEER Database: A Large Cohort Study

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