Long-term results of fertility-sparing treatment compared with standard radical surgery for early-stage epithelial ovarian cancer

Abstract

Background:The objective of this study is to evaluate the safety of fertility-sparing surgery (FSS) for early-stage epithelial ovarian cancer (EOC).Methods:A retrospective analysis was performed to identify patients treated for early-stage EOC and to compare the clinical outcomes of patients treated with FSS and radical surgery (RS).Results:A total of 1031 patients were treated at two Institutions, 242 with FSS (group A) and 789 with RS (group B). Median duration of follow-up was 11.9 years. At univariate analyses, FSS was associated with decreased risk of relapse (P=0.002) and of tumour-related death (P=0.001). Multivariate analysis did not confirm the independent positive role of FSS neither on relapse-free interval (RFI) nor on cancer-specific survival (CSS). Tumour grade was associated with shorter RFI (P<0.001) and shorter CSS (P=0.001). The type of treatment did not influence CSS or RFI in any grade group. We also found a significant association between low-grade tumours and younger age.Conclusions:Fertility-sparing surgery is an adequate treatment for patients with stage I EOC. The clinical outcome of patients with G3 tumours, which is confirmed to be the most important prognostic factor, is not determined by the type of treatment received.

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

“…Four studies were excluded due to overlapping data set [9,10,12,13], two has a sample of less that 20 patients undergoing FSS [11,14] while one did not report HR [15]. A total of eight studies were included in this systematic review and meta-analysis [5,6,[16][17][18][19][20][21]. A total of 2223 patients undergoing FSS were compared with 5809 patients undergoing radical surgery in these studies.…”

“…Other than borderline, germ cell and stromal ovarian tumors, stage 1 EOC has also been a focus of research for FSS with several studies reporting good clinical outcomes [5,14]. However, the level of evidence is either in the form of case series (Level 4) or at best from retrospective case-control studies (Level 3B) [24].…”

“…It is important to note that the FSS was carried out in younger women in all included studies while radical surgery was predominantly carried out in older females. The impact of age on overall survival has been investigated by several studies [6,20] and younger age has been associated with higher incidence of low grade tumors with better biological behavior [5]. Age was not adjusted in comparison of outcomes for the two surgical procedures in the included studies.…”

“…However, data from propensity-score matched (including age-matched) cohorts has shown that the choice of surgical procedure does not influence outcomes [13]. Also, multivariate analysis have demonstrated that while increase in age has been independently associated with poorer prognosis, the choice of surgical procedure has no effect on overall survival [5].…”

“…However, it is also important to preserve the survival rate of cancer patients undergoing FSS. There has been a general consensus that FSS may be offered to patients with borderline, germ cell and stromal ovarian tumors [5]. A number of observational studies have also demonstrated that FSS in stage 1 EOC may not decrease survival rates and it may be carried out in patients desirous of preserving fertility [5,6].…”