Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma

Abstract

Abstract:Objective: To assess the clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma (EOC). Methods: A retrospective study of young EOC inpatients (≤40 years old) was performed during January 1994 and December 2010 in eight institutions. Results: Data were analyzed from 94 patients treated with fertility-sparing surgery with a median follow-up time of 58.7 months. As histologic grade increased, overall survival (OS) and disease-free survival (DFS) of patients receiving fertility-sparing surgery declined. Neither staging surgery nor laparoscopy of early stage EOC with conservative surgery had a significant effect on OS or DFS. Normal menstruation recommenced after chemotherapy in 89% of the fertility-sparing group. Seventeen pregnancies among twelve patients were achieved by the end of the follow-ups. Conclusions: Fertility-sparing treatment for patients with EOC Stage I Grade 1 could be cautiously considered for young patients. The surgical procedure and surgical route might not significantly influence the prognosis. Standard chemotherapy is not likely to have an evident impact on ovarian function or fertility in young patients.

Fertility-Sparing Surgery in Ovarian Cancer: A Systematic Review

“…A total of 15 studies [12,13,16,19,20,21,22,23,24,25,26,27,28,29,30] comprising 913 patients (11-43 years of age) met the inclusion criteria. In terms of assignability of recurrences to stage and grade, the cumulative analysis of data from 4 studies [13,20,22,30] published by Marpeau et al 2008 [31] contained more detailed information than some of the original publications and was therefore employed for the meta-analysis.…”

“…The tumor type distribution showed a substantial variation between studies (e.g. mucinous tumors ranging from 36.2% [28] to 76.2% [25]).…”

“…However, the total number of pregnancies was not consistently stated; considering only the studies with complete information [12,13,19,20,21,22,23,27,28], the ratio of live births at term to the number of pregnancies was 77.0% (161 live births in 209 pregnancies). None of the studies provided details about the age of the women who became pregnant, and the majority of articles only provided incomplete information about undesired pregnancy outcomes [12,16,24,25,26,29].…”

Fertility-Sparing Surgery for Young Women with Early-Stage Epithelial Ovarian Cancer

“…In most studies, including this review, fertility-sparing surgery has been defined as the preservation of ovarian tissue in one or both adnexa and the uterus in women of reproductive age [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39] (table 1). To date, 918 patients with EOC who underwent fertility-sparing surgery have been captured in the literature.…”

“…The safety of fertility-sparing surgery in women with stage IC and grade 3 EOC has not been determined, although the results of several recent series have suggested that fertility-sparing surgery is safe in patients with stage IC grade 1-2 EOC, regardless of the type of stage 1C (positive peritoneal cytology, capsule invasion or tumor rupture) [19,20,23,25,28,29,32,33,34,35,36,37,38,39]. Patients with preoperative or intraoperative tumor rupture, surface excrescences, or malignant cells in ascitic fluid or peritoneal washings are classified as having stage IC disease.…”