Fertility preservation in young women with epithelial ovarian cancer

Abstract

BACKGROUND: Surgical management of ovarian cancer consists of hysterectomy with bilateral oophorectomy. In young women, this results in the loss of reproductive function and estrogen deprivation. In the current study, the authors examined the safety of fertility‐conserving surgery in premenopausal women with epithelial ovarian cancers. METHODS: Women aged ≤50 years with stage IA or IC epithelial ovarian cancer who were registered in the Surveillance, Epidemiology, and End Results database were examined. Patients who underwent bilateral oophorectomy were compared with those who underwent ovarian conservation. A second analysis examined uterine conservation versus hysterectomy. Multivariate Poisson regression models were developed to describe predictors of fertility preservation. Survival was examined using Cox proportional hazards models and the Kaplan‐Meier method. RESULTS: In total, 1186 women, including 754 women (64%) who underwent bilateral oophorectomy and 432 women (36%) who underwent ovarian preservation, were identified. Younger age, later year of diagnosis, and residence in the eastern or western United States were associated with ovarian preservation (P < .05 for all). Women with endometrioid and clear cell histologies and stage IC disease were less likely to have ovarian conservation (P < .05). In a Cox model, ovarian preservation had no effect on survival (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.39‐1.20). Young age, later year of diagnosis, residence in the eastern or western United States, single women, mucinous tumors, and patients with stage IA disease were more likely to have uterine preservation (P < .05 for all). In a multivariate model, uterine preservation had no effect on survival (HR, 0.87; 95% CI, 0.62‐1.22). CONCLUSIONS: Ovarian and uterine‐conserving surgery were safe in young women who had stage IA and IC epithelial ovarian cancer. Cancer 2009. © 2009 American Cancer Society.

Ovarian Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology

“…[112][113][114] For a young patient who wishes to maintain fertility, a unilateral salpingooophorectomy (USO; preserving the uterus and contralateral ovary) may be adequate for select unilateral stage I tumors (stage 1A and 1C, but not stage 1B) and/or low-risk ovarian tumors (ie, early-stage, grade 1 tumors; borderline tumors; see LCOH-6, LCOH-9, LCOH-10; pages 1141, 1143, and 1144, respectively). [115][116][117][118][119][120] Comprehensive staging may not be necessary for select patients, such as those with borderline epithelial tumors (see LCOH-6, page 1141).…”

Oncofertility in Canada: Gonadal Protection and Fertility-Sparing Strategies

“…The analysis by Kajiyama et al 77 of 572 women with stage i epithelial ovarian cancer (126 of whom were 40 years of age or younger) showed no differences in 5-year overall survival or disease-free survival between women who had undergone radical hysterectomy and those who had undergone fertility-sparing surgery (univariate and multivariate analysis). Despite small numbers of cases and the need for further research, preliminary evidence suggests that early stage i and lower-grade (1 and potentially 2) epithelial ovarian tumours might be able to be managed with fertility-sparing surgery without compromising 5-year survival 67,68 . Still, reconsideration of a switch to definitive surgical management may be considered after childbearing, given the persistent chance of recurrent disease and its associated poor prognosis 65 .…”

Methods and conditions of fertility preservation in early-stage ovarian tumors

“…Azonban IA stádiumú, grade 3-as tumorok esetén, a legtöbb ajánlás szerint, nem javasolt fertilitást megőrző kezelést végezni [21,22,23,24]. IC stádium vagy világos sejtes carcinoma esetén megoszlanak a vélemények azzal kapcsolatban, hogy végezhető-e konzerváló műtét.…”