Oncologic outcomes of fertility-sparing surgery in early stage epithelial ovarian cancer: a population-based propensity score-matched analysis

Abstract

Objective: To evaluate the safety of fertility-sparing surgery (FSS) in reproductive women (younger than 50 years) with early epithelial ovarian cancer (EOC).

Methods: Reproductive women diagnosed with stage I EOC in the Surveillance, Epidemiology and End Results (SEER) database were identified. Surgeries that did not undergo hysterectomy and/or bilateral salpingo-oophorectomy were categorized as FSS, whereas non-FSS included bilateral salpingo-oophorectomy and hysterectomy. Propensity-score matching (PSM) was conducted to balance the covariates. Risk factor was identified by COX analysis. Kaplan-Meier curves were performed to evaluate the overall survival (OS) and cancer-specific survival (CSS).

Results: 3556 patients with stage I EOC were identified and divided into non-FSS group and FSS group. After PSM, 625 pairs of patients with stage I EOC were included. FSS was not inferior to non-FSS in the OS curve [HR 0.9127, 95% CI (0.6971 ~ 0.1.195), P = 0.5174; HR: 0.9378, 95% CI (0.6358 ~ 0.1.383), P = 0.7460] and the CSS curve [HR 0.8284, 95% CI (0.5932 ~ 1.157), P = 0.2949; HR 0.9003, 95% CI (0.5470 ~ 1.482), P = 0.6803] both in overall cohort and in matched cohort. Univariate COX analysis identified older age (45-49), moderate-differentiated to un-differentiation grade, IC stage, bigger tumor size (> 10 cm) and chemotherapy as risk factors of prognostic outcome (P < 0.1). Not only in univariate subgroup analyses but also in bivariate factors subgroup analysis, the evidence was not enough to regard FSS as a harmful factor compared with non-FSS.

Conclusions: Fertility-sparing surgery was comparable to non-FSS in terms of survival in reproductive women with stage I EOC. Patients with high-risk factors could also consider FSS as an effective alternative compared with non-FSS.

Keywords: Fertility preservation; Ovarian cancer; Reproductive function; Survival.