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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.

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Data availability

All data were from the publicly available SEER database; no ethical approval was required.

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Funding

This research received no external funding.

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Authors

Contributions

QX and QL conceived of the presented idea and wrote the manuscript. QX and XM extracted the data from SEER database and analysed the data. QL verified the analytical methods and supervised the findings of this work. All authors contributed to the final version of the manuscript.

Corresponding author

Correspondence to Qiuyue Liao.

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The authors declare no conflict of interest.

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Xie, Q., Meng, X. & Liao, Q. Oncologic outcomes of fertility-sparing surgery in early stage epithelial ovarian cancer: a population-based propensity score-matched analysis. Arch Gynecol Obstet (2022). https://doi.org/10.1007/s00404-022-06536-x

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Keywords

  • Fertility preservation
  • Ovarian cancer
  • Reproductive function
  • Survival