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Park: Safety of fertility-sparing surgery for stage I ovarian clear cell carcinoma
Editorial

Journal of Gynecologic Oncology 2017; 28(6): e91.

Published online: 11 October 2017

DOI: https://doi.org/10.3802/jgo.2017.28.e91

Safety of fertility-sparing surgery for stage I ovarian clear cell carcinoma

Jeong-Yeol Park

Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Correspondence to Jeong-Yeol Park. Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. catgut1-0@hanmail.net

Received 30 September 2017       Accepted 30 September 2017

Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Fertility-sparing surgery can be performed safely in selected women with stage I epithelial ovarian cancer [1]. However, the safe indications for fertility-sparing surgery for stage I epithelial ovarian cancer vary from study to study. There has never been a well designed randomized controlled trial. Recent largest 2 retrospective studies reported different indications. In a Japanese study, fertility-sparing surgery can be performed safely only in stage IA, IC, grade 1–2, non-clear cell carcinoma and stage IA clear cell carcinoma [2]. In an Italian study, in the contrary, fertility-sparing surgery can be performed safely in all patients with stage I epithelial ovarian cancer except grade 3 disease [3]. In addition, indications for safe fertility-sparing surgery for stage I epithelial ovarian cancer vary slightly from one treatment guideline to another. The National Comprehensive Cancer Network (NCCN) treatment guideline suggests that fertility-sparing surgery can be performed in all patients with stage IA and IC epithelial ovarian cancer [4], but Gynecologic Cancer InterGroup (GCIG) consensus review suggests that fertility-sparing surgery is not recommended for stage IC, clear cell carcinoma [5]. The main issue is whether fertility-sparing surgery is safe for stage I ovarian clear cell carcinoma (OCCC). However, only few studies introduced this issue until now, and all of them included only small number of patients with stage I OCCC [267].
In this issue, Nasioudis et al. [8] reported the safety of fertility-sparing surgery in stages IA and IC OCCC in a large cohort using the National Cancer Institue's Surveillance, Epidemiology, and End Results (SEER) data base in this issue. This study includes the largest cohort of stage I OCCC treated with fertility-sparing surgery ever reported. The preservation of uterus and ovary in stage I OCCC did not affect on the survival outcomes in this cohort. The indications for fertility-sparing surgery can be extended to stage I OCCC [8]. The main reason for not recommending fertility-sparing surgery in OCCC was the concern about poor survival outcomes. However, recent studies suggested that the survival outcomes of early stage OCCC are similar with other histologic types [59]. Therefore, the indication for fertility-staging surgery for OCCC needs not to be different from other histologic types. Nasioudis et al.'s study [8] supported this well. However, it is not clear whether fertility-sparing surgery was performed in young women who want to preserve their fertility in this study. Further studies are needed to confirm the safety of fertility-sparing surgery in OCCC.

Notes

Conflict of Interest No potential conflict of interest relevant to this article was reported.

References

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4. National Cancer Institute (US). Joinpoint trend analysis software [Internet]. Bethesda, MD: National Cancer Institute;2017. cited 2017 Apr 17. Available from: http://surveillance.cancer.gov/joinpoint.
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7. Park JY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. Outcomes of fertility-sparing surgery among young women with FIGO stage I clear cell carcinoma of the ovary. Int J Gynaecol Obstet. 2016; 134:49–52.
8. Nasioudis D, Chapman-Davis E, Frey MK, Witkin SS, Holcomb K. Could fertility-sparing surgery be considered for women with early stage ovarian clear cell carcinoma? J Gynecol Oncol. 2017; 28:e71.
9. Miyamoto M, Takano M, Goto T, Kato M, Sasaki N, Tsuda H, et al. Clear cell histology as a poor prognostic factor for advanced epithelial ovarian cancer: a single institutional case series through central pathologic review. J Gynecol Oncol. 2013; 24:37–43.
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Jeong-Yeol Park
https://orcid.org/0000-0003-2475-7123

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