Could fertility-sparing surgery be considered for women with early stage ovarian clear cell carcinoma?

Dimitrios Nasioudis; Eloise Chapman-Davis; Melissa K. Frey; Steven S. Witkin; Kevin Holcomb

doi:10.3802/jgo.2017.28.e71

Journal List > J Gynecol Oncol > v.28(6) > 1148299

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Nasioudis, Chapman-Davis, Frey, Witkin, and Holcomb: Could fertility-sparing surgery be considered for women with early stage ovarian clear cell carcinoma?

Original Article

J Gynecol Oncol 2017;28(6):e71.

Published online: 4 November 2017

DOI: https://doi.org/10.3802/jgo.2017.28.e71

Could fertility-sparing surgery be considered for women with early stage ovarian clear cell carcinoma?

Dimitrios Nasioudis, Eloise Chapman-Davis, Melissa K. Frey, Steven S. Witkin, Kevin Holcomb

Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA

Correspondence to Dimitrios Nasioudis Department of Obstetrics and Gynecology, Weill Cornell Medicine, 1300 York Avenue, Box 35, New York, NY 10065, USA. Tel: +1-212-746-3165 Fax: +1-212-746-8799 E-mail: din2004@med.cornell.edu dnasioudis@gmail.com

Received 6 March 2017 Revised 17 April 2017 Accepted 19 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://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.

Abstract

Objective

The aim of the present retrospective population-based study was to investigate the oncologic impact of uterine and ovarian preservation (OP) in premenopausal women with stage IA or IC ovarian clear cell carcinoma (OCCC).

Methods

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database was accessed and a cohort of surgically-staged premenopausal women (age <50 years) diagnosed with unilateral stage IA or IC OCCC was drawn. Based on site-specific surgery codes, women who did not undergo hysterectomy and/or bilateral salpingo-oophorectomy (BSO) were identified. Overall survival (OS) and cancer-specific survival (CSS) rates were calculated following generation of Kaplan-Meier curves; comparisons were made with the log-rank test. Multivariate Cox analysis was performed to control for possible confounders.

Results

A total of 741 premenopausal women who met the inclusion criteria were identified. Based on available information, rate of uterine preservation was 14.5% (96/663) while the rate of OP was 28.1% (71/253). Five-year CSS rates were 90.8% for women who did not undergo hysterectomy compared with 87.7% for those who did (p=0.290). Similarly, 5-year CSS rates in the OP and BSO groups were 92.6% and 85%, respectively (p=0.060). After controlling for disease sub-stage (IA vs. IC), uterine or OP was not associated with a worse overall or cancer-specific mortality.

Conclusion

In the present cohort, uterine and OP did not have a negative impact on oncologic outcomes. Selection criteria for fertility-sparing surgery (FSS) could be expanded to include women with stage IA OCCC.

Keywords: Ovarian Neoplasms, Adenocarcinoma, Clear Cell, Fertility, Fertility Preservation

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Fig. 1.

Patient selection flowchart. CCC, clear cell carcinoma; OCCC, ovarian clear cell carcinoma.

Fig. 2.

Rate of hysterectomy among premenopausal women with unilateral CCC confined to the ovary per year of diagnosis (final selected model: 0 joinpoints). APC, annual percent charge; CCC, clear cell carcinoma. * The APC is significantly different from zero at alpha=0.05.

Fig. 3.

CSS of premenopausal women with unilateral CCC confined to the ovary stratified by performance of hysterectomy (n=564 and n=94 in the hysterectomy and uterine preservation groups, respectively; p=0.290 from the log-rank test). CCC, clear cell carcinoma; CSS, cancer-specific survival.

Fig. 4.

Rate of BSO among premenopausal women with unilateral CCC confined to the ovary per year of diagnosis (final selected model: 0 joinpoints). APC, annual percent charge; BSO, bilateral salpingo-oophorectomy; CCC, clear cell carcinoma. * The APC is significantly different from zero at alpha=0.05.

Fig. 5.

CSS of premenopausal women with unilateral CCC confined to the ovary stratified by performance of BSO (n=69 and n=181 in the USO and BSO groups, respectively; p=0.060 from the log-rank test). BSO, bilateral salpingo-oophorectomy; CCC, clear cell carcinoma; CSS, cancer-specific survival; USO, unilateral salpingo-oophorectomy.

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