Division of Obstetrics and Gynecology, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy.
Ann Oncol. 2013 Jan;24(1):138-44. doi: 10.1093/annonc/mds241. Epub 2012 Sep 3.
To assess the long-term oncological outcome and the fertility of young women with early-stage epithelial ovarian cancer (ES/EOC) treated with fertility-sparing surgery (FSS).
All patients treated with FSS for ES/EOC in two Italian centers were considered for this analysis. Univariate and multivariate analyses were used to test demographic characteristics and clinical features for the association with overall survival (OS), recurrence-free survival (RFS) and fertility.
From 1982 to 2010, 240 patients with malignant ES/EOC were treated with FSS in two tertiary centers in Italy. At a median follow-up of 9 years, 27 patients had relapsed (11%) and 11 (5%) had died of progressive disease. Multivariate analysis found only grade 3 negatively affected the prognosis of patients [hazard ratio (HR) for recurrence: 4.2, 95% confidence interval (CI): 1.5-11.7, P=0.0067; HR for death: 7.6, 95% CI: 2.0-29.3, P=0.0032]. Grade 3 was also significantly associated with extra-ovarian relapse (P=0.006). Of the 105 patients (45%) who tried to become pregnant, 84 (80%) were successful.
Conservative treatment can be proposed to all young patients when tumor is limited to the ovaries, as ovarian recurrences can always be managed successfully. Patients with G3 tumors are more likely to have distant recurrences and should be closely monitored.
评估采用保留生育功能手术（FSS）治疗早期上皮性卵巢癌（ES/EOC）的年轻女性的长期肿瘤学结局和生育能力。
考虑对两家意大利中心采用 FSS 治疗 ES/EOC 的所有患者进行此分析。使用单变量和多变量分析来测试与总生存（OS）、无复发生存（RFS）和生育能力相关的人口统计学特征和临床特征。
1982 年至 2010 年，意大利的两家三级中心对 240 例患有恶性 ES/EOC 的患者采用 FSS 治疗。在中位随访 9 年后，27 例患者复发（11%），11 例（5%）死于疾病进展。多变量分析发现仅 3 级肿瘤分级对患者的预后产生负面影响[复发的风险比（HR）：4.2，95%置信区间（CI）：1.5-11.7，P=0.0067；死亡的 HR：7.6，95% CI：2.0-29.3，P=0.0032]。3 级肿瘤分级也与卵巢外复发显著相关（P=0.006）。在尝试怀孕的 105 例患者（45%）中，84 例（80%）成功怀孕。
当肿瘤局限于卵巢时，可以向所有年轻患者提出保守治疗，因为卵巢复发总能得到成功处理。G3 肿瘤患者更有可能发生远处复发，应密切监测。
