Ditto Antonino, Martinelli Fabio, Bogani Giorgio, Lorusso Domenica, Carcangiu Marialuisa, Chiappa Valentina, Reato Claudio, Donfrancesco Cristina, De Carrillo Karla Jeanette Amaya, Raspagliesi Francesco
Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Gynecol Oncol. 2015 Jul;138(1):78-82. doi: 10.1016/j.ygyno.2015.05.004. Epub 2015 May 9.
Fertility-sparing surgery (FSS) is a strategy often considered in young patients with low-grade (G1-2) early-stage epithelial ovarian cancer (eEOC), while is still controversial in high-risk patients. We investigated the role of FSS in low and high-risk eEOC patients undergoing comprehensive surgical staging.
We analyzed data from patients operated for an eEOC from 1975 to 2011, focusing on patients submitted to FSS. Seventy patients out of 307 with eEOC were identified. Patients underwent FSS were compared with 237 patients underwent radical-comprehensive-staging (RCS) in the same period. Disease free (DFS) and overall (OS) survivals were evaluated using Kaplan-Meier and Cox models.
Overall, 307 patients had surgery for eEOC: 70 (22.8%) and 237 (77.2%) women had FSS and RCS, respectively. At univariate analysis, the execution of FSS not influenced DFS (HR:1.06 (95%CI: 0.56,2.02); p=0.84) and OS (HR:1.94 (95%CI: 0.75,4.98); p=0.16). Stage of disease was the only factor correlating with DFS (HR:4.73; 95%CI: 2.01,11.11; p<0.001). Independently, increased age (HR per 1-unit of age:1.06 (95%CI: 1.03,1.11); p<0.001) and high risk disease (HR:3.26; 95%CI: 1.23,8.62; p=0.01) remained associated with worse OS. Focusing on the high risk group (stage IAG3 or more) we observed that type of surgery (FSS v. RCS) did not influence DFS (p=0.77, log-rank test) and OS (p=0.08, log-rank test).
FSS upholds oncologic effectiveness of RCS, preserving reproductive and endocrine functions. FSS does not increase risk of recurrence among high risk eEOC patients. Further prospective studies on this issue are warranted to improve patients' care.
保留生育功能手术（FSS）是年轻的低级别（G1 - 2）早期上皮性卵巢癌（eEOC）患者常考虑的一种治疗策略，而在高危患者中仍存在争议。我们研究了FSS在接受全面手术分期的低危和高危eEOC患者中的作用。
我们分析了1975年至2011年因eEOC接受手术的患者数据，重点关注接受FSS的患者。在307例eEOC患者中识别出70例。将接受FSS的患者与同期接受根治性全面分期（RCS）的237例患者进行比较。使用Kaplan - Meier和Cox模型评估无病生存期（DFS）和总生存期（OS）。
总体而言，307例患者因eEOC接受了手术：分别有70例（22.8%）和237例（77.2%）女性接受了FSS和RCS。单因素分析显示，实施FSS对DFS（风险比：1.06（95%置信区间：0.56, 2.02）；p = 0.84）和OS（风险比：1.94（95%置信区间：0.75, 4.98）；p = 0.16）无影响。疾病分期是与DFS相关的唯一因素（风险比：4.73；95%置信区间：2.01, 11.11；p < 0.001）。独立来看，年龄增加（每增加1岁的风险比：1.06（95%置信区间：[1.03, 1.11]；p < 0.001）和高危疾病（风险比：3.26；95%置信区间：1.23, 8.62；p = 0.01）仍与较差的OS相关。聚焦高危组（IAG3期及以上），我们观察到手术类型（FSS与RCS）对DFS（p = 0.77，对数秩检验）和OS（p = 0.08，对数秩检验）无影响。
FSS维持了RCS的肿瘤学疗效，保留了生殖和内分泌功能。FSS不会增加高危eEOC患者的复发风险。有必要对此问题进行进一步的前瞻性研究以改善患者的治疗。
