Melamed Alexander, Rizzo Anthony E, Nitecki Roni, Gockley Allison A, Bregar Amy J, Schorge John O, Del Carmen Marcela G, Rauh-Hain J Alejandro
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, and the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2017 Jul;130(1):71-79. doi: 10.1097/AOG.0000000000002102.
To compare all-cause mortality between women who underwent fertility-sparing surgery with those who underwent conventional surgery for stage I ovarian cancer.
In a cohort study using the National Cancer Database, we identified women younger than 40 years diagnosed with stage IA and unilateral IC epithelial ovarian cancer between 2004 and 2012. Fertility-sparing surgery was defined as conservation of one ovary and the uterus. The primary outcome was time from diagnosis to death. We used propensity score methods to assemble a cohort of women who underwent fertility-sparing or conventional surgery but were otherwise similar on observed covariates and conducted survival analyses using the Kaplan-Meier method and Cox proportional hazard models.
We identified 1,726 women with stage IA and unilateral IC epithelial ovarian cancer of whom 825 (47.8%) underwent fertility-sparing surgery. Fertility-sparing surgery was associated with younger age, residence in the northeastern and western United States, and serous or mucinous histology (P<.05 for all). Propensity score matching yielded a cohort of 904 women who were balanced on observed covariates. We observed 30 deaths among women who underwent fertility-sparing surgery and 37 deaths among propensity-matched women who underwent conventional surgery after a median follow-up of 63 months. Fertility-sparing surgery was not associated with hazard of death (hazard ratio 0.80, 95% confidence interval [CI] 0.49-1.29, P=.36). The probability of survival 10 years after diagnosis was 88.5% (95% CI 82.4-92.6) in the fertility-sparing group and 88.9% (95% CI 84.9-92.0) in the conventional surgery group. In patients with high-risk features such as clear cell histology, grade 3, or stage IC, 10-year survival was 80.5% (95% CI 68.5-88.3) among women who underwent fertility-sparing surgery and 83.4% (95% 76.0-88.7) among those who had conventional surgery (hazard ratio 0.86, 95% CI 0.49-1.53, P=.61).
Compared with conventional surgery, fertility-sparing surgery was not associated with increased risk of death in young women with stage I epithelial ovarian cancer.
比较接受保留生育功能手术的Ⅰ期卵巢癌女性与接受传统手术的女性的全因死亡率。
在一项使用国家癌症数据库的队列研究中，我们确定了2004年至2012年间年龄小于40岁、被诊断为ⅠA期和单侧ⅠC期上皮性卵巢癌的女性。保留生育功能手术定义为保留一侧卵巢和子宫。主要结局是从诊断到死亡的时间。我们使用倾向评分方法组建了一组接受保留生育功能手术或传统手术但在观察到的协变量方面其他情况相似的女性队列，并使用Kaplan-Meier方法和Cox比例风险模型进行生存分析。
我们确定了1726例ⅠA期和单侧ⅠC期上皮性卵巢癌女性，其中825例（47.8%）接受了保留生育功能手术。保留生育功能手术与年龄较小、居住在美国东北部和西部以及浆液性或黏液性组织学相关（所有P<0.05）。倾向评分匹配产生了一组904例在观察到的协变量方面均衡的女性队列。在中位随访63个月后，我们观察到接受保留生育功能手术的女性中有30例死亡，接受倾向评分匹配的传统手术女性中有37例死亡。保留生育功能手术与死亡风险无关（风险比0.80，95%置信区间[CI]0.49-1.29，P=0.36）。保留生育功能组诊断后10年的生存率为88.5%（95%CI 82.4-92.6），传统手术组为88.9%（95%CI 84.9-92.0）。在具有透明细胞组织学、3级或ⅠC期等高风险特征的患者中，接受保留生育功能手术的女性10年生存率为80.5%（95%CI 68.5-88.3），接受传统手术的女性为83.4%（95%CI 76.0-88.7）（风险比0.86，95%CI 0.49-1.53，P=0.61）。
与传统手术相比，保留生育功能手术与Ⅰ期上皮性卵巢癌年轻女性的死亡风险增加无关。
