Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
Arch Gynecol Obstet. 2019 Jun;299(6):1651-1658. doi: 10.1007/s00404-019-05121-z. Epub 2019 Mar 28.
To examine survival of women who had uterine and ovarian preservation during surgical treatment for early-stage borderline ovarian tumors (BOTs).
The Surveillance, Epidemiology, and End Results Program was used to identify women aged < 50 years with stage I BOTs who underwent ovarian conservation at surgical treatment between 1988 and 2003. Survival outcomes were examined based on the use of concurrent hysterectomy at surgery.
Among 6379 cases of BOT, there were 1065 women who had utero-ovarian preservation at surgery, and there were 52 women who had hysterectomy with ovarian preservation alone. Women who had uterine preservation were more likely to be single and diagnosed in recent years (both, P < 0.05). On univariable analysis, women who had utero-ovarian preservation had cause-specific survival similar to those who had ovarian preservation alone without uterine preservation (10-year rates: 99.2% versus 98.1%, P = 0.42); however, overall survival was higher in the utero-ovarian preservation group compared to the hysterectomy group (95.8% versus 87.6%, P < 0.001). On multivariable analysis, utero-ovarian preservation remained an independent prognostic factor for improved overall survival (adjusted hazard ratio 0.35, 95% confidence interval 0.15-0.79, P = 0.012). Cardiovascular disease mortality was lower in the utero-ovarian preservation group compared to the hysterectomy group, but it did not reach statistical significance (20-year cumulative rate, 0.8% versus 3.0%, P = 0.29).
Our study suggests that utero-ovarian preservation for young women with early-stage BOTs may be associated with improved overall survival compared to ovarian preservation alone without affecting BOT-related survival outcome.
研究在手术治疗早期交界性卵巢肿瘤（BOT）期间行子宫和卵巢保留术的女性的生存情况。
利用监测、流行病学和最终结果计划（Surveillance, Epidemiology, and End Results Program），确定 1988 年至 2003 年期间手术治疗时行卵巢保留术且年龄<50 岁的 I 期 BOT 患者。基于手术时是否同时行子宫切除术，评估生存结局。
在 6379 例 BOT 中，有 1065 例患者行子宫-卵巢保留术，52 例患者仅行保留卵巢的子宫切除术。保留子宫的患者更可能是单身且近年诊断（两者，P<0.05）。单变量分析显示，行子宫-卵巢保留术的患者与未行子宫切除而仅行卵巢保留术的患者的肿瘤特异性生存率相似（10 年生存率：99.2%比 98.1%，P=0.42）；然而，子宫-卵巢保留组的总生存率高于子宫切除术组（95.8%比 87.6%，P<0.001）。多变量分析显示，子宫-卵巢保留术仍是改善总生存率的独立预后因素（调整后的危险比为 0.35，95%置信区间为 0.15-0.79，P=0.012）。与子宫切除术组相比，子宫-卵巢保留组的心血管疾病死亡率较低，但差异无统计学意义（20 年累积发生率，0.8%比 3.0%，P=0.29）。
本研究表明，与仅行卵巢保留术相比，年轻的早期 BOT 患者行子宫-卵巢保留术可能与总生存率的提高相关，而不会影响 BOT 相关的生存结局。
