Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Int J Gynecol Cancer. 2021 Mar;31(3):480-483. doi: 10.1136/ijgc-2020-001747.
Fertility-sparing surgery is rarely offered for patients with stage II epithelial ovarian carcinoma. The aim of the present study was to evaluate the overall survival of pre-menopausal patients with stage II epithelial ovarian carcinoma who did not undergo hysterectomy.
The National Cancer Database was accessed, and patients aged ≤40 years without a history of another tumor diagnosed between 2004 and 2015 with a pathological stage II epithelial ovarian carcinoma, who underwent lymphadenectomy and received multi-agent chemotherapy, were identified. Overall survival was compared with the log-rank test after generation of Kaplan-Meier curves. A Cox model was constructed to control for tumor histology.
A total of 185 patients met the inclusion criteria. The rate of uterine preservation was 24.3% (45 patients). Patients who did not undergo hysterectomy were younger (median 32 vs 37 years, p<0.001) and less likely to have high-grade tumors compared with those who underwent hysterectomy. The two groups were comparable in terms of presence of co-morbidities and performance of adequate lymphadenectomy (p>0.05). Median follow-up of the present cohort was 62.3 months (95% CI 53.6 to 71.0) and a total of 22 deaths occurred. There was no difference in overall survival between patients who did and did not undergo hysterectomy (p=0.50; 5-year overall survival rates 87.5% and 91.4%, respectively). After controlling for tumor histology, grade and substage, omission of hysterectomy was not associated with worse survival (HR 0.69, 95% CI 0.22 to 2.12).
Uterine preservation was not associated with worse survival in this cohort of pre-menopausal patients with stage II epithelial ovarian carcinoma.
对于 II 期上皮性卵巢癌患者，很少提供保留生育能力的手术。本研究的目的是评估未行子宫切除术的 II 期上皮性卵巢癌绝经前患者的总生存率。
访问国家癌症数据库，确定 2004 年至 2015 年间年龄≤40 岁、无另一种肿瘤病史、病理分期为 II 期上皮性卵巢癌、行淋巴结切除术和接受多药化疗的患者。通过生成 Kaplan-Meier 曲线后进行对数秩检验比较总生存率。构建 Cox 模型以控制肿瘤组织学。
共有 185 名患者符合纳入标准。保留子宫的比例为 24.3%（45 例）。未行子宫切除术的患者年龄较小（中位数 32 岁 vs 37 岁，p<0.001），且与行子宫切除术的患者相比，高级别肿瘤的发生率较低。两组在合并症的存在和充分的淋巴结切除术方面具有可比性（p>0.05）。本队列的中位随访时间为 62.3 个月（95%CI 53.6 至 71.0），共有 22 例死亡。行子宫切除术与未行子宫切除术的患者总生存率无差异（p=0.50；5 年总生存率分别为 87.5%和 91.4%）。在控制肿瘤组织学、分级和亚分期后，不切除子宫与生存率降低无关（HR 0.69，95%CI 0.22 至 2.12）。
在本队列的 II 期上皮性卵巢癌绝经前患者中，保留子宫与生存率降低无关。
