Canlorbe Geoffroy, Chabbert-Buffet Nathalie, Uzan Catherine
Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France.
Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France.
J Clin Med. 2021 Sep 18;10(18):4235. doi: 10.3390/jcm10184235.
(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane ("Cochrane Reviews") databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.
(1) 背景：尽管大多数上皮性卵巢癌（EOC）患者接受根治性手术，但早期疾病、交界性卵巢肿瘤（BOT）或非上皮性肿瘤患者可根据组织学亚型和预后因素接受保留生育功能手术（FSS）。(2) 方法：我们进行了一项系统评价，以评估FSS治疗卵巢癌的安全性和生育结局。我们在MEDLINE、PubMed、Cochrane图书馆和Cochrane（“Cochrane系统评价”）数据库中检索了1985年至2021年1月15日期间以英文或法文发表的文章。(3) 结果：对于BOT患者，应向有生育意愿的年轻女性提供FSS，即使在初次手术时发现有腹膜种植。黏液性BOT女性应首先进行单侧输卵管卵巢切除术，而对于浆液性BOT女性，囊肿切除术是一个可接受的选择。如果I期BOT患者术后仍存在不孕，可启动辅助生殖技术（ART）。对于EOC患者，仅应在对IA期1级（可能还有2级，或当前分类中的低级别）浆液性、黏液性或子宫内膜样肿瘤女性进行分期后考虑FSS。FSS也可提供给IC期1级（或低级别）疾病患者。对于浆液性、黏液性或子宫内膜样高级别IA期或低级别IC1或IC2期EOC女性，可进行双侧输卵管卵巢切除术并保留子宫，以便通过卵子捐赠实现妊娠。最后，FSS在非上皮性卵巢癌患者中，尤其是恶性卵巢生殖细胞肿瘤女性中发挥着重要作用。
