Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Int J Gynecol Cancer. 2022 Feb;32(2):165-171. doi: 10.1136/ijgc-2021-003115. Epub 2021 Dec 24.
Investigate the overall survival of patients with stage IC2/IC3 epithelial ovarian carcinoma undergoing fertility-sparing surgery.
Patients aged 45 years diagnosed between January 2004 and December 2015 with epithelial ovarian carcinoma, who underwent surgical staging and had tumor involving the ovarian surface (IC2), malignant ascites or positive cytology (IC3), were identified in the National Cancer Database. The fertility-sparing surgery group included patients who had preservation of the uterus and the contralateral ovary while the radical surgery group included patients who had hysterectomy with bilateral salpingo-oophorectomy. Overall survival was evaluated following generation of Kaplan-Meier curves while a Cox model was constructed to control for tumor grade and performance of lymphadenectomy. A systematic review of the literature was performed and cumulative relapse rate among patients with IC2/IC3 disease who underwent fertility-sparing surgery was calculated.
A total of 235 cases were identified; 105 (44.7%) patients underwent fertility-sparing surgery. There was no difference in overall survival between the fertility-sparing and radical surgery groups (p=0.37; 5- year overall survival rates 90.2% and 85%, respectively). After controlling for tumor grade and performance of lymphadenectomy, fertility-sparing surgery was not associated with worse overall survival (HR 1.22, 95% CI 0.56, 2.62). A systematic review identified 151 patients with stage IC2/IC3 disease who underwent fertility-sparing surgery. Cumulative relapse rate was 19.3% (n=29) while 12 (6.7%) deaths were reported. Median time to recurrence was 19 (range 1-128.5) months. Tumor recurrence involved the ovary exclusively in 42% (11/26) of patients, while 15% (4/26) had a lymph node, 35% (9/26) a pelvic/abdominal, and 8% (2/26) a distant tumor relapse.
In a large cohort of patients with stage IC2/IC3 epithelial ovarian carcinoma, fertility-sparing surgery was not associated with worse overall survival. However, based on a literature review, relapse rate is approximately 20%.
研究行保留生育功能手术的 IC2/IC3 期上皮性卵巢癌患者的总生存率。
本研究纳入了 2004 年 1 月至 2015 年 12 月期间在国家癌症数据库中诊断为上皮性卵巢癌且年龄<45 岁、接受手术分期且肿瘤累及卵巢表面（IC2）、有恶性腹水或细胞学阳性（IC3）的患者。保留生育功能手术组包括保留子宫和对侧卵巢的患者，根治性手术组包括行子宫切除术和双侧附件切除术的患者。通过生成 Kaplan-Meier 曲线评估总生存率，同时构建 Cox 模型以控制肿瘤分级和淋巴结切除术的执行情况。对文献进行了系统回顾，并计算了行保留生育功能手术的 IC2/IC3 疾病患者的累积复发率。
共纳入 235 例患者，其中 105 例（44.7%）患者接受了保留生育功能手术。保留生育功能手术组和根治性手术组的总生存率无差异（p=0.37；5 年总生存率分别为 90.2%和 85%）。在校正肿瘤分级和淋巴结切除术的执行情况后，保留生育功能手术与较差的总生存率无关（HR 1.22，95%CI 0.56，2.62）。系统回顾确定了 151 例接受保留生育功能手术的 IC2/IC3 期疾病患者。累积复发率为 19.3%（n=29），报告了 12 例（6.7%）死亡。中位复发时间为 19（范围 1-128.5）个月。肿瘤复发仅累及卵巢的患者占 42%（11/26），淋巴结受累的占 15%（4/26），盆腔/腹部受累的占 35%（9/26），远处肿瘤复发的占 8%（2/26）。
在大规模的 IC2/IC3 期上皮性卵巢癌患者中，保留生育功能手术与较差的总生存率无关。但是，根据文献回顾，复发率约为 20%。
