Gaughran Jonathan, Rosen O'Sullivan Hannah, Lyne Tom, Abdelbar Ahmed, Abdalla Mostafa, Sayasneh Ahmad
Women's Health, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
Faculty of Life Sciences & Medicine at Guy's, The School of Life Course Sciences, King's College London, London WC2R 2LS, UK.
J Clin Med. 2022 Jun 3;11(11):3195. doi: 10.3390/jcm11113195.
Fertility Sparing Surgery (FSS) appears to be a safe means of treating early-stage ovarian cancer based on relatively limited evidence. However, there is currently insufficient evidence to aid women in counselling about their potential fertility outcomes. The aim of this study was to assess the reproductive outcomes and prognosis of women who have undergone FSS for ovarian malignancy. Between 1 June 2008 and 1 June 2018, a retrospective review of a clinical database was conducted to identify all consecutive patients who underwent FSS in a central London gynaecological oncology centre. All patients with a histological diagnosis of ovarian malignancy (excluding borderline ovarian tumours) were eligible. All identified patients were then prospectively called into a follow up and asked to complete a questionnaire about their fertility outcomes. A total of 47 women underwent FSS; 36 were included in this study. The mean age was 30.3 years (95% Confidence Interval [CI]: 27.6 to 33.0 years). During the study period, 17/36 (47.2%) of the women had attempted to conceive following surgery, with a successful live birth rate of 52.9% (9/17). The mean time of recurrence was 125.3 months (95% CI: 106.5−144.1 months). The mean time to death was 139.5 months (95% CI: 124.3−154.8). The cancer grade, tumour stage and use of Assisted Reproductive Technology (ART) were the main factors significantly associated with the risk of recurrence and death. In conclusion, this study suggests that a large proportion of women will not attempt to conceive following FSS. For those who do attempt to conceive, the likelihood of achieving a live birth is high. However, careful counselling about the higher risk of recurrence and worse survival for women with high grade cancer, disease Stage > IA and potentially those who undergo ART is essential before contemplating FFS.
基于相对有限的证据，保留生育功能手术（FSS）似乎是治疗早期卵巢癌的一种安全方法。然而，目前尚无足够证据帮助女性咨询其潜在的生育结局。本研究的目的是评估因卵巢恶性肿瘤接受FSS治疗的女性的生殖结局和预后。2008年6月1日至2018年6月1日期间，对一个临床数据库进行了回顾性分析，以确定伦敦市中心一家妇科肿瘤中心所有连续接受FSS治疗的患者。所有经组织学诊断为卵巢恶性肿瘤（不包括卵巢交界性肿瘤）的患者均符合条件。然后，对所有确定的患者进行前瞻性随访，并要求他们填写一份关于其生育结局的问卷。共有47名女性接受了FSS；本研究纳入了36名。平均年龄为30.3岁（95%置信区间[CI]：27.6至33.0岁）。在研究期间，17/36（47.2%）的女性术后尝试怀孕，活产成功率为52.9%（9/17）。复发的平均时间为125.3个月（95%CI：106.5−144.1个月）。平均死亡时间为139.5个月（95%CI：124.3−154.8）。癌症分级、肿瘤分期和辅助生殖技术（ART）的使用是与复发和死亡风险显著相关的主要因素。总之，本研究表明，很大一部分女性在FSS后不会尝试怀孕。对于那些尝试怀孕的女性，活产的可能性很高。然而，在考虑进行FSS之前，对高级别癌症、疾病分期>IA期以及可能接受ART治疗的女性复发风险较高和生存较差的情况进行仔细咨询至关重要。
