Xiong Jiaqiang, Zhang Zhuoqun, Liu Yanyan, Fan Guanlan, Wu Kejia, Zhang Wei
Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 Jul 8;12:866443. doi: 10.3389/fonc.2022.866443. eCollection 2022.
Unilateral oophorectomy has the benefits of preserving the ovarian function of fertility and hormone secretion, but the precise inclusion criteria for candidates for this procedure remain controversial. This study aimed to compare the prevalence and therapeutic efficiency of unilateral oophorectomy in women with ovarian cancer who underwent bilateral oophorectomy; moreover, it aimed to identify the appropriate candidates for unilateral oophorectomy.
Female patients diagnosed with stage I-III ovarian cancer between 2000 and 2017 were retrospectively identified from the Surveillance, Epidemiology, and End Results program database. Overall survival (OS) and disease-specific survival (DSS) after unilateral or bilateral (salpingo-) oophorectomy were estimated. Cumulative mortality rates (CMRs) for non-cancer comorbidities were also estimated.
A total of 28,480 women with ovarian cancer were included in this study, of whom 11,517 died during the study period. Of the patients, 7.5% and 48.0% underwent unilateral and bilateral oophorectomy, respectively. Overall, for stage-Ia tumors, unilateral oophorectomy was associated with remarkably better OS and DSS than bilateral oophorectomy (OS: p < 0.001; DSS: p = 0.01). For stage-Ib and stage-Ic ovarian tumor, there was no significant difference between the OS and DSS of patients treated by unilateral oophorectomy and those treated by bilateral oophorectomy. For stage-II and stage-III ovarian cancer, unilateral oophorectomy was associated with remarkably worse OS and DSS than bilateral oophorectomy. Among the reproductive-age women younger than 50 years, the OS and DSS of patients with stage-I tumors receiving unilateral oophorectomy were comparable to those receiving bilateral oophorectomy, even for high-grade stage-Ic tumors (all p > 0.05). For those aged 50 years and older, OS and DSS of patients with stage-I tumor receiving unilateral oophorectomy were significantly worse than those receiving bilateral oophorectomy, even for low-grade stage-Ia ovarian tumor (OS: p < 0.001; DSS: p = 0.02).
Unilateral oophorectomy exhibited excellent oncological superiority and was equivalent to bilateral oophorectomy for stage-I ovarian tumors among women of reproductive age. For women of reproductive age, the criteria of unilateral oophorectomy can be appropriately broadened to high-grade stage-Ic diseases because of the better performance of unilateral oophorectomy in this population.
单侧卵巢切除术具有保留生育和激素分泌的卵巢功能的益处，但该手术候选者的确切纳入标准仍存在争议。本研究旨在比较接受双侧卵巢切除术的卵巢癌女性中单侧卵巢切除术的患病率和治疗效果；此外，旨在确定单侧卵巢切除术的合适候选者。
从监测、流行病学和最终结果计划数据库中回顾性识别出2000年至2017年间诊断为I - III期卵巢癌的女性患者。估计单侧或双侧（输卵管 -）卵巢切除术后的总生存期（OS）和疾病特异性生存期（DSS）。还估计了非癌症合并症的累积死亡率（CMR）。
本研究共纳入28480例卵巢癌女性，其中11517例在研究期间死亡。患者中，分别有7.5%和48.0%接受了单侧和双侧卵巢切除术。总体而言，对于Ia期肿瘤，单侧卵巢切除术与双侧卵巢切除术相比，OS和DSS显著更好（OS：p < 0.001；DSS：p = 0.01）。对于Ib期和Ic期卵巢肿瘤，单侧卵巢切除术治疗的患者与双侧卵巢切除术治疗的患者的OS和DSS之间无显著差异。对于II期和III期卵巢癌，单侧卵巢切除术与双侧卵巢切除术相比，OS和DSS显著更差。在年龄小于50岁的育龄女性中，接受单侧卵巢切除术的I期肿瘤患者的OS和DSS与接受双侧卵巢切除术的患者相当，即使是高级别Ic期肿瘤（所有p > 0.05）。对于年龄50岁及以上的患者，接受单侧卵巢切除术的I期肿瘤患者的OS和DSS显著低于接受双侧卵巢切除术的患者，即使是低级别Ia期卵巢肿瘤（OS：p < 0.001；DSS：p = 0.02）。
单侧卵巢切除术表现出优异的肿瘤学优势，对于育龄期女性的I期卵巢肿瘤等同于双侧卵巢切除术。对于育龄期女性，由于单侧卵巢切除术在该人群中表现更好，其标准可适当放宽至高等级Ic期疾病。
