Chatziioannou Stylianos Sergios, Papasideri Varvara, Sofoudis Chrisostomos
School of Medicine, European University of Cyprus, Nicosia, Cyprus.
First Department of Obstetrics and Gynecology, Maternity Hospital, Elena Venizelou, Kritis 33, 14563, Athens, Kifisia, Greece.
Arch Gynecol Obstet. 2025 May 23. doi: 10.1007/s00404-025-08062-y.
This systematic review evaluates the oncologic and reproductive outcomes of fertility-sparing surgery (FSS) in women diagnosed with stage I ovarian cancer, as classified by the International Federation of Gynecology and Obstetrics (FIGO). This study aimed to assess the safety and effectiveness of FSS in preserving fertility without compromising survival outcomes.
A systematic search was conducted in MEDLINE (PubMed), SCOPUS, and Google Scholar for studies published in English from 2014 onward. Studies involving women under 50 with stage I ovarian cancer who opted for FSS were included. Data extraction focused on oncologic outcomes (recurrence and survival rates) and reproductive outcomes (pregnancy and live birth rates). Study selection followed PRISMA guidelines. The primary outcomes evaluated in this review were reproductive outcomes (pregnancy and live birth rates, including use of assisted reproductive technologies) and oncologic outcomes (recurrence rates, overall survival, and disease-free survival) following fertility-sparing surgery in women with FIGO stage I ovarian cancer.
Seventeen studies comprising 1030 patients met the inclusion criteria. Pregnancy success rates ranged from 25% to 91.3%, with live birth rates exceeding 80% in most studies. Spontaneous conception was predominant, though 3.7% to 28% of patients required assisted reproductive technologies (ARTs). Despite 58% of patients expressing a desire for future pregnancy, only 13% actively attempted conception. Recurrence rates varied from 3% to 33.3%, with most studies reporting between 8 and 15%. Overall survival ranged from 88 to 100%, and disease-free survival remained above 90%. The highest recurrence was observed in mucinous ovarian carcinoma and FIGO Stage IC2/IC3 subtypes.
FSS in stage I ovarian cancer is a viable alternative to radical surgery in carefully selected patients, with favorable oncologic and reproductive outcomes. However, recurrence risks and fertility challenges highlight the need for multidisciplinary counseling, long-term surveillance, and further research to refine selection criteria and optimize fertility preservation techniques.
本系统评价评估了按照国际妇产科联盟（FIGO）分类诊断为I期卵巢癌的女性保留生育功能手术（FSS）的肿瘤学和生殖结局。本研究旨在评估FSS在不影响生存结局的情况下保留生育功能的安全性和有效性。
在MEDLINE（PubMed）、SCOPUS和谷歌学术中进行系统检索，纳入2014年以后发表的英文研究。纳入的研究对象为年龄在50岁以下、选择FSS的I期卵巢癌女性。数据提取集中在肿瘤学结局（复发率和生存率）和生殖结局（妊娠率和活产率）。研究选择遵循PRISMA指南。本综述评估的主要结局是FIGO I期卵巢癌女性保留生育功能手术后的生殖结局（妊娠率和活产率，包括辅助生殖技术的使用）和肿瘤学结局（复发率、总生存率和无病生存率）。
17项研究共1030例患者符合纳入标准。妊娠成功率在25%至91.3%之间，大多数研究的活产率超过80%。自然受孕为主，尽管3.7%至28%的患者需要辅助生殖技术（ART）。尽管58%的患者表示希望未来怀孕，但只有13%积极尝试受孕。复发率在3%至33.3%之间，大多数研究报告在8%至15%之间。总生存率在88%至100%之间，无病生存率保持在90%以上。黏液性卵巢癌和FIGO IC2/IC3亚型的复发率最高。
对于精心挑选的患者，I期卵巢癌的FSS是根治性手术的可行替代方案，具有良好的肿瘤学和生殖结局。然而，复发风险和生育挑战凸显了多学科咨询、长期监测以及进一步研究以完善选择标准和优化生育保留技术的必要性。
