Prognostic Evaluation of Fertility-Sparing Surgery in Patients with Epithelial Ovarian Cancer: A Population-Based Analysis.

Abstract

Background: Indications of fertility-sparing surgery (FSS) for young women with early stage epithelial ovarian cancer (EOC) are controversial. We aimed to evaluate the impact of FSS on the prognosis of patients.

Methods: Patients diagnosed with EOC, whose tumors were limited to unilateral ovaries and American Joint Committee of Cancer stage 1 or 2, were identified in the Surveillance, Epidemiology, and End Results database (2004-2017). Propensity score matching, restricted mean survival time, subgroup analysis, log-rank test, and two-stage test were used to evaluate the effect of FSS on cancer-specific survival (CSS).

Results: A total of 1836 patients with stage 1 or 2 were identified and divided into FSS and non-FSS groups. After propensity score matching, 172 pairs of patients were included. Before and after propensity score matching, log-rank test and restricted mean survival time results showed FSS had no significant effect on CSS at 3, 5, and 10 years. After propensity score matching, univariate and multivariate Cox regression analysis confirmed FSS was not a risk factor for CSS. The study population was stratified according to variables examined by Cox regression analysis (age, race, tumor grade, stage, chemotherapy). Subgroup analysis based on log-rank and two-stage test showed FSS had no significant effect on CSS in any subgroup except the subgroup of stage 2.

Conclusions: Fertility-sparing surgery does not lead to worse outcomes than non-FSS among stage 1 EOC patients younger than 50 years. Thus, indications of FSS for early-stage EOC patients with a strong desire for fertility preservation should be appropriately broaden.