Clinical Outcomes of Bilateral Oophorectomy Compared With Ovarian Preservation in Patients With Intravenous Leiomyomatosis Who Underwent Hysterectomy.

Abstract

OBJECTIVE Intravenous leiomyomatosis is a rare, histologically benign yet biologically aggressive smooth muscle tumor. Previous studies have indicated that ovarian hormones may play a crucial role in the pathogenesis of intravenous leiomyomatosis. However, the question of whether the deprivation of ovarian estrogen, including bilateral oophorectomy, reduces tumor recurrence in intravenous leiomyomatosis remains unclear. METHODS This retrospective cohort study, conducted across multiple centers in China from August 2003 to July 2023, focused on premenopausal patients with intravenous leiomyomatosis who underwent hysterectomy. Patients were categorized into either the bilateral oophorectomy group or the ovarian preservation group. The study compared disease-free survival (DFS) between these two groups. Univariate and multivariate analyses were employed to identify factors associated with DFS. RESULTS The study included 219 patients, with 132 (60.3%) in the bilateral oophorectomy group and 87 (39.7%) in the ovarian preservation group. Generally, patients in the bilateral oophorectomy group were older, were more likely to have given birth, and had a higher proportion of extrauterine disease compared with those in the ovarian preservation group. Kaplan-Meier curves showed significantly lower recurrence rates in the bilateral oophorectomy group compared with the ovarian preservation group (P=.01). The cumulative recurrence rates at 3 years, 5 years, and 10 years were 0.8%, 2.6%, and 4.0%, respectively, in the bilateral oophorectomy group and 9.0%, 10.3%, and 14.0%, respectively, in the ovarian preservation group. Multivariate analysis for DFS demonstrated that ovarian preservation significantly increased the risk of tumor recurrence (adjusted hazard ratio 0.14, 95% CI, 0.04-0.52, P=.003). CONCLUSION Simultaneous bilateral oophorectomy may reduce the risk of tumor recurrence for premenopausal women diagnosed with intravenous leiomyomatosis who undergo hysterectomy.