Fertility sparing surgery for malignant ovarian sex-cord stromal tumors: long-term obstetric and oncologic outcomes.

Objective: To evaluate the oncological and reproductive outcomes of patients with ovarian sex-cord stromal tumors (SCSTs) treated with fertility sparing surgery (FSS).

Material and methods: This retrospective study included patients diagnosed with malignant ovarian SCSTs between February 2007 and June 2020 at Başkent University Hospital, Ankara. All patients underwent FSS, which preserved at least one ovary and the uterus. Data on demographics, surgical and pathological features, adjuvant treatments, follow-up, recurrence, survival, and obstetric outcomes were collected. Follow-up continued until September 2025, with survival analyses performed using Kaplan-Meier and Cox regression methods.

Results: The median age of the 35 included patients was 29.0 years, with a median follow-up of 141.0 months. Recurrence occurred in 17.1%, and disease-related mortality was 8.6%. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 85.7% and 97.1%, respectively. No significant factors influenced DFS, while adjuvant therapy impacted OS in univariate analysis. All patients maintained regular menstrual cycles post-treatment. Nine patients conceived (36.0%), resulting in 12 pregnancies and 6 live births (50.0%). Chemotherapy did not significantly affect fertility outcomes.

Conclusion: FSS in patients with ovarian SCSTs demonstrated favorable oncologic and reproductive outcomes. Larger, prospective multicenter studies are necessary to optimize management strategies and establish definitive guidelines for fertility preservation in this patient population.