Fertility preservation in young women with epithelial ovarian cancer.
BACKGROUND
Surgical management of ovarian cancer consists of hysterectomy with bilateral oophorectomy. In young women, this results in the loss of reproductive function and estrogen deprivation. In the current study, the authors examined the safety of fertility-conserving surgery in premenopausal women with epithelial ovarian cancers.


METHODS
Women aged<or=50 years with stage IA or IC epithelial ovarian cancer who were registered in the Surveillance, Epidemiology, and End Results database were examined. Patients who underwent bilateral oophorectomy were compared with those who underwent ovarian conservation. A second analysis examined uterine conservation versus hysterectomy. Multivariate Poisson regression models were developed to describe predictors of fertility preservation. Survival was examined using Cox proportional hazards models and the Kaplan-Meier method.


RESULTS
In total, 1186 women, including 754 women (64%) who underwent bilateral oophorectomy and 432 women (36%) who underwent ovarian preservation, were identified. Younger age, later year of diagnosis, and residence in the eastern or western United States were associated with ovarian preservation (P<.05 for all). Women with endometrioid and clear cell histologies and stage IC disease were less likely to have ovarian conservation (P<.05). In a Cox model, ovarian preservation had no effect on survival (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.39-1.20). Young age, later year of diagnosis, residence in the eastern or western United States, single women, mucinous tumors, and patients with stage IA disease were more likely to have uterine preservation (P<.05 for all). In a multivariate model, uterine preservation had no effect on survival (HR, 0.87; 95% CI, 0.62-1.22).


CONCLUSIONS
Ovarian and uterine-conserving surgery were safe in young women who had stage IA and IC epithelial ovarian cancer.
Wright
Jason D
JD
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, and Herbert Irving Comprehensive Cancer Center, New York-Presbyterian Hospital, New York, New York 10032, USA. jw2459@columbia.edu
Shah
Monjri
M
Mathew
Leny
L
Burke
William M
WM
Culhane
Jennifer
J
Goldman
Noah
N
Schiff
Peter B
PB
Herzog
Thomas J
TJ
D000328:Adult; D005260:Female; D005298:Fertility; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality / Q000601:surgery*; D010052:Ovariectomy; D018426:SEER Program; D016896:Treatment Outcome