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A Swedish Nationwide prospective study of oncological and reproductive outcome following fertility-sparing surgery for treatment of early stage epithelial ovarian cancer in young women

Authors
  • Johansen, Gry1, 2
  • Dahm-Kähler, Pernilla3, 4
  • Staf, Christian3
  • Flöter Rådestad, Angelique1
  • Rodriguez-Wallberg, Kenny A.1, 5
  • 1 Karolinska Institutet, Stockholm, Sweden , Stockholm (Sweden)
  • 2 Karolinska University Hospital, Stockholm, Sweden , Stockholm (Sweden)
  • 3 Sahlgrenska University Hospital, Gothenburg, Sweden , Gothenburg (Sweden)
  • 4 Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden , Gothenburg (Sweden)
  • 5 Division of Gynecology and Reproduction, Karolinska University Hospital, Novumhuset Plan 4, Stockholm, 141 86, Sweden , Stockholm (Sweden)
Type
Published Article
Journal
BMC Cancer
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Oct 19, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12885-020-07511-y
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundEpithelial ovarian cancer (EOC) is rare in women of reproductive age and fertility-sparing surgery (FSS) may be applied in early stages. The purpose of this study was to investigate the safety and efficacy of FSS for treatment of EOC.MethodsThe Swedish nationwide population-based Quality Register for Gynecological Cancer was used to identify all women 18–40 years of age diagnosed with stage I EOC between 2008 and 2015. Detailed data on surgery, staging, histopathology, and follow-up were extracted and reviewed. Cross-linking of individuals to population-based registries allowed retrieval of data on obstetrical and reproductive outcomes after FSS. Disease-free survival (DFS) and overall survival (OS) rates were compared (Kaplan-Meier method) between women who underwent FSS vs. radical surgery (RS).ResultsIn total 83 women were identified; 36 who had FSS performed and 47 RS. The 5-year OS rate was 92% and no statistical differences between DFS or OS were found between women treated by FSS or RS. The recurrence rate after RS was 13% compared to 6% after FSS. Recurrences were more frequently found in women with stage IC tumor or with histologic subtypes with more aggressive behavior. In the FSS cohort, nine women gave birth to 12 healthy children, all delivered at fullterm. Only one women had received assisted reproductive technology treatment.ConclusionIn this nationwide population-based cohort study natural fertility was maintained after FSS. Specific histologic subtypes showed greater prognostic impact on the oncological outcome than the use of FSS. Recurrences occurred after FSS, but none in the uterus, which questions the need of hysterectomy in young women with EOC.Trial registrationThis article reports the results of a healthcare intervention using the data prospectively registered in the Swedish population-based registries including the Quality Register for Gynecological Cancer, the National Death Register, the Swedish Medical Birth Register, and the National Quality Register for Assisted Reproduction.

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