Similar survival with fertility-sparing vs. non-sparing epithelial ovarian cancer surgery

Key takeaways:

• Fertility-sparing surgery resulted in similar overall 5-year survival rates as non-sparing surgery.
• Fertility-sparing surgery was tied to lower overall survival for women with high-grade endometrioid tumors.

SAN FRANCISCO — Nearly 20% of women of reproductive age with epithelial ovarian cancer undergo fertility-sparing surgery, which may not negatively affect overall survival, except in the case of high-grade endometrioid tumors, data show.

“While we primarily think of postmenopausal patients when looking at ovarian cancer, about 14% of cases every year are diagnosed with patients under 50 [years], and most of these patients present in stage I,” Bonnie B. Song, MD, of the division of gynecologic oncology, department of obstetrics and gynecology at the University of Southern California, said during a presentation at the ACOG Annual Clinical & Scientific Meeting. “Fertility preservation may be an important consideration for these patients, but most patients report that they don't receive any fertility counseling. However, fertility counseling is associated with lower regret and improved quality of life in reproductive age patients with cancer.”

Song and colleagues conducted a population-based retrospective study with data from 3,027 women younger than 50 years (median age, 43 years) with stage I epithelial ovarian cancer who underwent primary surgical therapy from 2007 to 2020. Using the National Cancer Institute’s Surveillance, Epidemiology and End Result database, researchers identified those who underwent fertility-sparing surgery, defined as preservation of one ovary and the uterus for unilateral lesion and preservation of the uterus for bilateral lesions.

Overall, 17.6% of women underwent fertility-sparing surgery. Fertility-sparing surgery utilization was 13.4% in 2007 and 21.8% in 2020. Non-Hispanic white women, those with high-grade serous histology and those with stage IC disease had a 2.8 times increase in fertility-sparing surgery utilization (P = .05).

Women who underwent fertility-sparing surgery had similar overall 5-year survival rates as those who underwent non-sparing surgery (93.6% vs. 92.1%; adjusted HR = 0.87; 95% CI, 0.57-1.35). The overall survival association remained consistent for women with high-grade serous (92.9% vs. 92.4%), low-grade serous (100% vs. 92.2%), clear cell (97.5% vs. 86.1%), mucinous (92.1% vs. 86.6%), low-grade endometrioid (95.7% vs. 97.7%) and mixed histology (93.3% vs. 83.7%) tumors (P = .05 for all).

However, for women with high-grade endometrioid tumors, fertility-sparing surgery was associated with lower overall 5-year survival rates (71.9% vs. 93.8%; aHR = 2.9; 95% CI, 1.09-7.67).

Researchers observed no association between fertility-sparing surgery and bilateral ovarian lesions.

“Our findings of comparable overall survival across stage I epithelial ovarian cancer does reinforce our current data. However, prior studies of fertility-sparing surgery for hybrid epithelial ovarian cancer have shown mixed outcomes,” Song said. “Because the survival association with high-grade endometrial tumors was previously not reported, it will require further validation investigation.”