J Gynecol Oncol.  2019 Nov;30(6):e102. 10.3802/jgo.2019.30.e102.

Prognostic factors and effects of fertility-sparing surgery in women of reproductive age with ovarian clear-cell carcinoma: a propensity score analysis

• Yoshihara
• Kajiyama H
• Tamauchi S
• Suzuki S
• Takahashi
• Matsui S
• Kikkawa F

• KMID: 2458904
• DOI: http://doi.org/10.3802/jgo.2019.30.e102

Abstract

OBJECTIVE
The aim of this study was to investigate the clinical characteristics of young patients with stage I clear-cell carcinoma (CCC) and evaluate the prognostic factors and effects of fertility-sparing surgery (FSS) using propensity score (PS) adjustment.
METHODS
We conducted a regional multi-institutional study between 1986 and 2017. Among 4,277 patients with ovarian tumor, clinical and pathological data of 103 fertile women with stage I unilateral CCC were collected. We evaluated survival and reproductive outcomes in these patients. Additionally, to analyze the effects of FSS, baseline imbalance between patients with and those without FSS was adjusted with an inverse probability of treatment weighting using PSs involving independent clinical variables.
RESULTS
The mean patient age was 39.4 years, and the median follow-up period for surviving patients was 55.6 months. In multivariate analysis, stage IC2/IC3 (vs. IA/IC1) was the only independent prognostic factor for recurrence-free survival (RFS) and overall survival (OS). FSS was not associated with poorer prognosis when compared to the prognosis with non-preserving surgery with regard to both RFS and OS. No statistical difference in survival outcomes between FSS and other approaches was confirmed after PS adjustment. Among patients who underwent FSS, four deliveries with healthy neonates were noted without any gestational complications.
CONCLUSION
FSS can be considered in stage I CCC, specifically in stage IA and IC1 patients who strongly desire to have children in the future. Further clinical research is needed to clarify the optimal application of FSS for CCC.

Keyword

Ovarian Neoplasms; Adenocarcinoma, Clear Cell; Fertility Preservation; Pregnancy

MeSH Terms

Adenocarcinoma, Clear Cell
Child
Female
Fertility Preservation
Follow-Up Studies
Humans
Infant, Newborn
Multivariate Analysis
Ovarian Neoplasms
Pregnancy
Prognosis
Propensity Score*