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.
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.
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DOI：
10.1186/s12885-020-07511-y
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发表时间：
2020-10-19
期刊：
影响因子：
3.8
通讯作者：
Rodriguez-Wallberg KA
中科院分区：
文献类型：
--
作者：
Johansen G;Dahm-Kähler P;Staf C;Flöter Rådestad A;Rodriguez-Wallberg KA
上皮性卵巢癌（EOC）在育龄妇女中很少见，早期可采用保留生育能力的手术（FSS）。本研究的目的是探讨FSS治疗EOC的安全性和有效性。瑞典全国范围内基于人口的妇科癌症质量登记册用于确定2008年至2015年期间诊断为I期EOC的所有18 - 40岁女性。详细的资料，手术，分期，组织病理学，并随访提取和审查。将个人与基于人口的登记处交叉连接，可以检索FSS后的产科和生殖结局数据。采用Kaplan-Meier法比较了行FSS与根治性手术（RS）的女性的无病生存率（DFS）和总生存率（OS）。总共确定了83名妇女; 36名进行了FSS，47名进行了RS。5年OS率为92%，在接受FSS或RS治疗的女性之间未发现DFS或OS之间的统计学差异。RS后的复发率为13%，而FSS后为6%。患有IC期肿瘤或具有更具攻击性行为的组织学亚型的女性更容易复发。在FSS队列中，9名妇女生下了12名健康儿童，均为足月分娩。只有一名妇女接受了辅助生殖技术治疗。在这项全国范围内基于人群的队列研究中，FSS后维持了自然生育能力。与使用FSS相比，特定的组织学亚型对肿瘤结局的预后影响更大。FSS术后复发，但子宫内无复发，这对EOC年轻女性是否需要子宫切除提出了质疑。本文报告了使用瑞典人口登记处前瞻性登记的数据进行医疗干预的结果，这些登记处包括妇科癌症质量登记处、国家死亡登记处、瑞典医学出生登记处和国家辅助生殖质量登记处。
Epithelial 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. The 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). In 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. In 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. This 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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影响因子：
3.8
作者：
Kajiyama, H.;Shibata, K.;Kikkawa, F.
通讯作者：
Kikkawa, F.
影响因子：
4.7
作者：
Johansen, Gry;Dahm-Kahler, Pernilla;Rodriguez-Wallberg, Kenny A.
通讯作者：
Rodriguez-Wallberg, Kenny A.
影响因子：
4.7
作者：
Schilder, JM;Thompson, AM;van Nagell, J
通讯作者：
van Nagell, J
影响因子：
50.5
作者：
Fruscio, R.;Corso, S.;Colombo, N.
通讯作者：
Colombo, N.
与接受根治性手术的年轻女性接受卵巢癌的长期生存。
影响因子：
8.8
作者：
Kajiyama, H.;Shibata, K.;Mizuno, M.;Umezu, T.;Suzuki, S.;Nawa, A.;Kawai, M.;Nagasaka, T.;Kikkawa, F.
通讯作者：
Kikkawa, F.