Fertility-sparing surgery for treatment of non-epithelial ovarian cancer: Oncological and reproductive outcomes in a prospective nationwide population-based cohort study
Fertility-sparing surgery for treatment of non-epithelial ovarian cancer: Oncological and reproductive outcomes in a prospective nationwide population-based cohort study
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DOI：
10.1016/j.ygyno.2019.08.017
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发表时间：
2019-11-01
影响因子：
4.7
通讯作者：
Rodriguez-Wallberg, Kenny A.
中科院分区：
文献类型：
--
作者：
Johansen, Gry;Dahm-Kahler, Pernilla;Rodriguez-Wallberg, Kenny A.
目的：在一项前瞻性、全国性、基于人群的研究中，比较接受保留生育力手术（FSS）与根治性手术（RS）治疗NEOC的女性的肿瘤学结局，并报告FSS后女性的生殖结局。方法：使用瑞典妇科癌症质量登记册，我们确定了2008年至2015年期间接受FSS或RS治疗I期NEOC的所有18-40岁女性。使用Kaplan-Meier方法比较无进展生存期（PFS）和总生存期（OS）率。辅助生殖技术（ART）治疗和产科结局后FSS的使用数据提取从国家质量登记辅助生殖（Q-IVF）和瑞典医学出生Register.Results：在研究期间，73名妇女年龄在18-40接受了第一阶段NEOC诊断。大多数，78%（n = 57），进行了FSS。无论手术入路如何，5年OS率均为98%。与RS相比，接受FSS治疗的女性的OS和PFS率无统计学差异。RS后复发率高于FSS：分别为12.5%（2/16）和3.5%（2/57）。在FSS之后，11名妇女生下了13个健康的孩子（都是自然受孕的）。此外，12%的妇女在队列中发展不孕症，并接受ART治疗（n = 7）。结论：FSS是不相关的更糟糕的肿瘤学结果比RS在年轻女性早期NEOC。两组的预后均良好，OS为98%。在接受FSS治疗的妇女中，自然生育能力得到维持，只有12%的妇女需要ART治疗。(C)2019年，任作家。爱思唯尔公司出版
Objective: To compare the oncologic outcome of women who underwent fertility-sparing surgery (FSS) vs. radical surgery (RS) for treatment of NEOC in a prospective, nationwide, population-based study and report on the reproductive outcomes in women after FSS.Methods: Using the Swedish Quality Register for Gynecological Cancer, we identified all women ages 18-40 treated with either FSS or RS for stage I NEOC between 2008 and 2015. Progression-free survival (PFS) and overall survival (OS) rates were compared using the Kaplan-Meier method. Data on use of assisted reproductive technology (ART) treatments and obstetrical outcomes after FSS were extracted from the National Quality Register for Assisted Reproduction (Q-IVF) and the Swedish Medical Birth Register.Results: During the study period, 73 women ages 18-40 received a stage I NEOC diagnosis. The majority, 78% (n = 57), underwent FSS. The 5-year OS rate, regardless of surgical approach, was 98%. There were no statistical differences between OS and PFS rates in women treated with FSS, compared to RS. Recurrences were more common after RS than FSS: 12.5% (2/16) vs. 3.5% (2/57), respectively. Following FSS, 11 women gave birth to 13 healthy children (all conceived naturally). Additionally, 12% of the women in the cohort developed infertility and received ART treatment (n = 7).Conclusion: FSS is not associated with worse oncologic outcomes than RS in young women with early stage NEOC. The prognosis was excellent in both groups, with an OS of 98%. Natural fertility was maintained in women treated with FSS, only 12% required ART treatment. (C) 2019 The Authors. Published by Elsevier Inc.