Fertility-preserving surgery for advanced stage ovarian germ cell tumors
Introduction
Malignant ovarian germ-cell tumors (MOGCTs) represent approximately 2–3% of all ovarian tumors [1]. Contrary to the more prevalent epithelial carcinomas, their incidence peaks during childbeaging age [1], [2]. As such the majority of women diagnosed with MOGCTs may wish to retain their reproductive potential. Standard management of MOGCT includes surgical removal of the affected ovary and administration of adjuvant chemotherapy [1], [3]. Due to the sensitivity of these tumors to platinum-based chemotherapy, overall survival rates are excellent even for women with advanced disease [4], [5]. The oncologic safety of fertility-preserving surgery (unilateral salpingo-oophorectomy and uterine preservation) for women with early-stage disease has been extensively evaluated and is currently the gold standard [1], [3], [4]. Given the chemosensitivity of MOGCTs, the practice of fertility-preserving cytoreductive surgery has also been extrapolated and applied to women with advanced stage disease [6]. However, evidence on its safety is sparse and derives from single-institutional retrospective studies. In the present study we investigated the prevalence and safety of uterine preservation among young premenopausal women (age < 40 years) diagnosed with advanced stage (II-IV) MOGCTs, using a multi-institutional, hospital-based database.
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Materials and methods
A cohort of women diagnosed between 2004 and 2014 with a malignant ovarian germ-cell tumor (MOGCT) (ICD-O-3 histology codes 9060/3-9102/3) was drawn from the National Cancer Data Base (NCDB). The NCDB, established jointly by the American Cancer Society and Commission on Cancer of the American College of Surgeons, is a hospital-based database capturing approximately 70% of all malignancies diagnosed in the United States. Patient data are prospectively collected from participating
Results
A total of 526 eligible patients, managed in 288 institutions were identified. The median number of cases reported by a facility was 2; 33.7% of patients were treated in institutions that had reported only a single case while 37.7% and 28.6% were managed in facilities that reported 2–3 and > 3 cases respectively. Median patient age was 21 years (range 2–39); the majority was of White race (75.7%) while 15.4% and 5.5% were Black and Asian respectively. Most women had stage III disease (65%); 24.3%
Discussion
The results of the present study demonstrate that during the past decade across the United States, uterine preserving surgery is commonly offered to premenopausal women diagnosed with advanced stage MOGCTs. A non-statistically significant trend toward an increased use of uterine preservation was noted with no adverse effect on survival. Patient age was the only significant factor associated with the use of uterine-sparing surgery. A decrease in the rate of uterine preservation was observed
Conflicts of interest
No conflicts of interest to report.
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Cited by (26)
Outcomes after Fertility-sparing Surgery for Women with Ovarian Cancer: A Systematic Review of the Literature
2021, Journal of Minimally Invasive GynecologyReproductive outcomes following fertility-sparing surgery for malignant ovarian germ cell tumors: A systematic review of the literature
2020, Gynecologic OncologyCitation Excerpt :Median time to achieve pregnancy was also longer in the first two groups (10 and 11 months respectively) compared to the latter groups (4 and 5 months respectively), p = 0.04. It should also be noted that several studies [12,23,24,39,61] reported on patients with advanced stage disease, who had normal pregnancies following treatment, as such FSS should be pursued even for cases with extended disease. In another large study that included 105 patients with MOGCT, 42 out of 45 patients desiring pregnancy achieved one while the median time to pregnancy was 4.4 years while receipt of adjuvant treatment was not related to time to achieve pregnancy [40].
Fertility preserving surgery for high-grade epithelial ovarian carcinoma confined to the ovary
2020, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Certain providers are hesitant to offer FSS to patients with high-grade EOC given the relative high rates of relapse [6]. Given the rarity of EOC in young women, the majority of the evidence on the oncologic safety of FSS derives from small retrospective case series [2–42]. Given the paucity of evidence, the aim of the present retrospective study was to investigate the oncologic safety of uterine preservation in premenopausal women with early stage high-grade EOC using a large multi-institutional, population-based database.
Trends in the surgical management of malignant ovarian germcell tumors
2020, Gynecologic OncologyCitation Excerpt :Before the introduction of platinum-based chemotherapy in 1980s, radical resection was commonly performed given the dismal prognosis [5]. Currently, fertility-sparing surgery with preservation of the uterus and contralateral ovary is the golden standard for all patients with apparent early stage MOGCTs who wish to maintain their reproductive potential while it also offered even in the presence of residual tumor or advanced stage disease [1–8]. Several series have confirmed the excellent oncologic and reproductive outcomes following FSS for MOGCTs [7,8].
Analysis of solid ovarian tumours in a Spanish paediatric population
2020, Anales de PediatriaSuccessful yolk-sac tumor treatment with fertility-sparing partial oophorectomy
2019, Gynecologic Oncology ReportsCitation Excerpt :When treated early (Stage I and II), prognosis is good with stage-specific long term survival rates of 94.8% and 97.1% respectively (Nasioudis et al., 2017a). There is thus an urgent need to develop fertility-sparing surgical and treatment strategies for this patient group to minimize damage to their potential fertility (Aviki and Abu-Rustum, 2017; Nasioudis et al., 2017b). A report by de La Motte Rouge et al published in 2008 recorded that 21% of women presenting with yolk-sac cancers underwent radical surgery (bilateral salpingo oophorectomy with or without total abdominal hysterectomy) and 79% underwent conservative surgery (unilateral salpingo oophorectomy, unilateral oophorectomy or unilateral cystectomy) (de La Motte Rouge et al., 2008).