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Fertility-conserving surgery safe in early-stage ovarian cancer

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Ovarian- and uterine-conserving surgery appears to be safe in premenopausal women with stage IA or IC epithelial ovarian cancer, with no adverse impact on survival, US physicians report in the September 15th issue of Cancer.

“Compared with patients who have advanced stage disease, the prognosis for patients who have stage I tumors is excellent,” Dr. Jason D. Wright and co-investigators note. Moreover, about 3% to 17% of ovarian tumors occur in young women, who “are more likely to present with early stage disease and lower grade tumors.”

Although studies have shown that ovarian conservation in young women with ovarian cancer has been associated with good outcomes, the researchers add, “relatively little data specifically have addressed uterine conservation.”

Using data from the Surveillance, Epidemiology, and End Results (SEER) database, Dr. Wright, at Columbia University in New York, and his team analyzed outcomes for women ages 50 years or younger who had epithelial ovarian cancer diagnosed between 1988 and 2004. They analyzed ovarian preservation and uterine conservation separately.

Among 1186 women in the first analysis, 64% underwent bilateral oophorectomy and 36% had preservation of at least a portion of one ovary.

Ovarian preservation did not have a statistically significant effect on survival. Only tumor grade and stage were predictive of survival.

In the second analysis, 77% of the 2911 women underwent hysterectomy and 23% had uterine conservation. In a multivariate model, uterine preservation had no significant effect on survival, whereas histology, marital status, tumor grade and disease stage did predict survival.

“There were no differences in survival based on undergoing either oophorectomy or hysterectomy in any of the groups that we examined,” Dr. Wright and associates report. Average 5-year survival rates were all above 90%.

They note that patients with tumors with endometrioid and clear cell histologies were less likely to undergo ovarian conservative surgery. Thus, they emphasize, “Given the aggressive behavior of clear cell ovarian tumors, conservative surgical therapy should be approached with caution in these patients.”

Cancer 2009;115.