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Am J Obstet Gynecol. 2017 Nov;217(5):580.e1-580.e10. doi: 10.1016/j.ajog.2017.06.019. Epub 2017 Jun 27.

Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer.

Author information

1
Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA. Electronic address: koji.matsuo@med.usc.edu.
2
Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.
3
Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA.
4
Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL.
5
Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Colorado, Denver, CO.
6
Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
7
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY.

Abstract

BACKGROUND:

While there is an increasing trend of ovarian conservation at the time of surgical treatment for young women with stage I cervical cancer, the risk for subsequent ovarian cancer after ovarian conservation has not been well studied.

OBJECTIVE:

We sought to examine the incidence of and risk factors for metachronous ovarian cancer among young women with stage I cervical cancer who had ovarian conservation at the time of hysterectomy.

STUDY DESIGN:

The Surveillance, Epidemiology, and End Results Program was used to identify women aged <50 years who underwent hysterectomy with ovarian conservation for stage I cervical cancer from 1983 through 2013 (n = 4365). Time-dependent analysis was performed for ovarian cancer risk after cervical cancer diagnosis.

RESULTS:

Mean age at cervical cancer diagnosis was 37 years, and the majority of patients had stage IA disease (68.2%) and squamous histology (72.9%). Median follow-up time was 10.8 years, and there were 13 women who developed metachronous ovarian cancer. The 10- and 20-year cumulative incidences of metachronous ovarian cancer were 0.2% (95% confidence interval, 0.1-0.4) and 0.5% (95% confidence interval, 0.2-0.8), respectively. Mean age at the time of diagnosis of metachronous ovarian cancer was 47.5 years, and stage III-IV disease was seen in 55.6%. Age (≥45 vs <45 years, hazard ratio, 4.22; 95% confidence interval, 1.16-15.4; P = .018), ethnicity (non-white vs white, hazard ratio, 4.29; 95% confidence interval, 1.31-14.0; P = .009), cervical cancer histology (adenocarcinoma or adenosquamous vs squamous, hazard ratio, 3.50; 95% confidence interval, 1.17-10.5; P = .028), and adjuvant radiotherapy use (yes vs no, hazard ratio, 3.69; 95% confidence interval, 1.01-13.4; P = .034) were significantly associated with metachronous ovarian cancer risk. The presence of multiple risk factors was associated with a significantly increased risk of metachronous ovarian cancer compared to the no risk factor group: 1 risk factor (hazard ratio range, 2.96-8.43), 2 risk factors (hazard ratio range, 16.6-31.0), and 3-4 risk factors (hazard ratio range, 62.3-109), respectively.

CONCLUSION:

Metachronous ovarian cancer risk after ovarian conservation for women with stage I cervical cancer is <1%. Older age, non-white ethnicity, adenocarcinoma or adenosquamous histology, and adjuvant radiotherapy may be associated with an increased metachronous ovarian cancer risk.

KEYWORDS:

cervical cancer; metachronous ovarian cancer; ovarian conservation

PMID:
28666700
DOI:
10.1016/j.ajog.2017.06.019
[Indexed for MEDLINE]

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