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Int J Cancer. 2018 Mar 1;142(5):1022-1032. doi: 10.1002/ijc.31084. Epub 2017 Oct 16.

Identifying a candidate population for ovarian conservation in young women with clinical stage IB-IIB cervical cancer.

Author information

1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.
2
Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
3
Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan.
4
Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan.
5
Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
6
Department of Gynecologic Oncology, Aichi Cancer Center Hospital, Japan.
7
Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
8
Department of Gynecologic Oncology, Osaka International Cancer Institute, Osaka, Japan.
9
Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
10
Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan.
11
Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan.

Abstract

This study seeks to identify risk factors associated with ovarian metastasis and to characterize a population with minimum risk of ovarian metastasis in young women with stage IB-IIB cervical cancer. This was a nation-wide multicenter retrospective study in Japan examining consecutive cases of surgically-treated women with clinical stage IB-IIB cervical cancer who had oophorectomy at radical hysterectomy (n = 5,697). Multivariable analysis was performed to identify independent risk factors for ovarian metastasis. Ovarian metastasis was seen in 70 (1.2%, 95% confidence interval 0.9-1.5) cases. In the entire cohort, adenocarcinoma, lympho-vascular space invasion, uterine corpus tumor invasion, and pelvic/para-aortic nodal metastases remained independent risk factors for ovarian metastasis (all, adjusted-p < 0.05). In a sensitivity analysis of 3,165 women aged <50 years (ovarian metastasis, 1.0%), adenocarcinoma, parametrial tumor involvement, uterine corpus tumor involvement, and pelvic/para-aortic nodal metastases remained independent risk factors for ovarian metastasis (all, adjusted-P < 0.05). In the absence of these five risk factors (representing 46.1% of women aged <50 years), the incidence of ovarian metastasis was 0.14%. With the presence of adenocarcinoma alone (representing 18.9% of women aged <50 years), the incidence of ovarian metastasis was 0.17% and was not associated with increased risk of ovarian metastasis compared to the subgroup without any risk factors (p = 0.87). In conclusion, nearly two thirds of women aged <50 years with clinical stage IB-IIB cervical cancer had no risk factor for ovarian metastasis or had adenocarcinoma alone: these subgroups had ovarian metastasis rates of around 0.1% and may be a candidate population for ovarian conservation at surgical treatment.

KEYWORDS:

cervical cancer; early stage; ovarian metastasis; radical hysterectomy; risk factor

PMID:
28975603
DOI:
10.1002/ijc.31084
[Indexed for MEDLINE]

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