Fertility-Sparing surgery for young women with ovarian endometrioid carcinoma: a multicenteric comparative study using inverse probability of treatment weighting

Hiroaki Kajiyama; Masato Yoshihara; Satoshi Tamauchi; Nobuhisa Yoshikawa; Shiro Suzuki; Fumitaka Kikkawa

doi:10.1016/j.eurox.2019.100071

Fertility-Sparing surgery for young women with ovarian endometrioid carcinoma: a multicenteric comparative study using inverse probability of treatment weighting

Eur J Obstet Gynecol Reprod Biol X. 2019 Jun 12:4:100071. doi: 10.1016/j.eurox.2019.100071. eCollection 2019 Oct.

Authors

Hiroaki Kajiyama¹, Masato Yoshihara¹, Satoshi Tamauchi¹, Nobuhisa Yoshikawa¹, Shiro Suzuki¹, Fumitaka Kikkawa¹

Affiliation

¹ Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Japan.

Abstract

Introduction: The aim of this study was to evaluate the oncologic outcome of women with stage I ovarian endometrioid carcinoma (EC) who underwent fertility-sparing surgery (FSS).

Materials and nethods: Between 1986 and 2017, a total of 3227 patients with epithelial ovarian carcinoma were retrospectively evaluated based on a central pathological review and search of the medical records from multiple institutions. We identified 24 and 54 patients with stage I EC who underwent FSS and conventional radical surgery (CRS), respectively. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier and Cox regression analyses were employed to compare OS between the two groups.

Results: With follow-up of a total of 78 patients, 9 patients (11.5%) developed recurrence. In addition, 5 patients (6.4%) died of the disease. Recurrence was noted in 3 (10.7%) patients in the FSS group and 6 (11.1%) patients in the CRS group. Death was noted in 2 (8.3%) patients in the FSS group and 3 (5.6%) patients in the CRS group. In the original cohort, there was no significant difference in overall survival (OS) or recurrence-free survival (RFS) between the FSS and RS groups {Log-rank: OS (P = 0.630), RFS (P = 0.757)}. In the IPTW-adjusted cohort, the 5-year OS rates were 96.6 and 92.4% in patients with FSS and CRS, respectively (P = 0.319). Furthermore, the 5-year RFS rate was 88.6% for the FSS group and 88.1% for the CRS group (Log-rank: P = 0.556).

Conclusions: Young women with stage I EC undergoing FSS showed a relatively satisfactory prognosis, equal to those receiving CRC.

Keywords: CRS, conventional radical surgery; EC, endometrioid carcinoma; EOC, epithelial ovarian carcinoma; FIGO, the federation of gynecology and obstetrics; FSS, fertility-sparing surgery; Fertility-sparing surgery; IPTW, inverse probability of treatment weighting; Inverse probability of treatment weighting; OS, overall survival; Oncologic outcome; Ovarian endometrioid carcinoma; PS, propensity score; Propensity score; RFS, recurrence-free survival.