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Feinberg J, Hodgson A, Abu-Rustum NR, Roche KL, Park KJ. Clinical, Morphologic, and Molecular Features Associated With Ovarian Metastases From Pattern A Endocervical Adenocarcinomas. Am J Surg Pathol 2022; 46:509-518. [PMID: 34889854 PMCID: PMC8930534 DOI: 10.1097/pas.0000000000001845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ovarian metastases from endocervical adenocarcinomas (EAs) are rare but well-described. Silva Pattern A tumors have been reported to pose essentially no risk of lymph node metastases or recurrence. We describe a cohort of patients with Silva Pattern A EAs with ovarian metastases, as well as involvement of other sites. Eight pattern A EAs with ovarian metastases (4 synchronous, 4 metachronous) were identified from our institution's pathologic archives (2008-2021). Clinicopathologic and molecular features for each case were recorded. All patients were treated by hysterectomy; in each case, the entire tumor was submitted for histologic evaluation. The synchronous metastases were all clinically suspected to be ovarian primary tumors; EAs with metachronous ovarian involvement were confined to the uterus at initial diagnosis, with ovarian metastasis occurring 5 to 171 months after hysterectomy. Morphologically, all tumors were predominantly gland-forming, 5/8 (63%) displayed prominent mucinous differentiation, and 5/8 (63%) involved the corpus. All EAs were either noninvasive (exophytic/papillary/more complex than adenocarcinoma in situ) or showed nondestructive cervical stromal invasion to a depth of 5 mm or less. In the 5 tumors tested by next-generation sequencing, ARID1A, GNAS, and KRAS mutations were detected in 2 (40%), 3 (60%), and 4 (80%) cases, respectively. All 6 patients with follow-up (range, 32 to 181 mo; median, 99.5 mo) had at least 1 recurrence. All but one are without evident disease at last clinical assessment. In an otherwise typical Silva Pattern A EA, corpus involvement, mucinous differentiation, and certain gene mutations may be associated with risk for synchronous or metachronous ovarian metastases.
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Affiliation(s)
- Jacqueline Feinberg
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anjelica Hodgson
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Kay J. Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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2
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Ind T. Overview of fertility sparing treatments for cervical cancer. Best Pract Res Clin Obstet Gynaecol 2021; 75:2-9. [PMID: 34053867 DOI: 10.1016/j.bpobgyn.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
Until the late 1980s, the mainstay of treatment for cervical cancer has been either hysterectomy or radiotherapy. From the mid to late 1990s, surgical treatments have been focussed more on sparing fertility by preserving the corpus of the womb with trachelectomy or even conserving part of the cervical stroma with a cone biopsy. In carefully selected cases, less radical treatment that preserves the uterus has been considered safe. However, these approaches can be associated with specific operative and obstetric complications such as stitch ulceration, cervical stenosis, late miscarriage, and premature labour. Most guidelines agree that the management of such patients should be centralised in a unit with specialist gynaecological oncology, radiology, and histopathology services supported by specialist cancer nurses.
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Affiliation(s)
- Thomas Ind
- Royal Marsden Hospital, London, SW3 6JA, UK; St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK.
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3
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Safety and Prognostic Impacts of Ovarian Preservation during Radical Hysterectomy for Early-Stage Adenocarcinoma and Adenosquamous Cervical Cancer. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5791381. [PMID: 33274215 PMCID: PMC7683125 DOI: 10.1155/2020/5791381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022]
Abstract
Objective To identify the incidence of ovarian metastasis and the impact of ovarian preservation on oncological outcomes for early-stage adenocarcinoma and adenosquamous cervical cancer. Methods 281 patients with stages IA2-IB1 adenocarcinoma and adenosquamous cervical cancer who underwent radical hysterectomy with pelvic lymphadenectomy (RHND) were included in the study. The incidence of ovarian metastasis was evaluated from 173 patients who underwent oophorectomy during RHND. Subgroup analysis was performed for patients less than 50 years (196 of 281 patients) who were classified into two groups, ovarian preservation and nonovarian preservation groups. 5-year recurrence-free survival (5-yr RFS) and 5-year overall survival (5-yr OS) were evaluated and compared between these groups. Results There was no evidence of ovarian metastasis, synchronous ovarian cancer, or ovarian recurrence during follow-up. In patients less than 50 years of age, there were no statistically significant differences in the 5-yr RFS (P = 0.363), or 5-yr OS (P = 0.974) between the ovarian preservation and nonovarian preservation groups. In Kaplan-Meier analysis, the ovarian preservation group seemed to have a slightly better OS in long-term follow-up (after 15 years); however, the difference was not statistically significant. Conclusions Ovarian preservation was safe in adenocarcinoma and adenosquamous cervical cancer stages IA2-B1. However, the impact of ovarian preservation on oncological outcomes needs to be further investigated.
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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Cheng H, Huo L, Zong L, Kong Y, Yang J, Xiang Y. Oncological Outcomes and Safety of Ovarian Preservation for Early Stage Adenocarcinoma of Cervix: A Systematic Review and Meta-Analysis. Front Oncol 2019; 9:777. [PMID: 31475118 PMCID: PMC6702263 DOI: 10.3389/fonc.2019.00777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/31/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives: To evaluate the oncological outcomes and safety of ovarian preservation, and to review the prognostic factors for ovarian metastases in early stage cervical adenocarcinoma. Methods: PubMed, Embase, and Cochrane databases were searched for publications up to January 2019. Two investigators independently screened the studies for eligibility and extracted specific data. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using STATA statistical software version 19.0. Results: A total of 68 unique manuscripts were identified through the search strategy, and 10 studies were included in the meta-analysis of the safety of ovarian preservation. Fixed-effects model was used because of moderate heterogeneity. Pooled results of the included studies showed that ovarian preservation is not associated with a statistically significant OS (OR 1.00, 95% CI 0.64–1.56, I2 = 25.7%) or PFS (OR 0.98, 95% CI 0.57–1.66, I2 = 0%) in early stage cervical adenocarcinoma. In addition, 19 studies were included in the review of prognostic factors for cervical adenocarcinoma and risk factors for ovarian metastases. The incidence of ovarian metastases was 0% in stage IA, 2.8% in stage IB, 3.4% in stage IIA, and 11.8% in stage IIB cervical adenocarcinoma. International Federation of Gynecology and Obstetrics (FIGO) stage, tumor size, deep stromal invasion (DSI), lymph node metastasis (LNM), and vaginal invasion were significantly related to poor prognosis. Risk factors associated with ovarian metastases included age, FIGO stage, tumor size, DSI, parametrial invasion, corpus uteri invasion, LNM, vaginal invasion, and blood vessel invasion. Conclusions: Ovarian preservation in young patients with early stage cervical adenocarcinoma is safe and has no significant effect on OS or PFS. Preserving ovaries in patients with FIGO stage IIB seems not reasonable because of the high rate of ovarian metastasis.
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Affiliation(s)
- Hongyan Cheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lanqing Huo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liju Zong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujia Kong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yang J, Cai H, Xiao ZX, Wang H, Yang P. Effect of radiotherapy on the survival of cervical cancer patients: An analysis based on SEER database. Medicine (Baltimore) 2019; 98:e16421. [PMID: 31348242 PMCID: PMC6708958 DOI: 10.1097/md.0000000000016421] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cervical cancer is among the most frequent cancer types in women worldwide. Radiotherapy, including external beam radiation and brachytherapy, is one of the commonly used treatment options for cervical cancer. However, the adverse effects of radiation therapy on cervical cancer survival have been poorly investigated with inconclusive results. Therefore, the aim of this study was to determine the suitable radiotherapy modality according to patients' characteristics. A retrospective survival analysis of 44,602 patients was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate proportional hazard Cox model was used to evaluate the prognostic impact of different radiotherapy modalities, primary surgery, age, TNM stage, and tumor size. Our results indicated that patients without primary surgery, diagnosed at older age (≥45 years' old), at advanced TNM stages (III/IV) or with larger tumor size (≥3 cm) could benefit from radiotherapy. However, radiotherapy was detrimental in patients with primary surgery, diagnosed at younger age (<45 years' old), at earlier TNM stages (I/II) or with smaller tumor size (<3 cm). In addition, external beam radiation was in most cases less effective compared with combined external beam and brachytherapy. These results highlighted the necessity of realizing personalized radiotherapy treatments for patients with cervical cancer.
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Affiliation(s)
- Jian Yang
- Center of Growth, Metabolism, and Aging, Key Laboratory of Bio-Resources and Eco-Environment, College of Life Sciences, Sichuan University, Chengdu, Sichuan
| | - Haoyang Cai
- Center of Growth, Metabolism, and Aging, Key Laboratory of Bio-Resources and Eco-Environment, College of Life Sciences, Sichuan University, Chengdu, Sichuan
| | - Zhi-Xiong Xiao
- Center of Growth, Metabolism, and Aging, Key Laboratory of Bio-Resources and Eco-Environment, College of Life Sciences, Sichuan University, Chengdu, Sichuan
| | - Hangyu Wang
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, College of Pharmacy
| | - Ping Yang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
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Matsuo K, Shimada M, Mikami M. Ovarian conservation for young women with clinical stage IB-IIB cervical cancer in Japan. J Gynecol Oncol 2018; 28:e60. [PMID: 28541644 PMCID: PMC5447155 DOI: 10.3802/jgo.2017.28.e60] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan.
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
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8
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Ju UC, Kang WD, Kim SM. Is the ovarian preservation safe in young women with stages IB-IIA villoglandular adenocarcinoma of the uterine cervix? J Gynecol Oncol 2018; 29:e54. [PMID: 29770624 PMCID: PMC5981105 DOI: 10.3802/jgo.2018.29.e54] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/24/2018] [Accepted: 03/06/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Because villoglandular adenocarcinoma (VGA) of the uterine cervix has favorable features and outcomes, patients receive less radical surgery and young women preserve their ovaries. We aimed to evaluate the clinicopathological features and outcomes of VGA and to see if the ovarian preservation is safe in young women with VGA. Methods We retrospectively reviewed medical records and identified patients with VGA, who had been treated and followed from January 2004 to December 2015. Results This study consisted of 17 patients with VGA, including 9 premenopausal women. International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease was found in 12 patients (70.6%), IA1 in 2, IA2 in 1, IB2 in 1, and IIA1 in 1. Of the 12 women diagnosed with stage IB1 disease, a young woman received only conization and she has not showed a recurrence. During a median follow-up of 58 months (range: 12–116), 4 patients, who had undergone radical surgery for stage IB1 disease, had a recurrence and one of them died due to disease progression. Among patients with stages IB–IIA disease, 2 premenopausal women did not receive simultaneous oophorectomy or chemoradiation therapy. Both of them had a recurrent tumor at adnexa. Conclusion This study revealed favorable features and outcomes of VGA. However, the appropriate treatment for young women with early-stage VGA must be cautiously selected. Ovarian preservation might not be safe when young women with stages IB–IIA VGA undergo surgical procedures.
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Affiliation(s)
- U Chul Ju
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Woo Dae Kang
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Seok Mo Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
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Ovarian conservation is associated with better survival in young patients with T1N0M0 cervical adenocarcinoma: a population-based study. Arch Gynecol Obstet 2018; 297:775-784. [PMID: 29362924 DOI: 10.1007/s00404-018-4674-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/15/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Ovarian conservation is controversial in patients with cervical adenocarcinoma due to the risk of ovarian metastasis. The aim of this study is to evaluate the association of ovarian conservation with survival outcomes in young patients with T1N0M0 cervical adenocarcinoma. METHODS Women who were 45 years of age or younger with T1N0M0 cervical adenocarcinoma from 1988 to 2013 recorded in the Surveillance, Epidemiology, and End Results (SEER) database were included. Propensity score weighting was used to balance the intragroup differences. Cause-specific survival (CSS) and overall survival (OS) were compared using Kaplan-Meier estimates. A multivariate Cox model was used to adjust for covariates including propensity score. A stratified analysis was then conducted. RESULTS Totally, 1090 (79.7%) patients underwent oophorectomy and 278 (20.3%) patients whose ovaries were preserved were identified. Patients with preserved ovaries were younger, with a lower T classification and less likely to undergo pelvic lymphadenectomy (all p < 0.05). After propensity weighting, ovarian conservation group had better cause-specific survival (CSS) (5-year 98.8 versus 97.1%, 10-year 98.0 versus 95.2%, p = 0.0370) and overall survival (OS) (5-year 98.8 versus 97.1%, 10-year 96.5 versus 93.5%, p = 0.0025). After adjustment, the CSS benefit of ovarian conservation was marginally significant (p = 0.051) and OS benefit was still significant (p = 0.006). Stratified analysis showed that the CSS benefit was found in T1b classification (HR, 0.23; 95% CI 0.06-0.89, p = 0.033) and histological grade > 1 (HR 0.12; 95% CI 0.02-0.87; p = 0.035). CONCLUSION Among young women with T1N0M0 cervical adenocarcinoma, ovarian conservation is associated with better survival.
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10
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Schüring AN, Fehm T, Behringer K, Goeckenjan M, Wimberger P, Henes M, Henes J, Fey MF, von Wolff M. Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part I: Indications for fertility preservation. Arch Gynecol Obstet 2017; 297:241-255. [PMID: 29177593 PMCID: PMC5762797 DOI: 10.1007/s00404-017-4594-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/10/2017] [Indexed: 12/11/2022]
Abstract
Purpose Most guidelines about fertility preservation are predominantly focused on scientific evidence, but are less practically orientated. Therefore, practically oriented recommendations are needed to support the clinician in daily practice. Methods A selective literature search was performed based on the clinical and scientific experience of the authors, focussing on the most relevant diseases and gynaecological cancers. This article (Part I) provides information on topics that are essential for the fertility preservation indication, such as disease prognosis, disease therapy and its associated risks to fertility, recommending disease-specific fertility preservation measures. Part II specifically focusses on fertility preservation techniques. Results In breast cancer patients, fertility preservation such as ovarian tissue and oocyte cryopreservation is especially recommended in low-stage cancer and in women < 35 years of age. In Hodgkin’s lymphoma, the indication is mainly based on the chemotherapy regime as some therapies have very low, others very high gonadotoxicity. In borderline ovarian tumours, preservation of fertility usually is achieved through fertility sparing surgery, ovarian stimulation may also be considered. In cervical cancer, endometrial cancer, rheumatic diseases and other malignancies such as Ewing sarcoma, colorectal carcinoma, non-Hodgkin lymphoma, leukaemia etc., several other factors must be considered to enable an individual, stage-dependent decision. Conclusion The decision for or against fertility preservation depends on the prognosis, the risks to fertility and individual factors such as prospective family planning.
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Affiliation(s)
- A N Schüring
- UKM Kinderwunschzentrum, Department of Gynaecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer Campus 1, D-11, 48149, Münster, Germany.
| | - T Fehm
- Department of Gynaecology and Obstetrics, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - K Behringer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - M Goeckenjan
- Department of Gynaecology and Obstetrics, TU Dresden, Dresden, Germany
| | - P Wimberger
- Department of Gynaecology and Obstetrics, TU Dresden, Dresden, Germany
| | - M Henes
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - J Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology, Pulmology), University of Tübingen, Tübingen, Germany
| | - M F Fey
- Department of Medical Oncology, Inselspital and University of Berne, Berne, Switzerland
| | - M von Wolff
- Division of Gynaecological Endocrinology and Reproductive Medicine, University Women's Hospital, Berne, Switzerland
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Matsuo K, Machida H, Horowitz MP, Shahzad MMK, Guntupalli SR, Roman LD, Wright JD. Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer. Am J Obstet Gynecol 2017; 217:580.e1-580.e10. [PMID: 28666700 DOI: 10.1016/j.ajog.2017.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/05/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Koji Matsuo
- 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.
| | - Hiroko Machida
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Max P Horowitz
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - Mian M K Shahzad
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Colorado, Denver, CO
| | - Lynda D Roman
- 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
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
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12
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Matsuo K, Shimada M, Yamaguchi S, Kanao H, Nakanishi T, Saito T, Kamiura S, Iwata T, Mikami M, Sugiyama T. Identifying a candidate population for ovarian conservation in young women with clinical stage IB-IIB cervical cancer. Int J Cancer 2017; 142:1022-1032. [PMID: 28975603 DOI: 10.1002/ijc.31084] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 12/13/2022]
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.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Satoshi Yamaguchi
- Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Hiroyuki Kanao
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
| | - Toru Nakanishi
- Department of Gynecologic Oncology, Aichi Cancer Center Hospital, Japan
| | - Toshiaki Saito
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shoji Kamiura
- Department of Gynecologic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Toru Sugiyama
- Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan
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Zhou J, Chen Y, Zhang P, Lou H. Ovarian preservation in adenocarcinoma of the uterine cervix. J Ovarian Res 2017; 10:48. [PMID: 28738842 PMCID: PMC5525268 DOI: 10.1186/s13048-017-0339-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 06/16/2017] [Indexed: 11/16/2022] Open
Abstract
Background An upward trending incidence in cervical adenocarcinoma (ADC) has been reported in many countries. Because non-squamous histology has been associated with increased risk of ovarian metastases (OM), bilateral oophorectomy is commonly performed for ADC without due consideration for ovarian preservation, degrading the quality of life for young premenopausal patients. Methods Subjects were patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–IIB cervical ADC who underwent radical hysterectomy, including pelvic lymphadenectomy and bilateral salpingo-oophorectomy at our institution between Oct. 2006 and Sept. 2014. Clinicopathologic variables were studied by univariate and multivariate analyses. Results Of the 312 patients enrolled in the study, 14 patients (4.5%) developed OM. Multivariate analysis revealed that uterine corpus involvement (odds ratio [OR] 5.178, p = 0.019), parametrial involvement (OR 14.125, p = 0.005) and vaginal infiltration (OR 4.167, p = 0.047) were independently associated with metastasis. OM had no effect on either relapse-free survival (95% confidence interval [CI]: 0.077–4.095, p = 0.57) or overall survival (95% CI: 0.893–9.820, p = 0.076). Conclusion Cervical ADC is associated with an increased risk of OM. Ovarian preservation surgery in cervical ADC may be safe for young patients at an early FIGO stage without deep stromal, endometrial or perineural invasion, and particularly without uterine corpus invasion, parametrial involvement and infiltration into the vagina.
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Affiliation(s)
- Jiansong Zhou
- The Key Laboratory of Radiation Oncology of Zhejiang Province, Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Yuanyuan Chen
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Ping Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China.
| | - Hanmei Lou
- The Key Laboratory of Radiation Oncology of Zhejiang Province, Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China.
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Hu J, Jiao X, Yang Z, Cui H, Guo H, Wu Y, Zhu L. Should ovaries be removed or not in early-stage cervical adenocarcinoma: a multicenter retrospective study of 105 patients. J OBSTET GYNAECOL 2017. [PMID: 28631536 DOI: 10.1080/01443615.2017.1323198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jun Hu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xiaobing Jiao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Zhifeng Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Heng Cui
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
| | - Hongyan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yumei Wu
- Department of Obstetrics and Gynecology, Peking Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Lirong Zhu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Ovarian Conservation and Overall Survival in Young Women With Early-Stage Cervical Cancer. Obstet Gynecol 2017; 129:139-151. [PMID: 27926642 DOI: 10.1097/aog.0000000000001754] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify predictors of ovarian conservation at hysterectomy and to examine the association of ovarian conservation and survival of young women with early-stage cervical cancer. METHODS This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results Program to identify hysterectomy-based surgically treated patients with stage I cervical cancer diagnosed between 1983 and 2012 (N=16,511). Multivariable models were used to identify independent factors associated with ovarian conservation. Among the subgroup of 9,419 women younger than 50 years of age with stage I disease, survival outcomes and causes of death were examined for 3,908 (41.5%) women who underwent ovarian conservation at hysterectomy without radiotherapy. RESULTS On multivariable analysis, age younger than 50 years, stage IA disease, and squamous histology were independent factors associated with ovarian conservation (all, P<.001). Among 5,526 women younger than 50 years of age with stage IA disease who underwent hysterectomy without radiotherapy, overall survival was significantly higher in patients undergoing ovarian conservation than in those undergoing oophorectomy (20-year rate, 93.5% compared with 86.8%, P<.001); cervical cancer-specific survival was similar between the patients who underwent ovarian conservation and those who underwent oophorectomy (98.8% compared with 97.8%, P=.12). On multivariable analysis, ovarian conservation remained an independent prognostic factor for improved overall survival (adjusted hazard ratio 0.63, 95% confidence interval [CI] 0.49-0.82, P=.001) and was independently associated with lower cumulative risks of death resulting from cardiovascular disease (20-year cumulative rate, 1.2% compared with 3.3%, adjusted hazard ratio 0.47, 95% CI 0.26-0.86, P=.014) and other chronic disease (0.5% compared with 1.4%, adjusted hazard ratio 0.24, 95% CI 0.09-0.65, P=.005) compared with oophorectomy. Both cervical cancer-specific survival (20-year rate, 93.1% compared with 92.0%, P=.37) and overall survival (86.7% compared with 84.6%, P=.12) were similar between ovarian conservation and oophorectomy among 3,893 women younger than 50 years of age with stage IB disease who underwent hysterectomy without radiotherapy. CONCLUSION Among young women with stage IA cervical cancer, ovarian conservation at hysterectomy is associated with decreased all-cause mortality including death resulting from cardiovascular disease and other chronic diseases.
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Sato S, Itamochi H, Sugiyama T. Fertility-sparing surgery for uterine cervical cancer. Future Oncol 2016; 12:2345-55. [DOI: 10.2217/fon-2016-0260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The standard treatment for early cervical cancer of the uterus (CC) is radical hysterectomy with resection of the parametrium and pelvic lymphadenectomy. At least 40% of patients develop early-stage CC during child-bearing age, therefore preserving the uterus to maintain fertility has been an important consideration. Several surgical procedures including conization and vaginal or abdominal radical trachelectomy have been reported. These procedures are safe for removing lymph node negative CC tumors with <2 cm diameter. Recently, less radical surgical procedures that maintain fertility, such as conization, simple trachelectomy, minimally invasive surgery and neoadjuvant chemotherapy, have been indicated for tumors greater than 2 cm in diameter. In this review, we discuss the currently accepted surgical approaches for treating CC while maintaining fertility.
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Affiliation(s)
- Seiya Sato
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
| | - Hiroaki Itamochi
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
| | - Toru Sugiyama
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
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Chen J, Wang R, Zhang B, Lin X, Wei J, Jia Y, Yin Y, Ye S, Zhu T, Chen G, Yuan Y, Lu W, Li K. Safety of ovarian preservation in women with stage I and II cervical adenocarcinoma: a retrospective study and meta-analysis. Am J Obstet Gynecol 2016; 215:460.e1-460.e13. [PMID: 27133009 DOI: 10.1016/j.ajog.2016.04.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/09/2016] [Accepted: 04/19/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The safety of ovarian preservation remains uncertain in women with cervical adenocarcinoma and significant risk factors for ovarian metastases vary among different studies. OBJECTIVE We sought to evaluate the impact of ovarian preservation on prognosis in women with cervical adenocarcinoma and to assess clinical factors associated with ovarian metastases. STUDY DESIGN A retrospective study of 194 women with cervical adenocarcinoma was conducted and 159 women were followed up until the end of the study. To compare the impact of ovarian preservation on prognosis, women with successful follow-up were studied, including 33 women with ovarian preservation and 126 women who underwent bilateral salpingo-oophorectomy. For women who underwent radical hysterectomy, pelvic lymphadenectomy, and bilateral salpingo-oophorectomy, the risk factors for ovarian metastases were identified. A meta-analysis of the literature was carried out to further validate the findings. RESULTS There was no significant difference in survival between women with bilateral salpingo-oophorectomy and ovarian preservation (P = .423 for disease-free survival; P = .330 for overall survival). Tumor size (>4 cm), deep cervical stromal invasion, and lymph node metastasis were significant independent prognostic factors related to poor disease-free survival, and lymph node metastasis was significantly associated with overall survival. Of 153 women with cervical adenocarcinoma who underwent bilateral salpingo-oophorectomy, a significant difference was found in the relationship between ovarian metastasis and deep cervical stromal invasion, lymph node metastasis, and parametrial invasion. The meta-analysis showed that clinical stage IIB vs I-IIA (odds ratio, 4.64; 95% confidence interval, 2.11-10.23), deep stromal invasion (odds ratio, 10.63; 95% confidence interval, 3.12-36.02), lymph node metastasis (odds ratio, 8.54; 95% confidence interval, 4.15-17.57), corpus uteri invasion (odds ratio, 7.39; 95% confidence interval, 3.69-14.78), and parametrial invasion (odds ratio, 9.72; 95% confidence interval, 4.67-20.22) were significantly related to ovarian metastasis. CONCLUSION Ovarian preservation has no effect on prognosis in women with early-stage cervical adenocarcinoma. Risk factors for ovarian metastases were stage IIB, deep cervical stromal invasion, lymph node metastasis, corpus uteri invasion, and parametrial invasion. In women with early-stage cervical adenocarcinoma without these risk factors, ovarian conservation can be considered.
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Affiliation(s)
- Jing Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rui Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xingguang Lin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Juncheng Wei
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yao Jia
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ye Yin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuangmei Ye
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Gang Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongxun Yuan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Kezhen Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Jiao XB, Hu J, Zhu LR. The Safety of Ovarian Preservation in Early-Stage Adenocarcinoma Compared With Squamous Cell Carcinoma of Uterine Cervix: A Systematic Review and Meta-Analysis of Observational Studies. Int J Gynecol Cancer 2016; 26:1510-4. [DOI: 10.1097/igc.0000000000000780] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe aim of this study was to compare the incidence of ovarian metastasis (OM) in adenocarcinoma (ADC) and squamous cell carcinoma (SCC) in early-stage cervical cancer and evaluate the safety of ovarian preservation in early-stage ADC.MethodsTo perform a meta-analysis to compare the incidence of OM between early-stage ADC and SCC, we searched PubMed, EMBASE, and Cochrane for observational studies that compared it with pathological evidence after radical hysterectomy and oophorectomy. Odds ratios with 95% confidence intervals were calculated with a fixed effects model. We also found a few articles evaluating the oncological prognosis of patients with ovarian preservation to perform a systematic review.ResultsA total of 5 studies were included in the meta-analyses. The incidence of OM of patients with early-stage ADC and SCC were 2% and 0.4%, respectively (odds ratio, 5.27; 95% confidence interval, 2.14–13.45). In 1427 patients with ADC or SCC of the cervix FIGO stage (CIS-IIA) who underwent hysterectomy, no ovarian recurrences were observed after unilateral or bilateral ovarian preservation in ADC patients in the follow-up (30–68 months); however, 15 patients with SCC developed pelvic recurrence.ConclusionsAlthough the incidence of OM was higher in early-stage ADC than SCC according to ovarian pathology, it might be relatively safe to perform ovarian preservation with early-stage ADC because of low ovarian recurrence rate in short-term follow-ups.
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