Fertility preservation in women with borderline ovarian tumors
How does it impact disease outcome? A cohort study
Fertility preservation through assisted reproduction has undergone significant improvements. In addition to the tools of assisted reproductive technology, increasing evidence suggests that fertility-sparing surgery is safe for many patients affected by cancer.
A recent cohort study evaluated the effect of fertility-sparing surgery in women with borderline ovarian tumors, reports Medscape.
Data were analyzed on 213 women with borderline ovarian tumors who were followed for a mean of 75 months. A majority (81%) of the cases involved stage I disease, 4% involved stage II, and 15% involved stage III. The tumor type of 140 patients was serous, and 69 had mucinous borderline ovarian tumors. The mean age of the women was 38.7 years, and 62% were under the age of 40 years at the time of diagnosis.
Fertility-sparing surgery was performed on 112 patients. Almost half of these patients had conservative surgery (cystectomy, partial oophorectomy) on the ovary that contained the tumor. Of 50 patients (24%) who were diagnosed with recurrences, 40 had undergone conservative surgery, and 10 had undergone radical surgery. Multivariate analysis found fertility-sparing surgery to be associated with recurrence (hazard ratio, 2.57; 95% confidence interval, 2.3-7.6).
Twenty women in the entire cohort died during follow-up; in 11 cases, the cause of death was related to the ovarian tumor. Six of 11 women who died of ovarian tumor had undergone conservative surgery. Fertility preservation was not associated with mortality. A total of 67 pregnancies were documented in 42 women.
This study has found that advanced stage at diagnosis and conservative surgery were associated with recurrence. Survival, however, was not influenced by fertility-sparing surgery. The subsequent chance to conceive is likely to be variable and depends on the patient's age, ovarian reserve, tubal status, and other pathologies. This study adds to our current knowledge and supports the use of conservative surgery for women with borderline ovarian tumors who wish to maintain fertility.