Abstract
Objective: To examine the association between ovarian conservation and oncologic outcome in surgically-treated young women with early-stage, low-grade endometrial cancer. Methods: This multicenter retrospective study examined women aged <50 with stage I grade 1–2 endometrioid endometrial cancer who underwent primary surgery with hysterectomy from 2000 to 2014 (US cohort n = 1196, and Japan cohort n = 495). Recurrence patterns, survival, and the presence of a metachronous secondary malignancy were assessed based on ovarian conservation versus oophorectomy. Results: During the study period, the ovarian conservation rate significantly increased in the US cohort from 5.4% to 16.4% (P = 0.020) whereas the rate was unchanged in the Japan cohort (6.3–8.7%, P = 0.787). In the US cohort, ovarian conservation was not associated with disease-free survival (hazard ratio [HR] 0.829, 95% confidence interval [CI] 0.188–3.663, P = 0.805), overall survival (HR not estimated, P = 0.981), or metachronous secondary malignancy (HR 1.787, 95% CI 0.603–5.295, P = 0.295). In the Japan cohort, ovarian conservation was associated with decreased disease-free survival (HR 5.214, 95% CI 1.557–17.464, P = 0.007) and an increased risk of a metachronous secondary malignancy, particularly ovarian cancer (HR 7.119, 95% CI 1.349–37.554, P = 0.021), but was not associated with overall survival (HR not estimated, P = 0.987). Ovarian recurrence or metachronous secondary ovarian cancer occurred after a median time of 5.9 years, and all cases were salvaged. Conclusion: Our study suggests that adoption of ovarian conservation in young women with early-stage low-grade endometrial cancer varies by population. Ovarian conservation for young women with early-stage, low-grade endometrial cancer may be potentially associated with increased risks of ovarian recurrence or metachronous secondary ovarian cancer in certain populations; nevertheless, ovarian conservation did not negatively impact overall survival.
Original language | English |
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Pages (from-to) | 39-50 |
Number of pages | 12 |
Journal | Gynecologic Oncology |
Volume | 155 |
Issue number | 1 |
DOIs | |
State | Published - Oct 2019 |
Bibliographical note
Funding Information:We thank Drs. Yongmei Huang and Brendan H. Grubbs for their scientific inputs for this study. Research grant, Pfizer, Yakult Honsha, OncoThreapy Science, honoraria, Chugai, Daiichi-Sankyo, Ono Pharmaceutical, Eisai, Kyowa Hakko Kirin, and Bayer Yakuhin, advisory board, Merck Sharp and Dohme (K.H.); honorariums, Chugai and Astra Zeneca (T.E.); consultant, Tesaro and Clovis Oncology, research funding, Merck (J.D.W.); honorarium, Chugai, textbook editorial, Springer, and investigator meeting attendance expense, VBL therapeutics (K.M.); consultant, Quantgene (L.D.R.); research grant, Merck and Tesaro, advisory board/consultant, Tesaro, Stryker, Astra Zeneca, Celsion, Abbvie, Iovance, Clovis, Genentech, and speaker bureau, Astra Zeneca, Tesaro, and Merck (P.H.T.). Conceptualization: K.M. J.D.W.; Data curation: K.M. J.C.C. K.C.K. M.K. A.S.G. G.E.G. A.N. R.M.S. M.L.K. A.K. S.Y. D.M.G. J.S. J.D.S.L. T.T.Y. A.Y.L. M.S. M.K. T.O. S.N. J.Z.M. S.A. T.K. M.S.J. M.K.K. K.K.M.; Formal analysis: K.M.; Funding acquisition: K.M. L.D.R.; Investigation: all authors; Methodology: K.M. J.D.W.; Project administration: K.M. P.H.T. P.T.S. S.N. F.R.U. G.E.G. M.F. D.D.I. M.M.K.S. K. H. S.Y. S.R.G. A.O. A.M. R.L.S. B.J.R. M.M. Y.U. S.S. J.Z.M. T.E. Y.Y.; Resources: K.M.; Software: K.M.; Supervision: P.H.T. P.T.S. S.N. F.R.U. B.S.G. M.F. D.D.I. M.M.K.S. K. H. S.Y. S.R.G. A.O. A.M. W.B.G. R.L.S. B.J.R. M.M. Y.U. S.S. J.Z.M. T.E. Y.Y. J.D.W. L.D.R.; Validation: K.M.; Visualization: K.M.; Writing - original draft: K.M.; Writing - review & editing: all authors. Ensign Endowment for Gynecologic Cancer Research (K.M.).
Funding Information:
Research grant, Pfizer, Yakult Honsha, OncoThreapy Science, honoraria, Chugai, Daiichi-Sankyo, Ono Pharmaceutical, Eisai, Kyowa Hakko Kirin, and Bayer Yakuhin, advisory board, Merck Sharp and Dohme (K.H.); honorariums, Chugai and Astra Zeneca (T.E.); consultant, Tesaro and Clovis Oncology, research funding, Merck (J.D.W.); honorarium, Chugai, textbook editorial, Springer, and investigator meeting attendance expense, VBL therapeutics (K.M.); consultant, Quantgene (L.D.R.); research grant, Merck and Tesaro, advisory board/consultant, Tesaro, Stryker, Astra Zeneca, Celsion, Abbvie, Iovance, Clovis, Genentech, and speaker bureau, Astra Zeneca, Tesaro, and Merck (P.H.T.).
Publisher Copyright:
© 2019
Keywords
- Endometrial cancer
- Ovarian conservation
- Recurrence
- Secondary primary cancer
- Survival
ASJC Scopus subject areas
- Oncology
- Obstetrics and Gynecology