Outcomes After Fertility-sparing Surgery of Early-stage Ovarian Cancer: a Nationwide Population-based Study

Abstract Here we investigated the outcomes of early-stage epithelial ovarian cancer (EOC) following fertility-sparing surgery (FSS)or radical comprehensive staging surgery (RCS), as well as the suitability of FSS.Our analysis included 1297 early-stage EOC cases in the Taiwan Cancer Registry (TCR) database, which were newly-diagnosed between 2009–2017. Based on site-specific surgery codes, patients were divided into two groups:FSS (401 patients) and RCS (896 patients). Cancer-specific survival (CSS) was evaluated using the Kaplan–Meier method with log-rank testing and Cox models. Compared to the FSS group, patients in the RCS group were older (p < 0.001) and more commonly received adjuvant chemotherapy (p<0.001). Independent poor prognostic factors for CSS includedstage (p<0.001)and histologic grade (p< 0.001), but not histologic type (p= 0.13).CSS was similar between women who underwent FSS and those who underwent RCS (p=0.75).FSS group did not show significantly poorer CSS compared with RCS group in serous, mucinous, or endometrioid histologic type. Whereas, among clear cell carcinoma, FSS group had better CSS (HR: 0.28, 95% CI: 0.06–0.82, p=0.040) than RCS group. Endometrioid ovarian cancer patients had the highest frequency of developing second malignancies.FSS canbe a safe alternative procedure in selected young women with early-stage EOC who wish to preserve fertility regardless histologic type. Patients who receive FSS must undergo regular surveillance to detect disease recurrence and second malignancies.