Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues

Annals of Oncology, Oct 2016

Since the last two decades, the feasibility of fertility-sparing surgery (FSS) in early-stage epithelial ovarian cancer (EOC) has been explored by several teams and is reconsidered in this systematic review undertaken using the PRISMA guidelines. Borderline ovarian tumours and non-EOCs were excluded. This review comprises 1150 patients and 139 relapsing patients reported by 21 teams. This conservative treatment can be safely carried out for stage IA and IC grade 1 and 2 disease and stage IC1 according to the new FIGO staging system. Nevertheless, the number of patients reported with grade 2 disease is too small to definitively confirm whether FSS is safe in this subgroup. For patients with ‘less favourable’ prognostic factors (grade 3 or stage IC3 disease), the safety of FSS could not be confirmed, but patients should be informed that radical treatment probably may not necessarily improve their oncological outcome, because the poorest survival observed could be related to the natural history of the disease itself and not specifically to the use of conservative therapy. FSS could probably be considered in stage I clear-cell tumours but should remain contraindicated for stage II/III disease (whatever the histologic subtype). As the disease stage and the histologic data (tumour type and grade) are crucial to patient selection for this treatment, this implies careful and mandatory complete surgical staging surgery in this context and a pathological analysis (or review) of the tumour by an expert pathologist.

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Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues

Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues E. Bentivegna 2 3 S. Gouy 2 3 A. Maulard 2 3 P. Pautier 1 2 A. Leary 0 1 2 N. Colombo 2 6 P. Morice 2 3 4 5 0 Unit INSERM U981 , Villejuif , France 1 Department of Medical Oncology , Gustave Roussy, Villejuif 2 The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology 3 Department of Gynecologic Surgery , Gustave Roussy, Villejuif 4 University Paris Sud , Le Kremlin Bicêtre , France 5 Unit INSERM U10-30 , Villejuif 6 Department of Surgery and Interdisciplinary Medicine, University Milano-Bicocca , Milano , Italy 42. Zhang Q, Shen Q, Celestino J et al. Enhanced estrogen-induced proliferation in obese rat endometrium. Am J Obstet Gynecol 2009; 200(186): e1-e8. 43. Campagnoli C, Abba C, Ambroggio S et al. Life-style and metformin for the prevention of endometrial pathology in postmenopausal women. Gynecol Endocrinol 2013; 29(2): 119-124. 44. Sivalingam VN, Myers J, Nicholas S et al. Metformin in reproductive health, pregnancy and gynaecological cancer: established and emerging indications. Hum Reprod Update 2014; 20(6): 853-868. 45. Session DR, Kalli KR, Tummon IS et al. Treatment of atypical endometrial hyperplasia with an insulin-sensitizing agent. Gynecol Endocrinol 2003; 17(5): 405-407. 46. Shen ZQ, Zhu HT, Lin JF. Reverse of progestin-resistant atypical endometrial hyperplasia by metformin and oral contraceptives. Obstet Gynecol 2008; 112(2.2): 465-467. 47. Sivalingam V, McVey R, Gilmour K et al. A presurgical window-of-opportunity study of metformin in obesity-driven endometrial cancer. Lancet 2015; 385(Suppl. 1): S90. 48. Argenta P, Svendsen C, Elishaev E et al. Hormone receptor expression patterns in the endometrium of asymptomatic morbidly obese women before and after bariatric surgery. Gynecol Oncol. 2014; 133(1): 78-82. 49. Upala S, Anawin S. Bariatric surgery and risk of postoperative endometrial cancer: a systematic review and meta-analysis. Surg Obes Relat Dis 2015; 11(4): 949-955. 50. Adams TD, Stroup AM, Gress RE et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring) 2009; 17: 796-802. - introduction data collection data extraction and analysis findings D S I S G n N , , y S g ) g 1 n (n lo )s , liit-srayp rreceecun ,ittseagoh litsagppn ,II(11BC )M i s e t R ( r 2 1 r e f 1 W ,1 ,1 8 sh 1 6 th A s 0 t D D D 1 n , 7 n E W O U o D U o E N A D F m F m I C 1 M W 1 n s A , w s D s 1 th 2 D o h 2 8 th 5 n , O kn 47 tn , 6 n D D D n U o D U o O FU om E E 3 U F m F m D N N 4 3 D U o I M 1 G G I I 1 1 3 5 5 1 ] 0 8 0 3 0 0 2 2 ] 2 0 [ 8 , 2 a 2 [1 01 au egn ] 00 0 0 e v 2 2 00 e2 rp it –2 re 2o irc aM enB [91 lid b o h o c J M S 4 C I A s e Y I I 1 1 9 1 Cc 6 C n c 8 C a t 1 C t 8 C t 1 G G c 0 9 4 1 1 7 2 c 2 9 k 6 2 3 n 3 G G U 3 G G 1 1 1 1 c 5 9 4 2 3 2 3 8 2 3 1 G G 9 G G 4 G G 1 G  | Bentivegnaetal.  | Bentivegna et al. Authors, years Jobo 2000 [18] Schilder 2002 [23] Borgfeld 2007 [26] Kwon 2009 [28] Kajiyama 2010, 2014 [31, 34] Satoh 2010 [35] Hu 2011 [36] Kashima 2013 [38] n pts Recurrence (n) Stage IC1 (n rec, n tot) Stage IC2 (n rec, n tot) Stage IC3 (n rec, n tot) Location recurrence Peritoneum Three ovary, 8 peritoneum and/or nodes and/or liver NS One ovary, 2 nodes, 1 peritoneum, 1 brain NA discussion 1 D u E A O D O N N D 2 e n 0 m o 1 A 1 i m 5 , T ( 1 N 5 8 G G G G  | Bentivegnaetal. D O I I I B , I I I I I I 2 1 1 4 A ,2 U A A S A A in in id m c c io 1 u u tr ,l d l i m m e e o i 1 2 m -c r , , o r t s s d a e s u u n le m u ro ro e c o ro e d e s S se 4 1 S n S A s 1 N 3 N E N N 2 ? 5 0 0 1 0 1 1 I C I I I I I I I 1 1 2 1 1 1 4 2 0 D 4 E 2 o 5 2 10 g lli 01 i 2 l C on n i 2 I r om rk ta II ,S eh te ee r a o C P L C P T A N 1 3 1 1 G G kn su ts ts 2 ts ts 3 1 3 n irgn read ltea ltea 2G ltea ltea 1G ,1 ,1 u a G A A A A 1 N 7 p s y t i l itr su ou e o f s s r u ou s ed icn fte ro r u ix u sea yg se1 se4 icon 1m 2m m lo ts ts u ts ts tco tso lea lea 2m lea lea u i t t t t w ie ] v 3 e 1 r , o e 2 tt r 5 1 i u 0 , trea ,20 [10 ,7D ] ]9 itLl.3e ,rsrseay 1994bo ic2010o liiseg199 –[51416 [e20011 []00827 b o m s a c 2 aT tuh loo Fu sap 201 iro rak A C R M P Miyazaki 1988 [9] Colombo 1994 Zanetta 1997, Fuscio 2010 [10, 11, 13] Raspagliesi 1997, Ditto 2014 [14, 15] Morice 2001, 2005 [19, 20] Schilder 2002 [23] Sardi 2005 Anchezar 2009 [24, 25] Park 2008, Park 2016 [27, 44] Kwon 2009 [28] Muzii 2009 [29] Schlaerth 2009 [30] Kajiyama 2010, 2011a, 2011b, 2011c, 2014a, 2014b [31, 32, 34, 45–47] Satoh 2010 [35] Hu 2011 [36] Kashima 2013 [38] Ghezzi 2015 [41] Park 2016 [42] Total 3 I, 1 IIIA All IC NS Pathology review No Yes 5 (all stage IC) At least 1 Metastatic NA NA 1 ovary, 4 peritoneum, nodes or liver 1 NED, 1 DOD NED AWD NA 2 NED, 1 AWD, 2 DOD 1 NED, 3 AWD, 1 DOD At least 1 DOD DOD Authors, years n pts Stage (n) Recurrence (n) Location rec (...truncated)


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E. Bentivegna, S. Gouy, A. Maulard, P. Pautier, A. Leary, N. Colombo, P. Morice. Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues, Annals of Oncology, 2016, pp. 1994-2004, 27/11, DOI: 10.1093/annonc/mdw311