Dimitrios Nasioudis1, Melissa K Frey2, Eloise Chapman-Davis2, Thomas A Caputo2, Kevin Holcomb2. 1. Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA. Electronic address: dimitrios.nasioudis@uphs.upenn.edu. 2. Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
Abstract
OBJECTIVE: To evaluate the prevalence and safety of uterine preservation among premenopausal women diagnosed with a malignant ovarian germ-cell tumor (MOGCT) of advanced stage (stage II-IV). MATERIALS AND METHODS: The National Cancer Database was accessed and a cohort of women aged <40years, diagnosed with a MOGCT were identified. Those with stage II-IV disease who underwent cancer-directed surgery and received chemotherapy were selected for further analysis. Performance of hysterectomy was assessed from site-specific surgery codes. Overall survival (OS) was determined following generation of Kaplan-Meier curves and compared with the log-rank test. A Cox multivariate model was constructed to control for possible confounders. RESULTS: A total of 526 eligible patients were identified; rate of hysterectomy was 20.2%. Women who had a hysterectomy were older (median age 30.5 vs 20years, p<0.001) and more likely to present with bilateral tumors (12.6% vs 3.8%, p<0.001). No differences were noted based on tumor histology (p=0.67). Rate of uterine preservation was 82.8%, 79.5% and 75% for those with stage II, III and IV disease respectively (p=0.46). There was no difference in OS between women who had hysterectomy and those who did not (p=0.051); five-year OS rates were 87.1% and 94.4% respectively. After controlling for disease stage, tumor histology and patient race, uterine preservation was not associated with a decreased survival (HR: 0.59, 95% CI: 0.28, 1.24, p=0.19). CONCLUSIONS: Uterine preservation was not associated with decreased survival and should be considered in women with advanced stage GCTs interested in future fertility.
OBJECTIVE: To evaluate the prevalence and safety of uterine preservation among premenopausal women diagnosed with a malignant ovarian germ-cell tumor (MOGCT) of advanced stage (stage II-IV). MATERIALS AND METHODS: The National Cancer Database was accessed and a cohort of women aged <40years, diagnosed with a MOGCT were identified. Those with stage II-IV disease who underwent cancer-directed surgery and received chemotherapy were selected for further analysis. Performance of hysterectomy was assessed from site-specific surgery codes. Overall survival (OS) was determined following generation of Kaplan-Meier curves and compared with the log-rank test. A Cox multivariate model was constructed to control for possible confounders. RESULTS: A total of 526 eligible patients were identified; rate of hysterectomy was 20.2%. Women who had a hysterectomy were older (median age 30.5 vs 20years, p<0.001) and more likely to present with bilateral tumors (12.6% vs 3.8%, p<0.001). No differences were noted based on tumor histology (p=0.67). Rate of uterine preservation was 82.8%, 79.5% and 75% for those with stage II, III and IV disease respectively (p=0.46). There was no difference in OS between women who had hysterectomy and those who did not (p=0.051); five-year OS rates were 87.1% and 94.4% respectively. After controlling for disease stage, tumor histology and patient race, uterine preservation was not associated with a decreased survival (HR: 0.59, 95% CI: 0.28, 1.24, p=0.19). CONCLUSIONS: Uterine preservation was not associated with decreased survival and should be considered in women with advanced stage GCTs interested in future fertility.
Authors: M Bossart; H Plett; B Krämer; E Braicu; B Czogalla; M Klar; S Singer; D Mayr; A Staebler; A du Bois; S Kommoss; T Link; A Burges; F Heitz; M Grube; F Trillsch; P Harter; P Wimberger; P Buderath; A Hasenburg Journal: Arch Gynecol Obstet Date: 2022-09-21 Impact factor: 2.493