Koji Matsuo1, James C Cripe2, Katherine C Kurnit3, Michiko Kaneda4, Audrey S Garneau5, Gretchen E Glaser6, Aaron Nizam7, Rachel M Schillinger8, Michelle L Kuznicki9, Akira Yabuno10, Shiori Yanai11, Denise M Garofalo12, Jiro Suzuki13, Jessica D St Laurent14, Ting-Tai Yen15, Annie Y Liu16, Masako Shida17, Mamoru Kakuda18, Tetsuro Oishi19, Shin Nishio20, Jenna Z Marcus21, Sosuke Adachi22, Tetsuji Kurokawa23, Malcolm S Ross24, Max P Horowitz25, Marian S Johnson5, Min K Kim8, Alexander Melamed14, Karime K Machado15, Kosuke Yoshihara22, Yoshio Yoshida23, Takayuki Enomoto22, Kimio Ushijima20, Shinya Satoh19, Yutaka Ueda18, Mikio Mikami17, Bobbie J Rimel16, Rebecca L Stone15, Whitfield B Growdon14, Aikou Okamoto13, Saketh R Guntupalli12, Kosei Hasegawa10, Mian M K Shahzad9, Dwight D Im8, Marina Frimer7, Bobbie S Gostout6, Frederick R Ueland5, Shoji Nagao4, Pamela T Soliman3, Premal H Thaker2, Jason D Wright26, Lynda D Roman27. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. Electronic address: koji.matsuo@med.usc.edu. 2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA. 3. Department of Gynecologic Oncology and Reproductive Medicine, MD-Anderson Cancer Center, University of Texas, Houston, TX, USA. 4. Department of Gynecology, Hyogo Cancer Center, Hyogo, Japan. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA. 6. Division of Gynecologic Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA. 7. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Long Island, NY, USA. 8. Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA. 9. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA. 10. Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan. 11. Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan. 12. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA. 13. Department of Obstetrics and Gynecology, Jikei University School of Medicine, Tokyo, Japan. 14. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 15. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Johns Hopkins Medicine, Baltimore, MD, USA. 16. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 17. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan. 18. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan. 19. Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan. 20. Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan. 21. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rutgers New Jersey Medical School, Newark, NJ, USA. 22. Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan. 23. Department of Obstetrics and Gynecology, University of Fukui School of Medicine, Fukui, Japan. 24. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA. 25. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA. 26. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA. 27. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
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.
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.
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