The efficiency of fertility-sparing surgery in early stage epithelial ovarian cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Ya ¹ , QIN Tianqiang ² , CHEN Jing ³ ,  WANG Hongjing ¹

1. Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
3. West China Medical School, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

WANG Hongjing, Email: whjscdx@163.com

Keywords：

Epithelial ovarian cancer; Fertility sparing surgery; Radical comprehensive surgery; Meta-analysis

DOI：

10.7507/1672-2531.201609105

Video：

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Objective To systematically evaluate the efficiency of fertility-sparing surgery (FSS) compared with radical comprehensive surgery (RCS) in early stage epithelial ovarian cancer (eEOC). Methods We searched databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2016), Web of Knowledge, CBM, WanFang Data and CNKI to collect the studies about FSS compared with RCS for eEOC from ineaption to August 10^th, 2016. Two reviewers independently evaluated the eligibility of identified studies and extracted the data. Then, meta-analysis was performed using Stata 12.0 software. Results Eight studies involving 2 561 patients were included. The results of meta-analysis showed that: compared with RCS, the aggregated RR of overall survival (OS) of FSS (univariate analysis: RR=1.03, 95%CI 0.98 to 1.07,P=0.815; multivariate analysis: RR=0.81, 95%CI 0.52 to 1.28,P=0.255), the cumulative disease free survival (DFS) of FSS (univariate analysis: RR=1.02, 95%CI 0.96 to 1.09,P=0.968; multivariate analysis: RR=1.24, 95%CI 0.65 to 2.39,P=0.115) and the recurrence of FSS (RR=0.86, 95%CI 0.57 to 1.30,P=0.902), there was no significant difference. This pattern also emerged in the subgroup analysis for FIGO IA and IC patients, and the results showed that there was no significant difference between FSS and RCS in IA patients (OS: RR=0.99, 95%CI 0.98 to 1.02,P=0.186; DFS: RR=1.01, 95%CI 0.95 to 1.06,P=0.541); and IC patients (OS: RR=0.95, 95%CI 0.86 to 1.04,P=0.251; DFS: RR=0.94, 95%CI 0.80 to 1.11,P=0.664). Conclusion In eEOC, FSS does not have a negative effect on oncological outcomes compared with RCS. However, well-designed and large-scale trials are needed to verify this outcome in the future.

Citation： LIU Ya, QIN Tianqiang, CHEN Jing, WANG Hongjing. The efficiency of fertility-sparing surgery in early stage epithelial ovarian cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(4): 409-417. doi: 10.7507/1672-2531.201609105 Copy

1.	Ng JS, Low JJ, Ilancheran A. Epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol, 2012, 26(3): 337-345.
2.	Ledermann JA, Raja FA, Fotopoulou C,et al. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24(Suppl 6): vi24-32.
3.	du Bois A, Heitz F, Harter P. Fertility-sparing surgery in ovarian cancer: a systematic review. Onkologie, 2013, 36(7-8): 436-443.
4.	Zapardiel I, Diestro MD, Aletti G. Conservative treatment of early stage ovarian cancer: oncological and fertility outcomes. Eur J Surg Oncol, 2014, 40(4): 387-393.
5.	Fruscio R, Corso S, Ceppi L,et al. Conservative management of early-stage epithelial ovarian cancer: results of a large retrospective series. Ann Oncol, 2013, 24(1): 138-144.
6.	Plaxe SC, Braly PS, Freddo JL,et al. Profiles of women age 30-39 and age less than 30 with epithelial ovarian cancer. Obstet Gynecol, 1993, 81(5 (Pt 1)): 651-654.
7.	Rodriguez M, Nguyen HN, Averette HE,et al. National survey of ovarian carcinoma XII. Epithelial ovarian malignancies in women less than or equal to 25 years of age. Cancer, 1994, 73(4): 1245-1250.
8.	Bentivegna E, Gouy S, Maulard A,et al. Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues. Ann Oncol, 2016, 27(11): 1994-2004.
9.	Fotopoulou C, Braicu I, Sehouli J. Fertility-sparing surgery in early epithelial ovarian cancer: a viable option? Obstet Gynecol Int, 2012, 2012: 238061.
10.	Ofek SN, Rao S, Patole S. Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis, 2015, 34(5): 887-897.
11.	Liberati A, Altman DG, Tetzlaff J,et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol, 2009, 62(10): e1-34.
12.	Jadad AR, Moore RA, Carroll D,et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
13.	Lee JY, Jo YR, Kim TH,et al. Safety of fertility-sparing surgery in primary mucinous carcinoma of the ovary. Cancer Res Treat, 2015, 47(2): 290-297.
14.	Ditto A, Martinelli F, Lorusso D,et al. Fertility sparing surgery in early stage epithelial ovarian cancer. J Gynecol Oncol, 2014, 25(4): 320-327.
15.	Wright JD, Shah M, Mathew L,et al. Fertility preservation in young women with epithelial ovarian cancer. Cancer, 2009, 115(18): 4118-4126.
16.	Kajiyama H, Shibata K, Mizuno M,et al. Long-term survival of young women receiving fertility-sparing surgery for ovarian cancer in comparison with those undergoing radical surgery. Br J Cancer, 2011, 105(9): 1288-1294.
17.	Kajiyama H, Shibata K, Mizuno M,et al. Fertility-sparing surgery in young women with mucinous adenocarcinoma of the ovary. Gynecol Oncol, 2011, 122(2): 334-338.
18.	Schlaerth AC, Chi DS, Poynor EA,et al. Long-term survival after fertility-sparing surgery for epithelial ovarian cancer. Int J Gynecol Cancer, 2009, 19(7): 1199-1204.
19.	Ditto A, Martinelli F, Bogani G,et al. Long-term safety of fertility sparing surgery in early stage ovarian cancer: comparison to standard radical surgical procedures. Gynecol Oncol, 2015, 138(1): 78-82.
20.	Zanetta G, Chiari S, Rota S,et al. Conservative surgery for stage I ovarian carcinoma in women of childbearing age. Br J Obstet Gynaecol, 1997, 104(9): 1030-1035.
21.	Schilder JM, Thompson AM, DePriest PD,et al. Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol, 2002, 87(1): 1-7.
22.	Satoh T, Yoshikawa H. Fertility-sparing surgery for early stage epithelial ovarian cancer. Jpn J Clin Oncol, 2016, 46(8): 703-710.
23.	Satoh T, Hatae M, Watanabe Y,et al. Outcomes of fertility-sparing surgery for stage I epithelial ovarian cancer: a proposal for patient selection. J Clin Oncol, 2010, 28(10): 1727-1732.
24.	Thigpen T, Brady MF, Omura GA,et al. Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group experience. Cancer, 1993, 71(2 Suppl): 606-614.
25.	Duska LR, Chang YC, Flynn CE,et al. Epithelial ovarian carcinoma in the reproductive age group. Cancer, 1999, 85(12): 2623-2629.

1. Ng JS, Low JJ, Ilancheran A. Epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol, 2012, 26(3): 337-345.
2. Ledermann JA, Raja FA, Fotopoulou C,et al. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013, 24(Suppl 6): vi24-32.
3. du Bois A, Heitz F, Harter P. Fertility-sparing surgery in ovarian cancer: a systematic review. Onkologie, 2013, 36(7-8): 436-443.
4. Zapardiel I, Diestro MD, Aletti G. Conservative treatment of early stage ovarian cancer: oncological and fertility outcomes. Eur J Surg Oncol, 2014, 40(4): 387-393.
5. Fruscio R, Corso S, Ceppi L,et al. Conservative management of early-stage epithelial ovarian cancer: results of a large retrospective series. Ann Oncol, 2013, 24(1): 138-144.
6. Plaxe SC, Braly PS, Freddo JL,et al. Profiles of women age 30-39 and age less than 30 with epithelial ovarian cancer. Obstet Gynecol, 1993, 81(5 (Pt 1)): 651-654.
7. Rodriguez M, Nguyen HN, Averette HE,et al. National survey of ovarian carcinoma XII. Epithelial ovarian malignancies in women less than or equal to 25 years of age. Cancer, 1994, 73(4): 1245-1250.
8. Bentivegna E, Gouy S, Maulard A,et al. Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues. Ann Oncol, 2016, 27(11): 1994-2004.
9. Fotopoulou C, Braicu I, Sehouli J. Fertility-sparing surgery in early epithelial ovarian cancer: a viable option? Obstet Gynecol Int, 2012, 2012: 238061.
10. Ofek SN, Rao S, Patole S. Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis, 2015, 34(5): 887-897.
11. Liberati A, Altman DG, Tetzlaff J,et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol, 2009, 62(10): e1-34.
12. Jadad AR, Moore RA, Carroll D,et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
13. Lee JY, Jo YR, Kim TH,et al. Safety of fertility-sparing surgery in primary mucinous carcinoma of the ovary. Cancer Res Treat, 2015, 47(2): 290-297.
14. Ditto A, Martinelli F, Lorusso D,et al. Fertility sparing surgery in early stage epithelial ovarian cancer. J Gynecol Oncol, 2014, 25(4): 320-327.
15. Wright JD, Shah M, Mathew L,et al. Fertility preservation in young women with epithelial ovarian cancer. Cancer, 2009, 115(18): 4118-4126.
16. Kajiyama H, Shibata K, Mizuno M,et al. Long-term survival of young women receiving fertility-sparing surgery for ovarian cancer in comparison with those undergoing radical surgery. Br J Cancer, 2011, 105(9): 1288-1294.
17. Kajiyama H, Shibata K, Mizuno M,et al. Fertility-sparing surgery in young women with mucinous adenocarcinoma of the ovary. Gynecol Oncol, 2011, 122(2): 334-338.
18. Schlaerth AC, Chi DS, Poynor EA,et al. Long-term survival after fertility-sparing surgery for epithelial ovarian cancer. Int J Gynecol Cancer, 2009, 19(7): 1199-1204.
19. Ditto A, Martinelli F, Bogani G,et al. Long-term safety of fertility sparing surgery in early stage ovarian cancer: comparison to standard radical surgical procedures. Gynecol Oncol, 2015, 138(1): 78-82.
20. Zanetta G, Chiari S, Rota S,et al. Conservative surgery for stage I ovarian carcinoma in women of childbearing age. Br J Obstet Gynaecol, 1997, 104(9): 1030-1035.
21. Schilder JM, Thompson AM, DePriest PD,et al. Outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol, 2002, 87(1): 1-7.
22. Satoh T, Yoshikawa H. Fertility-sparing surgery for early stage epithelial ovarian cancer. Jpn J Clin Oncol, 2016, 46(8): 703-710.
23. Satoh T, Hatae M, Watanabe Y,et al. Outcomes of fertility-sparing surgery for stage I epithelial ovarian cancer: a proposal for patient selection. J Clin Oncol, 2010, 28(10): 1727-1732.
24. Thigpen T, Brady MF, Omura GA,et al. Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group experience. Cancer, 1993, 71(2 Suppl): 606-614.
25. Duska LR, Chang YC, Flynn CE,et al. Epithelial ovarian carcinoma in the reproductive age group. Cancer, 1999, 85(12): 2623-2629.

Chinese Journal of Evidence-Based Medicine

The efficiency of fertility-sparing surgery in early stage epithelial ovarian cancer: a meta-analysis

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