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Frontiers of Medicine

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ISSN 2095-0225(Online)

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Front. Med.    2018, Vol. 12 Issue (5) : 509-517    https://doi.org/10.1007/s11684-017-0554-3
RESEARCH ARTICLE
Possibility of women treated with fertility-sparing surgery for non-epithelial ovarian tumors to safely and successfully become pregnant---a Chinese retrospective cohort study among 148 cases
Bin Yang1, Yan Yu2, Jing Chen1, Yan Zhang1, Ye Yin1, Nan Yu1, Ge Chen1, Shifei Zhu1, Haiyan Huang3, Yongqun Yuan1, Jihui Ai1, Xinyu Wang2(), Kezhen Li1()
1. Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
2. Department of Gynecologic Oncology, Women’s Hospital, Zhejiang University, Hangzhou 310006, China
3. Department of Gynecologic Oncology, Women’s Hospital, Zhongxiang 431900, China
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Abstract

This study was performed to evaluate the oncological and reproductive outcomes of childbearing-age women treated with fertility-sparing surgery (FSS) for non-epithelial ovarian tumors in China. One hundred and forty eight non-epithelial ovarian tumor women treated with FSS between January 1, 2000 and August 31, 2015 from two medical centers in China were identified. Progression-free survival (PFS) was 88.5%, whereas overall survival (OS) was 93.9%. Univariate analysis suggested that delivery after treatment is related to PFS (P=0.023), whereas histology significantly influenced OS. Cox regression analysis suggested that only histology was associated with PFS and OS (P<0.05). Among the 129 women who completed adjuvant chemotherapy (ACT), none developed amenorrhea. Among the 44 women who desired pregnancy, 35 (79.5%) successfully had 51 gestations including 35 live births without birth defects. Non-epithelial ovarian tumors can achieve fulfilling prognosis after FSS and chemotherapy. Histology might be the only independent prognostic factor for PFS and OS. FSS followed by ACT appeared to have little or no effect on fertility. Meanwhile, postoperative pregnancy did not increase the PFS or OS. Use of gonadotropin-releasing hormone agonist was not beneficial for fertility.
Keywords malignant germ cell tumors      ovarian sex cord-stromal tumors      fertility-sparing surgery      prognosis      fertility     
Corresponding Author(s): Xinyu Wang,Kezhen Li   
Just Accepted Date: 29 August 2017   Online First Date: 07 December 2017    Issue Date: 29 September 2018
 Cite this article:   
Bin Yang,Yan Yu,Jing Chen, et al. Possibility of women treated with fertility-sparing surgery for non-epithelial ovarian tumors to safely and successfully become pregnant---a Chinese retrospective cohort study among 148 cases[J]. Front. Med., 2018, 12(5): 509-517.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0554-3
https://academic.hep.com.cn/fmd/EN/Y2018/V12/I5/509
CharacteristicsNo. of patients% of patients
Age at diagnosis
Median (range), year 22 (8?37)
Follow-up time
Median (range), month 72 (7?179)
Histology
Dysgerminoma2315.5
Immature teratoma5436.5
Yolk sac tumor3725
Mixed85.4
OSCST2617.6
FIGO stage
I12584.5
II64.1
III149.5
IV32
Staging surgery
Yes9765.5
No5134.5
Operation method
Laparotomy12081.1
Laparoscopy2818.9
Lymphadenectomy
Pelvic lymphadenectomy8154.7
PPL2315.5
No treatment4429.7
TCO
Biopsy2919.6
Wedge resection53.4
Cyst removal3019.6
No treatment8452
ACT cycle numbers
01912.8
≤47651.4
>45335.8
Menstrual status before treatment
Premenarchal21.4
Menses14698.6
Amenorrheic00
The experience of delivery
Parous4027.0
Non-parous10873.0
Tab.1  Characteristics of women treated with FSS for non-epithelial ovarian tumors
Fig.1  Kaplan–Meier curves for PFS and OS. (A) Progression-free survival of women with and without posterior delivery. (B) Overall survival of women with different histological types.
TotalRecurrenceDeath
n = 148n = 17Pn = 9P
Age (year)0.2840.479
≤227810 (12.82%)6 (7.69%)
>22707 (10.00%)3 (4.29%)
Histology
Immature teratoma547 (12.96%)0.0391 (1.85%)0.006
Non-teratoma685 (7.35%)0.1283 (4.41%)0.007
Sex cord-stromal tumor265 (19.23%)0.0115 (19.23%)0.009
FIGO stage0.2930.099
Early stage12514 (11.20%)6 (4.80%)
Advanced stage233 (13.04%)3 (13.04%)
ACT cycle number0.1630.564
0192 (10.53%)0
≤4767 (9.21%)4 (5.26%)
>4538 (15.09%)5 (9.43%)
GnRH-a using0.5740.969
Yes395 (12.82%)0
No10912 (11.01%)9 (8.27%)
Tab.2  Cox regression analysis of risk factors associated with prognosis of MOGCT or OSCST
Fig.2  Menstrual function of women who received chemotherapy after FSS.
Fig.3  Fertility outcomes of fertility-sparing surgery among 148 women.
Number (%)P
Age (year)0.321
≤2222 (44.9)
>2227 (55.1)
Histology
Immature teratoma20 (40.8)0.690
Non-teratoma20 (40.8)0.557
Sex cord-stromal tumor9 (18.4)0.941
FIGO stage0.923
Early stage43 (87.8)
Advanced stage6 (12.2)
ACT0.999
Yes44 (89.8)
No5 (10.2)
GnRH-a using0.209
Yes9 (18.4)
No40 (81.6)
Contralateral ovary0.383
Yes16 (32.7)
No treatment33 (67.3)
Tab.3  Binomial logistic regression analysis of the factors affecting post-operation conception
Prognostic factorsNumber (%)RR for PFS (95%)PaRR for OS (95%)Pa
Age (year)
≤22
>22		78 (52.7)
70 (47.3)		0.63 (0.25?1.59)0.3280.62 (0.15?2.50)0.620
Histology
Immature teratoma
Non-teratoma
OSCST		54 (36.5)
68 (45.9)
26 (17.6)		0.59 (0.20?1.70)
0.38 (0.12?1.17)		0.241
0.326
0.092		0.09 (0.01?0.77)
0.23 (0.06?0.98)		0.029
0.028
0.047
FIGO stage
Early stage, I
Advanced stage, II?IV		125 (84.5)
23 (15.5)		1.67 (0.60?4.60)0.3232.51 (0.63?10.07)0.193
Staging surgery
Yes
No		97 (65.5)
51 (34.5)		1.02 (0.41?2.57)0.9600.47 (0.12?1.76)0.260
Operation method
Laparotomy
Laparoscopy		120 (81.1)
28 (18.9)		0.63 (1.14?2.76)0.5390.69 (0.08?5.66)0.730
Lymphadenectomy
Pelvic
Pelvic and paraortic
No treatment		81 (54.7)
23 (15.5)
44 (29.7)		1.04 (0.39?2.83)
1.21 (0.30?4.85)		0.965
0.935
0.792		0.61 (0.15?2.5)
0.66 (0.07?6.05)		0.772
0.482
0.710
TCO
Wedge resection
Biopsy
Cyst removal
No treatment		5 (3.4)
29 (19.6)
30 (20.3)
84 (56.8)		1.00 (0.13?7.93)
1.33 (0.46?3.82)
0.83 (0.23?3.03)		0.928
0.998
0.601
0.782		1.75 (0.21?14.41)
0.44 (0.05?3.61)
0		0.811
0.602
0.446
0.970
ACT cycle numbers
0
≤4
>4		19 (12.8)
76 (51.4)
53 (35.8)		0.59 (0.13?2.69)
0.54 (0.21?1.38)		0.412
0.495
0.198		0
0.56 (0.15?2.09)		0.690
0.985
0.389
GnRH-a using
Yes
No		39 (26.4)
109 (73.6)		1.22 (0.44?3.43)0.7020.03 (0?28.91)0.320
Delivered posterior
Yes
No		46 (31.1)
102 (68.9)		10.39(1.4?77.9)0.02339.43 (0.12?13440)0.217
Tab.4  Univariate analysis of prognostic factors for PFS and OS
1 Ertas IE, Taskin S, Goklu R, Bilgin M, Goc G, Yildirim Y, Ortac F. Long-term oncological and reproductive outcomes of fertility-sparing cytoreductive surgery in females aged 25 years and younger with malignant ovarian germ cell tumors. J Obstet Gynaecol Res 2014; 40(3): 797–805
https://doi.org/10.1111/jog.12253 pmid: 24320102
2 Sieh W, Sundquist K, Sundquist J, Winkleby MA, Crump C. Intrauterine factors and risk of nonepithelial ovarian cancers. Gynecol Oncol 2014; 133(2): 293–297
https://doi.org/10.1016/j.ygyno.2014.02.007 pmid: 24530563
3 Nishio S, Ushijima K, Fukui A, Fujiyoshi N, Kawano K, Komai K, Ota S, Fujiyoshi K, Kamura T. Fertility-preserving treatment for patients with malignant germ cell tumors of the ovary. J Obstet Gynaecol Res 2006; 32(4): 416–421
https://doi.org/10.1111/j.1447-0756.2006.00417.x pmid: 16882268
4 Weinberg LE, Lurain JR, Singh DK, Schink JC. Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors. Gynecol Oncol 2011; 121(2): 285–289
https://doi.org/10.1016/j.ygyno.2011.01.003 pmid: 21256579
5 Bryk S, Farkkila A, Butzow R, Leminen A, Heikinheimo M, Anttonen M, Riska A, Unkila-Kallio L. Clinical characteristics and survival of patients with an adult-type ovarian granulosa cell tumor: a 56-year single-center experience. Int J Gynecol Cancer 2015; 25(1): 33–41
https://doi.org/10.1097/IGC.0000000000000304 pmid: 25347095
6 Yesilyurt H, Tokmak A, Guzel AI, Simsek HS, Terzioglu SG, Erkaya S, Gungor T. Parameters for predicting granulosa cell tumor of the ovary: a single center retrospective comparative study. Asian Pac J Cancer Prev 2014; 15(19): 8447–8450
https://doi.org/10.7314/APJCP.2014.15.19.8447 pmid: 25339044
7 Pectasides D, Pectasides E, Kassanos D. Germ cell tumors of the ovary. Cancer Treat Rev 2008; 34(5): 427–441
https://doi.org/10.1016/j.ctrv.2008.02.002 pmid: 18378402
8 Tomao F, Peccatori F, Del Pup L, Franchi D, Zanagnolo V, Panici PB, Colombo N. Special issues in fertility preservation for gynecologic malignancies. Crit Rev Oncol Hematol 2016; 97: 206–219
https://doi.org/10.1016/j.critrevonc.2015.08.024 pmid: 26358422
9 Yang ZJ, Liu ZC, Wei RJ, Li L. An analysis of prognostic factors in patients with ovarian malignant germ cell tumors who are treated with fertility-preserving surgery. Gynecol Obstet Invest 2016; 81(1): 1–9
https://doi.org/10.1159/000381771 pmid: 25967958
10 .Slayton RE, Park RC, Silverberg SG, Shingleton H, Creasman WT, Blessing JA. Vincristine, dactinomycin, and cyclophosphamide in the treatment ofmalignant germ cell tumors of the ovary. A Gynecologic Oncology Group Study (a final report). Cancer 1985; 56(2):243–248
pmid: 2988740
11 Williams SD, Birch R, Einhorn LH, Irwin L, Greco FA, Loehrer PJ. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med 1987; 316(23):1435–1440
https://doi.org/DOI: 10.1056/NEJM198706043162302 pmid: 2437455
12 Low JJ, Ilancheran A, Ng JS. Malignant ovarian germ-cell tumours. Best Pract Res Clin Obstet Gynaecol 2012; 26(3): 347–355
https://doi.org/10.1016/j.bpobgyn.2012.01.002 pmid: 22301054
13 Mangili G, Sigismondi C, Lorusso D, Cormio G, Candiani M, Scarfone G, Mascilini F, Gadducci A, Mosconi AM, Scollo P, Cassani C, Pignata S, Ferrandina G. The role of staging and adjuvant chemotherapy in stage I Malignant ovarian germ cell tumors (MOGTs): the MITO-9 study. Ann Oncol 2017; 28(2):333–338
https://doi.org/10.1093/annonc/mdw563
14 Pedersen-Bjergaard J, Daugaard G, Hansen SW, Philip P, Larsen SO, Rørth M. Increased risk of myelodysplasia and leukaemia after etoposide, cisplatin, and bleomycin for germ-cell tumours. Lancet 1991; 338(8763):359–363
pmid: 1713639
15 Borovskaya TG, Timina EA, Perova AV, Pakhomova AV, Shchemerova YA, Gol'dberg VE. Pharmacological correction of etoposide ovariotoxicity. Bull Exp Biol Med 2007; 143(5):614–616
pmid: 18239783
16 Fabbri R, Macciocca M, Vicenti R, Paradisi R, Klinger FG, Pasquinelli G, Spisni E, Seracchioli R, Papi A. Doxorubicin and cisplatin induce apoptosis in ovarian stromal cells obtained from cryopreserved human ovarian tissue. Future Oncol 2016; 12(14):1699–1711
https://doi.org/DOI:10.2217/fon-2016-0032 pmid: 27173589
17 Swerdlow AJ, Cooke R, Bates A, Cunningham D, Falk SJ, Gilson D, Hancock BW, Harris SJ, Horwich A, Hoskin PJ, Linch DC, Lister A, Lucraft HH, Radford J, Stevens AM, Syndikus I, Williams MV; England and Wales Hodgkin Lymphoma Follow-up Group. Risk of premature menopause after treatment for Hodgkin’s lymphoma. J Natl Cancer Inst 2014; 106(9): dju207
https://doi.org/DOI:10.1093/jnci/dju207 pmid: 25139687
18 Yoo SC, Kim WY, Yoon JH, Chang SJ, Chang KH, Ryu HS. Young girls with malignant ovarian germ cell tumors can undergo normal menarche and menstruation after fertility-preserving surgery and adjuvant chemotherapy. Acta Obstet Gynecol Scand 2010; 89(1): 126–130
https://doi.org/10.3109/00016340903348383 pmid: 19878051
19 Gadducci A, Lanfredini N, Tana R. Menstrual function and childbearing potential after fertility-sparing surgery and platinum-based chemotherapy for malignant ovarian germ cell tumours. Gynecol Endocrinol 2014; 30(7): 467–471
https://doi.org/10.3109/09513590.2014.907262 pmid: 24702194
20 Cong J, Li P, Zheng L, Tan J. Prevalence and Risk Factors of Infertility at a Rural Site of Northern China. PLoS One 2016; 11(5): e0155563
https://doi.org/10.1371/journal.pone.0155563 pmid: 27177147
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