Conservative Surgery in High-Risk Ovarian Cancer: Long-term oncologic outcomes
Giorgio Bogani (IT), Antonino Ditto (IT), Fabio Martinelli (IT), Mauro Signorelli (IT), Valentina Chiappa (IT), Domenica Lorusso (IT), Francesco Raspagliesi (IT)
[Bogani] National Cancer Institute, [Ditto] , [Martinelli] , [Signorelli] , [Chiappa] , [Lorusso] , [Raspagliesi]
Context: Conservative surgery is a strategy often considered in young patients with low-grade early-stage ovarian cancer. However, this approach is still controversial in high-risk patients. Objective: To investigate the role of conservative surgery in high-risk (IAG3 and more advanced stages) ovarian cancer patients Methods: Data of consecutive patients undergoing surgery for apparent early stage ovarian cancer were analyzed. Patients undergoing conservative surgery were compared with patients who underwent radical procedures. Propensity-score was used to compare two homogenous groups of patients and avoid possible allocation bias. Survival outcomes were assessed using Kaplan-Meier and Cox models Patients: Data from 430 patients, affected by apparent early stage ovarian cancer. Interventions: Conservative (fertility-sparing) and radical (including hysterectomy and bilateral salpingo-oophorectomy) surgical staging. Main outcome measure: Disease-free (DFS) and overall (OS) survivals Results: Overall, 71 (17%) and 359 (83%) patients had conservative and radical staging, respectively. Mean (SD) follow-up was 141.7 (112.9) months. At univariate analysis, the execution of conservative approach did not influence the DFS (HR: 1.05 (95%CI: 0.55-2.02); p=0.80) and OS (HR: 1.94 (95%CI: 0.75-4.99); p=0.18). Similarly, focusing on high-risk patients, we observed that conservative surgery did not influence DFS and OS, even after balancing our population using a propensity-score matching (p>0.1). Conclusions. Conservative staging upholds oncologic effectiveness of radical surgery, preserving reproductive and hormonal functions. Although patients affected by high-risk ovarian cancer experience worse survival outcomes than low-risk ovarian cancer, conservative approach per se does not influence the risk of recurrence and should not be denied even in this group of patients.