Should ovaries be removed or not in early-stage cervical adenocarcinoma: a multicenter retrospective study of 105 patients

Abstract

The study population consisted of 105 patients with stage IA to IIB cervical adenocarcinoma (AC) who underwent radical hysterectomy and pelvic lymphadenectomy from three institutions between 1994 and 2015, including 86 patients with bilateral salpingo-oophorectomy (BSO) and 19 patients with ovarian preservation operation. Ovarian metastasis were diagnosed in 3 of 86 patients in BSO group with an incidence rate of 3.5% (3/86). Among the 19 patients with ovarian preservation, none developed an ovarian recurrence in the follow-up (2–71 months). The 5-year overall survival rate of the BSO group and ovarian preservation group were 88.6% and 100%, respectively, with no significant difference (p = .266 > .05). FIGO stage was an independent risk factor of ovarian metastasis for cervical AC (p = .000 < .05). So we concluded that ovarian preservation in young women with early-stage cervical AC may be safe and not associated with an increased risk of overall mortality.

Impact statement

• There has been long-running considerable controversy regarding ovarian preservation in women with cervical AC. The incidence of ovarian metastasis in AC varies significantly from 0% to 12.9%. There were few studies regarding the prognosis and risk factors of cervical AC patients with ovarian preservation. No preoperative selection criteria of ovarian preservation in cervical AC have been officially recommended.

• In our study of 105 patients with stage IA to IIB cervical AC, the overall ovarian metastasis rate was 3.5% (3/86), and the incidence was 1.5% (1/66) with stage IA to IB. The 5-year overall survival rate of 19 cervical adenocarcinoma patients with ovarian preservation was 100%, and no ovarian recurrence was observed during the follow-up. Our univariate analysis with clinicopathologic variables revealed that only FIGO stage was the risk factor associated with ovarian metastasis of cervical AC.

• Our data implied that ovarian preservation in young women with early-stage cervical AC might be safe and not associated with an increased risk of overall mortality. Considering the deleterious effects of surgical castration on the long-term quality and quantity of life, we hold that ovarian preservation should be seriously considered in the surgical management of premenopausal women with early-stage cervical AC.

Keywords:

• Cervical cancer
• adenocarcinoma
• ovarian preservation
• ovarian metastasis
• overall survival

Acknowledgements

We would like to thank Qin Han (Department of Obstetrics and Gynecology, Peking University Third Hospital) and Yuan Yang (Department of Obstetrics and Gynecology, Peking University People’s Hospital) for the data collection, as well as Xueying Li (Department of Statistics, Peking University First Hospital) for the statistical analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.