Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Oct;155(1):39-50.
doi: 10.1016/j.ygyno.2019.08.007. Epub 2019 Aug 16.

Recurrence, death, and secondary malignancy after ovarian conservation for young women with early-stage low-grade endometrial cancer

Koji Matsuo  1 , James C Cripe  2 , Katherine C Kurnit  3 , Michiko Kaneda  4 , Audrey S Garneau  5 , Gretchen E Glaser  6 , Aaron Nizam  7 , Rachel M Schillinger  8 , Michelle L Kuznicki  9 , Akira Yabuno  10 , Shiori Yanai  11 , Denise M Garofalo  12 , Jiro Suzuki  13 , Jessica D St Laurent  14 , Ting-Tai Yen  15 , Annie Y Liu  16 , Masako Shida  17 , Mamoru Kakuda  18 , Tetsuro Oishi  19 , Shin Nishio  20 , Jenna Z Marcus  21 , Sosuke Adachi  22 , Tetsuji Kurokawa  23 , Malcolm S Ross  24 , Max P Horowitz  25 , Marian S Johnson  5 , Min K Kim  8 , Alexander Melamed  14 , Karime K Machado  15 , Kosuke Yoshihara  22 , Yoshio Yoshida  23 , Takayuki Enomoto  22 , Kimio Ushijima  20 , Shinya Satoh  19 , Yutaka Ueda  18 , Mikio Mikami  17 , Bobbie J Rimel  16 , Rebecca L Stone  15 , Whitfield B Growdon  14 , Aikou Okamoto  13 , Saketh R Guntupalli  12 , Kosei Hasegawa  10 , Mian M K Shahzad  9 , Dwight D Im  8 , Marina Frimer  7 , Bobbie S Gostout  6 , Frederick R Ueland  5 , Shoji Nagao  4 , Pamela T Soliman  3 , Premal H Thaker  2 , Jason D Wright  26 , Lynda D Roman  27
Affiliations
Multicenter Study

Recurrence, death, and secondary malignancy after ovarian conservation for young women with early-stage low-grade endometrial cancer

Koji Matsuo et al. Gynecol Oncol. 2019 Oct.

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.

Keywords: Endometrial cancer; Ovarian conservation; Recurrence; Secondary primary cancer; Survival.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest

Research grant, Pfizer, Yakult Honsha, OncoThreapy Science, honoraria, Chugai, Daiichi-Sankyo, Ono Pharmaceutical, Eisai, Kyowa Hakko Kirin, and Bayer Yakuhin, advisory board, Merck Sharp and Dohme (K.H.); honorariums, Chugai and Astra Zeneca (T.E.); consultant, Tesaro and Clovis Oncology, research funding, Merck (J.D.W.); honorarium, Chugai, textbook editorial, Springer, and investigator meeting attendance expense, VBL therapeutics (K.M.); consultant, Quantgene (L.D.R.); research grant, Merck and Tesaro, advisory board/consultant, Tesaro, Stryker, Astra Zeneca, Celsion, Abbvie, Iovance, Clovis, Genentech, and speaker bureau, Astra Zeneca, Tesaro, and Merck (P.H.T.).

Figures

Fig. 1.
Fig. 1.
Trends of ovarian conservation at hysterectomy. Proportion of women who had ovarian conservation at hysterectomy is shown over time for the US cohort (red color, P = 0.020) and the Japan cohort (blue color, P = 0.787). Solid lines represent the modeled value. Dots represent the observed values. Bars represent 95% confidence interval. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 2.
Fig. 2.
Survival outcome and metachronous secondary malignancy. Survival outcome is shown based on adnexal surgery status (ovarian conservation versus oophorectomy): (A) DFS and (B) OS in the US cohort, (C) DFS and (D) OS in the Japan cohort, and metachronous secondary malignancy in (E) the US cohort and (F) the Japan cohort. X-axis is truncated at 10 years, and Y-axis truncated to 60–100% or 0–40%. Abbreviations: DFS, disease-free survival; OS, overall survival; OC, ovarian conservation; and BSO, oophorectomy.
Fig. 3.
Fig. 3.
Composite endpoint, ovarian adverse event, and sensitivity analysis. Composite endpoint (recurrence, death, or metachronous secondary malignancy) for (A) the US cohort and (B) the Japan cohort is shown per adnexal surgery type (ovarian conservation versus oophorectomy). (C) Overall survival and (D) cumulative risk of ovarian adnexal event (ovarian recurrence or metachronous secondary ovarian cancer) are shown based on the study cohort. Disease-free survival is shown comparing ovarian conservation and ERT for (E) the US cohort and (F) the Japan cohort. Abbreviations: OC, ovarian conservation; and ERT, estrogen replacement therapy.
See this image and copyright information in PMC

Comment in

References

    1. Torre LA, Islami F, Siegel RL, Ward EM, Jemal A, Global cancer in women: burden and trends, Cancer Epidemiol. Biomark. Prev 26 (2017) 444–457.Torre LA, Islami F, Siegel RL, Ward EM, Jemal A. Global Cancer in Women: Burden and Trends. Cancer Epidemiol Biomarkers Prev 2017;26:444-457. - PubMed
    1. Cancer Stat Facts: Uterine Cancer. National Cancer Institute Surveillance, Epidemiology, and End Results Program. <https://seer.cancer.gov/statfacts/html/corp.html> (accessed 4/17/2019).
    1. Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E, Endometrial cancer, Lancet 387 (2015) 1094–1108.Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet 2015;387:1094-1108. - PubMed
    1. Uterine Neoplasms. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network. <https://www.nccn.org/professionals/physician_gls/> (accessed 4/17/2019).
    1. Wright JD, Take 'em or leave 'em: management of the ovaries in young women with endometrial cancer, Gynecol. Oncol 131 (2013) 287–288.Wright JD. Take 'em or leave 'em: management of the ovaries in young women with endometrial cancer. Gynecol Oncol 2013;131:287-8. - PubMed

Publication types

MeSH terms