ABSTRACT: Most patients diagnosed with endometrial carcinoma are postmenopausal. About 20% of newly diagnosed cases occur in premenopausal women; 5% of cases are diagnosed before the age of 40 years. The prognosis for early-stage endometrial carcinoma is much better for women younger than 40 years compared with postmenopausal women. In a large population-based study, the 5-year disease-specific survival rate was 93% in women younger than 40 years. Increased survival for younger patients appears to be due to the high percentage of early-stage, low-grade tumors in this population.
The standard treatment for both localized and advanced disease in patients with early-stage, well-differentiated endometrial cancer is total hysterectomy and bilateral salpingo-oophorectomy, often accompanied by lymphadenectomy. This regimen is recommended routinely for patients with endometrial cancer irrespective of the patient’s age and the stage of the tumor. The use of bilateral salpingo-oophorectomy in patients of reproductive age is highly controversial because of the high survival rate in young patients with early-stage low-grade disease and the desire of these patients to avoid surgical menopause. Studies are needed to examine the safety of ovarian conservation for young women with early-stage endometrial cancer.
The aim of this retrospective study was to investigate the effect of ovarian preservation on overall survival among young women with early-stage endometrial cancer and to assess the feasibility of ovarian preservation in this population. Data were obtained by retrospective chart review of medical records from 203 women who were 45 years or younger at the time of diagnosis. All patients were treated at 2 medical centers. Most uterine tumors in these patients were early-stage (82.3%), low-grade (66.5%), and endometrioid carcinomas (97.5%). All patients with ovarian preservation had early-stage tumors. Comparison groups were patients who underwent oophorectomy and those whose ovaries were retained. Cox proportional hazards models were used to assess survival, and Kaplan-Meier curves were generated to examine overall survival based on whether oophorectomy was performed. Multivariate logistic regression was used to identify independent risk factors for a coexistent ovarian malignancy. A meta-analysis was performed to further investigate the effect of organ preservation on survival and possible independent risk factors that affect survival.
Of the 203 patients, 169 (83.3%) underwent bilateral salpingo-oophorectomy; among the 34 (16.3%) remaining patients, 20 had both ovaries preserved, and 14 had a single ovary preserved. Analysis of the Kaplan-Meier curve and the Cox proportional hazards models showed that ovarian preservation had no effect on overall patient survival. With multivariate analysis, the most significant risk factor for ovarian involvement was intraoperative extrauterine disease. Meta-analysis validated these findings.
These findings show that organ preservation in young patients who have early-stage endometrial cancer has no significant impact on their overall survival. The authors recommend that the ovaries of these young women should be preserved after an extensive preoperative evaluation and intraoperative exploration.