Fertility-sparing surgery of malignant transformation arising from mature cystic teratoma of the ovary
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Nobuhisa Yoshikawa1,*, Toshiya Teshigawara1,*, Yoshiki Ikeda1, Kimihiro Nishino1, Jun Sakata1, Fumi Utsumi1, Kaoru Niimi1, Ryuichiro Sekiya2, Shiro Suzuki1, Michiyasu Kawai3, Kiyosumi Shibata2, Fumitaka Kikkawa1 and Hiroaki Kajiyama1
1Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
2Department of Obstetrics and Gynecology, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan
3Department of Obstetrics and Gynecology, Toyohashi Municipal Hospital, Toyohashi, Japan
*These authors have contributed equally to this work
Nobuhisa Yoshikawa, email: [email protected]
Hiroaki Kajiyama, email: [email protected]
Keywords: malignant transformation; mature cystic teratoma; fertility-sparing surgery; oncological outcome; reproductive outcome
Abbreviations: MT-MCT (malignant transformation arising from mature cystic teratoma of the ovary), FSS (fertility-sparing surgery), OS (overall survival), DFS (disease-free survival), EOC (epithelial ovarian cancer)
Received: February 20, 2018 Accepted: May 19, 2018 Published: June 08, 2018
Background: The purpose of this study was to evaluate the long-term clinical outcome of young women with malignant transformation arising from mature cystic teratoma of the ovary (MT-MCT) by comparing radical surgery and fertility-sparing surgery (FSS).
Patients and methods: All patients treated with radical surgery or FSS for MT-MCT in multiple institutions were registered in this analysis. Univariate and multivariate analyses were performed to evaluate clinical outcome, including overall survival (OS) and disease-free survival (DFS).
Results: From 1986 to 2016, 62 patients with MT-MCT were treated in our group. The median follow-up period was 38.0 (2.0-227.9) months, and the median age was 54 (17-82) years old. Multivariate analysis revealed that only advanced stage was significantly correlated with poorer prognosis of patients [hazard ratio (HR) for death: 6.58, 95% confidence interval (CI): 1.82–24.78, P = 0.0048; HR for recurrence: 5.59, 95% CI: 1.52–21.83, P = 0.01]. Of a total of 13 women with stage I-II disease at less than 45 years old, 7 were treated with FSS, and there was no recurrence except for in one woman with stage II MT-MCT. There was no significant difference in long-term oncological outcome between radical surgery and FSS.
Conclusion: FSS may be indicated for patients with stage I MT-MCT, who hope to preserve fertility, as no relapse was found after FSS.
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