| BackgroundAs a type of rare ovarian non-epithelial tumors,ovarian malignant sex cord-stromal tumors(MSCSTs)include granulosa cell tumors(OGCTs),poorly differentiated Sertoli-Leydig cell tumors(SLCTs)and ovarian fibrosarcoma.Sixty to ninety-five percent of MSCSTs are diagnosed at stage I,and mainly occur in reproductive-aged women,so more and more patients expect to preserve the ability of fertility.Based on the guidelines,for reproductive-aged patients with fertility needs,if the tumor is confined to one ovary,fertility-sparing surgery(FSS)with complete staging is available.The aim of the present study is to assess the difference in survival between FSS and radical surgery(RS),explore the pregnancy outcomes after FSS and find risk factors of disease-free survival(DFS)and pregnancy in stage I MSCSTs.MethodsWe retrospectively analyzed clinicopathological data of patients who were diagnosed with stage IA or IC MSCSTs,and they were divided into FSS and RS groups.Inverse Probability of Treatment Weighting(IPTW)was performed to balance variables between the two groups,and then we got a weighted cohort.Kaplan-Meier analysis was used to compare the difference of DFS between the two groups.Univariate and multivariate Cox regression analysis was used to find risk factors of DFS.Univariate Logistic regression analysis was used to assess risk factors of pregnancy.In addition,we searched literature on ovarian fibrosarcoma,collected clinical and prognostic information of the tumor,and compared survival difference of FSS and RS.ResultsA total of 95 OGCTs and 12 poorly differentiated SLCTs were included in this study.Fifty-four(50.5%)underwent FSS,and 53(49.5%)underwent RS.In the original cohort,more patients in the RS group received complete staging than FSS group(43%vs.32.7%,p=0.008).After IPTW,all of the covariates were well balanced,and there was no statistical difference in characteristics between the two groups(p>0.05).After a median follow-up time of 50 months(range 7-156 months),10 patients recurred(90%were at stage IC,20%received complete staging surgery,30%underwent adjuvant chemotherapy),2 patients died.There was no significant difference of DFS between the two groups both in original cohort(p=0.969)or weighted cohort(p=0.792).In the weighted cohort,stage IC[Hazard ratio(HR)=6.50,95%confidence interval(CI):1.45-29.10,p=0.014],tumor diameter>8cm(HR=16.80,95%CI:2.67-105.53,p=0.003),incomplete staging surgery(HR=4.67,95%CI:1.66-13.08,p=0.003)and no adjuvant chemotherapy(HR=12.98,95%CI:4.16-40.46,p<0.001)were 4 high-risk factors associated with a shorter DFS.Among 14 patients who had pregnancy desires,no one had recurrence.Finally,15 single pregnancies were successfully achieved in 11 patients,with a pregnancy rate of 78.6%and a live birth rate of 76.9%,including 10 term delivery,2 spontaneous abortions and 2 at pregnancy status.In univariate analysis,only adjuvant chemotherapy(p=0.009)was significantly associated with infertility[odds ratio(OR)=3.47,95%CI:1.37-8.79,p=0.009].Literature research of ovarian fibrosarcoma shows that the overall recurrence rate of 43 patients was 37.9%,and the 2-year DFS rate was 60.5%.The mortality rate was 37.2%and the 2-year overall survival rate was 58.3%.Among the 21 stage I patients,there was no significant difference in overall survival(p=0.801)and DFS(p=0.357)between the FSS and RS groups.ConclusionsIn premenopausal patients with tumors confined to ovary,no significant difference in DFS was noted between RS and FSS,stage IC,no complete staging surgery,without adjuvant chemotherapy and tumor size>8cm were four independent risk factors of DFS,adjuvant chemotherapy could prolong DFS in stage IC,but has no significant effect on stage IA.The pregnancy rate and live birth rate were 78.6%and 76.9%,respectively.Adjuvant chemotherapy was related to infertility after FSS.Due to the diversity of histological types and low incidence of ovarian sex cord stromal tumors,the essence of other pathological types and the safety of FSS still need to be supported by large sample research. |
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