| Objective(s):In the face of these special young ovarian malignancy patients with fertility,we should pay attention to their fertility needs,explore high-risk factors that can optimize the diagnosis and treatment system,truly achieve eugenics,and reduce disease pain,psychological and economic burdens for patients.This project will analyze the clinical characteristics of young patients with ovarian malignancies undergoing fertility preserving surgery,and analyze and discuss the factors related to pregnancy outcome,prognosis and quality of life of young patients undergoing fertility preserving surgery,in order to provide a theoretical basis for clinical decision making and standardized management of these patients.Methods:A total of 240 study subjects were included in the study,all patients who visited the Third Affiliated Hospital of Kunming Medical University between January 2013 and December 2020.The patients’(1)general data and(2)clinical data were obtained by searching and reviewing the medical record system.General information included preoperative age,marital status and pregnancy.The clinical data included clinical manifestations,tumor markers,tumor location,tumor size,surgical method,postoperative pathology,FIGO stage,chemotherapy,etc.The patients were followed up by telephone follow-up surveys,questionnaires and information tools to obtain general postoperative conditions,survival and recurrence,postoperative quality of life,quality of sexual life,pregnancy and fertility-related information,fetal development,and to consult the patients’ acceptance of postoperative multidisciplinary cooperative treatment and the application of assisted reproductive technology,The analysis and discussion of factors related to prognosis and quality of life were also conducted.The follow-up period ends in January 2023.Results:1 Analysis of factors associated with patients with tumor location in bilateral ovaries.There were 70 cases with ovarian location located bilaterally,and a comparative analysis of the differences in each index between the bilateral tumor debulking surgery group and the unilateral resection contralateral debulking surgery group showed that there were no statistical differences between the two groups in recurrence(P=0.269),death(P=1.000),pregnancy(P=0.190),preoperative and postoperative hormone FSH difference(P=1.000),preoperative and postoperative hormone E2difference(P=1.000)and preoperative and postoperative hormonal LH difference(P=1.000)were not statistically different(all with P>0.05).The median PFS of patients with tumor location in bilateral ovaries was calculated as 35.19,and according to the median PFS,the study subjects were divided into two groups with poor prognosis and good prognosis(poor prognosis: PFS ≤ 35.19,good prognosis:PFS > 35.19).Comparative analysis of the difference between poor and good prognosis for each index showed that there was a statistical difference in the prognosis of the different stages(P<0.001),and there was no statistical difference in the prognosis between all other variables(all P>0.05).2 Analysis of factors influencing PFS in patients with ovarian malignancy undergoing surgery to preserve fertility.In the univariate Cox proportional risk regression analysis,three risk factors associated with PFS were identified(p<0.05).These included: FIGO staging(p<0.001),preoperative unmarriedness(p=0.035)and no preoperative children(p=0.031).In the multifactorial Cox regression analysis,three indicators,FIGO staging,minimally invasive,and preoperative childbearing status,were independent predictors associated with PFS.These included: FIGO staging(HR=1.585,95% CI:1.238 to 2.028);minimally invasive(HR=0.26,95% CI: 0.063 to 1.076);and preoperative childbearing(HR=0.407,95% CI: 0.234 to 0.709).3 Analysis of factors influencing OS in patients with ovarian malignancy undergoing surgery to preserve fertility.Univariate Cox regression analysis revealed three risk factors associated with OS(p<0.05),including: FIGO stage(p<0.001),clinical presentation with abdominal pain and distention(p=0.046)and pathological subtype of other(ovarian clear cell carcinoma,ovarian endometrioid adenocarcinoma and SLCTs)(p=0.048).Multifactorial Cox regression analysis was performed,and the results showed that FIGO stage(HR=2.7,95% CI: 1.992 to 3.658,p<0.001)was an independent factor affecting OS.4 Ovarian function in patients with ovarian malignancy undergoing fertility preservation surgery.(1)Comparative analysis of sex hormones before and after surgery: Among 240 patients with ovarian malignancy,44 cases of sex hormones were collected before and after surgery,and the results of statistical analysis by paired sample t-test showed that FSH increased significantly after surgery compared with that before surgery,and there was a statistical difference between the two groups(p<0.05).Postoperative E2 decreased compared to preoperative,and there was no significant difference between the two groups(p=1.135).Postoperatively,LH increased mildly compared to preoperatively,with no statistically significant difference between the two groups(p=1.135).ANOVA was used to compare and analyze the difference in sex hormone FSH before and after surgery,the difference in sex hormone E2 before and after surgery and the difference in sex hormone LH before and after surgery,and the difference in these three indexes between the five surgical modalities,including: unilateral tumor debridement group,single adnexal resection group,bilateral tumor debridement group,unilateral resection contralateral to debridement group and unilateral resection contralateral to biopsy group,respectively,and the results showed that the three preand post-surgical The sex hormone changes were not statistically different(p>0.05)among the five surgical procedures: unilateral tumor debulking group,single adnexal resection group,bilateral tumor debulking group,unilateral resection contralateral debulking group and unilateral resection contralateral biopsy group.(2)A total of 101 cases of sex hormones were collected before and after chemotherapy,and the results of statistical analysis showed that FSH was significantly higher after chemotherapy than before surgery,and there was a statistically significant difference between the two groups(p<0.05).E2 decreased significantly after chemotherapy compared with that before surgery,and there was a statistical difference between the two groups(p<0.05).E2 increased after chemotherapy compared to pre-chemotherapy,and there was a statistically significant difference between the two groups(p<0.05).(3)Kupperman score(ovarian function score): A total of 194 patients completed the follow-up,with 64.95%(126/194)of patients with Kupperman score <= 6(no perimenopausal symptoms);30.93%(60/194)of patients with 6 <= 15(mild perimenopausal symptoms);and 15 <= 30(moderate perimenopausal symptoms).30points(moderate perimenopausal symptoms)in 3.09%(6/194)of patients;and a cumulative score of >= 30 points(severe perimenopausal symptoms)in 1.03%(2/194)of patients.5 Pregnancy outcomes in patients with ovarian malignancies undergoing fertility preservation surgery.A total of 194 patients were followed up.Among the 78 patients with fertility plans,the total pregnancy rate was 40.2%,including 33.5% of spontaneous pregnancies,and the total number of pregnancies was 88,with 72 full-term births and5 non-full-term births,among which 13 patients were successfully conceived by postoperative assisted reproduction.No abnormalities were found in any of the fetuses after birth.Among the patients who underwent fertility conservation surgery,pregnancy was the outcome of the study,and the results of the analysis by one-way logistic regression analysis showed that the effect of FIGO stage I(p<0.001z),no lymph node dissection after FSS(p=0.011a),and unilateral location of the tumor(p<0.019a)on pregnancy outcome was statistically significant.Multifactorial logistic regression analysis was performed,and the results showed that a total of 2 independent predictors associated with pregnancy outcome were derived.These included: FIGO stage I(OR=0.511,95% CI: 0.265-0.984,p=0.045),and no lymph node dissection after FSS(OR=0.078,95% CI: 0.008-0.743,p=0.027).6 Sexual life quality of ovarian cancer patients undergoing fertility preservation surgery.Among the 240 patients with ovarian malignancy,194 valid questionnaires were completed,and 64.9%(126/194)of the patients had sex and 35.1%(68/194)had no sex.Of the 126 patients who had sex,53.2%(67/126)had decreased sexual satisfaction,16.7%(21/126)had decreased sexual desire,and 21.7% had decreased sexual arousal,according to the six dimensions of female sexual function assessment.126),11.1%(14/126)of patients with sexual arousal disorders,8.7%(11/126)of patients with decreased vaginal wetness,7.1%(9/126)of patients with painful intercourse,and 3.2%(3/126)of patients with orgasmic disorders.7 Quality of life in patients with ovarian malignancies undergoing fertility preservation surgery.A total of 194 validated questionnaires were collected,and young ovarian cancer patients had better quality of life scores with overall health status(=5.45)scores.The low scores in the functional domain were emotional functioning(=3.48),then cognitive functioning(=3.50),social functioning(=3.51),somatic functioning(=3.66),and role functioning(=3.71),in that order.The highest score in the symptom domain was nausea and vomiting(=3.71 points),followed by pain(=3.70 points),loss of appetite(=3.69 points),diarrhea(=3.69 points),constipation(=3.66 points),shortness of breath(=3.65 points),economic difficulties(=3.46 points),insomnia(=3.45 points),and fatigue(=3.36 points).8 Assisted reproductive technology and multidisciplinary cooperation.Of the 240 patients with ovarian malignancy,a total of 194 patients completed follow-up,and a total of 78 had fertility plans,of which 13 patients had successful deliveries using assisted reproductive technologies,of which 2 patients recurred(E/N=2/13),and no patient died during the follow-up period.After Cox regression analysis,there was no significant correlation between the use of assisted reproductive technology and progression-free survival in patients with ovarian malignancy(p=0.284).There was also no significant correlation between the use of assisted reproductive technology and overall survival of patients with ovarian malignancy(p=0.532).A total of 194 patients completed follow-up,and those who thought they would consider using ART in a safe situation,were 106(54.6%);only 28 of them(14.4%)were aware of consulting ART;all follow-up patients scored their evaluation of ART treatment expectation on a scale of 1-10,and the quartile of the score was 7(5,8),as shown in Figure 20,with 25.3% of patients scoring 1-5(49/194),31.4%(61/194)of patients with scores of 5-7,26.3%(51/240)of patients with scores of 7-8,and 17%(33/194)of patients with scores >8.Overall,ART was expected to be scored in the range of 5-7.125 patients(64.4%)felt the need for multidisciplinary cooperation.Conclusion(s):1.Bilateral ovarian tumor debulking surgery is safe and feasible for young patients with bilateral ovarian malignancies.2.FIGO stage,marital status and preoperative fertility were associated with progression-free survival after fertility-preserving surgery in patients with ovarian malignancies;in addition,FIGO stage,clinical manifestation and pathological subtypes were associated with overall survival after fertility-preserving surgery in patients with ovarian malignancies.3.FIGO stage,lymph node dissection,and unilateral and bilateral tumor location were associated with pregnancy outcome after fertility preserving surgery in patients with ovarian malignancies.4.Whether lymph node dissection is performed after surgery is not related to the progression-free survival and overall survival of patients with ovarian malignancy who undergo fertility preservation surgery,but to the postoperative pregnancy outcome of patients.5.Chemotherapy may cause some damage to ovarian function,but it does not affect postoperative pregnancy outcome and has no significant teratogenic effect on the fetus.ART treatment does not affect the patient’s prognosis and is safe.Oncology-reproductive multidisciplinary cooperation is recommended. |
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