Title: Fertility-sparing surgery of malignant transformation arising from mature cystic teratoma of the ovary
Abstract: // Nobuhisa Yoshikawa 1, * , Toshiya Teshigawara 1, * , Yoshiki Ikeda 1 , Kimihiro Nishino 1 , Jun Sakata 1 , Fumi Utsumi 1 , Kaoru Niimi 1 , Ryuichiro Sekiya 2 , Shiro Suzuki 1 , Michiyasu Kawai 3 , Kiyosumi Shibata 2 , Fumitaka Kikkawa 1 and Hiroaki Kajiyama 1 1 Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan 2 Department of Obstetrics and Gynecology, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan 3 Department of Obstetrics and Gynecology, Toyohashi Municipal Hospital, Toyohashi, Japan * These authors have contributed equally to this work Correspondence to: 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 ABSTRACT 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.