Comparison of outcomes between fertility-sparing and radical surgery in patients with pathological stage I epithelial ovarian cancer: a single-center retrospective cohort study

Background: Fertility-sparing surgery (FSS) is increasingly considered for young patients with early-stage epithelial ovarian cancer, but evidence regarding its oncologic safety remains limited. We compared oncologic outcomes between FSS and radical surgery (RS) in patients with pathological International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian cancer and described reproductive outcomes after FSS.

Methods: We retrospectively reviewed patients with FIGO stage I epithelial ovarian cancer who underwent FSS or RS at West China Second Hospital from 2013 to 2021. Clinicopathological, treatment, follow-up, oncologic, and reproductive data were extracted from medical records and follow-up data. Potential confounding was addressed using multivariable Cox regression and propensity score matching.

Results: Among 472 patients, 425 underwent RS and 47 underwent FSS. Before matching, patients in the FSS group were younger and had more favorable tumor features; after matching, baseline characteristics were generally balanced. In the matched cohort, FSS and RS showed no significant differences in 5-year disease-free survival (DFS; 97.1% vs. 87.7%, P=0.15), 5-year overall survival (OS; 97.1% vs. 96.1%, P=0.75), or recurrence rate (4.2% vs. 8.8%, P=0.53). Similar findings were observed in the overall cohort and multivariable analyses. Among 15 patients desiring pregnancy after FSS, 10 achieved natural conception.

Conclusions: In this single-center retrospective cohort, FSS was not associated with significantly worse oncologic outcomes than RS in selected patients with pathological FIGO stage I epithelial ovarian cancer and was associated with favorable reproductive outcomes. Larger prospective studies with longer follow-up are warranted.