Work

Prognostic comparison of fertility-sparing surgery and hysterectomy in early-stage ovarian clear cell carcinoma: a population-based analysis

Year: 2026

Type: article

Abstract: OBJECTIVE: This investigation aimed to assess the applicability of fertility-sparing surgery (FSS) for early-stage ovarian clear cell carcinoma (OCCC) while examining the clinical requirements for lymph node dissection and adjuvant chemotherapy. SUBJECTS: A total of 849 stage I patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Survival outcomes were evaluated through Kaplan-Meier methodology for both overall survival (OS) and disease-specific survival (DSS). Prognostic determinants were examined using multivariate regression modeling. RESULTS: Among the 849 patients, 84.3% (716 cases) underwent hysterectomy, and 15.7% (133 cases) received FSS. No significant difference was found in OS (90.6% vs. 87.2%, P = 0.257) or DSS (91.6% vs. 87.7%, P = 0.302) between FSS and hysterectomy cohort. Tumor diameter > 10 cm, stage IC and lymphadenectomy were independent prognostic factors for patients with stage I OCCC. Among patients with a tumor diameter ≤ 10 cm, those who underwent FSS had better OS (97.9% vs. 88.3%, P = 0.034) and DSS (97.9% vs. 88.3%, P = 0.044) than those who received hysterectomy. In stage IA patients, there were no significant differences in prognosis between the two operations. Neither lymphadenectomy nor chemotherapy did not demonstrate superior prognosis in the FSS cohort, whereas chemotherapy was associated with inferior OS (93.5% vs. 84.9%, P = 0.007) and DSS (93.5% vs. 85.5%, P = 0.007) in the hysterectomy cohort. CONCLUSION: For patients with stage IC OCCC and a tumor diameter > 10 cm, the selection of FSS should be approached with caution. Given the limitations of the SEER database, larger-scale prospective cohort studies are required to validate the influence of lymphadenectomy and postoperative adjuvant chemotherapy on the prognosis of patients undergoing FSS.

Source: Archives of Gynecology and Obstetrics

DOI: 10.1007/s00404-026-08310-9