Impact of ovarian preservation on survival for premenopausal women with early-stage endometrial carcinoma: A systematic review and meta-analysis.
Antonio Raffone, Diego Raimondo, Daniele Neola et al.
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In 30 seconds
This systematic review and meta-analysis assessed ovarian preservation (OP) versus bilateral salpingo-oophorectomy (BSO) during surgical treatment of premenopausal women with early-stage endometrial carcinoma. Nine comparative studies, including 115 528 women, contributed to quantitative analyses. OP was associated with a lower hazard of death from any cause than BSO (hazard ratio 0.805, 95% confidence interval [CI]: 0.655-0.989). Estimates for endometrial-cancer death and recurrence did not show clear differences between groups. The authors noted risk of bias in the included studies and called for better-designed research.
Key findings
- Across nine studies with 115 528 women, OP versus BSO was associated with lower all-cause mortality (hazard ratio 0.805, 95% CI: 0.655-0.989).
- The estimate for death due to endometrial carcinoma was hazard ratio 1.079 (95% CI: 0.395-2.953).
- The estimate for recurrent disease was hazard ratio 1.332 (95% CI: 0.663-2.674).
- No pooled data were available for adverse events after ovarian surgery or quality of life.
Why it matters
Ovarian preservation may avoid surgical menopause in young women, and this analysis found no clear evidence of worse cancer-specific mortality or recurrence compared with BSO. The apparent all-cause survival association is clinically relevant but should be interpreted cautiously: the evidence came from comparative studies with acknowledged risk of bias, and the review could not assess pooled adverse-event or quality-of-life outcomes.
What to keep in mind
The included studies had risk of bias, and no pooled data were available for adverse events or quality of life.