Background: The effect of chemotherapy exposure (CE) on ovarian function in young women with ovarian neoplasms undergoing fertility-sparing treatment (FST) remains unclear. We investigated whether CE is correlated with the outcomes (1) during-treatment and (2) post-treatment amenorrhea, (3) conception rate, (4) pregnancy outcome, and (5) spontaneous menopausal age. Patients and methods: Eligibility criteria were patients with a diagnosis of epithelial (EOC) or nonepithelial (no-EOC) invasive ovarian neoplasm, premenopausal age, undergoing FST ± CE, histopathology confirmation, and adequate follow-up. The groups' outcomes were compared by logistic and linear regression analysis. Results: A total of 548 patients diagnosed during 1980 and 2014 were included, 198 in the EOC group and 350 in the no-EOC group, and 44% received chemotherapy, with a median follow-up of 15.9 years. In no-EOC patients, CE conferred a higher risk for Outcomes 1 (adjusted OR [aOR] 27; 95% CI 12 to 61; P <.0001) and 2 (aOR 5.42; 95% CI 1 to 24; P =.0256) and was associated with a younger menopausal age (adjusted β −5.52; 95% CI −10.53 to −0.52; P =.0313). Overall, 57% of patients attempted pregnancy, with a conception rate of 89%. In EOC patients, no association between CE and a decreased fertility was demonstrated (aOR, 3.05; 95% CI 0.72 to 12.88; P =.1298). Conclusions: CE in no-EOC was associated with an increased risk of during-treatment amenorrhea, post-treatment amenorrhea, and earlier spontaneous menopausal age; CE in EOC was not associated with any item at study. Patients undergoing FST had reassuringly high conception rates and low premature ovarian failure rates; however, in pretreatment counseling, the risks of this approach in such young population should be discussed.

Ceppi, L., Galli, F., Lamanna, M., Magni, S., Dell'Orto, F., Verri, D., et al. (2019). Ovarian function, fertility, and menopause occurrence after fertility-sparing surgery and chemotherapy for ovarian neoplasms. GYNECOLOGIC ONCOLOGY, 152(2), 346-352 [10.1016/j.ygyno.2018.11.032].

Ovarian function, fertility, and menopause occurrence after fertility-sparing surgery and chemotherapy for ovarian neoplasms

Ceppi, L;Lamanna, M;Magni, S;Verri, D;Delle Marchette, M;Lissoni, AA;Sina, F;Giuliani, D;Grassi, T;Landoni, F;Fruscio, R
2019

Abstract

Background: The effect of chemotherapy exposure (CE) on ovarian function in young women with ovarian neoplasms undergoing fertility-sparing treatment (FST) remains unclear. We investigated whether CE is correlated with the outcomes (1) during-treatment and (2) post-treatment amenorrhea, (3) conception rate, (4) pregnancy outcome, and (5) spontaneous menopausal age. Patients and methods: Eligibility criteria were patients with a diagnosis of epithelial (EOC) or nonepithelial (no-EOC) invasive ovarian neoplasm, premenopausal age, undergoing FST ± CE, histopathology confirmation, and adequate follow-up. The groups' outcomes were compared by logistic and linear regression analysis. Results: A total of 548 patients diagnosed during 1980 and 2014 were included, 198 in the EOC group and 350 in the no-EOC group, and 44% received chemotherapy, with a median follow-up of 15.9 years. In no-EOC patients, CE conferred a higher risk for Outcomes 1 (adjusted OR [aOR] 27; 95% CI 12 to 61; P <.0001) and 2 (aOR 5.42; 95% CI 1 to 24; P =.0256) and was associated with a younger menopausal age (adjusted β −5.52; 95% CI −10.53 to −0.52; P =.0313). Overall, 57% of patients attempted pregnancy, with a conception rate of 89%. In EOC patients, no association between CE and a decreased fertility was demonstrated (aOR, 3.05; 95% CI 0.72 to 12.88; P =.1298). Conclusions: CE in no-EOC was associated with an increased risk of during-treatment amenorrhea, post-treatment amenorrhea, and earlier spontaneous menopausal age; CE in EOC was not associated with any item at study. Patients undergoing FST had reassuringly high conception rates and low premature ovarian failure rates; however, in pretreatment counseling, the risks of this approach in such young population should be discussed.
Articolo in rivista - Articolo scientifico
Chemotherapy; Epithelial ovarian cancer; Fertility; Fertility-sparing treatment; Nonepithelial ovarian cancer; Oncology; Obstetrics and Gynecology
English
346
352
7
Ceppi, L., Galli, F., Lamanna, M., Magni, S., Dell'Orto, F., Verri, D., et al. (2019). Ovarian function, fertility, and menopause occurrence after fertility-sparing surgery and chemotherapy for ovarian neoplasms. GYNECOLOGIC ONCOLOGY, 152(2), 346-352 [10.1016/j.ygyno.2018.11.032].
Ceppi, L; Galli, F; Lamanna, M; Magni, S; Dell'Orto, F; Verri, D; Delle Marchette, M; Lissoni, A; Sina, F; Giuliani, D; Grassi, T; Landoni, F; Bonazzi, C; Fruscio, R
File in questo prodotto:
File Dimensione Formato  
1-s2.0-S0090825818314525-main.pdf

Solo gestori archivio

Tipologia di allegato: Publisher’s Version (Version of Record, VoR)
Dimensione 648.33 kB
Formato Adobe PDF
648.33 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/217181
Citazioni
  • Scopus 10
  • ???jsp.display-item.citation.isi??? 12
Social impact