Abstract
OBJECTIVE: To examine the trends in use and safety of ovarian conservation in young women with early-stage endometrial cancer undergoing hysterectomy. METHODS: We conducted a population-based analysis. The National Cancer Database was used to identify women younger than 50 years of age with stage I endometrioid adenocarcinoma of the endometrium who underwent hysterectomy from 1998 to 2012. Patients were stratified based on whether they underwent oophorectomy or had ovarian conservation. Multivariable models were used to examine predictors of ovarian conservation and the association between ovarian conservation and survival. RESULTS: The cohort of 15,648 women included 1,121 (7.2%) who had ovarian conservation and 14,527 (92.8%) who underwent oophorectomy. The rate of ovarian conservation was relatively stable from 6.9% (95% confidence interval [CI] 4.9-9.7%) in 1998 to 7.1% (95% CI 5.8-8.7%) in 2012 (P=.91). Ovarian conservation was more commonly performed in younger women, black women, those with low-grade and earlier stage tumors, and in women treated at community hospitals. In a multivariable model, ovarian conservation was not independently associated with survival (hazard ratio 0.94, 95% CI 0.65-1.37). Similarly, in a Kaplan-Meier analysis, there was no association between ovarian conservation and survival (P=.19). CONCLUSION: Ovarian conservation does not adversely affect survival for women with early-stage endometrial cancer. Despite the oncologic safety of ovarian conservation, the majority of young women with endometrial cancer still undergo oophorectomy at the time of surgery.