Trends, predictors, and safety of ovarian preservation in premenopausal women with high-grade endometrioid and non-endometrioid endometrial cancers.

OBJECTIVE

While ovarian preservation has been shown to be safe for premenopausal patients with low-grade, early-stage endometrioid endometrial cancer, there is limited data for higher risk tumors. We assessed the trends, predictors, and survival associated with ovarian preservation at the time of hysterectomy among premenopausal women with high-risk, early-stage endometrial cancers.

METHODS

Women <50 years of age with stage I-II grade 2 endometrioid or high-risk (grade 3 endometrioid, non-endometrioid) endometrial cancers diagnosed from 2012 to 2022 and recorded in the National Cancer Database (NCDB) were examined. A multivariable logistic regression model, was used to examine factors associated with ovarian preservation. Adjusted survival curves and a Cox proportional hazards model (with inverse probability of treatment weighting [IPTW]) were used to compare the hazards of survvial in women who did and did not undergo ovarian preservation.

RESULTS

A total of 7230 women including 295 (4.1 %) who underwent ovarian preservation were identified. The rate of ovarian preservation declined over time. Older age was associated with lower odds of ovarian preservation. After IPTW, 5-year survival was 94.2 % (95 % CI: 90.2-96.6 %) with ovarian preservation and 94.4 % (95 % CI: 93.5-95.2 %) with oophorectomy. In the weighted Cox proportional hazards model, ovarian preservation was not associated with overall survival (HR = 1.05, 95 % CI = 0.57-1.94).

CONCLUSIONS

Use of ovarian preservation in premenopausal women with high-risk endometrial cancers has decreased over time. Ovarian preservation was not associated with an adverse impact on survival.