Abstract：
To assess the difference in survival between fertility-sparing surgery (FSS) and radical surgery and explore pregnancy outcomes after FSS in stage I malignant sex cord-stromal tumours (MSCSTs).
We carried out a multicentre retrospective cohort study on patients who were diagnosed with MSCSTs and the tumour was confined to one ovary. The patients were divided into FSS and radical surgery groups. Inverse probability of treatment weighting (IPTW) was used to balance variables between the two groups. Kaplan-Meier analysis was used to compare the difference in disease-free survival (DFS). Univariate and multivariate Cox regression analysis was used to find risk factors of DFS. Univariate logistic regression analysis was used to assess risk factors of pregnancy.
In total, 107 patients were included, of whom 54 (50.5%) women underwent FSS and 53 (49.5%) received radical surgery. After IPTW, a pseudo-population of 208 was determined and all of the covariates were well balanced. After a median follow-up time of 50 months (range 7-156 months), 10 patients experienced recurrence and two died. There was no significant difference in DFS between the two groups, both in unweighted (P = 0.969) or weighted cohorts (P = 0.792). In the weighted cohort, stage IC (P = 0.014), tumour diameter >8 cm (P = 0.003), incomplete staging surgery (P = 0.003) and no adjuvant chemotherapy (P < 0.001) were the four high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully; the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (P = 0.009) was associated with infertility.
On the premise of complete staging surgery, FSS is safe and feasible in early stage MSCSTs with satisfactory reproductive outcomes.
We carried out a multicentre retrospective cohort study on patients who were diagnosed with MSCSTs and the tumour was confined to one ovary. The patients were divided into FSS and radical surgery groups. Inverse probability of treatment weighting (IPTW) was used to balance variables between the two groups. Kaplan-Meier analysis was used to compare the difference in disease-free survival (DFS). Univariate and multivariate Cox regression analysis was used to find risk factors of DFS. Univariate logistic regression analysis was used to assess risk factors of pregnancy.
In total, 107 patients were included, of whom 54 (50.5%) women underwent FSS and 53 (49.5%) received radical surgery. After IPTW, a pseudo-population of 208 was determined and all of the covariates were well balanced. After a median follow-up time of 50 months (range 7-156 months), 10 patients experienced recurrence and two died. There was no significant difference in DFS between the two groups, both in unweighted (P = 0.969) or weighted cohorts (P = 0.792). In the weighted cohort, stage IC (P = 0.014), tumour diameter >8 cm (P = 0.003), incomplete staging surgery (P = 0.003) and no adjuvant chemotherapy (P < 0.001) were the four high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully; the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (P = 0.009) was associated with infertility.
On the premise of complete staging surgery, FSS is safe and feasible in early stage MSCSTs with satisfactory reproductive outcomes.
摘要：
目的：评估保留生育力手术（FSS）和根治性手术之间的生存率差异，并探讨FSS在I期恶性性索间质肿瘤（MSCSTs）中的妊娠结局。
方法：我们对诊断为MSCST且肿瘤局限于一个卵巢的患者进行了一项多中心回顾性队列研究。将患者分为FSS组和根治性手术组。使用治疗加权的逆概率(IPTW)来平衡两组之间的变量。采用Kaplan-Meier分析比较无病生存期(DFS)的差异。采用单因素和多因素Cox回归分析发现DFS的危险因素。采用单因素logistic回归分析评价妊娠危险因素。
结果：总计，纳入107例患者，其中54名(50.5%)女性接受FSS,53名(49.5%)女性接受根治性手术.IPTW之后,我们确定了208个假群体,所有协变量均达到了良好平衡.中位随访时间为50个月（范围7-156个月）后，10例患者复发，2例死亡。两组间DFS无显著差异，未加权(P=0.969)或加权队列(P=0.792)。在加权队列中，级IC（P=0.014），肿瘤直径>8厘米（P=0.003），不完全分期手术(P=0.003)和无辅助化疗(P<0.001)是4个与DFS较短相关的高危因素.在有怀孕欲望的14名患者中，11例（78.6％）妇女成功怀孕；活产率为76.9％。在单变量分析中，只有辅助化疗(P=0.009)与不孕症相关.
结论：在完成分期手术的前提下，FSS在早期MSCST中是安全可行的，具有令人满意的生殖结局。
方法：我们对诊断为MSCST且肿瘤局限于一个卵巢的患者进行了一项多中心回顾性队列研究。将患者分为FSS组和根治性手术组。使用治疗加权的逆概率(IPTW)来平衡两组之间的变量。采用Kaplan-Meier分析比较无病生存期(DFS)的差异。采用单因素和多因素Cox回归分析发现DFS的危险因素。采用单因素logistic回归分析评价妊娠危险因素。
结果：总计，纳入107例患者，其中54名(50.5%)女性接受FSS,53名(49.5%)女性接受根治性手术.IPTW之后,我们确定了208个假群体,所有协变量均达到了良好平衡.中位随访时间为50个月（范围7-156个月）后，10例患者复发，2例死亡。两组间DFS无显著差异，未加权(P=0.969)或加权队列(P=0.792)。在加权队列中，级IC（P=0.014），肿瘤直径>8厘米（P=0.003），不完全分期手术(P=0.003)和无辅助化疗(P<0.001)是4个与DFS较短相关的高危因素.在有怀孕欲望的14名患者中，11例（78.6％）妇女成功怀孕；活产率为76.9％。在单变量分析中，只有辅助化疗(P=0.009)与不孕症相关.
结论：在完成分期手术的前提下，FSS在早期MSCST中是安全可行的，具有令人满意的生殖结局。
