| ObjectiveEarly endometrial cancer is mainly treated by surgery,but there is still controversy over whether young and low-risk patients can retain ovarian function.In this study,we compared and analyzed the relationship between ovarian preservation and postoperative recurrence,ovarian metastasis,sex hormone levels,sexual life function and quality of life in early stage patients with low-risk endometrial cancer,and to explore the safety and feasibility of ovarian preservation.MethodsFrom January 2008 to December 2013,94 patients with low-risk stage I endometrial cancer who underwent surgical treatment in Anhui Provincial Hospital were collected.All patients were clinically and pathologically diagnosedas stage I endometrial cancer with histological grade G1-G2.Among them,38 cases were ovaries preservation group and 56 cases were ovariectomized group.Age,complications,initial symptoms,preoperative CA125 levels,postoperative recurrence,ovarian metastasis,hormone levels and sexual quality of life were recorded.At the same time,single and multiple factors were used to analyze the influencing factors of ovarian metastasis,and SPSS 25.0 was used to analyze the differences between the two groups.Results1.Comparison of clinicopathological data between the two groups;the age of patients with endometrial cancer in this study group was 45 years and below;the overall average age was 41.19 ±3.67;1 case under 30 years old in ovarian preservation group;24 cases over 40 years old in Ovariectomy group;1 case under 30 years old in Ovariectomy group;39 cases over 40 years old in Ovariectomy group.With the increase of age,the number of patients also increased.There was no significant difference between the two groups statistically(P = 0.776).Preoperative CA125 was greater than 35U/ml in 16 cases,with 6 cases in ovary preservation group(15.8%)and 10 cases in ovariectomy group(17.9%).The difference between the two groups was statistically significant(P = 0.020);there was a statistically significant difference in the surgical and pathological stages between the two groups(P = 0.004).There was no significant difference in pathological grade and postoperative adjuvant therapy between the two groups(P>0.05).There were 4 cases(10.5%)of pelvic lymph node biopsy or resection in ovary preservation group and 15 cases(26.8%)in ovariectomy group.The difference was statistically significant(P= 0.048).2.Among the first clinical symptoms,69 cases(73.4%)had irregular vaginal bleeding,27 cases(71.1%)had ovarian preservation and 42 cases(75%)had ovarian resection,there was no significarnt difference between the two groups;31 FSFI score of ovarian preservation group was 18.7 ±3.7 and FSFI score of ovarian resection group was 7.6 ±4.1,which demonstrates a statistically significant difference(P=0.020).4.Kupperman score of ovarian preservation group was 7.57 ± 3.87,while the Kupperman score of ovariectomized group was 25.50 ± 2.12.Therefore,there was a statistically significant difference between the two groups.5.Compared with the monitoring level of sex hormone,the serum estradiol(E2)of ovarian preservation group was significantly higher than that of ovariectomized group,while luteinizing hormone(LH)and follicle stimulating hormone(FSH)were significantly lower than those of ovariectomized group(P<0.05).So there was a statistically significant difference between the two groups.6.There were 3 cases of recurrence mainly with ovarian metastasis in the ovarian preservation group,accounting for 7.8%;1 case of left ovarian metastasis,2 cases of bilateral ovarian metastasis,and the appearance of ovaries in the three cases of ovarian metastasis was not significantly abnormal during operation;2 cases out of 56 in ovariectomy group had recurrence disease after operation,accounting for 3.5%of the total,of which 1 were pelvic lymph node metastasis and the other was lung metastasis.5-year DFS of ovarian preservation group 92.1%(35/38)was no different from that of ovariectomy group96.4%(54/56)(P>0.05).Conclusions1.Ovarian preservation has no significant effect on the prognosis and overall survival rate of patients with endometrial cancer.Both of them have recurrence and metastasis after operation,and the difference is not obvious,but still need close follow-up.2.The effect of ovaries preservation on the quality of life,emotions and emotional development of patients\with endometrial cancer is less than that of ovariectomized patients.3.Ovarian preservation in low-risk early-stage endometrial cancer needs to be fully evaluated.Ovarian preservation may be considered safe and feasible in the short term,but it still needs to be validated by large-sample randomized controlled trials. |
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