• Ting Hu, Li Wu, Hui Xing, Ru Yang, Xiong Li, Kecheng Huang, Yao Jia, Qinghua Zhang, Zhilan Chen, Shaoshuai Wang, Dan Liu, Xiaobing Han, Zhongqiu Lin, Pengpeng Qu, Hongbing Cai, Xiaojie Song, Xiaoyu Tian, Hui Wang, Shixuan Wang, Xing Xie, Shuang Li, and Ding Ma.
• Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
• Ann. Surg. Oncol. 2013 Mar 1; 20 (3): 881-90.

BackgroundThere is no consensus on the selection criteria for ovarian preservation in cervical cancer, and the role of neoadjuvant chemotherapy (NACT) on ovarian metastasis (OM) is also unknown.MethodsA total of 1,889 cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB to IIB who underwent radical hysterectomy, pelvic lymphadenectomy, and bilateral salpingo-oophorectomy with or without NACT were enrolled. Clinicopathologic variables were studied by univariate and multivariate analyses. Meta-analyses of published data for risk factors of OM were also performed.ResultsTwenty-two (1.2%) of 1,889 patients were diagnosed as OM: 12 squamous cell carcinomas (SCC, 0.7%), five adenocarcinomas (2.7%), four adenosquamous carcinomas (5.6%), and one small cell carcinoma (7.7%). Multivariate analysis revealed that lymph node metastasis (LNM; odds ratio 5.75, 95% confidence interval 2.16-15.28), corpus uteri invasion (CUI; 5.53, 2.11-14.53), parametrial invasion (PMI; 8.24, 3.01-22.56), and histology and NACT (0.40, 0.13-1.22) were associated with OM. Furthermore, OM in patients with SCC was associated with PMI (5.67, 1.63-19.72), CUI (3.25, 0.88-12.01), and LNM (9.44, 2.43-36.65). FIGO stage (IIB vs. IB; 31.78, 1.41-716.33), bulky tumor size (12.71, 1.31-123.68), PMI (51.21, 4.10-639.19), NACT (0.003, 0.00-0.27), and CUI (44.49, 2.77-714.70) were independent clinicopathologic factors for OM in adenocarcinomas. In the meta-analysis, we identified six risk factors for OM: LNM, CUI, PMI, adenocarcinoma, large tumor size, and lymphovascular space involvement.ConclusionsOvarian preservation surgery may be safe in SCC patients without suspicious LNM, PMI, and CUI, and in adenocarcinomas in patients who received NACT without FIGO stage IIB disease, bulky tumor size (>4 cm), suspicious PMI, and CUI.

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