Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2025, Vol. 21 ›› Issue (03): 271 -277. doi: 10.3877/cma.j.issn.1673-5250.2025.03.004

Expert Editorial

Considerations on fertility sparing strategies in childbearing age patients with borderline and malignant ovarian tumors

Siyu Cao, Chengyu Zhao, Jinke Li()   

  1. Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2025-03-02 Revised:2025-05-22 Published:2025-06-01
  • Corresponding author: Jinke Li
  • Supported by:
    Project of Science & Technology Department of Sichuan Province(2021YJ0124)

With the increasing incidence of ovarian tumors among younger women, fertility-sparing surgery (FSS) has emerged as a strategy to balance oncologic control and fertility preservation. Ovarian tumors include borderline ovarian tumors (BOT), early-stage epithelial ovarian cancer (EOC), and non-epithelial ovarian cancer (NEOC). For BOT patients in childbearing age, unilateral salpingo-oophorectomy or cystectomy preserves fertility without significantly increasing recurrence risk. In early-stage EOC, especially International Federation of Obstetrics and Gynecology (FIGO) stage Ⅰ and well-differentiated EOC patients, FSS yields favorable overall survival (OS) in reproductive-aged patients, though certain subtypes, such as high-grade endometrioid carcinoma, may carry poorer prognosis. In NEOC patients with germ cell tumors and sex cord-stromal tumors meeting FSS indications, outcomes are favorable compared to non-FSS treatments. Assisted reproductive technology (ART), including oocyte, embryo, and ovarian tissue cryopreservation, offer additional fertility options. When applied to properly selected ovarian cancer patients, FSS is safe, feasible, and effective. However, challenges remain in indication criteria, surgical choice, long-term prognosis, and integration with ART. This review summarizes current evidence on FSS safety and fertility outcomes in childbearing age patients with BOT, early-stage EOC, and NEOC, aiming to provide clinical decision-making support and evidence-based guidance for fertility preservation in reproductive-aged patients.

[1]
Poonyakanok V, Warnnissorn M, Chaopotong P. Oncological outcomes and risk factors for recurrence of mucinous borderline ovarian tumors: a 15-year experience at a tertiary center[J]. J Obstet Gynaecol Res, 2024, 50(11): 2081-2092. DOI:10.1111/jog.16085.
[2]
Wang D, Jia S, Jia C, et al. Oncological and reproductive outcomes after fertility-sparing surgery in patients with seromucinous borderline ovarian tumor: results of a large retrospective study[J]. Gynecol Oncol, 2022, 165(3): 446-452. DOI:10.1016/j.ygyno.2022.04.002.
[3]
Kim SR, Madariaga A, Hogen L, et al. Safety of fertility sparing management in invasive mucinous ovarian carcinoma[J]. Gynecol Oncol, 2023, 174(7): 129-132. DOI:10.1016/j.ygyno.2023.05.003.
[4]
Miyamoto E, Suzuki H, Yoshihara M, et al. The prognostic impact of limited-staging surgery in patients with stage ⅠA epithelial ovarian cancer: a multi-center study with a propensity score-adjusted analysis[J]. Jpn J Clin Oncol, 2023, 53(8): 698-703. DOI:10.1093/jjco/hyad039.
[5]
Westermann T, Karabeg E, Heitz F, et al. Role of fertility-sparing surgery and further prognostic factors in borderline tumors of the ovary[J]. Int J Gynecol Cancer, 2024, 34(6): 898-905. DOI:10.1136/ijgc-2023-005214.
[6]
Guo L, Kang X, Su Y, et al. Oncologic and reproductive outcomes after fertility-sparing surgery for bilateral borderline ovarian tumors: a retrospective study[J]. Eur J Obstet Gynecol Reprod Biol, 2024, 296(5): 107-113. DOI:10.1016/j.ejogrb.2024.02.027.
[7]
Algera M D, Van De Vijver K K, Van Driel W J, et al. Outcomes of patients with early stage mucinous ovarian carcinoma: a Dutch population-based cohort study comparing expansile and infiltrative subtypes[J]. Int J Gynecol Cancer, 2024, 34(5): 722-729. DOI:10.1136/ijgc-2023-004955.
[8]
Li J, Qiao H, Liu Y, et al. Safety of fertility-sparing surgery in young women with stage Ⅰ endometrioid epithelial and mucinous ovarian cancer: a population-based analysis[J]. Eur J Surg Oncol, 2024, 50(1): 107276. DOI:10.1016/j.ejso.2023.107276.
[9]
Morice P, Scambia G, Abu-Rustum NR, et al. Fertility-sparing treatment and follow-up in patients with cervical cancer, ovarian cancer, and borderline ovarian tumours: guidelines from ESGO, ESHRE, and ESGE[J]. Lancet Oncol, 2024, 25(11): e602-e610. DOI:10.1016/s1470-2045(24)00262-6.
[10]
Ikeda Y, Yoshihara M, Yoshikawa N, et al. Is cystectomy an option as conservative surgery for young patients with borderline ovarian tumor? A multi-institutional retrospective study[J]. Int J Gynaecol Obstet, 2022, 157(2): 437-443. DOI:10.1002/ijgo.13844.
[11]
Zhao J, Wang D, Wang R, et al. Fertility-sparing surgery in children and adolescents with borderline ovarian tumors: a retrospective study[J]. J Ovarian Res, 2024, 17(1): 96. DOI:10.1186/s13048-024-01409-0.
[12]
Ricotta G, Maulard A, Candiani M, et al. Endometrioid borderline ovarian tumor: clinical characteristics, prognosis, and managements[J]. Ann Surg Oncol, 2022, 29(9): 5894-5903. DOI:10.1245/s10434-022-11893-7.
[13]
王明丹. 卵巢交界性肿瘤保留生育功能不同术式妊娠结局及预后的临床分析[D]. 沈阳:中国医科大学,2023. DOI:10.27652/d.cnki.gzyku.2023.001335.
[14]
Kuji S, Harada M, Yoshioka N, et al. Survival and reproductive outcomes after fertility-sparing surgery performed for borderline epithelial ovarian tumor in Japanese adolescents and young adults: results of a retrospective nationwide study[J]. J Obstet Gynaecol Res, 2022, 48(3): 806-816. DOI:10.1111/jog.15131.
[15]
Wang L, Zhong Q, Tang Q, et al. Second fertility-sparing surgery and fertility-outcomes in patients with recurrent borderline ovarian tumors[J]. Arch Gynecol Obstet, 2022, 306(4): 1177-1183. DOI:10.1007/s00404-022-06431-5.
[16]
Johansen G, Dahm-Kähler P, Staf C, et al. Reproductive and obstetrical outcomes with the overall survival of fertile-age women treated with fertility-sparing surgery for borderline ovarian tumors in Sweden: a prospective nationwide population-based study[J]. Fertil Steril, 2021, 115(1): 157-163. DOI:10.1016/j.fertnstert.2020.07.043.
[17]
戴勤慧. 290例卵巢交界性肿瘤保留生育功能的临床病例分析[D]. 青岛:青岛大学,2024. DOI:10.27262/d.cnki.gqdau.2024.000574.
[18]
Sobiczewski P, Piatek S, Michalski W, et al. Obstetric outcomes after conservative management of ovarian borderline tumors in women of reproductive age: a single center experience[J]. Eur J Obstet Gynecol Reprod Biol, 2022, 269(2): 126-131. DOI:10.1016/j.ejogrb.2021.12.029.
[19]
Song BB, Anderson ZS, Masjedi AD, et al. Fertility-sparing surgery for stage Ⅰ epithelial ovarian cancer[J]. Obstet Gynecol, 2024, 144(1): 68-78. DOI:10.1097/aog.0000000000005530.
[20]
Jorgensen K, Denham C, Kanbergs A, et al. All-cause and cancer-specific mortality after fertility-sparing surgery for stage ⅠA and ⅠC epithelial ovarian cancer[J]. Gynecol Oncol, 2023, 178(11): 60-68. DOI:10.1016/j.ygyno.2023.09.015.
[21]
Imterat M, Bizzarri N, Fruscio R, et al. Impact of substage and histologic type in stage Ⅰ ovarian carcinoma survival: a multicenter retrospective observational study[J]. Int J Gynecol Cancer, 2023, 33(1): 42-49. DOI:10.1136/ijgc-2022-003745.
[22]
Nasioudis D, Mulugeta-Gordon L, Mcminn E, et al. Oncologic outcomes of uterine preservation for pre-menopausal patients with stage II epithelial ovarian carcinoma[J]. Int J Gynecol Cancer, 2021, 31(3): 480-483. DOI:10.1136/ijgc-2020-001747.
[23]
Ayhan A, Tunç M, Akll H, et al. Fertility-sparing approach to malignant ovarian germ cell tumors - oncologic and obstetric outocome: a retrospective study[J]. Int J Gynaecol Obstet, 2024, 164(3): 1074-1079. DOI:10.1002/ijgo.15141.
[24]
Vasanth A, Patel SM, Arora R, et al. Study of neoadjuvant chemotherapy in advanced malignant ovarian germ cell tumors at a tertiary center in western India[J]. J Gynecol Oncol, 2024, 35(2): e19. DOI:10.3802/jgo.2024.35.e19.
[25]
李俊婷. 卵巢恶性性索间质肿瘤保留生育功能术后生存和妊娠结局的研究[D]. 济南:山东大学,2022. DOI:10.27272/d.cnki.gshdu.2022.000570.
[26]
Wang D, Jia C, Cheng H, et al. Analysis of outcomes and prognostic factors after fertility-sparing surgery in patients with early stage juvenile granulosa cell tumor of the ovary: experience from a tertiary center[J]. J Pediatr Adolesc Gynecol, 2022, 35(4): 486-491. DOI:10.1016/j.jpag.2021.12.005.
[27]
Johansen G, Lampic C, Flöter Rådestad A, et al. Health-related quality of life, sexual function, psychological health, reproductive concerns and fertility outcome in young women treated with fertility-sparing surgery for ovarian tumors - A prospective longitudinal multicentre study[J]. Gynecol Oncol, 2024, 189(10): 101-108. DOI:10.1016/j.ygyno.2024.07.004.
[28]
Marino G, Grassi T, De Ponti E, et al. Fertility outcomes in stage Ⅰ ovarian immature teratomas[J]. Int J Gynecol Cancer, 2024, 34(9): 1416-1422. DOI:10.1136/ijgc-2024-005534.
[29]
Mcbain R, Kashyap A, Bishop M, et al. Borderline tumours of the ovary: a 37-year experience at a tertiary referral centre[J]. Aust N Z J Obstet Gynaecol, 2025, 65(1): 163-172. DOI:10.1111/ajo.13876.
[30]
Cacciottola L, Camboni A, Gatti E, et al. Fertility potential and safety assessment of residual ovarian cortex in young women diagnosed with epithelial borderline and early-stage malignant ovarian tumors[J]. Gynecol Oncol, 2024, 183: 15-24. DOI: 10.1016/j.ygyno.2024.03.008.
[31]
Cosyns S, Van Moer E, De Quick I, et al. Reproductive outcomes in women opting for fertility preservation after fertility-sparing surgery for borderline ovarian tumors[J]. Arch Gynecol Obstet, 2024, 309(5): 2143-2152. DOI: 10.1007/s00404-024-07445-x.
[32]
Bunyaeva E, Kirillova A, Khabas G, et al. Feasibility of in vitro maturation of oocytes collected from patients with malignant ovarian tumors undergoing fertility preservation[J]. Int J Gynecol Cancer, 2021, 31(3): 475-479. DOI:10.1136/ijgc-2020-001754.
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