Outcome
After a median FU of 25.5 months since the first surgery (range 0-88), 29 tumor events occurred (8.3%) after a median delay of 30.5 months (range, 1-88) from diagnosis. The initial surgical management of these recurrent cases was TO in 10 cases (34%) and OSS in 19 cases (66%) (Table 1). New lesions occurred on the same ovary in eight patients (28%), on the contralateral ovary in 18 patients (62%), and on both ovaries in three patients (10%). Among these ipsilateral new lesions, one case had a juvenile cell granulosa tumor (JCGT) on the ipsilateral ovary 47 months after OSS of the OMT. A contralateral second event occurred in 48% of cases after surgical management by OSS. Treatment of recurrences was surgery in 23 out of 29 cases and could be conservative in 82% of cases (OSS/TO; 19/4) (Table 3). Four of them benefited from cryopreservation of the remaining ovarian healthy tissue. In these patients, only one was managed by TO at the first surgery. OSS was performed on all of them at the second surgery. Six patients (21%) were not operated on for this second event and benefited from a regular wait-and-see strategy. At a median FU of 9.5 months (range: 0, 65), these patients did not present any tumor progression. JCGT was treated by TO with salpingectomy, leading to complete microscopic surgical resection (FIGO stage Ia) without any adjuvant treatment. This patient was in CR2 four years after this second event. Three patients presented a third event, affecting both ovaries in each subject. Two of them were then treated by OSS and one by TO.
Overall, at the end of FU, 321 patients remained in CR1 (91.7%), 20 in CR2 (5.7%), and three in CR3 (0.9%), and six had stable disease (1.7%). All are alive at the end of FU (OS 100%). The 2 year-EFS was 95.2% [95% CI, 91.7 – 97.3] (Fig. 1A). At the last FU, 18 patients had two reduced ovaries after unique or multiple OSS (5%), and 132 patients (38%) had one whole ovary remaining after TO carried out at the first or second surgery. No patient needed bilateral oophorectomy (Supplemental Appendix 1).