Identifying a candidate population for ovarian conservation in young women with clinical stage IB–IIB cervical cancer

This study seeks to identify risk factors associated with ovarian metastasis and to characterize a population with minimum risk of ovarian metastasis in young women with stage IB–IIB cervical cancer. This was a nation‐wide multicenter retrospective study in Japan examining consecutive cases of surgically‐treated women with clinical stage IB–IIB cervical cancer who had oophorectomy at radical hysterectomy ( n  = 5,697). Multivariable analysis was performed to identify independent risk factors for ovarian metastasis. Ovarian metastasis was seen in 70 (1.2%, 95% confidence interval 0.9–1.5) cases. In the entire cohort, adenocarcinoma, lympho‐vascular space invasion, uterine corpus tumor invasion, and pelvic/para‐aortic nodal metastases remained independent risk factors for ovarian metastasis (all, adjusted‐ p  < 0.05). In a sensitivity analysis of 3,165 women aged <50 years (ovarian metastasis, 1.0%), adenocarcinoma, parametrial tumor involvement, uterine corpus tumor involvement, and pelvic/para‐aortic nodal metastases remained independent risk factors for ovarian metastasis (all, adjusted‐ P  < 0.05). In the absence of these five risk factors (representing 46.1% of women aged <50 years), the incidence of ovarian metastasis was 0.14%. With the presence of adenocarcinoma alone (representing 18.9% of women aged <50 years), the incidence of ovarian metastasis was 0.17% and was not associated with increased risk of ovarian metastasis compared to the subgroup without any risk factors ( p  = 0.87). In conclusion, nearly two thirds of women aged <50 years with clinical stage IB–IIB cervical cancer had no risk factor for ovarian metastasis or had adenocarcinoma alone: these subgroups had ovarian metastasis rates of around 0.1% and may be a candidate population for ovarian conservation at surgical treatment.