Introduction

The incidence of cervical cancer has declined markedly over the past several decades, due to the wide implementation of cytologic screening and increased detection of premalignant disease. However, the incidence of cervical adenocarcinoma is steadily increasing, especially in younger women. Nowadays, approximately two-thirds (60.3%) of women with adenocarcinomas are <50 years of age, among which more than a half (57.38%) are <40 years of age. From published case reports and retrospective case-control studies, a higher risk of ovarian metastasis was found in women with cervical adenocarcinoma than in those with squamous carcinoma. Some studies reported that the prevalence of ovarian metastasis was between 5.5-12.5% in adenocarcinoma, compared with 0-1.3% in squamous cell carcinoma. Due to the contradiction between the high incidence of ovarian invasion and the strong desire for ovarian retention in young women with cervical adenocarcinoma, debate has arisen concerning criteria and rationality for ovarian preservation in young women. Some gynecologic oncologists have suggested that ovarian preservation should not be recommended in cases of adenocarcinoma, while others accept treatment to preserve one or both ovaries at the time of radical surgery in young women with early-stage squamous cell carcinoma.

Although bilateral salpingo-oophorectomy (BSO) eliminates the possibility of concealed cancer in the ovaries, this procedure causes climacteric symptoms, including hot flashes, vaginal atrophy, sleep disorders, cardiovascular disease, osteoporosis, and emotional problems, due to the abrupt loss of estrogen. Studies have reported a significantly increased risk of cervical adenocarcinoma in women undergoing estrogen therapy. Therefore, safety concerns on hormone replacement therapy limits its application on women with cervical adenocarcinoma with BSO. Nevertheless, these women will lose ovarian function and have a poor quality of life after radical surgery. Ovarian preservation is thought to be particularly important for the physiological and psychosexual well-being of these premenopausal women.

The significant risk factors for ovarian metastases of cervical adenocarcinoma vary among different studies. Tumor size, deep stromal invasion (DSI), International Federation of Gynecology and Obstetrics (FIGO) stage, parametrial invasion (PMI), corpus uteri invasion (CUI), lymph node metastasis (LNM), lymph-vascular space involvement (LVSI), and vaginal invasion were all considered to be significantly associated with ovarian metastases of adenocarcinoma of the uterine cervix. However, most published studies were underpowered for a disease with low incidence rate, and no metaanalyses or studies on this issue including Chinese population were performed. Thus, studies to evaluate the risk factors for ovarian metastases in cervical adenocarcinoma are urgently needed.

To evaluate the safety of ovarian preservation in women with cervical adenocarcinoma and to determine the risk factors for ovarian metastases, the oncological outcomes were compared between women with ovarian preservation and BSO, while risk factors were evaluated for ovarian metastases among women with radical hysterectomy plus BSO. Additionally, a meta-analysis of the literature was carried out to further validate the findings.