A new analysis questions the conventional opinion that ovarian cancer is very deadly. Plus: Do new fetal heart monitoring technologies perform better than traditional methods? And do frozen oocytes lead to better birth rates than fresh?
The perception of ovarian cancer’s high mortality may not align with facts, according to a new analysis published in Obstetrics & Gynecology.
Researchers performed a descriptive analysis of the survival of all California residents who were diagnosed with epithelial ovarian cancer between 1994 and 2001. The California Cancer Registry was used to identify patients who had follow-up through 2011.
The authors compared the characteristics of women who survived more than 10 years with women who survived less than 2 years, those who survived for more than 2 years but less than 5 years, and women who survived for more than 5 years but less than 10 years.
Of the 11,541 survivors overall, 3582 women-roughly 31% (confidence interval 30.2 – 31.8)-survived more than 10 years. Tumors that were of nonserous histology, low grade, and early stage, and younger age of a patient were significant predictors of long-term survival. Some of the long-term survivors, however, were women who had high-risk cancer.
The researchers concluded that long-term survival in patients with epithelial ovarian cancer is not unusual, even among women who have high-risk disease. Still to be determined is why some patients who have advanced-stage, high-grade cancers survive longer than others who have tumors with the same histology. They believe that their findings will prove important for patient counseling.
New cardiac technology no better than traditional fetal heart monitoring
A new study supported by the National Institute of health found no benefit for a new form of fetal cardiac monitoring during birth over traditional fetal heart rate (FHR) tracings. The research, sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, showed that both mothers and babies fared the same whether fetal ECG ST-segment analysis or FHR was used intrapartum.
ECG ST-segment analysis, which is not commonly used in the United States, records the electrical activity of a fetus’s heart during labor, whereas with traditional FHR, only the pace of the beats is monitored.
More than 11,000 women with singleton fetuses were randomized in the multicenter trial, which was published in The New England Journal of Medicine. All were attempting vaginal delivery at more than 36 weeks’ gestation and had cervical dilation of 2 to 7 cm.
Half the patients were randomly assigned to “masked” monitoring with fetal ST-segment analysis and half to “open” monitoring. The “masked” system functioned as a normal FHR monitor whereas the “open” one displayed additional information for use when uncertain FHR patterns were detected. The primary outcome was a composite of intrapartum fetal death, neonatal death, an Apgar score of 3 or less at 5 minutes, neonatal seizure, umbilical-artery blood pH of 7.05 or less with a base deficit of 12 mmol/L or more, intubation for ventilation at delivery, or neonatal encephalopathy.
Adverse events occurred in 52 fetuses of neonates of women who had “open” monitoring versus 40 fetuses or neonates of the women who had “masked” monitoring, for a difference of 0.7% and a relative risk of 1.31 (95% confidence interval; 0.87-1.98; P=0.20), which was non-significant. The only significant difference between the two groups was in the frequency of a 5-minute Apgar score of 3 or less (0.3% versus 0.1%, P=0.02). Rates of cesarean delivery and operative delivery did not differ significantly between the two groups (16.9% versus 16.2%; P=0.30 and 22.8% versus 22.0%; P=0.31, respectively).
“Fetal ECG ST-segment analysis used as an adjunct to conventional intrapartum electronic fetal heart-rate monitoring,” the authors concluded, “did not improve perinatal outcomes or decrease operative-delivery rates.”
Do fresh or frozen eggs lead to higher birth rates?
Using frozen oocytes for in vitro fertilization (IVF) may lead to a lower birth rate than that with fresh oocytes, according to a research letter published in JAMA.
Researchers from the Center for Human Reproduction in New York compared rates of live birth and cycle cancellation with fresh versus frozen donor oocytes using aggregate data from the 2013 annual report of US IVF center outcomes published by the Society for Assisted Reproductive Technology. The data were on center-specific outcomes from 380 of 467 US-based fertility centers, which collectively performed 91.7% of all IVF cycles in 2013, and the information was reported voluntarily.
In 2013, there were 11,148 oocyte donation cycles, 20% of which used cryopreserved donor oocytes. Initiated cycles were canceled more often with fresh than with frozen oocytes (11.7% versus 8.5%, respectively). Overall birth rates were higher (49.6%) for cycles started with fresh oocytes than with frozen ones (43.2%), as were live births per embryo transfer (56.1% versus 47.1%, respectively). The number of embryos transferred was roughly the same whether fresh or frozen oocytes were used (1.7 versus 1.6, respectively).
In the discussion, the researchers urged caution about their findings because use of anonymized aggregate outcomes meant that it was not possible to adjust for confounders. They also speculated that the lower birth rate with cryopreserved oocytes may reflect “less opportunity for proper embryo selection due to small starting number of oocytes, leading to fewer embryos available for transfer.” The quality of the oocytes, they said, also may be impacted by the cryopreservation and thawing process.