Advanced-Stage Serous Borderline Tumors of the Ovary: A Clinicopathological Study of 49 Cases

Abstract

There is controversy about patient outcomes and pathological parameters of prognostic significance in patients with stage II or stage III ovarian serous borderline tumors. Forty-nine cases of stage II and III ovarian serous borderline tumors were identified on review of the medical records at Vancouver Hospital and British Columbia Cancer Agency for the period from 1979 to 1996. Pathological features assessed included presence of micropapillary architecture, tumor cell DNA content (ploidy), and characteristics of the extraovarian implants, including invasiveness and mitotic activity. Clinical follow-up information (3-17 years of follow-up) was obtained for 48 patients. Fifteen patients had stage II tumors and 34 had stage III tumors. Fourteen patients experienced tumor recurrence 1 to 8 (mean 3.5) years after presentation and of these, six patients died of disease (2, 3, 4, 7, 10, and 11 years after presentation). Patients with gross residual disease, as assessed by the surgeon, more frequently experienced a recurrence compared with patients without gross residual disease, but this difference did not reach statistical significance (0.05<p<0.1). The patients who died of disease all had stage III tumors. Patients with invasive implants had a significantly worse outcome than patients with noninvasive implants (p<0.005). Other pathological features (ploidy, micropapillary architecture, invasiveness of implants, mitotic activity of implants) were not significantly predictive of tumor recurrence or death. No single pathological feature or combination of features was present in all patients who subsequently died of disease. In conclusion, the prognosis for patients with advanced-stage serous borderline tumors in this population-based study is very favorable, with only six patients ultimately dying of progressive disease. The combination of stage (stage III) and invasiveness of extraovarian implants identifies a small subset of patients with advanced-stage serous borderline tumors with a significantly worse prognosis, who may benefit from adjuvant therapy.

Clinical outcome and risk factors for recurrence in borderline ovarian tumours

“…In addition, prognostic factors included clinical stage, histopathological subtype, and residual tumour, but the surgical method was not regarded as a prognostic factor (Trope et al, 2000;Gilks, 2003). The results of the present study, however, showed neither the stage nor the histopathological subtype of the disease was related with long-term prognosis, but showed that disease-free survival rates were significantly lower in cases managed by conservative surgery (Figure 1).…”

“…As many of the patients are relatively young (Harris et al, 1992), preservation of fertility has been attempted with favourable results (Morice et al, 2001). However, there are also reports of recurrence or poor prognosis (Kaern et al, 1993;Gilks, 2003), and more precise prognostic factors are required. We believe that it is important to get a clear picture of the present status of borderline ovarian tumours, as it has been more than 30 years since the introduction of the concept of these tumours.…”

Borderline epithelial tumors of the ovary

“…In subsequent studies, mitotic activity has not proven to be a significant predictor of recurrence or death. 50 It is important to emphasize that invasive implants are commonly found together with noninvasive implants. Hence, surgeons should be encouraged to biopsy as many implants as possible, and pathologists must liberally sample omentectomy specimens in search of invasive implants.…”

“…30,38,48,50 In a recent study of advanced-stage borderline serous tumors from a population of more than 4 million people in British Columbia, only six patients (12%) with invasive implants were found over a 17-year period. 50 In a large series of 99 patients with advanced disease at diagnosis, 6% of 81 typical borderline tumors and 17% of 18 micropapillary/cribriform borderline tumors had invasive implants. 39 Invasive implants may have histologic features of either borderline tumor or lowgrade serous carcinoma.…”

Prognostic Factors in Patients with Ovarian Serous Low Malignant Potential (Borderline) Tumors with Peritoneal Implants

“…Only a minor proportion of patients (13 of 171) treated during the initial period of our study and elsewhere had residual tumor Ͼ2 cm. In several series, persistent residual disease is an independent prognostic factor [3,11,21,24]. Interestingly, in our statistical analysis, only residual disease Ͼ2 cm had an impact on the recurrence rate, but this factor disappeared when we compared two groups of patients: those with no residual tumor and those with residual tumor.…”