The impact of clinicopathologic and surgical factors on relapse and pregnancy in young patients (≤40 years old) with borderline ovarian tumors

Abstract

BackgroundFertility sparing surgery has been extensively performed among patients with borderline ovarian tumors due to their age and favorable prognosis. Nevertheless, the prognosis and obstetric outcomes in these patients remain uncertain. Thus, the current study was carried out to evaluate the oncological safety and fertility benefits of different fertility sparing surgery subtypes and various clinicopathological parameters.MethodsYoung borderline ovarian tumor patients with an age of ≤40 years, who were admitted and treated in Zhejiang Cancer Hospital from January 1996 to December 2016, were enrolled in this study and reviewed retrospectively. The prognostic and obstetric effects of clinicopathological and surgical variables were evaluated using univariate/multivariate analyses and survival curves.ResultsA total of 92 eligible patients were enrolled in the analysis. Among these patients, 22 (24%) patients showed recurrence after a median follow-up of 46.5 months. Within the fertility sparing surgery group, patients at advanced stage (≥stage II), of serous type, with micropapillary and bilateral tumors were associated with a higher recurrence rate and a shorter recurrence interval. In terms of different modalities of fertility sparing surgery, adnexectomy was remarkably favored over cystectomy-including (P = 0.012); unilateral salpingo-oophorectomy had better prognosis than cystectomy and bilateral cystectomy was favored over unilateral salpingo-oophorectomy+contralateral cystectomy. Univariate Cox regression analysis indicated that the International Federation of Gynecology and Obstetrics stage (≥Stage II), the presence of bilateral and micropapillary lesions, and the application of cystectomy-including surgery were correlated with poorer disease-free survival, while the mucinous type of borderline ovarian tumors was related to improved disease-free survival. In this study, a total of 22 patients attempted to conceive and 15 (68%) of these patients achieved successful pregnancy.ConclusionsUnilateral salpingo-oophorectomy and bilateral cystectomy should be recommended as the preferred choice of treatment for young patients with unilateral and bilateral borderline ovarian tumor who desire to preserve fertility. In addition, borderline ovarian tumor patients at advanced stage (≥stage II), of serous type, with micropapillary and bilateral tumors should pay more attention to the risk of recurrence. Therefore, these patients should choose fertility sparing surgery carefully and attempt to achieve pregnancy as soon as possible.

Recurrence rate and associated factors of borderline ovarian tumors in the south of Vietnam

“…Factors consistently associated with recurrent BOT in our adjusted analysis included stage and pre‐operative capsule rupture of the primary BOT. Some previous studies have shown that higher FIGO clinical stages were associated with higher BOT recurrence rates . For example, in a study of 339 Italian women, those who had primary BOT at a more advanced stage had a higher recurrence rate (40%) after conservative surgeries, compared with stage I (15%) .…”

“…Some previous studies have shown that higher FIGO clinical stages were associated with higher BOT recurrence rates. 8,11,[14][15][16][17] For example, in a study of 339 Italian women, those who had primary BOT at a more advanced stage had a higher recurrence rate (40%) after conservative surgeries, compared with stage I (15%). 18 Also, the associations between tumor's characteristics (including rupture and stage) have been observed commonly in other studies 16 ; thus, our results are consistent with these previous findings.…”

Staging Procedures Fail to Benefit Women with Borderline Ovarian Tumours Who Want to Preserve Fertility: A Retrospective Analysis of 448 cases

“…However, the balance between oncological and reproductive outcomes should be assessed adequately; approximately 12%-36% of the patients with BOT who undergo FSS experience recurrence [20], and the most common site of recurrence is the residual ovary [20][21][22][23]. Previous studies have shown that the recurrence rate of BOT in patients who underwent FSS was markedly higher than that in patients who underwent radical surgeries (21.4% vs. 6.3%, P < 0.05) [9,24]. Furthermore, a large proportion of patients who underwent FSS experienced invasive recurrence [13].…”

“…Micropapillary lesions were defined as serous borderline tumours containing complex micropapillary structures [9]. Microinvasion was defined as stromal invasion restricted to an area of no more than 10 mm 2 [9].…”

“…Micropapillary lesions were defined as serous borderline tumours containing complex micropapillary structures [9]. Microinvasion was defined as stromal invasion restricted to an area of no more than 10 mm 2 [9]. Several surgical options are mentioned in this study such as FSS, which was performed to conserve the uterus and at least one ovary, and radical resection, which included hysterectomy and bilateral salpingo-oophorectomy [10].…”