Effects of Fertility-Sparing Surgery on Prognosis and Fertility of Patients With Ovarian Borderline Tumors

Xiaoxiao LIN; Lin TANG; Mingjie YANG; Bailei ZHANG

doi:10.3881/j.issn.1000-503X.16054

PDF(895 KB)

Acta Academiae Medicinae Sinicae ›› 2024, Vol. 46 ›› Issue (6) : 890-898. DOI: 10.3881/j.issn.1000-503X.16054

Original Articles

Effects of Fertility-Sparing Surgery on Prognosis and Fertility of Patients With Ovarian Borderline Tumors

Author information +

History +

Abstract

Objective To compare the safety and efficacy of fertility-sparing surgery in patients with ovarian borderline tumors (BOT). Methods A total of 121 BOT patients undergoing fertility-sparing surgery between January 2010 and October 2022 were retrospectively analyzed.The univariate analysis,multivariate analysis,and survival curves were employed to evaluate the clinicopathological and surgical variables and fertility. Results The 121 BOT patients included in this study showed the 5-year recurrence-free survival (RFS) rate of 65.8% and the recurrence rate of 30.5%.A total of 53 patients attempted to conceive and 40 (33.06%) of the patients achieved successful pregnancy.Different methods of fertility-sparing surgery did not affect the tumor recurrence rate,RFS,or pregnancy rate.The multivariate analysis indicated that the International Federation of Gynecology and Obstetrics (FIGO) stage ≥Ⅱ was an independent risk factor affecting both postoperative recurrence and RFS (P=0.011,OR=6.504,95%CI=1.534-27.58;P=0.033,HR=2.589,95%CI=1.082-6.194) in BOT patients.Tissue type (mucinous) was negatively correlated with the risk of recurrence after fertility-sparing surgery (P=0.011,OR=0.270,95%CI=0.099-0.739).The two unilateral surgical methods showed differences in the amount of intraoperative bleeding (P=0.010),postoperative hospital stay (P=0.001),duration of antibiotic use (P=0.002),and tumor rupture rate (P=0.030),which were not significantly different between the two bilateral surgical methods. Conclusions For young patients with fertility requirements,fertility-sparing surgery is safe and effective.After a comprehensive assessment of clinicopathological factors,unilateral cystectomy and bilateral cystectomy may be recommended as the preferred choice of treatment.For the patients with advanced FIGO stages who strongly prefer fertility sparing,fertility-sparing surgery can be performed with fully informed consent,and these patients should attempt to achieve pregnancy as soon as possible after the surgery.

Key words

ovarian borderline tumor / fertility-sparing surgery / recurrence / re-fertility

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

Xiaoxiao LIN , Lin TANG , Mingjie YANG , et al. Effects of Fertility-Sparing Surgery on Prognosis and Fertility of Patients With Ovarian Borderline Tumors[J]. Acta Academiae Medicinae Sinicae. 2024, 46(6): 890-898 https://doi.org/10.3881/j.issn.1000-503X.16054

References

List( Publishing order | Descend order by publishing year | Descend order by cited within ) Chart analysis

[1]	Hannibal CG, Vang R, Junge J, et al. A nationwide study of ovarian serous borderline tumors in Denmark 1978-2002.Risk of recurrence,and development of ovarian serous carcinoma[J]. Gynecol Oncol, 2017, 144(1):174-180.DOI:10.1016/j.ygyno.2016.11.007. Cited in this article [1]

[2]	Chang C, Chen J, Chen WA, et al. Assessing the risk of clinical and pathologic factors for relapse of borderline ovarian tumours[J]. Obstet Gynaecol, 2017, 37(2):233-237.DOI:10.1080/01443615.2016.1244810. Cited in this article [1]

[3]	Demirkiran F, Sal V, Bese T, et al. Risk factors for recurrence of borderline ovarian tumours:a tertiary centre experience[J]. Obstet Gynaecol, 2016, 36(8):1036-1040.DOI:10.1080/01443615.2016.1188276. Cited in this article [1]

[4]

Vang

, Hannibal

, Junge

, et al. Long-term behavior of serous borderline tumors subdivided into atypical proliferative tumors and noninvasive low-grade carcinomas:a population-based clinicopathologic study of 942 cases[J]. Surg Pathol, 2017, 41(6):725-737.DOI:10.1097/PAS.0000000000000824.

Cited in this article [1]

[5]	Ouldamer L, Bendifallah S, Nikpayam M, et al. Improving the clinical management of women with borderline tumours:a recurrence risk scoring system from a French multicentre study[J]. BJOG, 2017, 124(6):937-944.DOI:10.1111/1471-0528.14577. Cited in this article [1]

[6]	Song T, Lee YY, Choi CH, et al. Borderline ovarian tumor in women aged ≥ 65 years:impact on recurrence and survival[J]. Obstet Gynecol Reprod Biol, 2015, 184:38-42.DOI:10.1016/j.ejogrb.2014.10.001. Cited in this article [1]

[7]	Armstrong DK, Alvarez RD, Backes FJ, et al. NCCN guidelines insights:ovarian cancer,version 3.2022:featured updates to the NCCN guidelines[J]. J Natl Compr Canc Netw, 2022, 20(9):972-980.DOI:10.6004/jnccn.2013.0113. Cited in this article [1]

[8]

Trillsch

, Mahner

, Woelber

, et al. Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome:results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study[J]. Ann Oncol, 2014, 25(7):1320-1327.DOI:10.1093/annonc/mdu119.

Cited in this article [1]

[9]	Fang C, Zhao L, Chen X, et al. The impact of clinicopathologic and surgical factors on relapse and pregnancy in young patients (≤40 years old) with borderline ovarian tumors[J]. BMC Cancer, 2018, 18(1):1147.DOI:10.1186/s12885-018-4932-2. Cited in this article [1]

[10]	Huchon C, Bourdel N, Abdel Wahab C, et al. Borderline ovarian tumors:French guidelines from the CNGOF.Part 1.Epidemiology,biopathology,imaging and biomarkers[J]. J Gynecol Obstetr Hum Reprod, 2021, 50(1):101965.DOI:10.1016/j.jogoh.2020.101965. Cited in this article [2]

[11]	Chen RF, Li J, Zhu TT, et al. Fertility-sparing surgery for young patients with borderline ovarian tumors (BOTs):single institution experience[J]. J Ovarian Res, 2016, 9(16):1757-2215.DOI:10.1186/s13048-016-0226-y. Cited in this article [1]

[12]	Koskas M, Uzan C, Gouy S, et al. Fertility determinants after conservative surgery for mucinous borderline tumours of the ovary (excluding peritoneal pseudomyxoma)[J]. Hum Reprod, 2011, 26(4):808-814.DOI:10.1093/humrep/deq399. Cited in this article [1]

[13]	Morice P, Uzan C, Fauvet R, et al. Borderline ovarian tumour:pathological diagnostic dilemma and risk factors for invasive or lethal recurrence[J]. Lancet Oncol, 2012, 13(3):e103-e115.DOI:10.1016/S1470-2045(11)70288-1. Cited in this article [3]

[14]	Plett H, Harter P, Ataseven B, et al. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors[J]. Gynecol Oncol, 2020, 157(2):411-417.DOI:10.1016/j.ygyno.2020.02.007. Cited in this article [1]

[15]	Laurent I, Uzan C, Gouy S, et al. Results after conservative treatment of serous borderline tumours of the ovary with stromal microinvasion but without micropapillary pattern[J]. BJOG, 2009, 116(6):860-862.DOI:10.1111/j.1471-0528.2009.02118.x. Cited in this article [1]

[16]	Laurent I, Uzan C, Gouy S, et al. Results after conservative treatment of serous borderline tumors of the ovary with a micropapillary pattern[J]. Ann Surg Oncol, 2008, 15(12):3561-3566.DOI:10.1245/s10434-008-0159-9. Cited in this article [1]

[17]	Seong SJ, Kim DH, Kim MK, et al. Controversies in borderline ovarian tumors[J]. J Gynecol Oncol, 2015, 26(4):343-349.DOI:10.3802/jgo.2015.26.4.343. Cited in this article [1]

[18]	Daraï E, Fauvet R, Uzan C, et al. Fertility and borderline ovarian tumor:a systematic review of conservative management,risk of recurrence and alternative options[J]. Hum Reprod Update, 2013, 19(2):151-166.DOI:10.1093/humupd/dms047. Cited in this article [2]

[19]	Helpman L, Beiner ME, Aviel-Ronen S, et al. Safety of ovarian conservation and fertility preservation in advanced borderline ovarian tumors[J]. Fertil Steril, 2015, 104(1):138-144.DOI:10.1016/j.fertnstert.2015.03.038. Cited in this article [1]

[20]	Trope CG, Kaern J, Davidson B. Borderline ovarian tumours[J]. Best Pract Res Clin Obstet Gynaecol, 2012, 26(3):325-336.DOI:10.1016/j.bpobgyn.2011.12.006. Cited in this article [1]

[21]	Chen X, Fang C, Zhu T, et al. Identification of factors that impact recurrence in patients with borderline ovarian tumors[J]. J Ovarian Res, 2017, 10(1):23.DOI:10.1186/s13048-017-0316-5. Cited in this article [1]

[22]	Park JY, Kim DY, Kim JH, et al. Surgical management of borderline ovarian tumors:the role of fertility-sparing surgery[J]. Gynecol Oncol, 2009, 113(1):75-82.DOI:10.1016/j.ygyno.2008.12.034. Cited in this article [1]