Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France.
Hum Reprod Update. 2013 Mar-Apr;19(2):151-66. doi: 10.1093/humupd/dms047. Epub 2012 Dec 12.
The aim of this systematic review was to evaluate the fertility outcome after borderline ovarian tumor (BOT) management and the results of conservative management, risk of recurrence and alternative options.
The search strategy was based on relevant terms concerning BOT using Medline and the Central Cochrane Library. Both early and advanced stages of serous and mucinous BOT were included, but not rare entities such as endometrioid, Brenner or clear-cell BOT because of their low incidence. We considered all articles-case reports, original studies, meta-analyses and reviews-in English and French.
Overall, 230 articles were screened of which 120 were retained for review. Most pregnancies were spontaneous but some data were obtained from studies analyzing the contribution of assisted reproductive technology (ART). However, not all studies differentiated spontaneous pregnancy from those obtained after fertility treatment including ovulation induction, intrauterine insemination and IVF. Conservative management of early stage BOT resulted in a pooled estimate for spontaneous pregnancy rate of 54% with a low risk of lethal recurrence (pooled estimate: 0.5%). In patients with advanced stage BOT, the spontaneous pregnancy rates was lower (34% in the single series reporting pregnancy rate in this context) and the risk of lethal recurrence increased (pooled estimate: 2%).
This systematic review underlines that fertility subsequent to treatment of BOT depends mainly on histology and initial staging to distinguish early from advanced stages. In patients with advanced stage BOT, several alternative options to conservative management are available to allow patients to conceive without compromising their prognosis.
本系统评价旨在评估交界性卵巢肿瘤（BOT）治疗后的生育结局，以及保守治疗的结果、复发风险和替代方案。
检索策略基于使用 Medline 和中央 Cochrane 图书馆的有关 BOT 的相关术语。包括浆液性和黏液性 BOT 的早期和晚期阶段，但不包括罕见实体，如子宫内膜样、Brenner 或透明细胞 BOT，因为它们的发病率较低。我们考虑了所有的文章-病例报告、原始研究、荟萃分析和综述-英语和法语。
总共筛选了 230 篇文章，其中 120 篇被保留进行综述。大多数妊娠是自然发生的，但有些数据来自分析辅助生殖技术（ART）贡献的研究。然而，并非所有研究都将自然妊娠与那些在生育治疗后获得的妊娠区分开来，包括排卵诱导、宫腔内人工授精和 IVF。早期 BOT 的保守治疗导致自然妊娠率的汇总估计为 54%，致命复发的风险较低（汇总估计：0.5%）。在晚期 BOT 患者中，自然妊娠率较低（在报告这方面妊娠率的单一系列中为 34%），致命复发的风险增加（汇总估计：2%）。
本系统评价强调，BOT 治疗后生育能力主要取决于组织学和初始分期，以区分早期和晚期。对于晚期 BOT 患者，有几种替代保守治疗的选择，可以在不影响预后的情况下使患者受孕。
