Departments of Gynaecologic Surgery.
Ann Oncol. 2014 Jan;25(1):166-71. doi: 10.1093/annonc/mdt430. Epub 2013 Nov 28.
The aim of this study was to evaluate prognostic factors for recurrence after conservative treatment of a large series of 'apparent' stage I serous borderline ovarian tumors (SBOTs).
A review of 119 patients treated conservatively between 2000 and 2009 with follow-up data. All pathological slides were reviewed by the same expert pathologist. Prognostic factors for recurrence were studied (age, histological subtypes and surgical procedure).
Conservative surgical procedures were: unilateral cystectomy (n = 43, 36%); unilateral adnexectomy (UA; n = 50, 42%); bilateral cystectomies (n = 11, 9%) and UA + contralateral cystectomy (n = 15, 13%). Stromal microinvasion and/or a micropapillary pattern was present in 21 (18%) and 13 (11%) patients, respectively. With a median follow-up of 45 months, 38 (32%) patients relapsed (10 also had peritoneal disease in the form of noninvasive implants at the first recurrence). In 2 of these 38 patients, progression-to-invasive disease occurred at the second and third relapse (one patient died to the recurrence). Three prognostic factors for recurrence were identified in the univariate analysis: a young age (< or >30 years old), the type of conservative treatment (adnexectomy versus cystectomy) and tumor bilaterality. In the multivariate analysis, only age remained statistically significant.
In this series (the largest reported, to date, on recurrences after the conservative management of stage I SBOT), the risk of relapse was not related to tumor histological subtypes (micropapillary and stromal microinvasion) nor to the use of complete staging surgery. Invasive recurrences were very rare in stage I SBOT, but did occur. A young age, tumor bilaterality and the use of a cystectomy were identified as risk factors for recurrence, suggesting that management of fertility preservation (particularly in very young patients) should be associated with a meticulously conducted follow-up.
本研究旨在评估一系列大型“显性”I 期浆液性交界性卵巢肿瘤（SBOT）保守治疗后复发的预后因素。
回顾性分析了 2000 年至 2009 年期间接受保守治疗且有随访数据的 119 例患者。所有病理切片均由同一位专家病理学家进行了复查。研究了复发的预后因素（年龄、组织学亚型和手术方式）。
保守手术方式为：单侧卵巢囊肿切除术（n=43，36%）；单侧附件切除术（UA；n=50，42%）；双侧卵巢囊肿切除术（n=11，9%）和 UA+对侧卵巢囊肿切除术（n=15，13%）。间质微浸润和/或微乳头状模式分别存在于 21 例（18%）和 13 例（11%）患者中。中位随访 45 个月后，38 例（32%）患者复发（10 例在首次复发时也存在腹膜非浸润性种植）。在这 38 例患者中，有 2 例在第二次和第三次复发时进展为浸润性疾病（1 例患者死于复发）。单因素分析确定了 3 个与复发相关的预后因素：年龄较小（<30 岁或>30 岁）、保守治疗类型（附件切除术与囊肿切除术）和肿瘤双侧性。多因素分析仅年龄具有统计学意义。
在本系列研究（迄今为止报道的最大的关于 I 期 SBOT 保守治疗后复发的研究）中，复发风险与肿瘤组织学亚型（微乳头状和间质微浸润）或完全分期手术的应用无关。I 期 SBOT 中浸润性复发非常罕见，但确实存在。年轻、肿瘤双侧性和囊肿切除术被确定为复发的危险因素，这表明生育力保存的管理（特别是在非常年轻的患者中）应与精心进行的随访相结合。
