Department of Gynaecology and Gynaecologic Oncology.
Department of Gynaecology and Gynaecologic Oncology.
Ann Oncol. 2014 Jul;25(7):1320-1327. doi: 10.1093/annonc/mdu119. Epub 2014 Mar 11.
Approximately one-third of all borderline ovarian tumours (BOT) are diagnosed in patients with child-bearing potential. Detailed information regarding their specific characteristics and prognostic factors is limited.
Clinical parameters of BOT patients treated between 1998 and 2008 in 24 German centres were retrospectively investigated. Central pathology review and prospective follow-up were carried out. Patients <40 versus ≥40 years were analysed separately and then compared regarding clinico-pathological variables and prognosis.
A total of 950 BOT patients with a median age of 49.1 (14.1-91.5) years were analysed [280 patients <40 years (29.5%), 670 patients ≥40 years (70.5%)]. Fertility-preserving surgery was carried out in 53.2% (149 of 280) of patients <40 years with preservation of the primarily affected ovary in 32 of these 149 cases (21.5%). Recurrence was significantly more frequent in patients <40 years (19.0% versus 10.1% 5-year recurrence rate, P < 0.001), usually in ovarian tissue, whereas disease-specific overall survival did not differ between the subgroups. In case of recurrent disease, malignant transformation was less frequent in younger than in older patients (12.0% versus 66.7%, P < 0.001), mostly presenting as invasive peritoneal carcinomatosis. Multivariate analysis for patients <40 years identified advanced International Federation of Gynecology and Obstetrics (FIGO) stage and fertility-sparing approach as independent prognostic factors negatively affecting progression-free survival (PFS) while, for patients ≥40 years, higher FIGO stage and incomplete staging was associated with impaired PFS.
Despite favourable survival, young BOT patients with child-bearing potential are at higher risk for disease recurrence. However, relapses usually remain BOT in the preserved ovaries as opposed to older patients being at higher risk for malignant transformation in peritoneal or distant localisation. Therefore, fertility-sparing approach can be justified for younger patients after thorough consultation.
约三分之一的交界性卵巢肿瘤（BOT）发生在有生育潜能的患者中。关于其具体特征和预后因素的详细信息有限。
对 1998 年至 2008 年期间在 24 个德国中心接受治疗的 BOT 患者的临床参数进行回顾性研究。进行了中心病理复查和前瞻性随访。分别分析年龄<40 岁和年龄≥40 岁的患者，然后比较两组患者的临床病理变量和预后。
共分析了 950 例中位年龄为 49.1（14.1-91.5）岁的 BOT 患者[年龄<40 岁 280 例（29.5%），年龄≥40 岁 670 例（70.5%）]。<40 岁的患者中有 53.2%（149/280）接受了保留生育功能的手术，其中 32 例（149 例中的 32 例，21.5%）保留了原发受影响的卵巢。<40 岁的患者复发率明显更高（19.0%与 5 年复发率 10.1%，P<0.001），通常发生在卵巢组织中，而两组患者的疾病特异性总生存率无差异。在复发病例中，年轻患者恶性转化的比例低于年龄较大的患者（12.0%与 66.7%，P<0.001），主要表现为侵袭性腹膜癌病。<40 岁患者的多变量分析表明，国际妇产科联合会（FIGO）晚期分期和保留生育功能的方法是独立的预后因素，对无进展生存期（PFS）有负面影响，而对于年龄≥40 岁的患者，FIGO 分期较高和分期不完整与 PFS 受损相关。
尽管有良好的生存，但有生育潜能的年轻 BOT 患者疾病复发风险较高。然而，与年龄较大的患者相比，年轻患者保留的卵巢中复发通常仍为 BOT，而年龄较大的患者腹膜或远处转移部位发生恶性转化的风险更高。因此，在充分咨询后，可以为年轻患者提供保留生育功能的方法。
