Department of Gynecologic Surgery; Unit INSERM U10-30, Villejuif.
Department of Gynecologic Surgery.
Ann Oncol. 2014 Jul;25(7):1312-1319. doi: 10.1093/annonc/mdu139. Epub 2014 Apr 8.
The overall prognosis of stage I borderline ovarian tumors (BOT) is excellent but a small percentage of patients die to their disease. The prognostic factors for such a rare event are still not clearly defined. The aim of this study was to determine these factors for recurrence per se and recurrence in the form of invasive carcinoma in a large series of stage I tumors.
A retrospective review of patients with BOT. Three inclusion criteria were defined: (i) a centralized histological review; (ii) macroscopic stage I tumors; (iii) exclusion of metastatic disease to the ovaries.
From 2000 to 2010, 254 patients fulfilled inclusion criteria [140 had mucinous BOT (MBOT) and 114 a serous BOT (SBOT)], and 191 had undergone conservative management. After a median follow-up of 45 months, 43 patients had developed recurrences (31 borderline and 12 invasive). The risks of recurrences were statistically increased after conservative treatment, particularly after a cystectomy, in patients with stage IB and among patients with incompletely staged tumors. In the subgroup of conservatively treated patients (representing 75% of our population), the risks of recurrences were statistically increased in patients affected by a SBOT, in patients who had undergone a cystectomy, in patients with stage IB disease and in patients with a micropapillary pattern (MPP). MBOT and the presence of a MPP were identified as prognostic factors for invasive disease.
In the present series of BOT with the largest number of patients treated conservatively to date, the presence of a MPP and the mucinous subtype were associated with a higher rate of progression to carcinoma after conservative management. These important results suggest that MBOT belong to a 'high-risk' group likely to develop an invasive recurrence after fertility-sparing surgery in stage I BOT.
I 期交界性卵巢肿瘤（BOT）的总体预后良好，但仍有一小部分患者死于该疾病。对于这种罕见事件的预后因素仍未明确界定。本研究旨在确定 I 期肿瘤中较大系列肿瘤本身复发和以浸润性癌形式复发的这些因素。
对 BOT 患者进行回顾性分析。定义了三个纳入标准：（i）集中的组织学审查；（ii）宏观 I 期肿瘤；（iii）排除卵巢转移。
2000 年至 2010 年，254 名患者符合纳入标准[140 例黏液性 BOT（MBOT）和 114 例浆液性 BOT（SBOT）]，其中 191 例接受了保守治疗。中位随访 45 个月后，43 例患者出现复发（31 例交界性和 12 例浸润性）。保守治疗后，特别是在接受囊肿切除术的患者、IB 期患者和未完全分期的肿瘤患者中，复发的风险统计学上增加。在保守治疗的患者亚组（占我们人群的 75%）中，SBOT 患者、接受囊肿切除术的患者、IB 期疾病患者和微乳头状模式（MPP）患者的复发风险统计学上增加。MBOT 和 MPP 的存在被确定为浸润性疾病的预后因素。
在目前最大数量的接受保守治疗的 BOT 系列中，MPP 的存在和黏液型是与保守治疗后向癌进展的更高风险相关的因素。这些重要结果表明，MBOT 属于“高危”组，在 I 期 BOT 中保留生育功能的手术后可能会发生浸润性复发。
