Vancraeynest Eveline, Moerman Philippe, Leunen Karin, Amant Frédéric, Neven Patrick, Vergote Ignace
Departments of *Gynecologic Oncology, and †Pathology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Int J Gynecol Cancer. 2016 Oct;26(8):1399-406. doi: 10.1097/IGC.0000000000000782.
This study aimed to determine the overall survival (OS) and progression-free interval and the influence of fertility-preserving surgery (FPS) versus radical surgery (RS) in patients with serous borderline ovarian tumor (BOT).
Clinical parameters of patients with serous BOT treated between 1993 and 2013 in one institution were retrospectively investigated. All tumors were examined by one pathologist with experience in gynecological pathology.
One hundred thirty-two patients with serous BOT (inclusive 16 microinvasive) were analyzed (45% were ≤40 years), with a median follow-up of 6 years. Thirty-two percent (42/132) of the patients received FPS; 14% (18/132) relapsed (invasive or borderline). The 5-year progression-free survival was 89%. The risk of recurrence was higher in patients 40 years or younger (P = 0.019), after FPS (P = 0.002), in patients with a higher International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.016), for bilateral BOT (P = 0.0132), and for the micropapillary variant (P = 0.067). The OS at 5 years was 97%. There was no statistically significant difference in OS between FPS and RS [all (6 of 90) patients, except for 1, with RS died]. One patient died of relapsed BOT. Among the recurrences, low-grade invasive carcinoma was diagnosed in 4 patients. Three of these 4 patients were originally operated radically, 2 had a micropapillary variant FIGO stage III, and 1 had a papillary pattern FIGO stage II with microinvasion; all 3 had noninvasive implants and are alive. One patient with a micropapillary variant, FIGO stage IIIC with microinvasion and invasive implants, received FPS and died of disease.
The risk of recurrence is higher after FPS compared with RS; however, no influence on OS was observed. This was because most of the patients relapsed as BOT. Fertility preservation is justified in young patients with serous borderline tumors.
本研究旨在确定浆液性交界性卵巢肿瘤（BOT）患者的总生存期（OS）和无进展生存期，以及保留生育功能手术（FPS）与根治性手术（RS）的影响。
回顾性研究1993年至2013年在一家机构接受治疗的浆液性BOT患者的临床参数。所有肿瘤均由一位有妇科病理学经验的病理学家检查。
分析了132例浆液性BOT患者（包括16例微浸润患者）（45%年龄≤40岁），中位随访时间为6年。32%（42/132）的患者接受了FPS；14%（18/132）复发（浸润性或交界性）。5年无进展生存率为89%。40岁及以下患者（P = 0.019）、接受FPS后（P = 0.002）、国际妇产科联盟（FIGO）分期较高的患者（P = 0.016）、双侧BOT患者（P = 0.0132）以及微乳头亚型患者（P = 0.067）复发风险更高。5年OS率为97%。FPS与RS之间的OS无统计学显著差异[所有（90例中的6例）患者，除1例RS患者死亡外]。1例患者死于复发性BOT。在复发患者中，4例被诊断为低级别浸润性癌。这4例患者中的3例最初接受了根治性手术，2例为微乳头亚型FIGO III期，1例为乳头型FIGO II期伴微浸润；所有3例均有非浸润性种植灶且存活。1例微乳头亚型、FIGO IIIC期伴微浸润和浸润性种植灶的患者接受了FPS并死于疾病。
与RS相比，FPS后复发风险更高；然而，未观察到对OS有影响。这是因为大多数患者复发为BOT。对于年轻的浆液性交界性肿瘤患者，保留生育功能是合理的。
