Helpman Limor, Yaniv Assaf, Beiner Mario E, Aviel-Ronen Sarit, Perri Tamar, Ben-Baruch Gilad, Hogen Ben-David Liat, Jakobson-Setton Ariella, Korach Jacob
Sheba Medical Center, Tel Hashomer, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Acta Obstet Gynecol Scand. 2017 Nov;96(11):1300-1306. doi: 10.1111/aogs.13203. Epub 2017 Sep 21.
Borderline ovarian tumors are typically indolent neoplasms. Since many are diagnosed in younger women, fertility conservation is an important consideration and has been advocated based on retrospective data. The objective of this study was to identify features impacting on recurrence and survival in a series of borderline ovarian tumors, and to assess the safety of a fertility-sparing approach.
A historical cohort study of consecutive borderline ovarian tumors cases treated at a single institution over 30 years (1981-2011). Data on surgical approach (fertility-sparing or otherwise), disease stage, CA125 levels, histological features, adjuvant treatment and follow-up data were collected. Recurrence and survival were assessed using the Kaplan-Meier method and associations with the variables of interest were evaluated using a multivariate Cox proportional hazards model.
213 patients were included. Of 132 women age 40 years and below at diagnosis, 112 (85%) had a fertility-sparing procedure and 60 (46%) had conservation of an involved ovary. Fifty patients (24%) developed recurrences; fertility preservation (hazard ratio = 2.57; 95% confidence interval 1.1-6; p = 0.029) and advanced stage (hazard ratio = 4.15; 95% confidence interval 2.3-7.6; p < 0.001) were independently associated with recurrence on multivariate analysis. Eleven (5%) patients died of their disease. Fertility preservation was not associated with compromised survival.
Borderline ovarian tumors carry a good prognosis overall. Fertility preservation is associated with a higher risk of disease relapse; however, as most relapses are localized and may be salvaged with surgical treatment, overall survival is not compromised.
卵巢交界性肿瘤通常是惰性肿瘤。由于许多患者在年轻女性中被诊断出来，保留生育功能是一个重要的考虑因素，并且基于回顾性数据得到了提倡。本研究的目的是确定一系列卵巢交界性肿瘤中影响复发和生存的特征，并评估保留生育功能方法的安全性。
对一家机构在30年（1981 - 2011年）期间连续治疗的卵巢交界性肿瘤病例进行历史性队列研究。收集了手术方式（是否保留生育功能）、疾病分期、CA125水平、组织学特征、辅助治疗及随访数据。使用Kaplan-Meier方法评估复发和生存情况，并使用多变量Cox比例风险模型评估与感兴趣变量的关联。
纳入213例患者。在诊断时年龄40岁及以下的132名女性中，112例（85%）接受了保留生育功能的手术，60例（46%）保留了受累卵巢。50例（24%）出现复发；多变量分析显示，保留生育功能（风险比 = 2.57；95%置信区间1.1 - 6；p = 0.029）和晚期（风险比 = 4.15；95%置信区间2.3 - 7.6；p < 0.001）与复发独立相关。11例（5%）患者死于该疾病。保留生育功能与生存受损无关。
卵巢交界性肿瘤总体预后良好。保留生育功能与疾病复发风险较高相关；然而，由于大多数复发是局部性的，且可通过手术治疗挽救，因此总体生存不受影响。
