Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy; Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy.
Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy; Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy.
Eur J Cancer. 2019 Apr;111:61-68. doi: 10.1016/j.ejca.2019.01.021. Epub 2019 Feb 28.
Even if borderline ovarian tumours (BOTs) in young women treated with fertility-sparing treatment (FST) have an excellent outcome, the type of surgery might affect relapse and fertility. We investigated the effect of surgical approach (open surgery vs. laparoscopy) and type of surgery (salpingo-oophorectomy [SO] vs. cystectomy [Cy]) on oncologic and fertility outcomes in patients with BOT.
Patients with BOT treated at San Gerardo Hospital, Monza, with FST in 1978-2013 period were included. Cox models, stratified by decade of surgery, were used to investigate the association between time to first recurrence or conception and clinical factors.
Among 535 patients included, 271 underwent unilateral SO and 264 underwent Cy. Median follow-up was 13.5 years. Ten-year (10-yr) recurrence rate was 23% (95% confidence interval [CI]: 18-29%) for SO and 31% (95% CI: 24-38%) for Cy group (P = 0.10) in patients with unilateral tumour, whereas it was 62% (95% CI: 44-79%) and 72% (95% CI: 59-84%), respectively, (P = 0.35) in patients with bilateral tumour. Multivariable analysis showed no association between recurrence and surgical approach (P = 0.44), type of surgery (P = 0.06) and a negative association with advanced stage (hazard ratio [HR] = 3.18; 95% CI: 2.11-4.78; P < 0.001) and bilateral tumours (HR = 2.48; 95% CI: 1.78-3.47; P < 0.001). Among 252 patients (47.1%) with pregnancy desire, multivariable analysis showed no association between conception success and the type of surgery, surgical approach, histology and tumour laterality. Fertility after surgery was positively associated with prior pregnancy (HR = 1.68; 95% CI: 1.17-2.41; P = 0.005) and negatively associated with the number of surgical procedures (HR = 0.62; 95% CI: 0.53-0.73; P < 0.001).
The type of surgical procedures did not influence recurrence rate or fertility. However, additional surgical procedures decreased the fertility potential. These data can support clinicians in tailoring the best strategy for FST in young patients with BOT.
即使对接受保留生育功能治疗（FST）的年轻女性的交界性卵巢肿瘤（BOT）进行治疗，其预后也非常好，但手术类型可能会影响复发和生育能力。我们研究了手术方式（开腹手术与腹腔镜手术）和手术类型（输卵管卵巢切除术[SO]与囊肿切除术[Cy]）对 BOT 患者的肿瘤学和生育结局的影响。
纳入了 1978 年至 2013 年期间在圣杰尔达医院（意大利蒙扎）接受 FST 治疗的 BOT 患者。使用 Cox 模型，按手术年代分层，以调查首次复发或妊娠与临床因素之间的关联。
在纳入的 535 例患者中，271 例行单侧 SO，264 例行 Cy。中位随访时间为 13.5 年。单侧肿瘤患者的 10 年（10-yr）复发率为 23%（95%可信区间[CI]：18-29%），Cy 组为 31%（95% CI：24-38%）（P=0.10），而双侧肿瘤患者分别为 62%（95% CI：44-79%）和 72%（95% CI：59-84%）（P=0.35）。多变量分析显示，复发与手术方式（P=0.44）和手术类型（P=0.06）无关，与晚期疾病（风险比[HR]为 3.18；95%CI：2.11-4.78；P<0.001）和双侧肿瘤（HR 为 2.48；95%CI：1.78-3.47；P<0.001）呈负相关。在 252 例（47.1%）有妊娠愿望的患者中，多变量分析显示妊娠成功率与手术类型、手术方式、组织学和肿瘤侧别之间无关联。术后生育能力与既往妊娠呈正相关（HR 为 1.68；95%CI：1.17-2.41；P=0.005），与手术次数呈负相关（HR 为 0.62；95%CI：0.53-0.73；P<0.001）。
手术类型并不影响复发率或生育能力。然而，额外的手术程序会降低生育能力。这些数据可以为临床医生为接受 FST 的年轻 BOT 患者制定最佳治疗策略提供支持。
