Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, P. R. China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, P. R. China.
Hum Reprod. 2020 Feb 29;35(2):328-339. doi: 10.1093/humrep/dez307.
What are the oncofertility outcomes of young women (≤40 years old) with bilateral serous borderline ovarian tumors (SBOTs) after fertility-sparing surgery?
Fertility preservation with the bilateral ovarian cystectomy procedure is feasible for bilateral SBOTs, with an acceptable oncological outcome and worthwhile pregnancy rates.
Fertility-sparing approaches are becoming the standard management of young patients with unilateral SBOTs and other borderline histological subtypes. However, there is a paucity of evidence to dictate the best management in bilateral SBOTs.
STUDY DESIGN, SIZE, DURATION: This was a retrospective observational study performed at the Peking Union Medical College Hospital in Beijing, China, between January 1999 and January 2019.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Ninety-four women (≤40 years old) with pathologically confirmed bilateral SBOTs were included. Following preoperative counseling, patients self-selected into one of three treatment modalities: bilateral ovarian cystectomy (n = 48), unilateral adnexectomy plus contralateral cystectomy (UAC; n = 31), and radical surgery (n = 15). Univariate and multivariate analyses were used to determine the clinical and pathological features associated with disease-free survival and reproductive outcomes.
During the median follow-up of 64 months (range, 4-243 months), 61 patients (65%) developed relapse, including 3 (20%) in the radical group, 26 (84%) in the UAC group and 32 (67%) in the bilateral cystectomy group. In the multivariate analyses, preoperative CA-125>300 U/mL, fertility preservation and micropapillary pattern were independently associated with adverse disease-free survival (P = 0.001, 0.03 and 0.026, respectively). Fourteen patients (15%) experienced invasive recurrence, and three (3%) died of progressive disease. The micropapillary pattern was significantly associated with invasive evolution risk (P = 0.006). Of the 49 patients who attempted to conceive, 23 (47%) achieved 27 pregnancies (24 spontaneous and three after IVF-ET), resulting in 19 live births. There was no significant difference in disease-free survival (P = 0.13) or pregnancy rate (41 vs. 50%, P = 0.56) between the UAC and bilateral procedures.
LIMITATIONS, REASONS FOR CAUTION: As a retrospective study conducted in a referral center, inherent biases exist. The nonrandom allocation to treatment groups and relatively small number of patients attempt to conceive might limit the statistical power of our findings. Only 41 patients (43.6%) received complete staging during their initial surgeries, so an underestimation bias in terms of the FIGO stage and extraovarian implants might have occurred.
The ultraconservative bilateral ovarian cystectomy procedure should be proposed in bilateral SBOTs when technically feasible. Invasive evolution occurs frequently in these women, and intense follow-up and oncofertility counseling are warranted, especially for those with micropapillary patterns.
STUDY FUNDING/COMPETING INTEREST(S): No external funding was used for this study. There are no conflicts of interest to declare.
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年轻女性（≤40 岁）双侧浆液性交界性卵巢肿瘤（SBOT）行保留生育功能手术后的生育力结局如何？
对于双侧 SBOT，采用双侧卵巢囊肿切除术进行生育力保存是可行的，具有可接受的肿瘤学结局和有价值的妊娠率。
对于单侧 SBOT 和其他交界性组织学亚型的年轻患者，保留生育力的方法已成为标准治疗方法。然而，在双侧 SBOT 中，缺乏指导最佳治疗方法的证据。
研究设计、大小和持续时间：这是一项在中国北京协和医学院医院进行的回顾性观察性研究，时间为 1999 年 1 月至 2019 年 1 月。
参与者/材料、设置、方法：共纳入 94 名经病理证实为双侧 SBOT 的女性。在术前咨询后，患者自行选择以下三种治疗方式之一：双侧卵巢囊肿切除术（n=48）、单侧附件切除术加对侧囊肿切除术（UAC；n=31）和根治性手术（n=15）。采用单变量和多变量分析来确定与无病生存和生殖结局相关的临床和病理特征。
在中位随访 64 个月（范围 4-243 个月）期间，61 名患者（65%）复发，包括根治组 3 名（20%）、UAC 组 26 名（84%）和双侧囊肿切除术组 32 名（67%）。多变量分析显示，术前 CA-125>300 U/mL、生育力保存和微乳头状模式与不良无病生存独立相关（P=0.001、0.03 和 0.026）。14 名患者（15%）发生侵袭性复发，3 名（3%）因进行性疾病死亡。微乳头状模式与侵袭性演变风险显著相关（P=0.006）。在 49 名试图怀孕的患者中，23 名（47%）成功妊娠 27 次（24 次自然妊娠，3 次体外受精-胚胎移植），19 例活产。UAC 和双侧手术之间在无病生存率（P=0.13）或妊娠率（41%对 50%，P=0.56）方面无显著差异。
局限性、谨慎的原因：作为一项在转诊中心进行的回顾性研究，存在固有偏倚。治疗组的非随机分配和试图怀孕的患者数量相对较少可能限制了我们研究结果的统计效力。只有 41 名患者（43.6%）在初次手术时接受了完整分期，因此可能存在 FIGO 分期和卵巢外种植物低估的偏倚。
在技术可行的情况下，应在双侧 SBOT 中提出超保守的双侧卵巢囊肿切除术。这些女性中侵袭性演变经常发生，需要进行强烈的随访和生育力咨询，特别是对于那些具有微乳头状模式的患者。
研究资金/利益冲突：本研究无外部资金支持。不存在利益冲突。
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