Hôpital de Poissy-St Germain, Poissy, France; Université Versailles-St Quentin en Yvelines, France.
Institut Curie, St Cloud, France.
Gynecol Oncol. 2020 Apr;157(1):29-35. doi: 10.1016/j.ygyno.2019.12.046.
Description of fertility and prognosis of patients with borderline ovarian tumor (BOT) treated by fertility-sparing surgery through a longitudinal study from the French national cancer network.
All consecutive patients diagnosed with BOT from the French National Network dedicated to Ovarian Malignant Rare Tumors from 2010 and 2017 were selected. In 2018, an update was made by sending a questionnaire regarding recurrence and fertility to patients aged under 43 years at diagnosis and treated conservatively. We compared the characteristics of the patients with/without recurrence and with/without live birth.
Fifty-two patients aged 18 to 42 years presented a desire of pregnancy. Thirty patients (58%) presented a FIGO IA tumor, and 20 patients were treated by bilateral cystectomies (38%). We observed at least one live birth for 33 patients (63%) and local recurrences in 20 patients (38%). Both recurrence and live birth in 17 patients (33%) were reported, with recurrence occurring before pregnancy, after a second fertility-sparing treatment, in half of the cases. No factors associated with recurrence or live birth in this study were identified. Moreover, in this population, both recurrence and live birth were independent of age, with a linear risk along time. Disease-free survival was worse for patients treated with bilateral cystectomy (n = 20, 38%), with no difference in terms of fertility.
Two third of the patients experienced life birth after conservation surgery. We did not highlight an age/time from surgery for which the risk of recurrence outweighs the chance of pregnancy and to radicalize surgery. Moreover, almost a quarter of the live birth occurred after recurrence, with no more further event to date in these patients. The results encourage to consider a second fertility-sparing surgery after local borderline recurrence in the case of pregnancy desire. All these decisions must be discussed in specialized multidisciplinary boards.
通过法国国家癌症网络的纵向研究，描述行保留生育功能手术的交界性卵巢肿瘤（BOT）患者的生育能力和预后。
从 2010 年至 2017 年，选择法国专门针对卵巢恶性罕见肿瘤的国家网络中诊断为 BOT 的所有连续患者。2018 年，通过向诊断时年龄小于 43 岁且接受保守治疗的患者发送有关复发和生育能力的问卷进行了更新。我们比较了有/无复发和有/无活产的患者的特征。
52 名 18 至 42 岁的患者有生育要求。30 名患者（58％）为 FIGO IA 肿瘤，20 名患者接受双侧卵巢囊肿切除术（38％）。我们观察到 33 名患者（63％）至少有一次活产，20 名患者（38％）有局部复发。17 名患者（33％）报告了复发和活产，其中一半患者在妊娠前、第二次生育保留治疗后发生了复发。在这项研究中，未发现与复发或活产相关的因素。此外，在该人群中，复发和活产均与年龄无关，随着时间的推移呈线性风险。接受双侧卵巢囊肿切除术（n=20，38％）的患者无疾病生存状况较差，但在生育能力方面无差异。
行保留生育功能手术后，三分之二的患者实现了生育。我们没有强调手术时的年龄/时间，因为复发的风险超过了妊娠的机会并使手术激进化。此外，近四分之一的活产发生在复发后，这些患者目前尚无进一步的事件。这些结果鼓励在有生育要求的情况下，在局部交界性复发后考虑进行第二次生育保留手术。所有这些决定都必须在专门的多学科委员会中进行讨论。
