孕期交界性卵巢肿瘤的管理：一项法国多中心研究的结果

Management of borderline ovarian tumours during pregnancy: Results of a French multi-centre study.

作者信息

Zilliox M, Lecointre L, Azais H, Ballester M, Bendifallah S, Bolze P A, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Lavoue V, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C, Lapointe M, Akladios C

机构信息

Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France.

Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France; I-Cube UMR 7357 Science Laboratory, Strasbourg, France; IHU: Institute for Minimally Invasive Hybrid Image Guided Surgery, Strasbourg, France.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:412-418. doi: 10.1016/j.ejogrb.2020.11.033. Epub 2020 Nov 13.

DOI:10.1016/j.ejogrb.2020.11.033

PMID:33296755

Abstract

OBJECTIVE

To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices.

MATERIALS AND METHODS

A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility.

RESULTS

The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population.

CONCLUSION

BOTs remain rare, but this study - despite its small sample size - supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.

摘要

目的

评估孕期发现的卵巢交界性肿瘤（BOTs）的诊断和预后特征，并建立法国相关诊疗实践的清单。

材料与方法

对2005年至2017年间在法国五个盆腔肿瘤学专家中心接受治疗的14例孕期诊断为BOTs的患者进行回顾性多中心病例研究，包括临床特征、肿瘤组织学特征、手术过程、辅助治疗、随访和生育情况等数据。

结果

患者的平均年龄为29.3岁[标准差（SD）6.2]。大多数BOTs在孕早期通过超声诊断（85.7%），其中大多数病例（78.5%）还接受了磁共振成像以确诊（真阳性率54.5%）。大多数患者在孕期接受了手术（57%），两例进行了全面分期手术（14.3%）。腹腔镜手术比其他手术更常进行（50%），单侧附件切除术比囊肿切除术更常见（57.5%）。肿瘤大小对手术方式有显著影响（腹腔镜手术的平均大小为7.5 cm，中转开腹为11.9 cm，初次开腹为14 cm；P = 0.08），但切除类型无影响。大多数患者最初诊断为国际妇产科联盟IA期（92.8%）肿瘤，但许多患者在全面分期手术后分期上调（57.1%）。大多数BOTs为浆液性（50%），两例有微乳头成分（28.5%），一例有微浸润种植。两例BOTs为双侧性（14.2%）。平均随访时间为31.4（SD 14.8）个月。两名患者出现复发病变（14.2%），研究人群中至今无死亡记录。