The Clinical Analysis Of Borderline Ovarian Epithelial Tumors In 62 Cases.

Object:Exploring the clinical pathologic features, management and prognosis of borderline ovarian epithelial tumors.Methods: By retrospective investigating, the clinical data of 62 patients with borderline ovarian epithelial neoplasm tumors who had operation in our hospital in last 11 years display below:(1) the main clinical pathologic features include: chief complaint and main symptoms, hypersound display the feature of ovarian tumors, serological examination before operation;(2) exploring the tumors and abdominopelvic cavity during the operation, frozen section pathological results in the operation; (3) treatments (conservative surgery or radical surgery), pathology results after operation; (4) the follow-up therapy (second surgery, chemotherapy after surgery, etc), recurrence and metastasis.Results: The age of patients are 18-81, average age are 39.8 years old. 24 patients were serous borderline ovarian tumor (38.7%); 21 patients were mucious borderline ovarian tumor (33.9%), 15 patients were seromucous borderline ovarian tumors (24.1%), two cases were special type tumors (3.2%). 18 cases were abdominal bulge or abdominal mass, which is the common symptom of borderline ovarian tumors, 16 cases were abdominal pain feature, 14 cases were abdominal distension,9 cases were found by health examination, 5 cases were vaginal bleeding and urinary system symptoms. In the 62 cases of BOT patients, 45 patients did CA125 inspection before the operation, 15 cases did CA199 inspection, 23 cases did CEA inspection. 32 cases had the positive result of CAl25 (71.1%), 5 cases had the positive result of CAl99 (33.3%), 2 cases had the positive result of CEA (8.7%). 94.4% patients who had the serous borderline ovarian tumor, 52.9% patients who had mucious borderline ovarian tumor and 62.5% patients who had seromucous borderline ovarian tumors had the positive result of CAl25. 62.9% (22/35) patients of phaseⅠand 90% (9/10) of phaseⅢhad the positive result of CAl25.The tumors stage were later, the positive result of CAl25 was higher. In the first operation, the size of the tumors were 5.0-40cm, average size was 18.5cm. Involvement ovarian side: 21 cases occur in the left ovarian, 22 cases occur in the right ovarian, and 19 cases occur in the both ovarian.The ovarian tumors affiliate ascites occur in 5 cases, 15 patients did cytological examination of ascites or rinse solution. 5 cases found tumor cells. During the operation, 57 cases did quick frozen pathological inspectors, 5 cases do not, 45 cases had the same result with postoperative pathological inspectors, which accuracy rating was 78.9%. The clinical stages: 50 cases were phaseⅠ(80.6%), 2 cases were phaseⅡ(3.2%), 10 cases were phaseⅢ(16.1%). The most important treatment of the ovarian borderline tumors was surgery. During the 62 patients, 14 cases had the standard management of epithelial ovarian cancer, 3 cases had the tumer primary cytoeductive surgery. 45 cases had conservative surgery. 10 cases had pelvic lymph node dissection. One of them had the positive result of lymph nodes, (inguinal lymph nodes). 11 patients(including 8 cases of phaseⅠand 3 cases of phaseⅢ)followed by adjuvant chemotherapy.adjuvant chemotherapy regimens for time span was quite different.There was a single drug like cisplatin, combination chemotherapy like cyclophosphamide+carboplatin and paclitaxel plus carboplatin.Rules in the use of drugs contained cunning intra-abdominal medication during the operation,systemic intravenous chemotherapy after operation and intra-abdominal medication after operation.Course of chemotherapy treatment was 1～11 month. The disease free survival in phaseⅠpatients that did chemotherapy was 87.5%. The disease free survival in phaseⅠpatients that did not do chemotherapy was 91.7%, both of them did not have statistical significance (P = 0.44). By statistical analysis, between different pathological types whether taked chemotherapy were not statistically significant. The disease-free survival rate of the patients who taked the conservative surgery did chemotherapy and no chemotherapy was 85.7% and 95% (P = 0.46). 44 patients were follow-up in 62 cases and 18 cases were lost, 44 patients'follow-up times were 2 months-84 months. 37 cases were disease-free survival. Patients in our group were followed up shorter, so all follow-up patients were survived in five years and seven years, no one deaths.During follow-up period, 4 patients of recurrence gone to surgery, and two of them were phaseⅠ,two of them were phaseⅢ. 3 cases of phaseⅢnow lived with tumor. Disease-free survival of tumor occured in unilateral ovarian was 96.9%, occured in bilateral ovarian was 58.3%, so the difference had statistical significance (P=0.02). According to the phaseⅠ, disease-free survival for patients was 93.8%, 100% in phaseⅡand 50% in phaseⅢ. The difference had statistically significance (P=0.006). Disease-free survival of cystectomy in phaseⅠwas 60% (3/5), and disease-free of salpingo-oophorectomysurvival rate was 100% (17/17), the difference had statistically significance (P=0.04). 3 patients did laparoscopic surgery, and now all are disease-free survival.Conclusion: the disease incidence in serous borderline ovarian tumor is higher than in mucious borderline ovarian tumor; quick frozen pathological inspectors have high accuracy in diagnosing ovarian tumor that has great value to gynecologist; the most common treatment of ovarian borderline tumor is surgical treatment; during the young or having fertility requirements of early ovarian borderline tumour patients, conservative surgery is effective and feasible; adjuvant chemotherapy are failed to improve prognosis in phaseⅠor no tumor residues; The patients of ovarian borderline tumors with late clinical stages have lower disease-free survival of tumor, and patients that tumor in bilateral side have lower disease-free survival of tumor than that in unilateral side, but overall survival is not affected.