| Objective:The factors affecting the prognosis of these patients were analyzed by comparing the clinical characteristics of ovarian cancer(OC)and borderline ovarian tumors(BOT)undergoing fertility-sparing surgery(FSS),and the influence of FSS on pregnancy outcome was evaluated,so as to further explore the safety and feasibility of fertility conservation surgery.Methods:The clinical characteristics of patients and their survival,recurrence and reproductive outcomes with OC or BOT under the age of 45 who received FSS in Fujian Provincial Maternity and Children’s Hospital from January 2012 to December2018 were retrospectively collected and analyzed.The collected data were grouped according to the following conditions:(1)According to histological types,the data were divided into two groups: OC group and BOT group;(2)According to the prognosis situation of recurrence or not,they were divided into two groups:recurrence group and non-recurrence group;(3)According to the surgical approach,they were divided into two groups: open group and laparoscopic group;(4)According to the outcome of pregnancy,they were divided into two groups: pregnant group and non-pregnant group.The clinical data of the above groups were statistically analyzed by SPSS 25.0 software,univariate and multivariate analysis,P<0.05 was considered statistically significant.Results:1.A total of 93 patients with BOT or OC receiving FSS were included in this study,with an average age of 27.53±7.89 years old(5-45 years old).There were 33cases(35.5%)in OC group and 60 cases(64.5%)in BOT group.The OC group included 5 cases(5.4%)of epithelial ovarian cancer,18 cases(19.4%)of malignant ovarian germ cell tumor,and 10 cases(10.8%)of malignant sex cord-stromal tumor,most of whom had early stages,and the first symptoms were mostly found in physical examination and abdominal pain.Univariate analysis showed that age,body mass index(BMI),the proportion of complicating with other gynecological diseases in OC group was slightly lower than that in BOT group,and the tumors in OC group were mostly located on the left side,while those in BOT group were mostly located on the right side,the difference was statistically significant(P<0.05).Elevated AFP indicated the more possibility of malignant germ cell tumor(P<0.05).2.The median follow-up time in this study was 53.0(39.0-70.5)months,and all patients followed up survived.In this study,there were 9 patients(9.7%)with recurrence duration ranging from 4 to 60 months.Patients with CA125>500 U/ml,elevated CA153,concurrent appendectomy,and tumor cells found in ascites/peritoneal lavage had a poor prognosis(P<0.05).Multivariate analysis suggested that appendectomy was an independent risk factor for recurrence.The patients were further divided into mucinous and non-mucinous subgroups according to the presence or absence of mucinous components in histology.Only in the non-mucinous group,the recurrence rate of patients with appendectomy was higher than that of patients without appendectomy(P<0.05),and there was no significant correlation between appendectomy and recurrence in the mucinous group(P>0.05).However,there was no significant correlation between histological type,FIGO staging,surgical approach,tumor rupture,postoperative chemotherapy or not.3.Compared with the open surgery group,laparoscopic surgery group significantly shortened the operation time,postoperative exhaust time and length of hospital stay,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the intraoperative tumor rupture,blood loss and postoperative complications between the two group(P>0.05).4.There were 39 patients who had fertility requirements and 26 patients had successful conception.The conception rate was 66.7%.The number of pregnancies was 33 times,the natural conception rate was 93.9%,the successful pregnancy rate was 84.8%,the abortion rate was 15.2%,and all the offspring were alive and develop well.In addition,the infertility patients accounted for 15.4%.The results showed that the proportion of patients with early stage and without adjuvant chemotherapy was higher in the pregnant group than in the non-pregnant group(P<0.05).Conclusions:1.Young patients with OC and BOT undergoing FSS have various histological types,atypical symptoms,and the preoperative diagnosis is difficult.However,increased AFP has a great reference value for MOGCT diagnosis.2.Although a small number of patients recurred,the survival prognosis was good,and appendectomy was an independent risk factor for recurrence in patients with non-mucinous ovarian tumor.3.Compared with open surgery,laparoscopic surgery significantly shortened the operative time,postoperative exhaust time and hospitalization time.It indicates that laparoscopic surgery has more advantages in postoperative recovery.4.The postoperative pregnancy rate of the patients undergoing fertility conservation surgery was 66.7%,but postoperative adjuvant chemotherapy will reduce their pregnancy rate.5.Therefore,it can be considered that FSS is safe and feasible for young patients with fertility requirements diagnosed with EOC in early stage,MOGCT,OSCST and BOT. |
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