Clinical Analysis Of Pregnancy Outcome And Prognosis Of Different Fertility Preserving Operations For Borderline Ovarian Tumors

Objective: To retrospectively analyze the different fertility-sparing surgery for patients with borderline ovarian tumors,and study their effects on pregnancy outcome and prognosis,to provide guidance and help clinical workers to choose treatment plans.Methods: The clinical data of 325 patients with borderline ovarian tumors who underwent fertility-sparing surgery at Shengjing Hospital of China Medical University from 2015 to 2021 were collected.The basic personal information,preoperative ultrasound,MRI and CT imaging characteristics,ovarian tumor markers,intraoperative findings,surgical methods,surgical approaches,frozen and paraffin pathology,surgical pathological staging,and other information of the patients included in the study were collected and summarized through the inpatient medical record system.Through telephone follow-up and records of outpatient and inpatient medical records systems,the patient’s pregnancy intention,pregnancy outcome,and whether there is recurrence after surgery were collected.The deadline for follow-up was July 2022.After checking and sorting out the data,SPSS25.0 software was used for statistical analysis.A P-value of less than 0.05 was considered to be statistically significant.Results: Among 325 borderline ovarian tumor patients undergoing fertility-sparing surgery,118 patients had fertility desire.The postoperative pregnancy rate was 57.63%(68/118),the natural pregnancy rate was 83.82%(57/68),and the assisted reproduction rate was 16.18%(11/68).Univariate analysis showed that the choice of surgical methods and approaches and whether preoperative CA125 was within the normal range affected the pregnancy outcome,with significant differences(P<0.05).The pregnancy rate after cystectomy was 69.57%(32/46),the pregnancy rate after unilateral salpingo-oophorectomy was 70.83%(17/24),the pregnancy rate after unilateral salpingo-oophorectomy +contralateral oophorectomy/cystectomy was 44.00%(11/25),and the pregnancy rate after fertility-sparing staging surgery was 34.78%(8/23).There was a statistical difference between cystectomy and the stage operation with fertility preservation(P<0.0083).The variables P<0.10 in univariate analysis: surgical method,surgical approach and serum CA125 were included in the logistic regression analysis.The results showed that the surgical method affected the pregnancy outcome,and the difference was statistically significant(P<0.05).The preoperative imaging features and tumor markers were not specific,and most of them were initially diagnosed by intraoperative frozen pathology.The coincidence rate of frozen pathology and paraffin pathology is different in different histological types,and the difference was statistically significant(P<0.05).Univariate analysis showed that FIGO stage,tumor laterality,micropapillary architecture,ascites,and implant factors had significant effects on recurrence(P<0.05).Micropapillary architecture is an independent risk factor for the recurrence of BOT patients and the risk of recurrence with micropapillary architecture is 4.908 times by multivariate logistic regression analysis.Conclusion: The clinical manifestations and assistant examinations of patients with borderline ovarian tumors are not specific.The pregnancy rate after cystectomy was better than that of stage operation with fertility preservation.The pregnancy rate after laparoscopy was better than that after laparotomy.FIGO stage,tumor laterality,micropapillary subtype,ascites,and implantation affect recurrence.The micropapillary architecture is an independent risk factor for recurrence of BOT patients.Micropapillary architecture is an independent risk factor for recurrence of borderline ovarian tumors.