The Clinical Features And Prognostic Factors Of Borderline Ovarian Tumors

BackgroundBorderline ovarian tumors (BOTs) also known as low malignant potential ovarian (LMP), is a primary epithelial ovarian tumors, compared to benign ovarian tumors and early stage epithelial ovarian cancer(EOC), its cytologic features is malignancy, but without a direct violation, can occur, Metastasis, recurrence, or even lead to death, but its the overall prognosis is better. In1973,Borderline ovarian tumors was included in the classification of ovarian tumors by International Federation of Gynecolog and Obsterics (FIGO), making it an independent clinical and pathological types of ovarian tumors. The histological and clinical manifestations of LMP are between benign and malignant, accounting for between10%-20%of epithelial ovarian tumors, serous borderline tumor (S-BOT) and mucinous borderline tumors are common.On LMP pathology and treatment, In particular, whether to retain reproductive function and to apply adjuvant chemotherapy, recurrence and prognosis is still the focus of attention in the present study. Borderline ovarian tumor prognostic factors literature is mixed. Age, menstruation, oral contraceptives, pregnancy situation, surgical procedures and histological type of tumor recurrence are all prognosis factors, comprehensive surgical staging can improve disease free survival rate of patients. LMP is a low malignant potential tumors, early detection and early treatment as well as standard surgery can achieve good therapeutic purposes. Most ovarian tumors are lack of specific clinical manifestations, early majority have no symptoms, usually finding in routine physical examination or ultrasound examination. Although the LMP is a rare, but because of its predilection for the child-bearing age, the existence of recurrence and the possibility of malignancy, it can’t give radical treatment as ovarian cancer and simple treatment as benign tumors. Some scholars have pointed that borderline tumors was divided into partial benign and partial vicious, so the study of the LMP is significance.For LMP patients, there are a lot of confusion on clinical diagnosis and treatment, mainly in the following points:1. the preoperative diagnosis. clinical signs and laboratory examinations for LMP have no typical characteristics, resulting difficulties in clinical diagnosis and choicing the surgical approach. Through patient history, physical examination, laboratory examinations, a preliminary judgment of its nature, whether could guide clinical treatment?2. Although laparoscopic surgery has been widely used in gynecological treatment, but for the LMP patients, whether laparoscopy is the best option?3. Which factors are the risk factors for LMP patients with? Which patients are adapt to chemotherapy?In this study, in order to provide the basis for the clinical diagnosis and treatment of LMP, we combined with clinical data to explore the above problems.ObjectivesTo compare the clinical and pathological features of the LMP, benign ovarian tumors and, LMP in stage I for improving the diagnosis of LMP. To analyse the adaptation of the different surgical conditions is based on studying LMP several surgical methods, and we collected and analyzed the LMP prognostic factors, in further to explore the value of chemotherapy for the risk factors.MethodsLMP patients were treated from2000to2011in the Affiliated Provincial Hospital of Anhui Medical University and the Lu’an People’s Hospital for a total of133cases. according to the WHO on the diagnostic criteria was proved to be LMP. During the same period,78cases of hospitalized EOC patients in stage I were selected as a comparison. This study compares the LMP and EOC between age of onset, marriage, family history, B ultrasonic characteristics, CA125, CA199, and histological types of differences, and analyzes the various factors of LMP. The data were analyzed using statistical software SPSS17.0.Results1. The preoperative characteristics:1) Benign, LMP are younger than the EOC (P <0.05), and the age of the average prevalence is ten years later than the EOC.2) The EOC group of menopausal history and family history was significantly higher than the benign and the LMP group (P<0.05) difference was statistically significant.3) Ultrasound examination showed that benign ovarian tumors have rare nipple and parenchyma, and the size of tumors is smaller, there is a significant difference (P <0.05), the nipple and paid area of EOC group is more common than the LMP group. And resistance index from high to low.4) Three groups of tumor markers are from low to high, and tumor markers of benign and borderline tumors is difference (P<0.05), while there is no significant differences in borderline and ovarian cancer group.2.1)The recurrence rate of Laparoscopic is higher than laparotomy in LMP group, the difference is statistically significant (X2=4.857, P=0.028). The recurrence rate of tumor diameter>5cm and the above I c stage is higher than the tumor diameter<5cm and below I c stage(P<0.05).2) The recurrence rate of cystectomy (27.3%) is higher than oophorectomy (17.4%) and radical surgery (4.5%)(P <0.05).Conservative surgery patients have younger age, earlier stages, higher adjuvant chemotherapy than radical surgery (P<0.05).3) The recurrence rate of not comprehensive staging surgery is higher than the comprehensive surgical staging (P <0.05). 3.1) Tumor progression-free survival (PFS) rate of FIGO Ⅰ, Ⅱ and Ⅲ were95.1%,75.0%,68.2%,with a statistically significant difference (P<0.05). Microinvasion and no-microinvasion5-year PFS was63.2%,93.5%, the difference was also statistically significant.2) The prognostic factors of LMP5-year tumor progression-free survival (PFS) were analyzed by univariate and logistic regression statistical analysis, the results were showed:initial surgery (conservative, radical surgery), FIGO stage, microinvasion, peritoneal, residuallesions, surgical approach (laparotomy, laparoscopy) were the factors of the LMP,with statistically significant (P<0.05, OR values within the confidence interval).3) On chemotherapy for risk factors, the rate is lower than the non-chemotherapy group (P<0.05).Conclusion1. The prevalence of younger age, elevated tumor markers, transvaginal ultrasound ovarian cystic mass within the papillae, solid areas or dense atrial septum, the room septal thickening should be alert to the potential for ovarianmalignant tumors, such as the Joint Doppler flow spectrum detection of tumor resistance index<0.05, contribute to the preoperative diagnosis.2. Younger and want to preserve fertility in patients with the line to preserve fertility in surgical staging. When the installments below I c of the tumor is less than5cm in diameter, you can consider laparoscopic surgery.3. Microinvasion, and peritoneal seeding and residual disease, laparoscopic surgery, Ⅱ of above, there is no comprehensive staging for ovarian low malignant tumor prognostic factors, response in patients with close follow-up, conditions were given chemotherapy.