| Objective:To summarize the clinical and pathological characteristics of borderline ovarian tumors and analysis the prognostic factors.Methods:The clinical data of 90 patients admitted to The First Affiliated Hospital Of Guangxi Medical University from January 2008 to December 2017 were collected and analyzed retrospectively.Wilcoxon rank sum test,chi-square test and Fischer exact probability method were used to analyze the characteristics of basic data of disease data.Chi-square test of R×C table and binary logistic regression analysis were used to analyze the related factors of tumor recurrence.Results:Serum CA125,CA199 and CEA were detected before operation.The results showed that the proportion of patients with elevated serum CA125,CA199 and CEA were 58.90%(53/90),28.90%(26/90)and 5.56%(5/90),respectively.A total of 61 patients(67.78%)underwent fertility-preserving surgery,including 36 cases with unilateral salpingo-oophorectomy(USO),18 cases with cystectomy(C),3 cases with bilateral cystectomy(BC)and 4 cases with USO+contralateral C(CC)while 11 cases received conservative surgery comprehensive surgical staging.A total of 28 patients(31.11%)underwent non-fertility-preserving surgery,of which 15 underwent comprehensive staged surgery.Operative approaches: laparoscopy in 19 cases and laparotomy in 71 cases.Postoperative chemotherapy: A total of 4 patients received adjuvant chemotherapy before and after surgery.The scheme was intravenous combined chemotherapy,mainly platinum.The total course of treatment was at least 2 times,up to 6 times.Median size of the tumors was 11(7,5)cm.SBOT's median size was 9(6.5,11.5)cm,while MBOT's was 13(10,18)cm.Tumor's median size of patients with BOT who received laparoscopic surgery or laparotomy was 10(7,11.5)cm and 12(8,17.75)cm respectively.74 cases(82.22%)were limited to unilateral ovary.16 cases(17.78%)were involved bilateral Ovary.Serous BOT was found in 41 cases(45.56%),of which 3 cases were micropapillary BOT.There were 49 cases of mucinous BOT(54.44%).There were 7 cases with microinvasion,2 cases with peritoneal infiltration,1 case with intraepithelial carcinogenesis,1 case with appendix metastasis and no lymph node involvement.Operative-pathological stages: stage I 77 cases,including IA 49 cases,IB 6 cases,IC 15 cases;stage II 6 cases,stage III 5 cases;stage IV 2 cases.The median interval between the first operation and the first recurrence was 12 months.19 cases(21.11%)patients had recurrence,1 cases was tumor-related death.10 cases were loss to follow-up.Median duration from surgery to recurrence was 12 months.Correlation factor of BOT were Subcutaneous ecchymosis,peritoneal implantation,micropapillosis,preservative operation of fertility.However,there were no effect on recurrent rate with the factor of micro-invasive carcinoma,comprehensive staging surgery,FIGO stages.Subcutaneous ecchymosis was an independent risk factor for BOT recurrence.Contraceptive measures were taken in 7 cases after operation.One case was lost to follow-up.Natural pregnancy was obtained in 20 cases after operation,the total pregnancy rate was 37.74%(20/53).Conclusion: Conservative surgery is feasible for young BOT patients with stage I FIGO.Among them,CC is suitable for BOT patients who desire preservation of fertility with only one adnexa or both ovaries involved.The rest of them are recommended with USO.Patients can be received surgery by laparoscope,especially for patients whose size of BOT lower than 10 cm.The recurrence rate of BOT was not affected by lymph node dissection.Young,early FIGO stage and fertility-preserving patients can not undergo lymphadenectomy or pelvic lymphadenectomy alone.Whether appendectomy is performed does not affect the recurrence rate after operation.If appendix appearance is normal during operation and the ovary tumor is not mucous,routine appendectomy is not necessary.Peritoneal infiltrative implantation is an independent risk factor after BOT.It affects the survival rate of patients after BOT.The greater omentum area is large,and the exploration of infiltrative implantation is not easy to find.Therefore,the greater omentum should be removed routinely to avoid missed diagnosis.Postoperative chemotherapy has no significant effect on the recurrence rate,but chemotherapy can reduce the risk of canceration in serous BOT patients with invasive implants.Therefore,patients with advanced FIGO stage and suspected invasive implants or residual lesions may consider postoperative chemotherapy. |
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