Analysis Of Factors Influencing Recurrence Of Patients With Borderline Ovarian Tumors And Postoperative Recurrence And Pregnancy With Fertility Sparing-surgery

Objective:Through retrospective analysis and follow-up,this study analyzed the factors affecting the recurrence of patients with borderline ovarian tumors and the postoperative recurrence and pregnancy after fertility sparing-surgery(FSS),in order to provide guidance for clinical treatment of borderline ovarian tumors.Methods:A retrospective analysis was made on 415 patients with borderline ovarian tumors who were initially operated in the gynecology ward of Shengjing Hospital Affiliated to China Medical University from September 1,2013 to September 1,2019.The clinical and pathological data:age,smoking hi story(none,yes),drinking history(none,yes),obesity(BMI<25,BMI>25),history of estrogen use(none,yes),genetic history(none,yes),marital status(unmarried,married,divorced),sexual history(none,yes),preoperative childbirth(none,yes),menopause(no,yes),chief complaint(abdominal pain and abdominal distention,touching mass,physical examination findings and others),tumor size(<10cm,>10cm),tumor site(unilateral,bilateral),pathology(serous,mucinous,others),micropapillary pattern(none,yes),invasive implantation(no,yes),surgical approach(laparotomy,laparoscopy),lymphadenectomy(no,yes),omentectomy(no,yes),FSS(no,yes),FIGO stage(stage ?,stage ? and above),and biological information preoperative tumor marker CA125(normal<35U/ml,rise>35U/ml),CA199(normal<37U/ml,rise>37U/ml),CEA(normal ?5ng/ml,rise>5ng/ml),HE4(normal<140pmol/L,rise?140pmol/L),ROMA-Before(normal<11.4%,rise?11.4%),ROMA-After(normal<29.9%,rise?29.9%)were consulted through the medical record query system of our hospital.The recurrence and pregnancy of the patients were investigated through telephone follow-up and outpatient and impatient medical records.The deadline of follow-up was December 2019 Spss23.0 was used to analyze the dataResults:In this study,415 patients were collected,of which 21 lost follow-up,and a total of 394 patients were included in the study.All patients survived until the follow-up deadline.25 patients relapsed with a recurrence rate of 6.3%.The univariate analysis of the factors affecting the recurrence of BOT patients found that age,preoperative fertility,tumor site,micropapillary pattern,invasive implantation,FSS and FIGO stage all affected recurrence,and the differences were statistically significant(P<0.05).COX and Logistic multivariate analysis results:FIGO stage,FSS and micropapillary pattern were independent risk factors affecting BOT recurrence.Among them COX multivariate analysis results:FIGO stage ? and above increased the risk of recurrence by 18.204 times compared with stage ?(HR=18.204,95%CI=4.441?74.618).The risk of FSS was 14.931 times higher than that without fertility preservation operation(HR=14.931,95%CI=4.304?51.794).The risk of recurrence was 4.289 times higher in those with micropapillary pattern than in those without micropapillary pattern(HR=4.289,95%CI=1.642?11.205).Logistic multivariate analysis results:FIGO stage ? and above increased the risk of recurrence by 20.406 times compared with stage ?(OR=20.406,95%CI=3.854?108.038).The risk of FSS was 7.305 times higher than that without fertility preservation operation(OR=7.305,95%CI:1.386?38.510).The risk of recurrence was 5.965 times higher in those with micropapillary pattern than in those without micropapillary pattern(OR=5.965,95%CI=1.794?19.828).20 patients with FSS relapsed with a recurrence rate of 10.2%.The univariate analysis of the patients with FSS found that preoperative fertility,tumor site,micropapillary pattern,surgical approach and FIGO stage affected recurrence,and the differences were statistically significant(P<0.05).COX and Logistic multivariate analysis showed that FIGO stage,micropapillary pattern were independent risk factors for recurrence of BOT patients with FSS.Among them COX multivariate analysis results:FIGO stage ? and above increased the risk of recurrence by 21.286 times compared with stage ?(HR=21.286,95%CI=3.622?125.103).The risk of recurrence was 4.593 times higher in those with micropapillary pattern than in those without micropapillary pattern(HR=4.593,95%CI=1.505?14.016).Logistic multivariate analysis results:FIGO stage ? and above increased the risk of recurrence by 25.287 times compared with stage ?(OR=25.287,95%CI=2.846?224.697).The risk of recurrence was 6.941 times higher in those with micropapillary pattern than in those without micropapillary pattern(OR=6.941,95%CI=1.601?30.085).Among the patients with FSS,63 had fertility requirements,3 5 were pregnant,and the pregnancy rate was 55.6%The univariate analysis of influencing factors of pregnancy found that omentectomy and chemotherapy had an impact on pregnancy rate,and the differences were statistically significant(P<0.05).The pregnancy rate of patients without omentectomy and chemotherapy was higherConclusion:1.The total recurrence rate of BOT patients was 6.3%.Univariate analysis found that age,preoperative fertility,tumor site,micropapillary pattern,invasive implantation,FSS and FIGO stage are factors that affect the recurrence of BOT patients.COX and Logistic multivariate analysis found that FIGO stage,FSS and micropapillary pattern are independent risk factors that affect BOT recurrence.COX multivariate analysis found that the recurrence risk increased by 18.204 times,14.931 times,and 4.289 times,respectively.Logistic multivariate analysis found that the recurrence risk increased by 20.406 times,7.305 times,and 5.965 times,respectively.2.The recurrence rate of BOT patients with FSS is 10.2%.Univariate analysis found that preoperative fertility,tumor site,micropapillary pattern,surgical approach and FIGO stage are factors that affect the recurrence of BOT patients with FSS.COX and Logistic multivariate analysis found that FIGO stage and micropapillary pattern are independent risk factors that affect the recurrence in BOT patients with FSS COX multivariate analysis found that the recurrence risk increased risk by 21.286 and 4.593 times,respectively.Logistic multivariate analysis found that the recurrence risk increased risk by 25.287 and 6.941 times,respectively.3.There were 63 cases of BOT with fertility requirements,and the pregnancy rate was 55.6%.Univariate analysis found that omentectomy and chemotherapy are the factors affecting pregnancy in BOT patients with fertility requirements.