Clinical Analysis Of 253 Patients With Borderline Ovarian Tumors

Objective:To investigate the diagnosis,treatment,and prognosis of borderline ovarian tumors through retrospective analysis of the clinical data of 253 patients.Methods:The clinical data of 253 patients with BOT from Jan 2007 to Dec 2016 was collected from the Affiliated Hospital of Qingdao University,and all the patients were followed up through telephone and outpatient medical records.The clinical data,including general information(age,obstetrical history,infertility and endometriosis,etc.),symptom and sign,serum tumor marker level,results of color Doppler ultrasound and other imaging examinations,malignant risk index,operation information(tumor rupture,ovary involvement,peritoneal implantation,adhesion,surgical methods,surgical approaches and restaged surgery,etc.),surgical pathological staging,intraoperative frozen pathological result,postoperative pathological results and adjuvant chemotherapy,etc.Follow-up information contains postoperative recurrence,malignant transformation and pregnancy,etc.Statistical analysis was implemented to reveal factors which affected the consistency of intraoperative frozen and postoperative pathological results,recurrence and re-pregnancy.Results:The average age of 253 patients with BOT was 40.92 years old(SD=15.29).One hundred and forty-three cases(56.52%)were serous,94 cases(37.15%)were mucinous,11 cases(4.35%)were mixed,3 cases(1.19%)were endometrioid,and 2cases(0.79%)were Brenner tumor.Two hundred and twenty-five cases(88.93%)were FIGO stage I,10 cases(3.95%)were stage II,and 18 cases(7.11%)were stage III,while no stage IV patient was presented.Of all the patients,136 cases(53.75%)showed no clinical symptoms.Ultrasound revealed cystic echo in 156 cases(61.66%).A majority of 220 cases(86.96%)had unilateral ovarian lesions,while the rest 33cases(13.04%)had bilateral lesions.For tumor markers,113 cases(47.08%)manifested elevated CA125 levels,while CA199 increased in 52 cases(22.32%).CA125 increased significantly in serous BOT(P=0.001),while CA199 and CEA increased significantly in mucinous BOT(P=0.027;P=0.004).There were 66 patients(27.5%)with malignant risk index RMI-II score≥200.There were 121 patients(47.82%)with radical surgery,while the rest 132 cases(52.17%)choose fertility-preserving surgery.There were 133 cases(52.57%)with transabdominal surgery,while the rest 120 cases(47.43%)adopted laparoscopic surgery.Patients with tumor diameter<10cm,age≤40 years old,normal CA125,early FIGO staging and RMI<200 had a high proportion of laparoscopic surgery(P<0.05),while patients with RMI<200 and age≤40 years old had a high proportion of fertility preservation surgery(P<0.05).One case(0.40%)was found with residual lesions and 5 cases(1.98%)experienced re-staged surgery.A total of 42cases(16.6%)received postoperative adjuvant chemotherapy.Eleven patients(4.35%)had recurrence,of which ten had reoperation.After the reoperation surgery,nine were proved to be BOT and one(0.40%)had malignant change.Two patients died of irrelevant cancers and therefore disease-related mortality is 0%.Ovarian borderline tumor recurrence was associated with high FIGO stage,fertility preserving surgery,invasive peritoneal implantation and chemotherapy(P<0.05),and it was not associated with patient age,tumor diameter,unilateral/bilateral,CA125 level,pathological type,surgical approach,tumor rupture,lymphadenectomy,omentectomy,appendectomy and comprehensive tumor staging(P>0.05).The recurrence of stage I was related to conservative surgery,and that of stage III was related to invasive peritoneal implantation(P<0.05).Fifty-two patients with BOT had fertility desire,and 41 in which were pregnant,with a pregnancy rate of 78.72%.There was no significant difference in pregnancy rate between different surgical methods(enucleation vs salpingo-oophorectomy)and approaches(open vs laparoscopic surgery).The pregnancy interval after laparoscopic surgery was shorter than that after open surgery(P=0.001).The pregnancy rate was negatively correlated with the postoperative ovarian surgeries(P=0.044).There were 211 cases with consistent intraoperative frozen pathology and postoperative pathological results,the coincidence rate was 83.40%.Tumor diameter≥10cm,normal CA125,non-serous,FIGO stage I,no peritoneal implantation,and borderline component less than 10%were associated with the inconsistency of the intra-/postoperative pathological results.Multivariate Logistic analysis showed that pathological type was an independent factor to inconsistent pathological results.The difference between intraoperative postoperative pathology results resulted in an increased number of re-staging surgeries(χ~2=4.909,P=0.027).Conclusions:1.Patients with BOT are mostly young and at stage I,with low malignancy rate and disease-related mortality.2.Preoperative diagnosis of BOT is difficult,and intraoperative cryopathologic examination is of high diagnostic value.Histopathological type is an independent factor affecting the inconsistency of intra-/postoperative pathological results.3.Fertility preservation,especially laparoscopic surgery,is safe and feasible for early stage patients.Lymphadenectomy,omentectomy,or appendectomy does not affect recurrence and survival,and is not recommended as a routine operation.Adjuvant chemotherapy does not reduce the recurrence rate and therefore it should not routinely provided for patients except invasive peritoneal implantation and residual lesions.4.Different operation scopes of fertility preserving surgery do not affect fertility.Laparoscopic surgery can shorten the postoperative pregnancy interval,and the pregnancy rate is negatively correlated with the postoperative ovarian surgeries.