| BackgroundBorderline ovarian borderline tumors(BOTs)is a special type of tumor,its biological behavior and clinical characteristics are different from ovarian malignancy,between benign and malignant tumors,with low malignant potential,accounting for about 10-15%of all ovarian tumors.The histological types were serous type,mucous type,endometrioid type,clear cell type,mixed type and transitional cell type.BOTs often have insidious onset and no clinical symptoms.According to the 2014 edition of the International Federation of Gynecology and Obstetrics(FIGO)Surgical-Pathological Staging Method,70%of patients with BOTs were diagnosed with stage I.In addition,BOTs occurs at an early age,with about 1/3 of patients with borderline ovarian tumors under 40 years of age.Therefore,more and more clinicians and patients tend to choose conservative surgical treatment with fertility preservation.However,fertility-preserving surgery may increase a patient’s risk of tumor recurrence.At present,the influence of different surgical methods on patients’prognosis and pregnancy outcome is still controversial,which is a hot spot of clinicians’research.ObjectiveIn this study,medical records and postoperative follow-up data of 165 young early BOTs patients were retrospectively analyzed to explore the clinical characteristics,recurrence and pregnancy outcomes of BOTs patients after surgical treatment,so as to provide guidance for clinical diagnosis and problems occurring in the treatment process.MethodsA total of 165 young(≤40 years old)patients with borderline ovarian tumors diagnosed as early stage(FIGO stage I)and undergoing fertility conservation surgery were enrolled in the Department of Gynecology of the First Affiliated Hospital of Zhengzhou University from April 2012 to August 2019.Patients’clinical manifestations and signs,preoperative ultrasonography,CT,tumor markers and other auxiliary examinations,treatment methods,intraoperative exploration,intraoperative freezing pathology and postoperative routine pathology were recorded in detail.The postoperative prognosis of the patients was followed up through telephone consultation and outpatient reexamination,including postoperative recurrence and pregnancy outcome.The SPSS26.0 software was used for statistical analysis of the data.The t test or rank sum test was used for statistical analysis of the numerical variables.The χ2 test,χ2 test with continuous correction or Fisher’s exact probability method were used for statistical analysis of the classification variables.Results1.A total of 165 patients were included in this study,ranging in age from 13 to 40 years old,with an average age of 28.39±5.699 years old.According to tumor stage,107 patients(64.8%)were in stage IA,11(6.7%)were in stage IB,and 47(28.5%)were in stage IC.According to the pathological types,there were 84 cases(50.9%)of serous tumor,58 cases(35.2%)of mucinous tumor,and 23 cases(13.9%)of other types(including 19 cases of mixed plasma-mucinous tumor and 4 cases of endometrioid tumor).2.102 cases(61.8%)had no obvious clinical manifestations,and pelvic masses were generally found during routine or other system diseases physical examination.Non-specific symptoms were presented in 63 patients(38.2%),including 33 patients(20.0%)with abdominal pain(3 of whom were admitted to the emergency room for acute abdominal pain),12 patients(7.3%)with abdominal distension,2 patients(1.2%)with abdominal mass increase,8 patients(4.8%)with abnormal vaginal bleeding,7 patients(4.2%)with abnormal vaginal bleeding,and 1 patient(0.6%)with frequent urination.3.All 165 BOTS patients were examined by a physician at the attending level,and the results were reviewed by a physician at associate chief physician level or above.Ultrasound results indicated cystic mass in 53 cases,cystic solid mass in 100 cases,solid mass in 12 cases,of which 113 cases probed the papillary solid area,58 cases suggested multilocular,and 98 cases probed blood flow signal.Statistical analysis showed that the tumor diameter of the SBOTs group was smaller than that of the non-SBOTs group.Multilocular changes of tumors in the SBOTs group were less than those in the non-SBOTs group,the differences were statistically significant(P<0.05),and there was no statistically significant difference in the remaining ultrasound indicators(P>0.05).4.Before surgery,72 patients(43.6%)had positive serum CA125 and 65 patients(39.4%)had positive serum CA199.The positive rate of CA125 in SBOTs patients was higher than that in MBOTs patients,and the difference was statistically significant(P=0.029).The positive rate of CA199 in MBOTs patients was higher than that in SBOTs patients,and the difference was statistically significant(P<0.05).Ultrasound examination showed that the BOTs were mainly cystic(40.6%)and cystic and solid(53.9%),most of which could detect papillary hyperecho and blood flow signals,and some presented multilocular changes.5.Intraoperative exploration involved unilateral ovaries in 142 cases(86.1%),bilateral ovaries in 23 cases(13.9%),ascites in 25 cases(15.2%)and no ascites in 140 cases(84.8%).The median tumor diameter was 8.5cm.Among 153 cases,112 cases(73.2%)were accurately diagnosed by rapid freezing pathology.Among the factors affecting the accuracy of rapid freezing,there were statistically significant differences in tumor maximum diameter(P=0.001),histological type(P<0.05)and intraoperative tumor rupture(P=0.003),while there were no statistically significant differences in age,surgical approach,FIGO stage and tumor involvement in unilateral and bilateral ovaries(P>0.05).6.Fertility conservation surgery was performed in all patients,including 43 patients(26.1%)in the open group and 122(73.9%)patients in the laparoscopic group.Uni lateral ovarian cyst excision was performed in 76 cases(46.1%),unilateral adnexectomy was performed in 68 cases(41.2%),bilateral ovarian cyst excision was performed in 11 cases(6.7%),unilateral ovarian cyst excision+contralateral ovarian cyst excision was performed in 10 cases(6.1%).Fourteen patients(8.5%)underwent comprehensive staging operation at the same time to preserve fertility function,while 151 patients(91.5%)did not.Open group in the preoperative child birth,tumor histological type,presence of ascites,tumor diameter compared with the laparoscopic group,the difference was statistically significant(P<0.05),while the FIGO stage,tumor involving the single and double side ovaries,whether caused differences of intraoperative tumor rupture,whether comprehensive stage has no statistical significance(P>0.05).In addition,there was no significant difference between the open group and the laparoscopic group on the recurrence rate and pregnancy outcome(P>0.05).7.The median follow-up time of the 165 patients was 44 months(13-101 months),17 patients(10.3%)had postoperative recurrence,and there was no death.Univariate analysis showed that patients’ age,preoperative CA125 level,preoperative CA199 level,surgical approach,fertility preservation and full-scale staging,FIGOstaging,intraoperative tumor rupture or not,and histological type had no effect on postoperative recurrence of BOTs(P>0.05),but tumor involvement on unilateral and bilateral ovaries had an effect on postoperative recurrence(P=0.021).The effect of tumor involvement in the ovarian site on the recurrence rate of BOTS was analyzed and the curve graph was plotted.It can be seen that the tumor-free survival time of FIGO stage I BOTS patients with tumor involvement in unilateral ovaries was higher than that of patients with tumor involvement in bilateral ovaries,the difference was statistically significant(P=0.008).8.There were 95 cases with pregnancy plan after operation,among which 49 cases(51.58%)had successful pregnancy.Among successful pregnancy patients,the proportion of incomplete staging patients in the laparoscopic group was higher than that in the open group,and the difference was statistically significant(P=0.022).There was no statistically significant difference in other clinicopatho logical characteristics between the two groups(P>0.05).Conclusion1.Preoperative adjuvant examination for borderline ovarian tumors lacks specificity,so it is necessary to combine rapid intraoperative pathology with conventional postoperative pathological results to make a diagnosis.2.For young borderline ovarian tumor patients with stage I who underwent fertility conservation surgery,there was no significant difference in the effect of open and laparoscopic approaches on postoperative recurrence rate and pregnancy outcome.The site of ovarian tumor involvement has an influence on postoperative recurrence of patients and is an independent influencing factor for tumor recurrence,and the disease-free survival of unilateral BOTs is higher than that of bilateral BOTs.3.Laparoscopic incomplete staging is a relatively high proportion of successful pregnancy patients,so it is feasible to choose laparoscopic incomplete staging to preserve fertility function. |
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