| Objective To summarize and analyze the clinicopathological characteristics,operation methods,tumor and reproductive prognosis of patients with borderline ovarian tumor(BOT)during the past 10 years.Methods The clinical medical records of 147 patients who were surgically treated and pathologically diagnosed as borderline ovarian tumors from January 2008 to December 2017 in the General Hospital of Ningxia Medical University were collected,and clinical data(age,symptoms,auxiliary examination,operation method,adjuvant chemotherapy,reproductie history,past medical history,etc.),the pathological data(intraoperative frozen and paraffin section of the postoperative pathology,pathological type and pathological staging)and postoperative follow-up data(tumor prognosis and reproductive outcomes)were retrospectively analyzed.Results 1.General clinical data: The average age of onset of 147 BOTS patients was41.9±15.7 years old,and those less than 40 years old accounted for 46.94%(69/147).The main reasons for medical treatment were as following: 53.74%(79/147)of patients found in routine physical examination,37.41%(55/147)of patients with abdominal distension,3.40%(5/147)of patients with irregular vaginal bleeding,2.04%(3/147)of patients with abdominal mass palpation,2.04%(3/147)of patients with compression symptoms such as frequent urination and anal distension,1.36%(2/147)of patients with lumbosacral discomfort.The clinical stages included 145 patients with stage Ⅰ,1 patient with stage Ⅱ,and 1 patient with stage ⅡI.2.Preoperative auxiliary diagnosis: 2.1 Serological detection of tumor markers:the Elevated proportion of CA125,CA199,CEA,HE4 were 47.62%(70/147),25.17%(37/147),5.44%(8/ 147),1.36%(2/147).The differential expression of CA125 and CA199 in different histological types(serous,mucinous,other types of tumors)was statistically significant(P<0.05),there was no significant difference in the expression of CEA and HE4 among different histological types(P > 0.05).Two tumor markers were elevated in 26.53%(39/147),of which CA125 and CA199 were simultaneously elevated in 20.41%(30/147).2.2 Color Doppler ultrasonography of pelvic cavity: 83.67%(123/147)of the tumors were unilateral and16.33%(24/147)of the tumors were bilateral.A total of 171 tumors were found in 147 patients,of which 56.14%(96/171)tumors were cystic,4.09%(7/171)solid,39.77%(68/171)mixed,and 63.16% of tumors with regular morphology(108/171),90.64%(155/171)with clear tumor boundaries,71.35%(122/171)of tumors with poor sound penetration under ultrasound,multilocular cysts accounted for 51.83%(85/164),papillary processes were found in the tumor accounting for 66.08%(113/171),39.18%(67 / 171)of tumors had abnormal blood flow signals.3.Pathological type: patients with bilateral tumors did not present two different pathological diagnoses in the same pathological report.Serous tumors accounted for 51.02%(75/147),mucinous tumors accounted for 46.26%(68/147),and other tumors accounted for2.72%(4/147,including 2 cases of clear cell tumor,1 case of endometrioid tumor,and 1case of mixed tumor).4.Consistency between frozen pathology and paraffin pathology: 95.24%(140/147)of the results of frost pathology in operation were consistent with those of paraffin pathology after operation.The intraoperative diagnosis of benign tumor accounted for 4.08%(6/147)and diagnosis of malignant tumor was 0.68%(1/147).The pathological consistency between frozen and postoperative paraffin was statistically different in pathological types(P<0.05).5.Surgical methods: fertility preserving surgery accounted for 52.38%(77 / 147),including 19 cases of unilateral tumor enucleation,44 cases of unilateral adnexectomy,10 cases of bilateral tumor enucleation,4 cases of unilateral adnexectomy + contralateral tumor enucleation),and radical surgery accounted for 47.62%(70 / 147).There were statistical differences in age,preoperative birth and surgical approach between the two groups(P <0.05).Surgical approach: 59.86%(88/147)of patients underwent laparoscopic surgery and40.14%(59/147)of patients underwent transabdominal surgery.There were significant differences in age,maximum diameter of tumor,ascites presence and pathological types between laparoscopic surgery and open surgery(P <0.05).Postoperative adjuvant chemotherapy was applied in 9 cases(3 cases in the patients undergoing fertility preservation surgery and 6 cases in the patients undergoing radical surgery).6.Follow-up: 6.1 Tumor prognosis: The average follow-up time of 147 patients was55.3±34.6 months,and 0 patients died due to the disease itself during the follow-up period.There were 9 cases of recurrence(8 cases after fertility conservation surgery and 1 case after radical surgery),and the median time of recurrence was 18 months(6-84 months).There were significant differences between the two groups in age,surgical method and ovarian surface involvement(P < 0.05).6.2 Reproductive prognosis: 52.38%(77/147)of the patients underwent fertility preservation surgery,and 49.35%(38/77)of the patients had fertility intention during the follow-up period,of which 55.26%(21/38)of the patients were pregnant.The cumulative number of pregnancies was 32 and the rate of full-term delivery was 59.38%(19/32).The mean time to menstruation after surgery was 1.49±1.1 months,and the mean time to pregnancy after surgery was 25.4±20.8 months.There were no statistical differences in age,surgical methods and pathological types between pregnant group and non-pregnant group(P > 0.05).Conclusion 1.Borderline ovarian tumors are more common in childbearing age and have no specific clinical manifestations.The diagnosis mainly depends on pathological examinations.2.Fertility-preserving surgery is feasible for stage Ⅰ borderline ovarian tumors with fertility requirements.Age and ovarian surface involvement were the influencing factors of ovarian borderline tumor recurrence.The pathologic type after recurrence still maintained borderline characteristic.3.Clinicopathological factors such as age,operation method,pathological type,postoperative chemotherapy or not,have no significant effect on postoperative pregnancy. |
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