Borderline ovarian tumors: French guidelines from the CNGOF. Part 2. Surgical management, follow-up, hormone replacement therapy, fertility management and preservation

ObjectivesSince the recognition of borderline ovarian tumors (BOTs) in the 1970s, the management of this subset of epithelial ovarian tumors has presented a challenge to clinicians. The majority present at an early stage, but their diagnosis is often only made following surgery, hence the heterogeneity of surgical management. Borderline ovarian tumors are morphologically diverse, and their behavior is subsequently also heterogeneous. We aimed to assess recurrence rates and the rate of malignant transformation in patients diagnosed with BOT. Secondary objectives included a review of current management and assessment of tumor markers, stage, cyst dimensions, and the presence of micropapillary features as prognostic indicators of recurrence.MethodsThis retrospective cohort study included all patients treated with BOT between 2000 and 2015 in the southeast region of Scotland. Clinical, surgicopathological, and follow-up data were collated. Data were analyzed with reference to recurrence and malignant transformation.ResultsTwo hundred seventy-five patients underwent treatment for BOT in the study period. Surgical management was highly variable. A diagnosis of recurrent/persistent BOT or ovarian malignancy following initial treatment of BOT was rare, with only 12 (4%) of 275 cases. There were 7 cases (3%) of ovarian malignancy. Advanced International Federation of Gynecology and Obstetrics stage was the most prominent prognostic factor. Elevated preoperative serum CA-125 and the presence of micropapillary features correlated with advanced stage at presentation. With a lack of clear guidance, follow-up was highly variable with a median of 43 months (0–136 months).ConclusionsTo our knowledge, this study is the largest BOT cohort in the United Kingdom. Recurrent disease is rare in optimally staged, completely resected, early-stage BOT, without high-risk features. Caution is needed in women electing not to undergo completion staging after diagnosis and in those opting for a fertility-preserving approach. Thorough informed consent and clear plans for surveillance and follow-up are needed with consideration of delayed completion surgery as appropriate.

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One-Year Follow-Up of Postmenopausal Women on Hormone Replacement Therapy in Kuwait

Medical Principles and Practice ◽

10.1159/000157515 ◽

1994 ◽

Vol 4 (4) ◽

pp. 220-228

Author(s):

A. Omu ◽

N. Al-Qattan

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Postmenopausal Women ◽

Hormone Replacement ◽

One Year

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Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy

Medicina ◽

10.3390/medicina55090573 ◽

2019 ◽

Vol 55 (9) ◽

pp. 573 ◽

Cited By ~ 8

Author(s):

Marta D’Alonzo ◽

Valentina Elisabetta Bounous ◽

Michela Villa ◽

Nicoletta Biglia

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Hormone Replacement ◽

Current Evidence ◽

Conjugated Equine Estrogen ◽

Colon Cancer Risk ◽

Increased Risk ◽

Intact Uterus ◽

Progestin Therapy

Hormone replacement therapy (HRT) remains the most effective treatment for menopausal symptoms and has been shown to prevent bone loss and fracture. The progestogen is added to provide endometrial protection in women with an intact uterus. After the publication of the initial WHI (Women’s Health Initiative) results in 2002 reporting an overall increased risk of breast cancer, many women discontinued HRT. Despite the re-analysis of the results by subgroups of patients and updates with extended follow-up, much controversy remains, which we will analyze later in the text. Different types of estrogen or progestogen, as well as different formulations, doses, and durations, may play a role in HRT’s effects on breast tissue. Evidence states that conjugated equine estrogen (CEE), compared to estro-progestin therapy, shows a better profile risk (HR 0.79, CI 0.65–0.97) and that, among different type of progestins, those structurally related to testosterone show a higher risk (RR 3.35, CI 1.07–10.4). Chronic unopposed endometrial exposure to estrogen increases the risk of endometrial hyperplasia and cancer, whereas the association with progestins, especially in continuous combined regimen, seems to reduce the risk (RR 0.71, CI 0.56–0.90). HRT was also associated with a protective effect on colon cancer risk (HR 0.61, CI 0.42–0.87). Data about ovarian and cervical cancer are still controversial.

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Hormone Replacement Therapy Influences Matrix Metalloproteinase Expression and Intimal Hyperplasia Development after Vascular Injury: A Follow-Up Study

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.10.030 ◽

2010 ◽

Vol 52 (6) ◽

pp. 1744

Author(s):

Richard B. Cook ◽

Deidra J. Mountain ◽

Stacy S. Kirkpatrick ◽

James E. Chalk ◽

David C. Cassada ◽

...

Keyword(s):

Hormone Replacement Therapy ◽

Matrix Metalloproteinase ◽

Replacement Therapy ◽

Vascular Injury ◽

Intimal Hyperplasia ◽

Hormone Replacement ◽

Follow Up Study

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Hormone replacement therapy and mortality in 52- to 70-year-old women: the Kuopio Osteoporosis Risk Factor and Prevention Study

Acta Endocrinologica ◽

10.1530/eje.1.02059 ◽

2006 ◽

Vol 154 (1) ◽

pp. 101-107 ◽

Cited By ~ 15

Author(s):

Kati Pentti ◽

Risto Honkanen ◽

Marjo T Tuppurainen ◽

Lorenzo Sandini ◽

Heikki Kröger ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factor ◽

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Cancer Mortality ◽

Hormone Replacement ◽

Breast Cancer Mortality ◽

Prevention Study ◽

Osteoporosis Risk

Objectives: To analyze prospectively the association between hormone replacement therapy (HRT) and mortality in women before old age. Design and methods: A group of 11 667 women (91% of the age cohort of the area) aged 52–62 years from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study were followed for 7 years in 1994–2001. Information about HRT use and health events was obtained from two repeated questionnaires in 1989 and 1994. Information about deaths and causes of death from the follow-up period was obtained from the Statistics Finland. Cox’s proportional-hazards models were used to calculate risk of death related to the use of HRT. Results: At the start of follow-up, 2203 women had used HRT >5 years, 3945 women ≤5 years and 5519 women had never used it. During the follow-up, 361 deaths occurred. Compared with non-users of HRT, the adjusted hazard ratio (HR) of death from any cause was 1.05 (95% confidence interval (CI) 0.80–1.36) in women who used HRT ≤5 years and 1.06 (95% CI 0.78–1.46) in women who used HRT >5 years. The adjusted HR for coronary heart disease (CHD) mortality in women who used HRT ≤5 years was 0.79 (95% CI 0.36–1.73), and in women who used HRT >5 years, 2.16 (95% CI 0.93–4.98). For breast cancer mortality the adjusted HR for ≤5 years of HRT use was 0.96 (95% CI 0.32–2.82) and 2.62 (95% CI 0.98–7.00) for >5 years of HRT use. Conclusions: History of HRT use does not affect overall or CHD mortality in women. More than 5 years of HRT use may increase the risk of breast cancer mortality.

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