Abstract
Background This study aimed to evaluate the effect of clinicopathologic and surgical factors on the prognosis and fertility outcomes of patients with borderline ovarian tumour (BOT). Methods We performed a retrospective analysis of BOT patients who underwent surgical procedures in West China Second University Hospital from January 2008 to January 2015. The disease-free survival (DFS) outcomes and potential prognostic factors were evaluated using the Kaplan-Meier method and Cox regression analysis, respectively. Furthermore, fertility outcomes were analysed using Pearson Χ 2 and Fisher’s correlation tests. Results A total of 448 patients were included, with a median age of 37.1 years and a median follow-up time of 113 months; 52 (11.6%) recurrences were observed, with a mean recurrence interval of 80.2 months and four (0.9%) deaths; 118 (26.3%) patients underwent staging surgery and the remaining 330 (73.7%) underwent unstaged surgery. In total, 233 patients undergoing fertility-sparing surgery (FSS) attempted to conceive, and 92 (39.48%) of them achieved pregnancy. No significant differences in fertility outcomes were found between the staging and unstaged surgery groups ( P = 0.691). In univariate analysis, staging surgery was associated with DFS (hazard ratio [HR] = 2.191; P = 0.005), but it was not an independent prognostic factor ( P = 0.600) for DFS on multivariate analysis. Multivariate Cox analysis revealed that advanced FIGO stage (≥stage II), positive ascites\pelvic washings, and laparotomy approach were independent prognostic factors for DFS in patients with BOT, whereas advanced stage (≥stage II), laparotomy approach, cystectomy-related procedures, invasive implants, and bilateral tumours were independent prognostic factors for DFS in patients undergoing FSS. In addition, laparoscopy resulted in better prognosis than laparotomy in patients with early-stage (stage I) tumours and a desire for fertility preservation. Conclusion Patients with BOT fail to benefit from surgical staging in terms of prognosis and fertility outcomes. Laparoscopy is recommended for patients with stage I disease who desire to preserve their fertility. Physicians should pay more attention to the risk of recurrence in patients who want to preserve fertility with advanced stage (≥stage II) disease, invasive implants, and bilateral tumours, and choose FSS carefully.
The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study
