High-Risk Borderline Ovarian Tumors: Analysis of Clinicopathological Features and Prognostic Impact of Different Follow-Up Strategies

Abstract Background The clinical high-risk (CHR) for psychosis paradigm is changing psychiatric practice. However, a widespread confounder, i.e. baseline exposure to antipsychotics (AP) in CHR samples, is systematically overlooked. Such exposure might mitigate the initial clinical presentation, increase the heterogeneity within CHR populations, and confound the evaluation of transition to psychosis at follow-up. This is the first meta-analysis examining the prevalence and the prognostic impact on transition to psychosis of ongoing AP treatment at baseline in CHR cohorts. Methods Major databases were searched for articles published until 20 April 2020. The variance-stabilizing Freeman-Tukey double arcsine transformation was used to estimate prevalence. The binary outcome of transition to psychosis by group was estimated with risk ratio (RR) and the inverse variance method was used for pooling. Results Fourteen studies were eligible for qualitative synthesis, including 1588 CHR individuals. Out of the pooled CHR sample, 370 individuals (i.e. 23.3%) were already exposed to AP at the time of CHR status ascription. Transition toward full-blown psychosis at follow-up intervened in 112 (29%; 95% CI 24–34%) of the AP-exposed CHR as compared to 235 (16%; 14–19%) of the AP-naïve CHR participants. AP-exposed CHR had higher RR of transition to psychosis (RR = 1.47; 95% CI 1.18–1.83; z = 3.48; p = 0.0005), without influence by age, gender ratio, overall sample size, duration of the follow-up, or quality of the studies. Conclusions Baseline AP exposure in CHR samples is substantial and is associated with a higher imminent risk of transition to psychosis. Therefore, such exposure should be regarded as a non-negligible red flag for clinical risk management.

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Minimally invasive treatment options to borderline ovarian tumors

10.1055/s-0039-1685392 ◽

2016 ◽

Author(s):

Punita Bhardwaj ◽

T. K. Das ◽

S. Batra ◽

Keyword(s):

Early Stage ◽

Treatment Options ◽

Malignant Potential ◽

Ovarian Tumors ◽

Conservative Approach ◽

Uncertain Malignant Potential ◽

Invasive Treatment ◽

Younger Women ◽

Borderline Ovarian Tumors

Borderline Ovarian tumors are tumors of uncertain malignant potential. They have favour able prognosis. They occur in younger women and present at an early stage. They are difficult to diagnose preoperatively as macroscopic picture is a combination of benign and invasive ovarian tumors. Over the years surgical treatment has changed from radical to conservative approach without overlooking oncologic safety. Follows up is essential. Prolonged follow up (>10 yrs) is required because of later recurrences. Special attention is to be paid to the conserved ovary in follow up.

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Ultrasonographic diagnosis and longitudinal follow-up of recurrences after conservative surgery for borderline ovarian tumors

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.07.024 ◽

2016 ◽

Vol 215 (6) ◽

pp. 756.e1-756.e9 ◽

Cited By ~ 8

Author(s):

Dorella Franchi ◽

Sara Boveri ◽

Davide Radice ◽

Rosalba Portuesi ◽

Vanna Zanagnolo ◽

...

Keyword(s):

Conservative Surgery ◽

Ovarian Tumors ◽

Ultrasonographic Diagnosis ◽

Borderline Ovarian Tumors

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Borderline Ovarian Tumors: Fifteen Years’ Experience at a Scottish Tertiary Cancer Center

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001364 ◽

2018 ◽

Vol 28 (9) ◽

pp. 1683-1691 ◽

Cited By ~ 6

Author(s):

James May ◽

Karolina Skorupskaite ◽

Mario Congiu ◽

Nidal Ghaoui ◽

Graeme A. Walker ◽

...

Keyword(s):

Malignant Transformation ◽

Surgical Management ◽

Early Stage ◽

Ovarian Tumors ◽

Ca 125 ◽

Ovarian Malignancy ◽

Borderline Ovarian Tumors ◽

Gynecology And Obstetrics ◽

Preoperative Serum

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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Prognostic Significance of Angiogenesis and Ki-67, p53, and p21 Expression: A Population-Based Endometrial Carcinoma Study

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.5.1382 ◽

1999 ◽

Vol 17 (5) ◽

pp. 1382-1382 ◽

Cited By ~ 122

Author(s):

Helga B. Salvesen ◽

Ole Erik Iversen ◽

Lars A. Akslen

Keyword(s):

High Risk ◽

Endometrial Carcinoma ◽

Cox Regression ◽

Figo Stage ◽

Population Based ◽

Prognostic Impact ◽

Histologic Type ◽

Ki 67 ◽

Cox Regression Analysis

PURPOSE: For endometrial carcinoma patients, there is a need for improved identification of high-risk groups that may benefit from postoperative adjuvant therapy. We therefore studied the prognostic impact of markers for cell proliferation, cell-cycle regulation, and angiogenesis among endometrial carcinoma patients in a population-based setting. PATIENTS AND METHODS: All patients diagnosed with endometrial carcinoma between 1981 and 1985 in Hordaland County, Norway, were studied. The median follow-up for the survivors was 11.5 years (range, 8 to 15 years), with no patient lost because of insufficient follow-up information. Paraffin-embedded tumor tissue, available in 96% of the cases (n = 142), was studied immunohistochemically for microvessel density (MVD) and expression of Ki-67, p53, and p21 proteins. We used the hot spot method for calculation of MVD, and expression of Ki-67 and p21 protein, because this approach may increase the probability of detecting small aggressive clones of possible prognostic relevance. The importance of these tumor markers was investigated in univariate survival analyses and Cox regression analysis. RESULTS: The majority of traditional clinicopathologic variables was significantly associated with the tumor biomarkers. Age, International Federation of Gynecology and Obstetrics (FIGO) stage, histologic type, histologic grade, MVD, as well as Ki-67, p53, and p21 protein expression, all significantly influenced survival in univariate analyses (P ≤ .05). In the Cox regression analysis, age, FIGO stage, MVD, Ki-67 expression, and p53 expression were the only variables with independent prognostic impact (P ≤ .05), whereas histologic type, histologic grade, and p21 expression had no independent influence. A group of high-risk patients with more than one unfavorable marker was identified. CONCLUSION: In addition to age and FIGO stage, MVD, Ki-67, and p53 protein expression showed an independent prognostic impact. Thus, information derived from routine histologic specimens identified a subgroup of high-risk endometrial carcinoma patients in this population-based study.

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LONG TERM FOLLOW UP OF BORDERLINE OVARIAN TUMORS IN ONCOLOGIC CENTER IN WARSAW

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200303001-00150 ◽

2003 ◽

Vol 13 (Suppl 1) ◽

pp. 43.2-43

Author(s):

P. Sobiczewski ◽

M. Bidzinski ◽

J. Radziszewski ◽

P. Derlatka

Keyword(s):

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

Long Term Follow Up

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Impact of infertility treatment in patients with previous history of borderline ovarian tumors: Results of a multicenter study

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.5055 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 5055-5055

Author(s):

A. Fortin ◽

P. Morice ◽

A. Thoury ◽

C. Yazbeck ◽

S. Camatte ◽

...

Keyword(s):

Retrospective Study ◽

Early Stage ◽

Case Reports ◽

Previous History ◽

Infertility Treatment ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

History Of

5055 Background: The use of infertility drugs (ID) in infertile patients treated conservatively for ovarian malignancies remains theoretically contraindicated. Few recent case reports seem to suggest that ID could be used in patients treated for a borderline ovarian tumors (BOT). The aim of this multicenter retrospective study was to report the outcomes of the largest series of patients with a previous history of a BOT who underwent the use of ID. Methods: A multicenter retrospective study was conducted among centers which participate in the French National Register on In Vitro Fertilization registry to evaluate the outcomes of patients with a previous history of a BOT treated with ID. Four criteria were defined to select cases: 1. Histologic confirmation of BOT, 2. The use of a conservative surgery, 3. The use of ID and 4. A follow-up ≥ 12 months after the end of infertility treatment. Results: Thirty cases fulfilled inclusion criteria. Infertility therapy began in November 1989. Disease stages were: I (n = 20), II /III with noninvasive implants (n = 8) and unknown in 2 cases. The mean number of cycles of ovarian induction per patient was 2.6 (range,1–10). After a median follow-up of 42 months after infertility treatment, 4 recurrences were observed (all of them were borderline tumors on a remaining ovary treated by surgery alone). All patients are currently disease-free. Thirteen patients have since become pregnant. The median interval between treatment of the BOT and the use of ID is shorter in patients who relapsed compared to patients who did not (5 versus 29 months; p=.07). Conclusions: These results suggest that infertility drugs could be safely used in patients who experience infertility after conservative management of an early-stage BOT. A minimal interval should be respected between treatment of the ovarian tumor and the use of infertility drugs in order to decrease the risk of recurrence. No significant financial relationships to disclose.

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Borderline ovarian tumors: Long-term survival and preservation of fertility.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15508 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15508-e15508

Author(s):

Natasha Gercovich ◽

Carlos Garcia Gerardi ◽

Ernesto Gil Deza ◽

Eduardo L. Morgenfeld ◽

Edgardo G. J. Rivarola ◽

...

Keyword(s):

Young Patients ◽

Conservative Surgery ◽

Ovarian Tumors ◽

Population Characteristics ◽

Borderline Tumor ◽

Term Survival ◽

Borderline Tumors ◽

Borderline Ovarian Tumors ◽

The Usa

e15508 Background: Borderline ovarian tumors, also called low-malignancy potential tumors, are infrequent tumors present predominantly in pre-menopause women. Their evolution after surgical treatment is generally very good. The main objective of this paper is to show the evolution of a group of borderline tumors treated at our institution. Methods: Between January 1, 2000 and January 1, 2010, 36 patients diagnosed with ovarian borderline tumors were examined by two independent pathologists, according to the guidelines established by the USA Association of Directors of Anatomic and Surgical Pathology. These patients were followed at IOHM and comprise this paper’s study group. Results: Population Characteristics: Mean Age: 41 years (Range: 20-85). Affected Ovary (Right: 17 pts; Left: 14 pts; Both: 5 pts). Pathology: Mucinous (17 pts), Serous (16 pts), Clear, Brenner and Endometroid Cells (1 pt each). Stages: IA (24 pts), IB (5 pts), IC (2pts), IIIA (4 pts), IIIC (1 pt). Five patients presented non-invasive peritoneal implants and three presented positive peritoneal liquid. All patients were surgically treated: 28 with total anexohisterectomy (TAH) and 8 with unilateral ooforectomy. No patient was given any chemotherapy or radiotherapy treatment. Four patients did not attend follow-up consultations and were lost after 4, 6, 12 and 29 months with no evidence of disease (NED). Thirty-two patients were followed bi-annually during the first five years and annually thereafter. One patient became pregnant after the surgery. All patients are alive and NED with an average follow up of 50 months (range: 29-133). Conclusions: 1) Although half the cases in the study were under 35 years old, there were 12 tumors present in patients over 50 years of age and 1 borderline tumor present in an 85 year old patient. 2) Surgically treated ovarian borderline tumors have a high chance of being curable without the need of chemotherapy or radiotherapy. 3) Conservative surgery in young patients allows a conservation of fertility, provided they are subject to an adequate follow-up.

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Initial [18F]FDG PET/CT in high-risk DTC patients

Nuklearmedizin ◽

10.3413/nukmed-0766-15-09 ◽

2016 ◽

Vol 55 (03) ◽

pp. 99-103 ◽

Cited By ~ 7

Author(s):

Ina Binse ◽

Andreas Bockisch ◽

Sandra Rosenbaum-Krumme ◽

Marcus Ruhlmann

Keyword(s):

High Risk ◽

Fdg Pet ◽

Patient Management ◽

Whole Body ◽

Prognostic Impact ◽

Full Remission ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

SummaryIn a previous paper, we published the impact of initial [18F]FDG PET/CT (FDG-PET/CT) in high-risk patients with differentiated thyroid cancer (DTC) and described the changes in therapy management. The aim of the present study was to evaluate the prognostic impact of the initial FDG-PET/CT on a patient’s follow-up over three years and the rate of complete remission. Patients, methods: This study included 109 DTC patients who underwent radioiodine treatment (RIT), including posttherapeutic whole-body scintigraphy with FDG-PET/CT and a follow-up over three years. The follow-up included high-resolution sonography of the neck and determination of serum Tg as well as Tg antibodies every six months. The results of initial FDG-PET/CT and whole-body scintigraphy were compared with the status after three years of follow-up. Results: 24/109 patients (22%) presented FDG-positive lesions, 22/109 patients (20%) only iodine-positive lesions, and 63/109 patients (58%) neither FDG-positive nor iodine-positive lesions. After three years, 83/109 patients (76%) revealed full remission, 15/109 patients (14%) tumour persistence and 11/109 patients (10%) a progressive disease. The negative predictive value (NPV) was calculated for patients without FDG-positive lesions (NPV 85%) and patients without any lesions (NPV 91%) regarding full remission in the follow-up. Conclusion: FDG-PET/CT has a high NPV (85% to 91%) in DTC patients regarding recurrence-free follow-up after three years. The change in patient management in patients with iodine-negative lesions can lead to a higher rate of full remissions in the follow-up after additional surgery. Therefore, FDG-PET/ CT should be performed in all high-risk DTC patients in the context of the first RIT to improve patient management and risk stratification.

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Diagnosis, Treatment, and Follow‐Up of Borderline Ovarian Tumors

The Oncologist ◽

10.1634/theoncologist.2012-0139 ◽

2012 ◽

Vol 17 (12) ◽

pp. 1515-1533 ◽

Cited By ~ 86

Author(s):

Daniela Fischerova ◽

Michal Zikan ◽

Pavel Dundr ◽

David Cibula

Keyword(s):

Ovarian Tumors ◽

Borderline Ovarian Tumors

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