Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors.
Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Ovarian Epithelial
/ pathology
Female
Fertility Preservation
/ methods
Humans
Live Birth
Lymph Node Excision
Lymph Nodes
/ pathology
Middle Aged
Neoplasm Recurrence, Local
/ pathology
Neoplasm Staging
Ovarian Neoplasms
/ pathology
Pregnancy
Pregnancy Rate
Retrospective Studies
Young Adult
Borderline tumors of the ovary
Conservative treatment
Fertility sparing surgery
Radical surgery
Recurrence
Journal
Gynecologic oncology
ISSN: 1095-6859
Titre abrégé: Gynecol Oncol
Pays: United States
ID NLM: 0365304
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
15
11
2019
revised:
05
02
2020
accepted:
05
02
2020
pubmed:
3
3
2020
medline:
31
10
2020
entrez:
3
3
2020
Statut:
ppublish
Résumé
Borderline ovarian tumors (BOT) are considered a biological category with increased epithelial proliferation and cellular atypia in the absence of invasive growth. Since BOT occur often in young patients fertility sparing surgery (FSS) is an important issue. With this study we aimed to evaluate risk factors for relapses and fertility of patients after FSS. Patients diagnosed with BOT and treated between 2000 and 2018 were included. External pathological review was done in all patients. FSS was performed after individual discussion and a complete surgical staging according to FIGO, without lymphadenectomy and with a waiver for preservation of uterus and one ovary. Among 352 Patients 80.2% had FIGO I and 63.9% had a serous BOT. Eighteen patients (5.1%) relapsed and 4 cases of malignant transformation were reported (1.1%). One patient of the latter died, all others have no evidence of disease. The overall recurrence-rate was 1.1% in FIGO-Stage I and 25.5% in FIGO III-IV (HR = 27; 95%-CI 7.7-95; p ≤.001). 95 patients underwent FSS. Thirteen (13.7%) of these patients relapsed, all as BOT. In multivariate analysis FIGO stages II-IV (HR = 27; 95%-CI: 8.1-102; p ≤.001) and FSS (HR = 12; 95%-CI: 2.9-47; p = .001) remained significant risk factors for recurrent disease. Pregnancy rate among forty-one patients attempting to conceive was 82.9%. 29 patients experienced at least one life-birth, in total 38 life-births were reported. FSS in stage I is a safe procedure and life-birth-rates after FSS are high. More advanced FIGO stages have to be discussed individually and relapse rates have to be weighed against FSS. A central review of pathology, as we performed routinely, is mandatory and may have contributed to our low rate of invasive relapses.
Sections du résumé
BACKGROUND
Borderline ovarian tumors (BOT) are considered a biological category with increased epithelial proliferation and cellular atypia in the absence of invasive growth. Since BOT occur often in young patients fertility sparing surgery (FSS) is an important issue. With this study we aimed to evaluate risk factors for relapses and fertility of patients after FSS.
METHODS
Patients diagnosed with BOT and treated between 2000 and 2018 were included. External pathological review was done in all patients. FSS was performed after individual discussion and a complete surgical staging according to FIGO, without lymphadenectomy and with a waiver for preservation of uterus and one ovary.
RESULTS
Among 352 Patients 80.2% had FIGO I and 63.9% had a serous BOT. Eighteen patients (5.1%) relapsed and 4 cases of malignant transformation were reported (1.1%). One patient of the latter died, all others have no evidence of disease. The overall recurrence-rate was 1.1% in FIGO-Stage I and 25.5% in FIGO III-IV (HR = 27; 95%-CI 7.7-95; p ≤.001). 95 patients underwent FSS. Thirteen (13.7%) of these patients relapsed, all as BOT. In multivariate analysis FIGO stages II-IV (HR = 27; 95%-CI: 8.1-102; p ≤.001) and FSS (HR = 12; 95%-CI: 2.9-47; p = .001) remained significant risk factors for recurrent disease. Pregnancy rate among forty-one patients attempting to conceive was 82.9%. 29 patients experienced at least one life-birth, in total 38 life-births were reported.
CONCLUSION
FSS in stage I is a safe procedure and life-birth-rates after FSS are high. More advanced FIGO stages have to be discussed individually and relapse rates have to be weighed against FSS. A central review of pathology, as we performed routinely, is mandatory and may have contributed to our low rate of invasive relapses.
Identifiants
pubmed: 32115229
pii: S0090-8258(20)30102-5
doi: 10.1016/j.ygyno.2020.02.007
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
411-417Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest H. Plett: nothing to disclose; P.Harter: Honoraria: Astra Zeneca, Roche, Sotio, Tesaro, Stryker, ASCO, Zai Lab, MSD; Advisory Board: Astra Zeneca, Roche, Tesaro, Lilly, Clovis, Immunogen, MSD/Merck; Research funding (Inst): Astra Zeneca, Roche, GSK, Boehringer Ingelheim, Medac, DFG, European Union, DKH, Tesaro, Genmab; F. Heitz: Honoraria: AstraZeneca, Roche, Tesaro, Clovis; Advisory Board: Astra Zeneca, Roche, Tesaro, Clovis; A. du Bois: personal fees from Roche, personal fees from Astra Zeneca, personal fees from Tesaro, personal fees from Clovis, personal fees from Pfizer, personal fees from Genmab, personal fees from Pharmar, personal fees from Biocad, outside the submitted work; B. Ataseven: Roche Advisory board, lecture, travel/accommodation expenses Tesaro Advisory board, travel/accommodation expenses Amgen Advisory board Celgene lecture PharmaMar travel/accommodation expenses Clovis lecture Astra Zeneca lecture; S. Schneider: Roche: lecture Tesaro: Advisory board,lecture, travel/accommodation expenses Clovis: lecture Astra: Zeneca lecture A. Traut, S. Prader, S. Lax, A. Staebler, F. Kommoss and S. Heikaus: nothing to disclose.