Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study

Borderline ovarian tumors and extended patient follow-up: an individual institution's experience

INTRODUCTION

Borderline tumors of the ovary (BOT) comprise nearly 20% of all ovarian malignancies and are associated with a favorable prognosis. However, since these lesions can present with malignant features and recur, a further evaluation of appropriate patient management and long-term follow-up is warranted.

METHODS

We report a physician group's retrospective experience treating BOT patients at a single institution. Patient demographics, disease pathology, treatment type (surgery, chemotherapy), and patient surveillance (e.g., disease-free survival (DFS), overall survival, follow-up via CA-125/radiology/physical exam) data were reviewed in all cases.

RESULTS

In the present study, 78 BOT patients treated from April 2001 until February 2009 were identified and confirmed via pathologic diagnosis. The majority (87%) underwent surgery, although nearly 13% of patients also received adjuvant chemotherapy. In the study population, 12% of the patients developed progressive disease, which was primarily detected via CA-125 and physical exam/disease symptomatology. DFS for these patients was 38 months. Recurrent disease was significantly related to the administration of chemotherapy (P = 0.0024) and prolonged time since initial treatment (P < 0.001).

DISCUSSION

Since BOT can be aggressive and eventually recur, continued (i.e., long-term) surveillance with CA-125 evaluation and physical examination should be considered for optimal patient follow-up.

Surgery in advanced borderline tumors

Our retrospective study evaluates the role of conservative surgery, performed in 10 of 22 patients affected by advanced stage serous borderline ovarian tumor. Although patients who underwent conservative surgery had a higher recurrence rate (60% after conservative surgery and 8% after radical surgery), all patients are alive without evidence of disease.

Ovarian epithelial tumors of low malignant potential: a case series of 5 adolescent patients

Epithelial ovarian neoplasms are uncommon in pediatric and adolescent patients, accounting for approximately 20% to 30% of ovarian tumors in adolescent females and women younger than 25. Tumors of low malignant potential (LMP) account for a significant proportion of epithelial neoplasms in this patient population. This case series describes 5 adolescent patients, with a mean age of 14.4 +/- 2.4 years, diagnosed with ovarian tumors of LMP at one institution. Between November 2001 and January 2006, 5 patients were diagnosed with ovarian tumors of LMP of 126 patients who had surgery for adnexal masses. All patients underwent initial surgery via laparotomy. Two patients underwent ovarian cystectomy, and 3 had at least a unilateral salpingo-oophorectomy. One patient had stage IIIc disease, whereas the other 4 patients, not all completely staged, had presumed stage I disease. Three patients developed recurrent ovarian masses on follow-up. Two had recurrent LMP tumors (one bilateral) and one was a benign mucinous cystadenoma. This case series of 5 adolescent patients with ovarian tumors of LMP highlights the importance of considering epithelial neoplasms in any pediatric or adolescent patient with a pelvic mass and supports conservative management, with staging and fertility-sparing surgery; however, appropriate follow-up is essential, as evidenced by 3 of 5 patients exhibiting recurrent ovarian masses.

[French recommendations for ovarian cancer management during pregnancy]

Evaluation of the fetus using prenatal ultrasound has resulted in increased detection of asymptomatic adnexal masses during pregnancy. Such masses are rarely malignant (1/10 000 to 1/50 000 pregnancies), but the possibility of borderline or cancer must be considered. It is a common assumption by both patients and physicians that if an ovarian cancer is diagnosed during pregnancy, treatment necessitates sacrificing the well-being of the fetus. However, in most cases, it is possible to offer appropriate treatment to the mother without placing the fetus at serious risk. The care of a pregnant woman with cancer involves evaluation of sometimes competing maternal and fetal risks and benefits. These recommendation approaches attempt to balance these risks and benefits; however, they should be considered advisory and should not replace specific interdisciplinary consultation with specialists in maternal-fetal medicine, gynecologic oncology, and pediatrics, as well as imaging and pathology, as needed. Second level ultrasound including Doppler is needed. MRI is not often necessary, and CA 125 is of low contribution. We suggest surgery be performed after 15 SA for ovarian masses which (1) persist into the second trimester, (2) are greater than 5 to 10 cm in diameter, or (3) have solid or mixed solid and cystic ultrasound characteristics. During antepartum surgical staging and debulking, homolateral salpingo-oophorectomy and peritoneal cytology and exploration are necessary. Women found to have advanced stage epithelial ovarian cancer should consider having completion of the debulking of the reproductive organs at the conclusion of the pregnancy. If chemotherapy is indicated, we recommend delaying administration, if possible, after the delivery or at least after 20 SA in order to minimize the potential fetal toxicity.

Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany

The aim of this survey was to analyse the standard of care in diagnostic, surgery, chemotherapy and aftercare management for patients with borderline tumours of the ovary (BOTs) in Germany. A structured questionnaire comprising different dimensions was sent to all 1114 gynaecological departments. The questionnaire could be returned anonymously. The overall response rate was 29.0% (323 departments). Most departments were on secondary care (71.8%), tertiary care (23.2%) or university hospital (5.0%) level. Most clinicians performed not more than five BOT operations (89.2%) per year. Most departments (93.2%) used in addition to classical bimanual examination and vaginal ultrasound, tumour marker CA-125 detection, CT scan, MRI or PET-CT techniques. Departments in university and tertiary care hospitals performed more often a fresh frozen section (87 vs 64%). In young women, clinicians performed much seldom unilateral salpingo-oophorectomy (92%) and only in 53% biopsies of the contralateral ovary. Generally, biopsies of the contralateral ovary were performed in 4-53% of the patients. Chemotherapy was mostly favoured in 'high-risk' patients with tumour residual, microinvasion or invasive implants. Thus, a high grade of insecurity in diagnostic and therapy of BOT exists in some gynaecological departments and underlines the need for more educational and study activities.

A clinicopathologic multivariate analysis affecting recurrence of borderline ovarian tumors

OBJECTIVE

To evaluate the risk factors associated with recurrence of borderline ovarian tumors that may be used as evidence of the efficacy of select preventive procedures.

METHODS

Various clinicopathologic factors of 234 patients with borderline ovarian tumors admitted to our hospital between January 2001 and June 2007 were reviewed. Univariate and multivariate logistic regression models were constructed to evaluate the risk factors for odds ratio (OR) and statistical significance. The survival was assessed by the Kaplan-Meier method and proportional hazards model.

RESULTS

Recurrence of borderline ovarian tumors was observed in 26 cases and the median time to recurrence was 29.4 months. Of these cases, 5 occurred involving the ipsilateral ovary, 9 involved the contralateral ovary, and 12 spread to the pelvic peritoneum, including 3 patients who had progressed to invasive carcinoma. No tumor-related deaths were reported. The results of the multivariate logistic regression analysis showed that conservative surgical procedures (OR=2.304; p=0.024), cyst rupture (OR=2.213; p=0.038), advanced FIGO stage (OR=4.114; p=0.000), microinvasion (OR=2.291; p=0.046), and peritoneal implants (OR=2.101; p=0.016) may be independent predictive factors of recurrence. The proportional hazards model identified surgical procedure (relative risk, RR=3.752, p=0.007), cyst rupture (RR=1.985, p=0.006), FIGO stage (RR=3.746, p=0.001), microinvasion (RR=1.153, p=0.009) and peritoneal implants (RR=2.742, p=0.010), as independently related to disease-free survival.

CONCLUSIONS

Although patients with borderline ovarian tumors have an excellent prognosis, the risk of recurrence remains. Identification of patients with high-risk factors is essential for offering more selective treatments to prevent recurrence.

Laparoscopy in the treatment of ovarian tumours of low malignant potential

Laparoscopy is increasingly used by gynaecologists for the investigation of adnexal masses. Uncertainty exists whether ovarian tumours of low malignant potential can effectively be treated by laparoscopy, whether staging bears a benefit for all patients, whether port-site metastases are a problem and how long patients need to be followed up after surgery. This review summarises the evidence to address these important questions.

Endoscopic surgery in patients with borderline tumor of the ovary: A follow-up study of thirty-five patients

STUDY OBJECTIVE

To study the long-term outcome of 35 patients after endoscopic surgery of ovarian borderline tumor.

DESIGN

Descriptive study (Canadian Task Force classification II-2).

SETTING

Outpatient clinic.

PATIENTS

Thirty-five women with histologically proven ovarian borderline tumors underwent adnexal surgery by laparoscopy in an outpatient clinic.

INTERVENTIONS

We report a series of 41 patients treated by endoscopic surgery for borderline tumors of the ovary, 35 of whom were followed up for 2 to 12 years after surgery.

MEASUREMENTS AND MAIN RESULTS

Of a total of 3138 patients referred for endoscopic surgery to treat ovarian tumors, 7 were found to have cancer, and 41 were found to have borderline tumors. The borderline tumor was diagnosed before surgery by vaginal ultrasonography in 45.7% of patients, during surgery in an additional 22.9%, but only by postoperative histologic study in 31.4% of patients. There were no intraoperative or postoperative complications in the patients with borderline tumor, and all have remained healthy for the period of their follow-up.

CONCLUSION

Provided a strict management protocol is followed, endoscopic surgery is safe and effective for the treatment of borderline tumors of the ovary.