1
|
Li N, Ming X, Li Z. Unilateral cystectomy and serous histology are associated with relapse in borderline ovarian tumor patients with fertility-sparing surgery: a systematic review and meta-analysis. Arch Gynecol Obstet 2020; 302:1063-1074. [PMID: 32748055 DOI: 10.1007/s00404-020-05716-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/27/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Surgical procedures, histological subtypes, and surgical approaches are involved in the recurrence of borderline ovarian tumors (BOTs), but whether those three factors affect relapse remains controversial. This study aimed to explore the effects of surgical procedures, histological subtypes, and surgical approaches on the relapse and pregnancy rates of BOT after fertility-preserving surgery (FPS) according to the patients' characteristics. METHODS A systematic search of PubMed, Embase, and the Cochrane library was conducted from their inception to November 2018. Studies that investigated the impact of surgical procedures, histological subtypes, and surgical approaches on the relapse and pregnancy rates in patients with BOT after FPS were eligible. The pooled odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. RESULTS Thirty-five studies involving a total of 2921 patients with BOT after FPS were included. The pooled ORs indicated that the risk of relapse was significantly increased in patients who underwent unilateral cystectomy or with serous BOT. There was no significant difference between laparoscopy and laparotomy on the risk of relapse. Surgical procedures, histological subtypes, and surgical approaches did not influence pregnancy rates. CONCLUSIONS Patients who underwent unilateral cystectomy or with serous BOT presented an excess risk of relapse after FPS, but the surgical approach did not affect the risk of relapse. The pregnancy rate is not affected by surgical procedures, histological subtypes, and surgical approaches.
Collapse
Affiliation(s)
- Na Li
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, People's Republic of China
| | - Xiu Ming
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| |
Collapse
|
2
|
Chevrot A, Héquet D, Fauconnier A, Huchon C. Impact of surgical restaging on recurrence in patients with borderline ovarian tumors: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 248:227-232. [PMID: 32248048 DOI: 10.1016/j.ejogrb.2020.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/28/2020] [Accepted: 03/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The benefits of restaging surgery for patients with a borderline ovarian tumor (BOT) discovered on initial surgery are debatable. We performed a meta-analysis to evaluate the role of restaging surgery on recurrence in patients with BOTs. STUDY DESIGN We systematically reviewed published studies comparing restaging surgery and incomplete surgery in BOT patients from January 1985 to December 2017. Endpoints were recurrence and mortality rates. Study design features that possibly affected participant selection, reporting of recurrence and death, and manuscript publication were assessed. For pooled estimates of the effect of restaging surgery on recurrence, fixed-effect meta-analytical models were used. RESULTS Of the 577 articles initially selected, four retrospective observational studies (Restaging group: 166 patients; Non-Restaging group: 394 patients) met our research criteria. No significant differences in terms of recurrence between the two groups were observed (pooled Peto Odds Ratio [OR] = 0.88; 95 % confidence interval [CI]: 0.41-1.92). The number of deaths was insufficient for statistical analysis. CONCLUSIONS This meta-analysis based on retrospective studies, suggests that restaging surgery does not significantly reduce recurrence in patients with BOT.
Collapse
Affiliation(s)
- A Chevrot
- Department of Gynecology, Poissy-St Germain hospital, Poissy, France.
| | - D Héquet
- Department of Surgical Oncology, Institut Curie, St Cloud, France
| | - A Fauconnier
- Department of Gynecology, Poissy-St Germain hospital, Poissy, France; EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - C Huchon
- Department of Gynecology, Poissy-St Germain hospital, Poissy, France; EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| |
Collapse
|
3
|
Borderline Ovarian Tumors: Fifteen Years' Experience at a Scottish Tertiary Cancer Center. Int J Gynecol Cancer 2019; 28:1683-1691. [PMID: 30365457 DOI: 10.1097/igc.0000000000001364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Since 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. METHODS This 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. RESULTS Two 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). CONCLUSIONS To 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.
Collapse
|
4
|
Prognostic Factors for Recurrence After Fertility-Preserving Surgery in Patients With Borderline Ovarian Tumors: A Systematic Review and Meta-analysis of Observational Studies. Int J Gynecol Cancer 2018; 27:1833-1841. [PMID: 28816706 DOI: 10.1097/igc.0000000000001092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to find the unfavorable prognostic factors for recurrence after fertility-preserving surgery (FPS) in patients with borderline ovarian tumors (BOTs). METHODS To perform a meta-analysis to compare the recurrence rates of BOT patients after FPS according to different prognostic factors, we searched PubMed, EMBASE, and Cochrane for observational studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with a fixed-effects model. RESULTS We analyzed 32 studies that included 2691 BOT patients who underwent FPS, 383 patients of whom had a relapse in the follow-up. In meta-analysis, risks associated with recurrence in patients with unilateral cystectomy (OR, 2.49; 95% CI, 1.86-3.33) or serous borderline ovarian tumors (OR, 3.15; 95% CI, 1.97-5.02) were significantly increased, and there was no significantly increased OR for patients with laparoscopy compared with those with laparotomy (OR, 0.96; 95% CI, 0.57-1.60). CONCLUSIONS Unilateral cystectomy (19.4%) and serous BOTs (19.2%) are significantly associated with higher recurrence rates, and no negative impact of laparoscopy on recurrence can be demonstrated when compared with laparotomy in the meta-analysis.
Collapse
|
5
|
Shin YJ, Lee HJ, Kim KR, Nam JH, Park JY. Port-site recurrence 6 years after laparoscopic surgery for early stage ovarian borderline malignancy. J OBSTET GYNAECOL 2017; 38:291-292. [PMID: 28830247 DOI: 10.1080/01443615.2017.1340437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- You-Jung Shin
- a Department of Obstetrics and Gynecology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Republic of Korea.,b Hankook General Hospital , Jeju , Republic of Korea
| | - Hee-Jin Lee
- c Department of Pathology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Republic of Korea
| | - Kyu-Rae Kim
- c Department of Pathology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Republic of Korea
| | - Joo-Hyun Nam
- a Department of Obstetrics and Gynecology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Republic of Korea
| | - Jeong-Yeol Park
- a Department of Obstetrics and Gynecology , University of Ulsan College of Medicine, Asan Medical Center , Seoul , Republic of Korea
| |
Collapse
|
6
|
Theophilou G, Lima KMG, Martin-Hirsch PL, Stringfellow HF, Martin FL. ATR-FTIR spectroscopy coupled with chemometric analysis discriminates normal, borderline and malignant ovarian tissue: classifying subtypes of human cancer. Analyst 2016; 141:585-594. [DOI: 10.1039/c5an00939a] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Spectrochemical discrimination of ovarian cancer.
Collapse
Affiliation(s)
| | | | | | - Helen F. Stringfellow
- Department of Obstetrics and Gynaecology
- Central Lancashire Teaching Hospitals NHS Foundation Trust
- Preston
- UK
| | | |
Collapse
|
7
|
Black JD, Altwerger GH, Ratner E, Lu L, Silasi DA, Azodi M, Santin AD, Schwartz PE, Rutherford TJ. Management of Borderline Ovarian Tumors Based on Patient and Tumor Characteristics. Gynecol Obstet Invest 2015; 81:000431219. [PMID: 26067608 DOI: 10.1159/000431219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 05/06/2015] [Indexed: 02/28/2024]
Abstract
BACKGROUND Borderline ovarian tumors are staged similarly to invasive ovarian tumors. AIMS We wanted to better understand which tumors were associated with disease recurrence. METHODS We performed a retrospective cohort analysis at a single institution between 1984 and 2005. Cases were confirmed by pathology report. Multivariate analysis was done to evaluate factors associated with recurrence. RESULTS 143 cases were identified. Mean follow-up was 73.5 months. The overall risk of recurrence was 12%. The hazard ratio for risk of recurrence was highest among seromucinous tumors at 4.04 and lowest among mucinous tumors at 0.53. Only 4% of mucinous tumors, 15.5% of serous tumors and 28.6% of seromucinous tumors recurred. 2% of mucinous tumors had an appendix positive for metastasis. No mucinous tumor had nodal disease. CONCLUSIONS Based on our data, a low rate of appendiceal or lymph node involvement was observed in mucinous tumors, as was a low risk of recurrence. Less aggressive staging may be considered if a mucinous tumor is identified on frozen section with a normal-appearing appendix in the absence of pseudomyxoma peritonei. In patients with a serous or a seromucinous tumor, complete surgical staging is recommended. © 2015 S. Karger AG, Basel.
Collapse
Affiliation(s)
- Jonathan D Black
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Conn., USA
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Kleppe M, Bruls J, Van Gorp T, Massuger L, Slangen B, Van de Vijver K, Kruse A, Kruitwagen R. Mucinous borderline tumours of the ovary and the appendix: A retrospective study and overview of the literature. Gynecol Oncol 2014; 133:155-8. [DOI: 10.1016/j.ygyno.2014.02.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/04/2014] [Accepted: 02/08/2014] [Indexed: 11/24/2022]
|
9
|
Patrono MG, Minig L, Diaz-Padilla I, Romero N, Rodriguez Moreno JF, Garcia-Donas J. Borderline tumours of the ovary, current controversies regarding their diagnosis and treatment. Ecancermedicalscience 2013; 7:379. [PMID: 24386008 PMCID: PMC3869475 DOI: 10.3332/ecancer.2013.379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Indexed: 12/02/2022] Open
Abstract
Borderline ovarian tumours generally affect women of reproductive age. The positive prognosis is related to the fact that over 80% of cases are diagnosed at an early stage of the disease. Although radical surgery is the standard of care for this disease, fertility-sparing surgery can be performed in selected cases. Since it was first described in 1929, the knowledge of the molecular and histologic characteristics has been significantly improved. In this review, advances in the clinical behaviour, pathologic characteristics, prognostics factors, and different strategies of treatment are discussed.
Collapse
Affiliation(s)
- María Guadalupe Patrono
- Gynaecology Oncology Programme, Clara Campal Comprehensive Cancer Centre, HM Hospitals, Madrid 28050, Spain
| | - Lucas Minig
- Gynaecology Oncology Programme, Clara Campal Comprehensive Cancer Centre, HM Hospitals, Madrid 28050, Spain
| | - Ivan Diaz-Padilla
- Gynaecology Oncology Programme, Medical Oncology, Comprehensive Oncology Centre Clara Campal, HM Hospitals, Madrid 28050, Spain
| | - Nuria Romero
- Gynaecology Oncology Programme, Medical Oncology, Comprehensive Oncology Centre Clara Campal, HM Hospitals, Madrid 28050, Spain
| | - Juan Francisco Rodriguez Moreno
- Gynaecology Oncology Programme, Medical Oncology, Comprehensive Oncology Centre Clara Campal, HM Hospitals, Madrid 28050, Spain
| | - Jesus Garcia-Donas
- Gynaecology Oncology Programme, Medical Oncology, Comprehensive Oncology Centre Clara Campal, HM Hospitals, Madrid 28050, Spain
| |
Collapse
|
10
|
Nomogram to predict the probability of relapse in patients diagnosed with borderline ovarian tumors. Int J Gynecol Cancer 2013; 23:264-7. [PMID: 23295940 DOI: 10.1097/igc.0b013e31827b8844] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aimed to develop a nomogram predicting the probability of relapse in individual patients who have surgery for borderline ovarian tumors (BOTs). METHODS This retrospective study included 801 patients with BOT diagnosed between 1985 and 2008 at 6 gynecologic cancer centers. We analyzed covariates that were associated with the risk of developing a recurrence by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The 5 most significant or clinically important variables associated with an increased risk of recurrence were included in the nomogram. The nomogram was internally validated. RESULTS Fifty-one patients developed a recurrence after a median observation period of 57 months. Age at diagnosis, the International Federation of Gynecology and Obstetrics stage, cell type, preoperative serum CA125, and type of surgery (radical vs fertility-sparing) were associated with an increased risk of recurrence and were used in the nomogram. Bootstrap-corrected concordance index was 0.67 and showed good calibration. CONCLUSIONS Five factors that are commonly available to clinicians treating patients with BOT were used in the development of a nomogram to predict the risk of recurrence. The nomogram will be useful to counsel patients about risk-reduction strategies to minimize the risk of recurrence or to inform patients about a very low risk of recurrence making intensive follow-up unwarranted.
Collapse
|
11
|
Zacharakis D, Thomakos N, Biliatis I, Rodolakis A, Simou M, Daskalakis G, Bamias A, Antsaklis A. Ultrasonographic markers and preoperative CA-125 to distinguish between borderline ovarian tumors and stage I ovarian cancer. Acta Obstet Gynecol Scand 2012. [PMID: 23193945 DOI: 10.1111/aogs.12046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Preoperative evaluation of ovarian masses has become increasingly important for optimal planning of treatment. The aim of this study was to assess the role of preoperative serum cancer antigen 125 (CA-125) levels in correlation with ultrasonographic features in order to distinguish between borderline ovarian tumors (BOTs) and stage I epithelial ovarian carcinoma (EOC). DESIGN Retrospective study. SETTING Tertiary University Hospital. POPULATION We reviewed all women with BOTs and stage I EOC from January 2000 to December 2010. Data from 165 women (66 BOTs and 99 stage I EOC) were analyzed. METHODS Multivariable logistic regression with stepwise selection of variables was used to determine which clinical variables, ultrasound features and CA-125 level were independently associated with invasiveness. MAIN OUTCOME MEASURES Utility of ultrasonographic markers and CA-125 in the preoperative differential diagnosis between BOTs and stage I EOC. RESULTS Women with CA-125 > 100 IU mL(-1) had almost three times greater likelihood of belonging in the EOC group [odds ratio (OR) 3.02; confidence interval (CI) 95%: 1.13-8.12]. Furthermore, the presence of large solid component (≥20% of the tumor comprised of solid components) was associated with 4.25 times greater odds of it to representing ovarian cancer rather than a BOT (OR 4.25; 95% CI: 2.05-8.82). In contrast, the presence of papillary projections was associated with a 73% lower likelihood of EOC (OR 0.27; 95% CI: 0.13-0.58). CONCLUSIONS Preoperative CA-125 > 100 IU mL(-1) combined with the presence of a large solid component and the absence of papillary projections seems to improve the discriminative ability in favor of stage I EOC.
Collapse
Affiliation(s)
- Dimitrios Zacharakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Prognosis in patients with serous and mucinous stage I borderline ovarian tumors. Int J Gynecol Cancer 2012; 22:770-7. [PMID: 22426410 DOI: 10.1097/igc.0b013e31824b4076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The purpose to this study was to compare the clinicopathologic characteristics and prognosis of patients with serous stage I borderline ovarian tumors (BOTs) to patients with mucinous stage I BOTs. METHODS This was a retrospective cohort series of patients with stage I BOTs diagnosed and treated between 1995 and 2009 at a single institution. The records were analyzed for patients' clinicopathologic information. The recurrence rates were compared using the Kaplan-Meier method. RESULTS During the study period, 198 patients (73.6%) with mucinous BOTs and 71 patients (26.4%) with serous BOTs were identified. Patients with serous tumors tended to be asymptomatic (53.5%) and frequently had elevated CA-125 levels and positive results from peritoneal cytology. Conversely, mucinous tumors were more related to the presence of symptoms (70.7%), elevated CA-19-9 levels, and pseudomyxoma and were larger tumors with a mean size of 15.6 cm. After a median follow-up of 56.5 months, 15 patients had developed 16 recurrences. Among these, 14 borderline recurrences developed in 6 patients with mucinous tumors and in 7 patients with serous tumors, and 2 invasive recurrences developed in only patients with mucinous tumors. No difference in recurrence rate between mucinous and serous tumors was observed. In addition, no disease-related death occurred. CONCLUSIONS Our study found that, although distinct differences in clinical and pathologic characteristics between stage I mucinous and serous BOTs are seen, result from tumor histology was not associated with disease prognosis.
Collapse
|
13
|
Winser A, Ledermann JA, Osborne R, Gabra H, El-Bahrawy MA. Survey of the management of borderline ovarian tumors in the United Kingdom. World J Obstet Gynecol 2012; 1:3-13. [DOI: 10.5317/wjog.v1.i2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Borderline ovarian tumors (BOTs) represent approximately 10% of ovarian neoplasms and are a heterogeneous group of tumors with variable biological behaviour. The majority present with disease confined to the ovary and have an excellent prognosis after surgical removal. A small proportion subsequently has recurrent disease or progression to invasive cancer. Tumor recurrence can occur up to 20 years after surgical resection. There are no robust clinical, histological or molecular markers that distinguish high risk cases and no satisfactory treatment for patients with progressive disease. This results in great variability in management in different centres. We conducted a national survey on the management of borderline ovarian tumors in cancer centres representing different regions in the United Kingdom. In this article we review the literature for the current concepts in diagnosis, treatment and follow up of BOTs and we report the results of the survey of current practice in the United Kingdom. On that basis we provide recommendations for the management of patients with BOTs.
Collapse
|
14
|
Borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol 2012; 26:325-36. [DOI: 10.1016/j.bpobgyn.2011.12.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/23/2011] [Indexed: 01/09/2023]
|
15
|
Comparaison des facteurs épidémiologiques des tumeurs frontières séreuses et mucineuses de l’ovaire : implications thérapeutiques. Bull Cancer 2012; 99:551-6. [DOI: 10.1684/bdc.2012.1570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
16
|
Nomelini RS, da Silva TM, Tavares Murta BM, Murta EFC. Parameters of blood count and tumor markers in patients with borderline ovarian tumors: a retrospective analysis and relation to staging. ISRN ONCOLOGY 2012; 2012:947831. [PMID: 22577583 PMCID: PMC3345227 DOI: 10.5402/2012/947831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 02/20/2012] [Indexed: 11/26/2022]
Abstract
The aim of this paper was to evaluate the parameters of blood count and tumor markers in borderline ovarian tumors. We evaluated 21 patients who had confirmed histopathologic diagnosis of borderline ovarian tumor. We recorded age, parity, tumor type, stage of cancer, serum levels of tumor markers (CA-125, CA-15.3, CA-19.9, CEA, AFP), and the parameters of blood count, fasting glucose, disease-free survival and overall. The patients were divided into two groups, stage IA (n = 13) and stage IB-IIIC (n = 8). The unpaired t-test and Fisher's exact test were used, with P values of less than 0.05 being considered to indicate statistical significance. Levels of red blood cells, hematocrit, and hemoglobin were significantly higher in stage IA when compared with stage IB-IIIC (P < 0.05). The levels of tumor marker CEA had a tendency to be higher in the group stage IB-IIIC (0.08). Abnormal levels of CEA and CA-19.9 were found more frequently in stages IB-IIIC. Therefore, parameters of blood count, CEA, and CA-19.9 should be targeted for further research in identifying prognostic factors in borderline tumors.
Collapse
Affiliation(s)
- Rosekeila Simões Nomelini
- Discipline of Gynecology and Obstetrics, Oncological Research Institute (IPON), Federal University of Triângulo Mineiro, 38025-440 Uberaba, MG, Brazil
| | | | | | | |
Collapse
|
17
|
Tang A, Kondalsamy-Chennakesavan S, Ngan H, Zusterzeel P, Quinn M, Carter J, Leung Y, Obermair A. Prognostic value of elevated preoperative serum CA125 in ovarian tumors of low malignant potential: a multinational collaborative study (ANZGOG0801). Gynecol Oncol 2012; 126:36-40. [PMID: 22370601 DOI: 10.1016/j.ygyno.2012.02.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Previous studies on prognostic factors in ovarian tumors of low malignant potential (LMP) were too small for robust conclusions. We examined the prognostic impact of preoperative serum CA125 ≥ 50 U/ml levels in patients diagnosed with ovarian LMP tumors in a large multinational cohort. METHODS This retrospective study included 940 patients with ovarian LMP tumors diagnosed between 1985 and 2008 at six gynecologic cancer centers. Patients either had radical treatment (bilateral salpingo-oophorectomy with or without hysterectomy) or conservative, fertility-sparing treatment. Multivariate Cox proportional hazard models were used to determine independent prognostic factors for disease-free (DFS) and overall survival (OS). Based on receiver operating characteristic curve (ROC), a preoperative serum CA125 level ≥ 50 U/ml was considered "elevated". RESULTS CA125 was more often elevated in serous than in mucinous tumors and in advanced FIGO stages (2 to 4) compared to stage 1. DFS at 5 years was 89% and 95% in patients with elevated and normal CA125 levels (p<0.05). Similarly, the 5-year OS was 90% among patients with elevated CA125 compared to 95% among patients with normal levels (p<0.05). For both DFS and OS elevated CA125 levels and advanced stages of the disease were independent prognostic factors. Analysis of subgroups revealed that CA125 was only prognostic in serous LMP tumors. CONCLUSIONS In the context of serous ovarian LMP tumors, elevated preoperative serum CA125 represents a biomarker independently associated with impaired disease-free and overall survival. CA125 is available in most centers and could inform surgeons about the risk of treatment failure.
Collapse
Affiliation(s)
- Amy Tang
- Queensland Centre for Gynaecological Cancer, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Tumor borderline de ovario en adolescente. Semergen 2011. [DOI: 10.1016/j.semerg.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
19
|
Trillsch F, Mahner S, Ruetzel J, Harter P, Ewald-Riegler N, Jaenicke F, du Bois A. Clinical management of borderline ovarian tumors. Expert Rev Anticancer Ther 2010; 10:1115-24. [PMID: 20645700 DOI: 10.1586/era.10.90] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Borderline ovarian tumors (BOTs) are epithelial tumors of the ovaries characterized by cellular proliferation and nuclear atypia but without an infiltrative growth pattern. As they frequently affect younger patients the clinical management is complicated by considerations such as preserving fertility and reducing postoperative morbidity. Over the past several decades surgical therapy has shifted from a radical approach to more conservative treatment. There are various modes of surgery applied to the patients. All these developments have to be considered from an oncologic standpoint as BOTs represent a potentially malignant disease. Oncologic safety, as well as patients' desires and expectations, have to be balanced to reach the most appropriate treatment for BOTs. For this reason current literature will be discussed in this review to give a thorough overview of this topic and to develop recommendations for the surgical management of these patients. Open questions will be identified to elaborate the need for future surveys and research.
Collapse
Affiliation(s)
- F Trillsch
- University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | | | | | | | | | | | | |
Collapse
|
20
|
Benito V, Lubrano A, Arencibia O, Medina N, Álvarez Eva E, Andújar M, Falcón Juan M, Falcón O. Serous and mucinous borderline ovarian tumors: are there real differences between these two entities? Eur J Obstet Gynecol Reprod Biol 2010; 153:188-92. [PMID: 20728981 DOI: 10.1016/j.ejogrb.2010.07.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 07/07/2010] [Accepted: 07/13/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical outcome and pathological features of patients with borderline ovarian tumors (BOT) with special emphasis on serous and mucinous histology. STUDY DESIGN Medical and anatomopathological records were reviewed in the Gynecological Oncology Department of the Canarian University Hospital between 1990 and 2005. Survival rates were analyzed by using the Kaplan-Meier technique. RESULTS The study included 163 patients. Serous tumors corresponded to 68 cases and mucinous tumors to 91 cases. Eighty-nine percent of patients were at FIGO stage I, 1.2% at stage II and 9.8% at stage III. Serous histology was significantly related to the presence of peritoneal implants (22.4% vs 3.6%; p=0.001), positive peritoneal cytology (35.7% vs 8.5%; p=0.001) and bilaterality (27.9% vs 1.1%, p<0.0001). Event-free survival (EFS) rates at 2, 5 and 10 years were 96.7%, 92.7% and 90.5%, respectively, with a mean survival time of 183 months (CI 95% 172-193). Thirteen recurrence cases were found (7.9%) with a mean time to recurrence of 39.6 months (range 4-140). Overall survival (OS) rates at 2, 5 and 10 years were 100%, 96.4% and 93.6%, respectively, with a mean time of 189 months (CI 95% 179-198). Mucinous BOT were associated with significantly lower OS rates than serous BOT (10 years OS: 88.5% vs 98.2%; p=0.01). CONCLUSIONS Serous tumors present more unfavorable anatomopathological characteristics but are associated with better prognosis than mucinous tumors. If mucinous BOT diagnosis is retained physicians should be aware that their aggressive potential is not negligible.
Collapse
Affiliation(s)
- Virginia Benito
- Department of Gynecology Oncology, University Hospital of Canary Islands, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Vereczkey I, Tóth E, Orosz Z. [Diagnostic problems of ovarian mucinous borderline tumors]. Magy Onkol 2009; 53:127-33. [PMID: 19581178 DOI: 10.1556/monkol.53.2009.2.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
About 15-20% of all ovarian epithelial neoplasms are of borderline type (or atypical proliferative or carcinoma of low malignant potential) and about 5-7% are mucinous type, which are the second most common type behind the serous borderline tumors. The borderline tumor is a serious diagnostic and treatment problem both for the pathologists and for clinicians. These tumors appeared to be intermediate in their histologic and prognostic features between the benign cystadenomas and clearly malignant carcinomas. The borderline tumors occur most commonly in childbearing age, and show an indolent course. Their prognosis is good, but they are resistant to the traditional chemotherapies. To diagnose the intraepithelial carcinoma, to detect the microinvasion and the expansive invasion in a mucinous borderline tumor, to differentiate from the metastasis of colorectal tumors may be very problematic in the majority of the cases. Eleven cases diagnosed as mucinous borderline ovarian tumor in our institute from 2000 to 2008 were reviewed. Eight out of 11 were intestinal type while three were cervical (mullerian) type. In 5 cases our diagnosis was intraepithelial carcinoma and in 5 cases we found microinvasion. We discuss all of these problems according to the latest literature and our experience, mentioning the problems of the peritoneal and ovarian pseudomyxomas.
Collapse
Affiliation(s)
- Ildikó Vereczkey
- Országos Onkológiai Intézet Sebészi és Molekuláris Daganatpatológiai Centrum 1122 Budapest Ráth György u. 7-9.
| | | | | |
Collapse
|
22
|
Anchezar JP, Sardi J, Soderini A. Long-term follow-up results of fertility sparing surgery in patients with epithelial ovarian cancer. J Surg Oncol 2009; 100:55-8. [PMID: 19402079 DOI: 10.1002/jso.21297] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess clinical and obstetric outcome in young patients with epithelial ovarian cancer treated with fertility sparing surgery. METHODS Eighteen patients younger than 40 years carrying epithelial ovarian tumors were submitted to fertility sparing surgery between 1988 and 2003. Disease-free (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Statistical analysis was performed with the chi(2) test. RESULTS Disease free survival (DFS) 83.3% and overall survival (OS) 94.4% of patients treated with conservative surgery at 10 years. Up to date, six of seven patients who attempted pregnancy delivered seven healthy newborns. CONCLUSION Conservative surgery in young women with epithelial ovarian cancer is an appropriate therapeutic option in patients who wish to preserve childbearing potential. Long-term follow-up results shows excellent overall survival and pregnancy results.
Collapse
Affiliation(s)
- Juan P Anchezar
- Gynecologic Oncology Program, Buenos Aires University, Buenos Aires, Argentina.
| | | | | |
Collapse
|
23
|
De Iaco P, Ferrero A, Rosati F, Melpignano M, Biglia N, Rolla M, De Aloysio D, Sismondi P. Behaviour of ovarian tumors of low malignant potential treated with conservative surgery. Eur J Surg Oncol 2009; 35:643-8. [DOI: 10.1016/j.ejso.2008.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 09/19/2008] [Accepted: 09/30/2008] [Indexed: 01/25/2023] Open
|
24
|
Vereczkey I, Tóth E, Orosz Z. [Diagnostic difficulties in serous "borderline" tumors of the ovary]. Magy Onkol 2009; 53:23-31. [PMID: 19318323 DOI: 10.1556/monkol.53.2009.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
About 15-20% of all ovarian neoplasms are of borderline type (or atypical proliferative or carcinoma of low malignant potential). They represent a common diagnostic and treatment problem both for the pathologist and for clinicians. The borderline tumors occur most commonly in childbearing age, show an indolent course and have good prognosis but are resistant to the traditional chemotherapies. The serous borderline tumors are the most common types of borderline ovarian tumors and they can cause differential diagnostic problems even for the experienced pathologist. We studied 30 cases which were diagnosed in our institute from 2000 to 2008. Thirteen were typical serous borderline tumors, in 7 cases the pattern was micropapillary, in 2 cases with microinvasion and in the remaining 8 cases the borderline tumors were associated with low-grade serous carcinomas. Seventeen of the 22 borderline cases were stage I tumors. There were noninvasive implants in the remaining 5 cases and in the cases of the low-grade carcinomas we could find, besides the noninvasive implants (in 3 cases), invasive implants or metastasis too. The main diagnostic problems in serous ovarian borderline tumors are the presence of micropapillary pattern, to detect microinvasion, or to differentiate the pseudo-borderline pattern of the low-grade serous tumors from a real borderline tumor and especially to diagnose the extraovarian diseases (types of implants). We discuss these diagnostic problems and criteria according to recent literature and our experience.
Collapse
Affiliation(s)
- Ildikó Vereczkey
- Országos Onkológiai Intézet Sebészi és Molekuláris Daganatpatológiai Centrum 1122 Budapest Ráth György u. 7-9, Hungary.
| | | | | |
Collapse
|
25
|
Ji J, Försti A, Sundquist J, Lenner P, Hemminki K. Survival in ovarian cancer patients by histology and family history. Acta Oncol 2008; 47:1133-9. [PMID: 18607880 DOI: 10.1080/02841860701784544] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Earlier studies suggest that histology has no prognostic significance in patients with invasive ovarian tumors. Studies about the effect of family history on survival have given conflicting results, which we try to clarify in this study. As an additional question, we examined whether family members share survival experience. METHODS We used the nation-wide Swedish Family-Cancer Database to estimate hazard ratios (HRs) for cause-specific and overall survival in ovarian cancer patients by histology and family history. HRs show the probability of death in the study group compared to the reference group. RESULTS A total of 6,049 ovarian cancer patients with specific histologies were retrieved from our Database from years 1993 to 1999. Compared to women with epithelial ovarian cancer, women with borderline epithelial tumors had the best survival (HR 0.02 and 0.14 for cause-specific and overall survival). Good survival was also noted for patients with sex cord-stromal tumors and germ cell tumors. Among specific subtypes of epithelial ovarian cancers, good survival was noted for women with clear cell and endometrioid carcinomas and mucinous cystadenocarcinoma. The study covered 80 mother-daughter pairs with a family history. Patients with a family history had a poorer survival than sporadic cases in both maternal and offspring generations. When the survival was analyzed according to the probands' length of survival, there was a non-significant concordance of prognosis. CONCLUSION Our data showed that histology and family history are prognostic factors for ovarian tumors. Patients with a family history had a more aggressive course than the sporadic cases.
Collapse
|
26
|
Huang JYJ, Buckett WM, Gilbert L, Tan SL, Chian RC. Retrieval of immature oocytes followed by in vitro maturation and vitrification: A case report on a new strategy of fertility preservation in women with borderline ovarian malignancy. Gynecol Oncol 2007; 105:542-4. [PMID: 17379282 DOI: 10.1016/j.ygyno.2007.01.036] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 01/19/2007] [Accepted: 01/21/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND We report a novel fertility preservation strategy in a woman with borderline ovarian tumors involving retrieval of immature oocytes, in vitro maturation (IVM) and subsequent cryopreservation. CASE A 43-year-old woman underwent laparotomy for cystic ovarian masses on day 18 of her menstrual cycle. A diagnosis of bilateral borderline ovarian tumors was made following histological frozen section analysis. Left salpingo-oophorectomy, right ovarian cystectomy, omentectomy and lymph node sampling were performed. All visible follicles on the surface of the removed ovary were aspirated. Four immature oocytes were retrieved and underwent IVM. Three oocytes matured after 48 h and were cryopreserved. CONCLUSION Immature oocytes can be successfully isolated from the oophorectomy specimen regardless of the day of menstrual cycle, matured in vitro and cryopreserved, providing a possible strategy for fertility preservation in this group of women.
Collapse
Affiliation(s)
- Jack Y J Huang
- Department of Obstetrics and Gynecology, McGill University Health Center, McGill University, Montreal, Quebec, Canada H3A 1A1
| | | | | | | | | |
Collapse
|