1
|
Cacciottola L, Camboni A, Gatti E, Marbaix E, Vignali M, Donnez J, Dolmans MM. Fertility potential and safety assessment of residual ovarian cortex in young women diagnosed with epithelial borderline and early-stage malignant ovarian tumors. Gynecol Oncol 2024; 183:15-24. [PMID: 38492474 DOI: 10.1016/j.ygyno.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To establish the safety and quality of ovarian cortex surrounding epithelial ovarian tumors in women eligible for fertility-sparing surgery by identifying occult malignant lesions and characterizing the ovarian follicle pool. METHODS Multicentric retrospective study of 48 subjects (15-45 years), diagnosed with borderline ovarian tumors (BOTs) or early-stage epithelial ovarian cancers (EOCs) and eligible for fertility-sparing surgery. Histological samples of ovarian cortex surrounding tumors were analyzed to characterize the follicle pool, find any occult malignant lesion using tumor-specific markers (cytokeratin 7 and mucin 1), and quantify tumor-infiltrating lymphocytes (TILs) by CD3 and tumor associated macrophages (TAMs) by CD68. RESULTS Occult ovarian lesions were observed in 6 out of 45 cases investigated (14.6%), including one mucinous stage-I BOT (1/14), one serous stage-I BOT (1/13), 3 advanced-stage serous BOTs (3/11) and one early-stage serous EOC (1/7). Notably, follicle density was significantly lower in subjects diagnosed with ovarian tumors compared to controls (p < 0.001) and at a younger age. Significantly higher follicle atresia was encountered in the ovarian tumor group then in controls (20.1 ± 8.8% vs 9.2 ± 9.4%, p < 0.001) at all ages. Both TILs and TAMs were found in ovarian tumors irrespective of histotype, but no link was established with the status of the ovarian reserve. CONCLUSIONS Personalized counseling for fertility preservation is required in the event of BOTs and early-stage EOCs. Fertility-sparing surgery and adjuvant gamete preservation should be considered, balancing the oncological risks according to tumor stage and histotype and fertility potential, especially at a younger age.
Collapse
Affiliation(s)
- L Cacciottola
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - A Camboni
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Department of Anatomopathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - E Gatti
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - E Marbaix
- Department of Anatomopathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Prof Emeritus, Université Catholique de Louvain, Belgium
| | - M Vignali
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - J Donnez
- Prof Emeritus, Université Catholique de Louvain, Belgium; Société de Recherche Pour l'Infertilité, Brussels, Belgium
| | - M M Dolmans
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| |
Collapse
|
2
|
Clinicopathological Characteristics and Prognosis of 91 Patients with Seromucinous and Mucinous Borderline Ovarian Tumors: a Comparative Study. Reprod Sci 2022; 30:1927-1937. [DOI: 10.1007/s43032-022-01114-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/20/2022] [Indexed: 12/15/2022]
|
3
|
He Y, Zhong J, Yang H, Shan N, Cheng A. Clinical Characteristics Predict Recurrence in Borderline Ovarian Tumor Patients with Fertility-Preserving Surgery. Int J Gen Med 2022; 15:2197-2206. [PMID: 35250297 PMCID: PMC8892716 DOI: 10.2147/ijgm.s349451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/11/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Yunan He
- Reproductive Medical Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, People’s Republic of China
| | - Jiaojiao Zhong
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, People’s Republic of China
| | - Hui Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, People’s Republic of China
| | - Nianchun Shan
- Department of Gynecology and Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- Nianchun Shan, No. 87 Xiangya Road, Hunan, 41008, People’s Republic of China, Tel/Fax +86-731-89753999, Email
| | - Anran Cheng
- Department of Gynecology and Obstetrics, Xiamen Maluanwan Hospital, Xiamen,Fujian, People’s Republic of China
- Department of Gynecology Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Anran Cheng, Department of Gynecology and Obstetrics, Xiamen Maluanwan Hospital, Dongyao Cun, Maluanwan New Town, Haicang District, Xiamen, Fujian, 361027, People’s Republic of China, Tel/Fax +86-592-213 7792, Email
| |
Collapse
|
4
|
Canlorbe G, Chabbert-Buffet N, Uzan C. Fertility-Sparing Surgery for Ovarian Cancer. J Clin Med 2021; 10:jcm10184235. [PMID: 34575345 PMCID: PMC8466872 DOI: 10.3390/jcm10184235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022] Open
Abstract
(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.
Collapse
Affiliation(s)
- Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France;
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
- Correspondence:
| | - Nathalie Chabbert-Buffet
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France;
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
| |
Collapse
|
5
|
Qi Y, Wang M, Yang Y, Zeng Z, Zhou Y. Analysis of Factors Influencing Relapse and Pregnancy in Patients with Borderline Ovarian Tumors. J Cancer 2021; 12:5275-5285. [PMID: 34335944 PMCID: PMC8317534 DOI: 10.7150/jca.56387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/23/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: This retrospective study analyzed the factors affecting recurrence in patients after surgery with borderline ovarian tumors and postoperative recurrence and pregnancy after fertility-sparing surgery (FSS), to provide guidance for clinical treatment of borderline ovarian tumors and propose a therapeutic strategy for fertility protection. Methods: A total of 415 patients with borderline ovarian tumors were initially operated on in the gynecology ward of Shengjing Hospital Affiliated with China Medical University from September 1, 2013, to September 1, 2019. Central pathology review and prospective follow-up were carried out. The clinical and pathological data were consulted through the medical record query system of our hospital. The recurrence and pregnancy of the patients were investigated through telephone follow-up and outpatient and inpatient medical records. The influence of clinical and pathological variables on recurrence and pregnancy were evaluated using univariate/multivariate analyses. Results: In this study, 415 patients were collected, of which 21 lost follow-up, and a total of 394 eligible patients were included in the analysis. Among these patients, 25 patients relapsed with a recurrence rate of 6.3% and there were 196 patients with fertility-sparing surgery, of the 63 patients attempting to conceive, 35 were able to attain pregnancy with a pregnancy rate of 55.6%. All patients survived until the follow-up deadline. In univariate and multivariate analyses, FSS, FIGO stage, and micropapillary pattern were independent risk factors for recurrence of BOTs. FIGO stage, micropapillary pattern were independent risk factors for recurrence of BOTs with FSS. The risk of recurrence was not related to omentectomy nor postoperative chemotherapy. While omentectomy and chemotherapy had an impact on the pregnancy rate (P <0.05) and the pregnancy rate of patients without omentectomy or chemotherapy was higher. Conclusion: Omentectomy did not affect recurrence and it is not recommended as a routine operation. Adjuvant chemotherapy does not reduce the recurrence rate. While omentectomy and chemotherapy had an impact on the pregnancy rate, and both of them should be carried out more carefully in patients with fertility requirements.
Collapse
Affiliation(s)
- Ya Qi
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| | - Min Wang
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| | - Yuwei Yang
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| | - Zhi Zeng
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| | - Yingying Zhou
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
6
|
Stambough KC, Muscal JA, Edwards CL, Dietrich JE. Prevention of Recurrent Mucinous Borderline Ovarian Tumor with Aromatase Inhibitor. J Pediatr Adolesc Gynecol 2020; 33:610-612. [PMID: 32251836 DOI: 10.1016/j.jpag.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Aromatase inhibitors (AIs) are used for estrogen-modulated conditions. Some borderline ovarian tumors (BOT) express estrogen receptors. We present 2 cases of progression from mucinous cystadenoma to mucinous BOT (mBOT) after prior cystectomies in whom an AI was used with recurrence prevention. CASES Two patients underwent laparoscopic ovarian cystectomy for mucinous cystadenoma. Serial imaging demonstrated recurrent ovarian cysts for which both underwent fertility sparing surgery (FSS) with ovarian cystectomy for mBOT. Both patients were initiated on an AI and have been without recurrence. SUMMARY AND CONCLUSION BOT predominantly occur in reproductive aged females. FSS with cystectomy is an option, but recurrence occurs in 12-36% of cases. The use of AI in prevention of recurrent BOT shows promise, and more studies are needed to explore this treatment.
Collapse
Affiliation(s)
- Kathryn C Stambough
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Jodi A Muscal
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Creighton L Edwards
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
7
|
Li N, Gou J, Li L, Ming X, Hu TW, Li Z. Staging procedures fail to benefit women with borderline ovarian tumours who want to preserve fertility: a retrospective analysis of 448 cases. BMC Cancer 2020; 20:769. [PMID: 32807135 PMCID: PMC7433083 DOI: 10.1186/s12885-020-07262-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate the effect of clinicopathologic factors on the prognosis and fertility outcomes of BOT patients. Methods We performed a retrospective analysis of BOT patients who underwent surgical procedures in West China Second University Hospital from 2008 to 2015. The DFS outcomes, potential prognostic factors and fertility outcomes were evaluated. Results Four hundred forty-eight patients were included; 52 recurrences were observed. Ninety-two patients undergoing FSS achieved pregnancy. No significant differences in fertility outcomes were found between the staging and unstaged surgery groups. Staging surgery was not an independent prognostic factor for DFS. Laparoscopy resulted in better prognosis than laparotomy in patients with stage I tumours and a desire for fertility preservation. Conclusion Patients with BOT fail to benefit from surgical staging. Laparoscopy is recommended for patients with stage I disease who desire to preserve fertility. Physicians should pay more attention to risk of recurrence in patients who want to preserve fertility.
Collapse
Affiliation(s)
- Na Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, P.R. China
| | - Jinhai Gou
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Lin Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Xiu Ming
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Ting Wenyi Hu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China. .,Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.
| |
Collapse
|
8
|
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
|
9
|
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
|
10
|
Raad J, Rolland L, Grynberg M, Courbiere B, Mathieu d'Argent E. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Fertility]. ACTA ACUST UNITED AC 2020; 48:330-336. [PMID: 32004782 DOI: 10.1016/j.gofs.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Borderline ovarian tumours (BOT) represent around 15% of all ovarian neoplasms and are more likely to be diagnosed in women of reproductive age. Overall, given the epidemiological profile of BOT and their favourable prognosis, ovarian function and fertility preservation should be systematically considered in patients presenting these lesions. METHODS The research strategy was based on the following terms: borderline ovarian tumour, fertility, fertility preservation, infertility, fertility-sparing surgery, in vitro fertilization, ovarian stimulation, oocyte cryopreservation, using PubMed, in English and French. RESULTS AND CONCLUSIONS Fertility counselling should become an integral part of the clinical management of women with BOT. Patients with BOT should be informed that surgical management of BOT may cause damage ovarian reserve and/or peritoneal adhesions. Nomogram to predict recurrence, ovarian reserve markers and fertility explorations should be used to provide a clear and relevant information about the risk of infertility in patients with BOT. Fertility-sparing surgery should be considered for young women who wish preserving their fertility when possible. There is insufficient evidence to claim a causal relation between controlled ovarian stimulation (COS) and BOT. However, in case of poor prognosis factors, the use of COS should be considered cautiously through a multidisciplinary approach. In case of infertility after surgery for BOT, COS can be performed without delay, once histopathological diagnosis of BOT is confirmed. There is insufficient consistent evidence that fertility drugs and COS increase the risk of recurrence of BOT after conservative management. The conservative surgical treatment can be associated to oocyte cryopreservation considering the high risk of recurrence of the disease. In women with BOT recurrence in a single ovary and in women with bilateral ovarian involvement when the conservative management is not possible, other fertility preservation strategies are available, but still experimental.
Collapse
Affiliation(s)
- J Raad
- Service de médecine de la reproduction, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
| | - L Rolland
- Centre clinicobiologique d'AMP, pôle femmes-Parents-Enfants, hôpital de La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - M Grynberg
- Service de médecine de la reproduction, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Unité Inserm U1133, université Paris-Diderot, 75013 Paris, France
| | - B Courbiere
- Centre clinicobiologique d'AMP, pôle femmes-Parents-Enfants, hôpital de La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; CNRS, IRD, IMBE, Aix-Marseille université, Avignon université, 13005 Marseille, France
| | - E Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; UMR_S938 université Pierre-et-Marie-Curie, Paris 6, institut universitaire de cancérologie (IUC), Paris, France
| |
Collapse
|
11
|
Margueritte F, Sallee C, Lacorre A, Gauroy E, Larouzee E, Chereau E, De La Motte Rouge T, Koskas M, Gauthier T. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Epidemiology and Risk Factors of Relapse, Follow-up and Interest of a Completion Surgery]. ACTA ACUST UNITED AC 2020; 48:248-259. [PMID: 32004784 DOI: 10.1016/j.gofs.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide clinical practice guidelines from the French college of obstetrics and gynecology (CNGOF) based on the best evidence available, concerning epidemiology of recurrence, the risk or relapse and the follow-up in case of borderline ovarian tumor after primary management, and evaluation of completion surgery after fertility sparing surgery. MATERIAL AND METHODS English and French review of literature from 2000 to 2019 based on publications from PubMed, Medline, Cochrane, with keywords borderline ovarian tumor, low malignant potential, recurrence, relapse, follow-up, completion surgery. From 2000 up to this day, 448 references have been found, from which only 175 were screened for this work. RESULTS AND CONCLUSION Overall risk of recurrence with Borderline Ovarian Tumour (BOT) may vary from 2 to 24% with a 10-years overall survival>94% and risk of invasive recurrence between 0.5 to 3.8%. Age<40 years (level of evidence 3), advanced initial FIGO stage (LE3), fertility sparing surgery (LE2), residual disease after initial surgery for serous BOT (LE2), implants (invasive or not) (LE2) are risk factors of recurrence. In case of conservative treatment, serous BOT had a higher risk of relapse than mucinous BOT (LE2). Lymphatic involvement (LE3) and use of mini invasive surgery (LE2) are not associated with a higher risk of recurrence. Scores or Nomograms could be useful to assess the risk of recurrence and then to inform patients about this risk (gradeC). In case of serous BOT, completion surgery is not recommended, after conservative treatment and fulfillment of parental project (grade B). It isn't possible to suggest a recommendation about completion surgery for mucinous BOT. There is not any data to advise a frequency of follow-up and use of paraclinic tools in general case of BOT. Follow-up of treated BOT must be achieved beyond 5 years (grade B). A systematic clinical examination is recommended during follow-up (grade B), after treatment of BOT. In case of elevation of CA-125 at diagnosis use of CA-125 serum level is recommended during follow-up of treated BOT (grade B). When a conservative treatment (preservation of ovarian pieces and uterus) of BOT is performed, endovaginal and transabdominal ultrasonography is recommended during follow-up (grade B). There isn't any sufficient data to advise a frequency of these examinations (clinical examination, ultrasound and CA-125) in case of treated BOT. CONCLUSION Risk of relapse after surgical treatment of BOT depends on patients' characteristics, type of BOT (histological features) and modalities of initial treatment. Scores and nomogram are useful tools to assess risk of relapse. Follow-up must be performed beyond 5 years and in case of peculiar situations, use of paraclinic evaluations is recommended.
Collapse
Affiliation(s)
- F Margueritte
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - C Sallee
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - A Lacorre
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - E Gauroy
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Larouzee
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, 75000 Paris, France
| | - E Chereau
- Service de gynécologie-obstétrique, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
| | - T De La Motte Rouge
- Département d'oncologie médicale, centre Eugène Marquis, avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - M Koskas
- Service de gynécologie-obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, 75000 Paris, France
| | - T Gauthier
- Service de gynécologie-obstétrique, CHU de Limoges, hôpital mère-enfant, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87000 Limoges, France.
| |
Collapse
|
12
|
Canlorbe G, Lecointre L, Chauvet P, Azaïs H, Fauvet R, Uzan C. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Therapeutic Management of Early Stages]. ACTA ACUST UNITED AC 2020; 48:287-303. [PMID: 32004786 DOI: 10.1016/j.gofs.2020.01.016] [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] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning early stage borderline ovarian tumors (BOT). METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane, Embase, and international databases. RESULTS Considering management of early stage BOT, if surgery is possible without a risk of tumor rupture, the laparoscopic approach is recommended compared to laparotomy (Grade C). In BOT, it is recommended to take all the measures to avoid tumor rupture, including the peroperative decision of laparoconversion (Grade C). In BOT, extraction of the surgical specimen using an endoscopic bag is recommended (Grade C). In case of early stage, uni or bilateral BOT, suspected in preoperative imaging in a postmenopausal patient, bilateral adnexectomy is recommended (Grade B). In cases of bilateral BOT and desire of fertility preservation, a bilateral cystectomy is recommended (Grade B). In case of mucinous BOT and desire of fertility preservation, it is recommended to perform a unilateral adnexectomy (Grade C). In case of endometrioid BOT and desire of fertility preservation, it is not possible to establish a recommendation of treatment choice between cystectomy and unilateral adnexectomy. In case of mucinous BOT at definitive histological analysis in a woman of childbearing age who had an initial cystectomy, surgical revision for unilateral adnexectomy is recommended (Grade C). In the case of serous BOT with definitive histological analysis in a woman of childbearing age who has had an initial cystectomy, it is not recommended to repeat surgery for adnexectomy in the absence of residual suspicious lesion during initial surgery and/or on postoperative imaging (referent ultrasound or pelvic MRI) (Grade C). An omentectomy is recommended for complete initial surgical staging when BOT is diagnosed on extemporaneous analysis or suspected on preoperative radiological elements (Grade B). There is no data in the literature to recommend the type of omentectomy to be performed. If restaging surgery is decided for a presumed early stage BOT, an omentectomy is recommended (Grade B). Multiple peritoneal biopsies are recommended for complete initial surgical staging when BOT is diagnosed on extemporaneous or suspected on preoperative radiological elements (Grade C). In case of restaging surgery for a presumed early stage BOT, exploration of the abdominal cavity should be complete and peritoneal biopsies should be performed on suspicious areas or systematically (Grade C). A primary peritoneal cytology is recommended in order to achieve complete initial surgical staging when BOT is suspected on preoperative radiological elements (Grade C). In case of restaging surgery for presumed early stage BOT, a first peritoneal cytology is recommended (Grade C). For early serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (Grade C). For early stage endometrioid BOT, and in the absence of a desire to maintain fertility, hysterectomy is recommended for initial surgery or if restaging surgery is indicated (Grade C). For endometrioid-type early stage BOT, if there is a desire for fertility preservation, the uterus may be retained subject to good evaluation of the endometrium by imaging and endometrial sampling (Grade C). In case of surgery (initial or restaging if indicated) for early stage BOT, it is recommended to evaluate the macroscopic appearance of the appendix (Grade B). In case of surgery (initial or restaging if indicated) for early stage BOT, appendectomy is recommended only in case of macroscopically pathological appearance of the appendix (Grade C). Pelvic and lumbar aortic lymphadenectomy is not recommended for initial surgery or restaging surgery for early stage BOT regardless of histologic type (Grade C). In case of BOT diagnosed on definitive histology, the indication of restaging surgery should be discussed in Multidisciplinary Collaborative Meeting. For presumed early stage BOT, it is recommended to use the laparoscopic approach to perform restaging surgery (Grade C). Restaging surgery is recommended for serous BOT with micropapillary appearance and unsatisfactory abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended in case of mucinous BOT if only a cystectomy has been performed or the appendix has not been visualized, then a unilateral adnexectomy will be performed (Grade C). If a restaging surgery is decided in the management of a presumed early stage BOT, the actions to be carried out are as follows: a peritoneal cytology (Grade C), an omentectomy (there is no data in the literature recommending the type of omentectomy to be performed) (Grade B), a complete exploration of the abdominal cavity with peritoneal biopsies on suspect areas or systematically (Grade C), visualization of the appendix± the appendectomy in case of pathological macroscopic appearance (Grade C), unilateral adnexectomy in case of mucinous TFO (Grade C).
Collapse
Affiliation(s)
- G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France; Biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Sorbonne université, 75012 Paris, France.
| | - L Lecointre
- Centre hospitalier universitaire Hautepierre, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - P Chauvet
- Département de chirurgie gynécologique, CHU Estaing, Clermont-Ferrand, France; EnCoV, IP, UMR 6602 CNRS, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - R Fauvet
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Caen, 14000 Caen, France; Unité de recherche Inserm U1086 « ANTICIPE » - Axe 2 : biologie et thérapies innovantes des cancers localement agressifs (BioTICLA), université de Normandie Unicaen, 14000 Caen, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France; Biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Sorbonne université, 75012 Paris, France
| |
Collapse
|
13
|
Vo TM, Duong KA, Tran LTH, Bui TC. Recurrence rate and associated factors of borderline ovarian tumors in the south of Vietnam. J Obstet Gynaecol Res 2019; 45:2055-2061. [PMID: 31368150 DOI: 10.1111/jog.14072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
AIM This study aimed to determine the recurrence rate and related risk factors of borderline ovarian tumors (BOT). METHODS We conducted a retrospective cohort study with 433 patients who were surgically treated for primary BOT at Tu Du Hospital from 11/2008 to 09/2015. We used the life table method to estimate the cumulative recurrence rate. We used the log-rank test and Cox proportional hazard model to determine recurrence-associated factors. RESULTS Median follow-up time was 43 months (range: 3-105 months). Eighteen patients developed recurrence. The cumulative BOT recurrence rates at year 1, 2, 3 and 4 were 1.2% (95% confidence interval [CI] = 0.5-2.8), 3.0% (95% CI = 1.7-5.2), 4.6% (95% CI = 2.9-7.4), and 5.1% (95% CI = 3.2-8.0), respectively. In the final multivariate model, a higher recurrence rate was significantly associated with primary tumor stages (stage I vs stages II and III, hazards ratio [HR] = 4.44, 95% CI = 1.60-12.38), pre-operative tumor's capsule rupture (HR = 4.14, 95% CI = 1.78-9.64), and cystectomy (HR = 5.33, 95% CI = 1.43-19.91). CONCLUSION The overall BOT recurrence rate in women in southern Vietnam was moderate. Primary tumor stage, capsule rupture, and cystectomy were main factors associated with BOT recurrence. Appropriate follow-up strategies for patients with high-risk factors are needed for early detection and management of recurrence.
Collapse
Affiliation(s)
- Tuan M Vo
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kim A Duong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ly T-H Tran
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Thanh C Bui
- Stephenson Cancer Center, Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
14
|
Ovarian conservation in management of pediatric gynecology malignancies. Curr Opin Obstet Gynecol 2018; 30:316-325. [DOI: 10.1097/gco.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|