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Baba T, Koshiyama M, Kagabu M, Mikami Y, Minamiguchi S, Moritani S, Ishikawa M, Okamoto A, Terao Y, Nakanishi T, Katabuchi H, Tokunaga H, Satoh T, Konishi I, Yaegashi N. Ovarian serous borderline tumors with recurrent or extraovarian lesions: a Japanese, retrospective, multi-institutional, population-based study. Int J Clin Oncol 2023; 28:1411-1420. [PMID: 37526805 DOI: 10.1007/s10147-023-02393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Ovarian serous borderline tumors (SBT) are typically unilateral and are primarily treated using hysterectomy and bilateral salpingooophorectomy (SO). However, most young patients prefer fertility-sparing surgeries (FSS) with tumorectomy or unilateral SO. Micropapillary morphology and invasive implants have been designated as histopathological risk indicators for recurrence or metastasis, but their clinical impact remains controversial because of limitations like diagnostic inconsistency and incomplete surgical staging. METHODS A nationwide multi-institutional population-based retrospective surveillance was conducted with a thorough central pathology review to reveal the clinical features of SBT. Of 313 SBT patients enrolled in the Japanese Society of Clinical Oncology's Surveillance of Gynecologic Rare Tumors, 289 patient records were reviewed for clinical outcomes. The glass slides of patients at stage II-IV or with recurrence or death were re-evaluated by three gynecological pathologists. RESULT The 10-year overall and progression-free survival (PFS) rates were 98.6% and 92.3%. The median recurrence period was 40 months and 77.0% was observed in the contralateral ovary within 60 months. Patients aged ≤ 35 years underwent FSS more frequently and relapsed more (p < .001). A clinic-pathological analysis revealed diagnosis during pregnancy, FSS, and treatment at non-university institutes as well as advanced stage and large diameter were independent risk factors of recurrence. Among patients having pathologically confirmed SBTs, PFS was not influenced by the presence of micropapillary pattern or invasive implants. CONCLUSION The recurrence rate was lower in this cohort than previous reports, but the clinical impacts of incomplete resection and misclassification of the tumor were still significant on the treatment of SBT.
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Affiliation(s)
- Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-Cho, Shiwa, Iwate, 028-3695, Japan.
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Masafumi Koshiyama
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masahiro Kagabu
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-Cho, Shiwa, Iwate, 028-3695, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Suzuko Moritani
- Department of Diagnostic Pathology, Shiga University of Medical Science Hospital, Setatsukinowa-Cho, Otsu, 520-2192, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Aikou Okamoto
- Department of Gynecology and Obstetrics, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yasuhisa Terao
- Department of Gynecology and Obstetrics, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Toru Nakanishi
- Department of Gynecologic Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hideki Tokunaga
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8675, Japan
| | - Toyomi Satoh
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan
| | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobuo Yaegashi
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8675, Japan
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Yoshiba T, Takei Y, Manaka Y, Suzuki T, Fujiwara H. A patient with a mucinous borderline ovarian tumor after fertility‐sparing surgery in whom puncture fluid cytology on oocyte retrieval led to a diagnosis of recurrence. J Obstet Gynaecol Res 2022; 48:2635-2639. [DOI: 10.1111/jog.15365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Takahiro Yoshiba
- Department of Obstetrics and Gynecology Jichi Medical University Shimotsuke Tochigi Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology Jichi Medical University Shimotsuke Tochigi Japan
| | - Yumi Manaka
- Department of Obstetrics and Gynecology Jichi Medical University Shimotsuke Tochigi Japan
| | - Tatsuya Suzuki
- Department of Obstetrics and Gynecology Jichi Medical University Shimotsuke Tochigi Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology Jichi Medical University Shimotsuke Tochigi Japan
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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.
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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.
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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).
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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
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Short-term Outcomes and Pregnancy Rate After Laparoscopic Fertility-Sparing Surgery for Borderline Ovarian Tumors: A Single-Institute Experience. Int J Gynecol Cancer 2019; 28:274-278. [PMID: 29324543 PMCID: PMC5794247 DOI: 10.1097/igc.0000000000001170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective We investigated the short-term outcomes and pregnancy rate after a laparoscopic approach to fertility preservation in patients with borderline ovarian tumors (BOTs). Methods Clinic-pathologic variants of patients with BOTs who underwent conservative surgery at the Tianjin Central Hospital of Obstetrics and Gynecology between January 2009 and July 2015 were retrospectively analyzed. Results Among 211 patients with BOTs, 74 (35.1%) received conservative surgery (44 cases using a laparoscopic approach and 30 cases using a laparotomy approach). The mean age of the laparotomy group was significantly younger than that of the laparoscopic group (P = 0.024). The maximal longitude of the tumor in the laparotomy group was significantly longer than that in the laparoscopic group (P < 0.001). The number of incomplete surgery cases in the laparoscopic group was significantly greater than that in the laparotomy group (P < 0.001). The 2 groups showed no significant differences in gravidity and parity before surgery, abnormality of serum tumor makers, tumor lateralities, ascites, histology, duration of follow-up, pregnancy rate after surgery, or postoperative recurrence. Total recurrent rate was 6.7% (5/74). Two cases in laparotomy group and 3 cases in laparoscopic group relapsed respectively. There was no significant difference of recurrent rate between the 2 groups. The total pregnant rate was 33.8% (25/74). Nine patients (30%) in the laparotomy group and 16 patients (36.4%) in the laparoscopic group became pregnant during follow-up respectively. There were no significant differences in the postoperative durations of pregnancy, pregnancy type, age at pregnancy, tumor lateralities, ascites, or type of pathology between 2 groups. The pregnancy rate of incomplete surgery cases in laparoscopic group was significantly higher than that of laparotomy group (P = 0.011). No recurrence occurred among the pregnant cases. Conclusions A comprehensive laparoscopic surgery was not performed in incomplete surgery patients undergoing complete exploration. Good short-term outcomes and pregnancy were observed in patients receiving conservative laparoscopic surgery for BOTs, especially in patients receiving incomplete conservative laparoscopic surgery.
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Zhang W, Wang L, Xin Z. Combination of serum CA19-9 and CA125 levels and contrast-enhanced ultrasound parametric data facilitates to differentiate ovarian serous carcinoma from ovarian malignant epithelial cancer. Medicine (Baltimore) 2018; 97:e0358. [PMID: 29668586 PMCID: PMC5916679 DOI: 10.1097/md.0000000000010358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ovarian serous carcinoma (OSC) is semimalignant ovarian tumors that localized in the ovary at the initial presentation, and can be surgically resected in an excellent prognosis. In contrast, surgical treatment plus adjuvant chemotherapy for ovarian malignant epithelial cancer (OMEC) is the standard treatment stratagem that is painful with poor prognosis and cost quite expensively. Thus, the accurate preoperative differentiation of OSC from OMEC is important for determining the treatment methods and decreasing the cost for individual patients. This study aims to determine whether contrast enhanced ultrasound (CEUS) together with CA19-9/CA125 can improve the ability to differentiate ovarian serous carcinoma from ovarian malignant epithelial cancer. The positive rate of cancer antigen (CA) 199 and CA125 in ovarian malignant epithelial tumors was 68% and 94%, respectively, which was a higher incidence than in the serous carcinoma. The mean serum CA19-9 and CA125 concentration was significantly higher in the patients with ovarian malignant epithelial tumors (CA19-9, 514.0 ± 104.8 U/mL; CA125, 440.0 ± 154.8 U/mL) than that in the patients with ovarian serous carcinoma (CA19-9, 58.0 ± 14.3 U/mL; CA125, 63.0 ± 25.8 U/mL). The time to peak in ovarian serous carcinoma was significantly longer than in ovarian malignant epithelial tumors. However, the peak intensity, area under the curve, and washout time in ovarian serous carcinoma were significantly lower than in ovarian malignant epithelial tumors. The addition of CA19-9/CA125 increased the sensitivities from 79% CEUS only to 85% for CEUS plus CA19-9/CA125 data, and increased the specificities from 65% CEUS only to 91% for CEUS plus the CA19-9/CA125 information. Thus, the addition of the serum CA19-9/CA125 levels to parametric CEUS data was of significant diagnostic value for differentiating OSC from OMEC.
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The Evaluation of Risk Factors Associated With Relapse and Recurrence of Borderline Ovarian Tumors With Long-Term Follow-up. Int J Gynecol Cancer 2017; 26:1053-61. [PMID: 27177283 DOI: 10.1097/igc.0000000000000722] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The goal was to analyze the risk factors of relapse and to compare the type of recurrence in patients with borderline tumors treated and followed up in Oncologic Center in Warsaw. MATERIALS AND METHODS This is a retrospective-prospective cohort study of 307 patients with confirmed borderline ovarian tumors treated in the Maria Sklodowska-Curie Memorial Cancer Center in Warsaw between 1994 and 2010. Univariate and multivariate analysis as well as Kaplan-Meier estimates were used to explore the impact of different covariates on progression-free survival. The analysis included the following potential prognostic factors: age, CA 125 value, stage according to classification of the International Federation of Gynecology and Obstetrics (FIGO), methods and radicality of operation, staging, tumor capsule rupture, histopathology, implants, ascites, and microinvasion. The analysis of relapses was also performed. RESULTS Univariate analysis showed the negative impact of 2 factors on progression-free survival: FIGO II/III (implants) (P = 0.011) and ascites (P = 0.027). The multivariate analyses showed the detrimental effect of FIGO Ic (HR, 2.63; 95% confidence interval [CI], 1.12-6.17, P = 0.027), FIGO II or III (implants) (HR, 3.67; 95% CI, 1.56-8.61, P = 0.003), and incomplete staging (HR, 3.63; 95% CI, 1.09-12.07, P = 0.035), but not ascites (P > 0.1). Relapse occurred in 32 (10%) patients: in 22 patients as borderline and in 10 patients as invasive tumor. Seven (70%) patients with invasive relapse died of disease. All patients with borderline relapses were successfully managed by second surgery, which in 80% was again conservative. CONCLUSIONS Relapses in borderline ovarian tumor are uncommon, in 10% of patients. Invasive relapses are rare, only in 3% of patients, but often with fatal course irrespective of the treatment applied. The most important clinical risk factors of relapse are implants (FIGO II/III), FIGO Ic, and incomplete staging and this patients as well as patients with ascites should be closely followed. Relapses of borderline histology are easily detected and successfully managed by surgery.
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Cheng A, Li M, Kanis MJ, Xu Y, Zhang Q, Cui B, Jiang J, Zhang Y, Yang X, Kong B. Is it necessary to perform routine appendectomy for mucinous ovarian neoplasms? A retrospective study and meta-analysis. Gynecol Oncol 2017; 144:215-222. [DOI: 10.1016/j.ygyno.2016.10.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
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Cosyns S, De Sutter P, Tournaye H, Polyzos NP. Necessity of appendectomy for mucinous borderline ovarian tumors. Systematic review. Arch Gynecol Obstet 2016; 294:1283-1289. [DOI: 10.1007/s00404-016-4174-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
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Shim SH, Kim SN, Jung PS, Dong M, Kim JE, Lee SJ. Impact of surgical staging on prognosis in patients with borderline ovarian tumours: A meta-analysis. Eur J Cancer 2016; 54:84-95. [DOI: 10.1016/j.ejca.2015.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/21/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
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Ozcan A, Töz E, Turan V, Sahin C, Kopuz A, Ata C, Sancı M. Should we remove the normal-looking appendix during operations for borderline mucinous ovarian neoplasms?: A retrospective study of 129 cases. Int J Surg 2015; 18:99-103. [DOI: 10.1016/j.ijsu.2015.04.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/31/2015] [Accepted: 04/11/2015] [Indexed: 11/25/2022]
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Vasconcelos I, Olschewski J, Braicu I, Sehouli J. Limited efficacy of platinum-based adjuvant treatment on the outcome of borderline ovarian tumors. Eur J Obstet Gynecol Reprod Biol 2015; 186:26-33. [PMID: 25602531 DOI: 10.1016/j.ejogrb.2014.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/07/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
Adjuvant treatment of borderline ovarian tumors (BOT) remains highly debatable. This article evaluates the benefits of platinum-based adjuvant treatment in patients with BOT. The PubMed and Cochrane Library databases were systematically searched for articles using the terms ((Borderline) OR (low malignant potential) AND (ovarian)) AND ((tumor) OR (cancer)) AND ((follow-up) OR (survival) OR (treatment) OR (chemotherapy) OR (adjuvant treatment)). We identified 31 articles including 4965 patients. Together, 592 patients presented non-invasive-, 244 invasive- and 77 unspecified implants. Central pathological examination was performed in 23 studies. Nine studies included more than 90% stage I patients, while 11 included only advanced stage patients. Nineteen studies reported patients undergoing complete cytoreduction, ten reported response rates and eight compared survival outcomes. All studies provided information regarding either mortality or recurrence rates. A meta-analysis of the 13 studies providing separate mortality data for both treatment groups, including 2206 women, favored surgical treatment only (OR=7.44; 95% CI=3.39-16.32; p<0.0005) albeit with moderate heterogeneity of the studies (I(2)=35.0%) but no asymmetry (Egger's test p=0.44). Regarding survival data, 4 studies reported no difference between groups. In the adjuvant setting, 4 reported worse outcome and 1 reported a nonsignificant trend to worse outcome. At present, there is no evidence to support the use of adjuvant treatment in patients with BOT.
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Affiliation(s)
- Ines Vasconcelos
- Department of gynecology Campus Virchow, Charité Medical University of Berlin, Germany.
| | - Jessica Olschewski
- Department of gynecology Campus Virchow, Charité Medical University of Berlin, Germany
| | - Ioana Braicu
- Department of gynecology Campus Virchow, Charité Medical University of Berlin, Germany
| | - Jalid Sehouli
- Department of gynecology Campus Virchow, Charité Medical University of Berlin, Germany
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Uzan C, Nikpayam M, Ribassin-Majed L, Gouy S, Bendifallah S, Cortez A, Rey A, Duvillard P, Darai E, Morice P. Influence of histological subtypes on the risk of an invasive recurrence in a large series of stage I borderline ovarian tumor including 191 conservative treatments. Ann Oncol 2014; 25:1312-1319. [PMID: 24713312 DOI: 10.1093/annonc/mdu139] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The overall prognosis of stage I borderline ovarian tumors (BOT) is excellent but a small percentage of patients die to their disease. The prognostic factors for such a rare event are still not clearly defined. The aim of this study was to determine these factors for recurrence per se and recurrence in the form of invasive carcinoma in a large series of stage I tumors. METHODS A retrospective review of patients with BOT. Three inclusion criteria were defined: (i) a centralized histological review; (ii) macroscopic stage I tumors; (iii) exclusion of metastatic disease to the ovaries. RESULTS From 2000 to 2010, 254 patients fulfilled inclusion criteria [140 had mucinous BOT (MBOT) and 114 a serous BOT (SBOT)], and 191 had undergone conservative management. After a median follow-up of 45 months, 43 patients had developed recurrences (31 borderline and 12 invasive). The risks of recurrences were statistically increased after conservative treatment, particularly after a cystectomy, in patients with stage IB and among patients with incompletely staged tumors. In the subgroup of conservatively treated patients (representing 75% of our population), the risks of recurrences were statistically increased in patients affected by a SBOT, in patients who had undergone a cystectomy, in patients with stage IB disease and in patients with a micropapillary pattern (MPP). MBOT and the presence of a MPP were identified as prognostic factors for invasive disease. CONCLUSIONS In the present series of BOT with the largest number of patients treated conservatively to date, the presence of a MPP and the mucinous subtype were associated with a higher rate of progression to carcinoma after conservative management. These important results suggest that MBOT belong to a 'high-risk' group likely to develop an invasive recurrence after fertility-sparing surgery in stage I BOT.
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Affiliation(s)
- C Uzan
- Department of Gynecologic Surgery; Unit INSERM U10-30, Villejuif
| | | | | | - S Gouy
- Department of Gynecologic Surgery
| | - S Bendifallah
- Department of Obstetrics and Gynaecology, Hopital Tenon, Paris; INSERM UMRS 938, Paris; Universite Pierre et Marie Curie (Paris VI), Paris
| | - A Cortez
- Department of Pathology, Hopital Tenon, Paris
| | - A Rey
- Department of Biostatistics, Institut Gustave Roussy, Villejuif
| | - P Duvillard
- Department of Pathology, Institut Gustave Roussy, Villejuif
| | - E Darai
- Department of Obstetrics and Gynaecology, Hopital Tenon, Paris; INSERM UMRS 938, Paris; Universite Pierre et Marie Curie (Paris VI), Paris
| | - P Morice
- Department of Gynecologic Surgery; Unit INSERM U10-30, Villejuif; University Paris Sud, Le Kremlin Bicêtre, France.
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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]
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