Behavior of Borderline Tumors With Particular Interest to Persistence, Recurrence, and Progression to Invasive Carcinoma: A Prospective Study

Abstract

PURPOSE: Borderline tumors account for 10% to 20% of epithelial ovarian tumors, and their prognosis is outstanding; nevertheless, a mortality of up to 20% has been reported, particularly in earlier reports. There is a lack of information about the actual mortality and the rate of progression into invasive carcinoma in large and prospectively accrued populations. PATIENTS AND METHODS: All women with borderline ovarian tumors undergoing primary surgery in our department or referred within 3 months from surgery performed elsewhere from 1982 to 1997 were prospectively accrued and observed. RESULTS: We studied 339 women (83.4% stage I, 7.9% stage II, and 8.5% stage III). The median age at diagnosis was 39 years. A total of 150 women underwent radical surgery, and 189 underwent fertility-sparing surgery. After surgery, 13 women had macroscopic residual disease. With a median follow-up of 70 months, 317 women are alive with no clinical disease (eight with documented subclinical persistence of implants), three are alive with clinical disease, two died of disease, 10 died of other reasons, and seven women have been lost to follow-up. The recurrence of disease was higher after fertility-sparing surgery (35 of 189 cases) than after radical surgery (seven of 150 cases); nevertheless, all but one woman with recurrence of borderline tumor or progression to carcinoma after conservative surgery were salvaged. We observed seven progressions (2.0%) into invasive carcinoma, five in serous tumors (2.4%), and two in mucinous tumors (1.6%). The disease-free survival is 99.6% in stage I patients, 95.8% in stage II, and 89% in stage III. CONCLUSION: The survival of patients with borderline tumors is higher than previously described in some retrospective studies. Conservative surgery is safe and may be proposed to several patients with early and disseminated disease after thorough discussion of all therapeutic options. Progression to carcinoma is approximately 2% and may be observed in both mucinous and serous tumors.

Malignancies following in situ cervical cancer in Hispanic Americans and non-Hispanic Whites

“…However, both Hispanic and non-Hispanic Whites show an elevation in the pool of smoking-related cancers (Table 2) However, it is difficult to see how surveillance bias accounts for the histology of ovarian cancers following CCIS. We show that about 40% of such cases are borderline tumors of low malignant potential (Table 3), which is twice the prevalence in our comparison group(s) and higher than published estimates (10-20%) [29,30]. To be sure, this histologic finding is a statistical observation, but one that may call for a biologic investigation.…”

Fertility results after conservative treatment of advanced stage serous borderline tumour of the ovary

“…In larger studies that focus on the assessment of fertility results in patients with all stage of disease, Gottlieb et al 4 reported three cases (two with Stage II and one Stage III disease) in patients with advanced stage, and Morris et al 5 three cases (with Stage III disease) 4,5 . Zanetta et al 17 have reported an important series of 399 patients with borderline tumour of whom 24 with peritoneal implants were treated conservatively 17 . However, the fertility results were not detailed 17 .…”

Fertility-sparing surgery and outcome in fertile women with ovarian borderline tumors and epithelial invasive ovarian cancer

“…However, the ACTION trial concluded that optimally staged early epithelial ovarian cancers patients do not benefit from the use of adjuvant chemotherapy [20,21] The conflicting results indicates that properly staged invasive ovarian cancer stage Ia should not receive adjuvant chemotherapy, but not properly staged stage Ia patients should undergo a thorough staging procedure in order to avoid adjuvant chemotherapy. Borderline tumors have a very low risk of recurrence and they rarely respond to chemotherapy or irradiation [22]. Thus, adjuvant treatment with chemotherapy or irradiation should not be offered patients with borderline tumors [9].…”