Clinical outcome and risk factors for recurrence in borderline ovarian tumours

Abstract

We investigated the long-term prognosis of borderline ovarian tumours and determined risk factors for recurrence. One hundred and twenty-one borderline ovarian tumours treated between 1994 and 2003 at the participating institutions in the Tohoku Gynecologic Cancer Unit were retrospectively investigated for clinical stage, histopathological subtype, surgical technique, postoperative chemotherapy, the presence or absence of recurrence, and prognosis. The median follow-up period was 57 months (1 -126 months). One hundred and nine cases (90.6%) were at clinical stage I. The histopathological subtypes consisted of 91 cases of mucinous tumour (75.2%), 27 cases of serous tumour (22.3%), and three cases of endometrioid tumour. Conservative surgery was used in 53 cases (43.8%), radical surgery in 68 cases (56.2%), a staging laparotomy in 43 cases (35.5%), and postoperative adjuvant therapy in 30 cases (24.8%). Recurrence was found in eight cases, but no tumour-related deaths were reported. Although no significant difference in disease-free survival rate was seen between different clinical stages, the difference in disease-free survival rate between serous and nonserous (mucinous and endometrioid) types was significant (Po0.05). The 10-year disease-free survival rate was 89.1% for the radical surgery group and 57.4% for the conservative surgery group -this difference was significant (Po0.05). In the conservative surgery group, cystectomy and serous tumour were independent risk factors for recurrence. Although recurrence was observed, the long-term prognosis of borderline ovarian tumour was favourable, without tumour-related deaths. Considering the favourable prognosis, conservative surgery can be chosen as far as the patient has a nonserous tumour and receive adnexectomy. However, in cases of serous type and/or receiving cystectomy special care should be given as relative risk rates of recurrence elevate by 2 -4-folds.

High-Risk Borderline Ovarian Tumors: Analysis of Clinicopathological Features and Prognostic Impact of Different Follow-Up Strategies

“…Several studies indicate a low rate (38%) of complete staging of BOTs during initial surgery [37]. Restaging operation is a matter of substantial controversy in patients with BOTs: although in up to 50% of cases occult metastases are identified during comprehensive restaging [36], the influence of staging quality on the prognosis is controversial [38].…”

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

“…On the one hand, this is due to the fact that following conservative surgical management for BOT, the patient outcome is still excellent, but otherwise the rare recurrences usually exhibit a peritoneal location (Seidman et al, 1998;Trope et al, 2000;Yokoyama et al, 2006).…”

“…In most cases, ovarian cancer begins asymptomatically, spreading in the peritoneal cavity and will then be diagnosed at an advanced stage during the time of primary diagnosis (FIGO stage III or IV), whereas the BOT is diagnosed mostly in stage I (Gotlieb et al, 2005;Sehouli et al, 2005a, b;Yokoyama et al, 2006). Similar to early carcinomas of the ovary, BOTs are most commonly detected as accidental histopathological findings after primary surgery for benign or suspected ovarian mass Jones, 2006;Schem et al, 2007;Chang et al, 2008).…”

“…According to current studies evaluating conservative surgery in this group, high conception rates were achieved after a simple ovarian cystectomy (Longacre et al, 2005;Marcickiewicz and Brannstrom, 2006;Tinelli et al, 2006;Yinon et al, 2007), but the high risk of local recurrence of up to 75% still limited the routine implementation (Suh-Burgmann, 2006). Results of cystectomy for BOT suggest a higher risk of intraoperative cyst rupture and of recurrence when compared with USO or BSO (Poncelet et al, 2006;Yokoyama et al, 2006). For this reason, ovarian cystectomy or a partial adnexectomy can be performed after a very careful informing of the patient about the recurrence risk and providing that the patient is willing to undergo a careful and prolonged follow-up.…”

“…Having an incidence of 1.8 -4.8 out of 100 000 women per year, they belong to the seldom 'non-benign' epithelial ovarian tumours (Hart, 2005;Tinelli et al, 2006;Wong et al, 2007). In contrast to the case of ovarian carcinomas, most of the patients are diagnosed at an early stage I (Gotlieb et al, 2005;Yokoyama et al, 2006;Cusido et al, 2007). Today no specific diagnostic method is able to discriminate reliably between an early carcinoma of the ovary and a borderline tumour Hart, 2005;Sehouli et al, 2005a, b;Kurman et al, 2008).…”