Prognostic Factors for Recurrence After Fertility-Preserving Surgery in Patients With Borderline Ovarian Tumors: A Systematic Review and Meta-analysis of Observational Studies

Jiao, Xiaobing; Hu, Jun; Zhu, Liangjun

doi:10.1097/igc.0000000000001092

Cited by 23 publications

(17 citation statements)

References 42 publications

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“…Nevertheless, when we particularly examined whether the surgical type was cystectomy or not (Model B), cystectomy increased the risk of recurrence. This finding is consistent with results from a multi‐center study, systematic reviews and meta‐analysis which showed that cystectomy was a significant risk factor for BOT recurrence …”

Section: Discussionsupporting

confidence: 92%

“…This finding is consistent with results from a multi-center study, systematic reviews and meta-analysis which showed that cystectomy was a significant risk factor for BOT recurrence. [23][24][25] In the univariate analyses, peritoneal implants and chemotherapy were associated with BOT recurrence. These variables were included in initial multivariate models.…”

Section: Discussionmentioning

confidence: 96%

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Recurrence rate and associated factors of borderline ovarian tumors in the south of Vietnam

Duong

Tran

et al. 2019

J of Obstet and Gynaecol

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

Recurrence rate and associated factors of borderline ovarian tumors in the south of Vietnam

Duong

Tran

et al. 2019

J of Obstet and Gynaecol

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“…Furthermore, a large proportion of patients who underwent FSS experienced invasive recurrence [13]. Regarding surgical patterns, a meta-analysis showed that unilateral cystectomy is significantly associated with high recurrence rates [10].…”

Section: Discussionmentioning

confidence: 99%

“…Microinvasion was defined as stromal invasion restricted to an area of no more than 10 mm 2 [9]. Several surgical options are mentioned in this study such as FSS, which was performed to conserve the uterus and at least one ovary, and radical resection, which included hysterectomy and bilateral salpingo-oophorectomy [10]. Moreover, the concepts of surgery types need to be clarified: staging, and non-staging surgery.…”

Section: Methodsmentioning

confidence: 99%

Staging Procedures Fail to Benefit Women with Borderline Ovarian Tumours Who Want to Preserve Fertility: A Retrospective Analysis of 448 cases

Gou

et al. 2020

Preprint

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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: 448 patients were included; 52 recurrences were observed. 92 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.

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“…Microinvasion was defined as stromal invasion restricted to an area of no more than 10 mm 2 [9]. Several surgical operation types are mentioned in this study, such as FSS, which was performed to conserve the uterus and at least a portion of one ovary [10], and radical resection, which included total hysterectomy and bilateral salpingo-oophorectomy. Moreover, the concepts of three surgery types need to be clarified: complete staging, incomplete staging, and unstaged surgeries.…”

Section: Methodsmentioning

confidence: 99%

Staging Procedures Fail to Benefit to the Fertility-preserved Women with Borderline Ovarian Tumors: A Retrospective Analysis of 448 cases

Gou

et al. 2020

Preprint

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Purpose The study is aimed to evaluate the potential effect of clinicopathologic and surgical factors on the prognosis and fertile outcomes in the patients with borderline ovarian tumors. Patients and Methods We performed a retrospective analysis involving BOT patients who had underwent surgical procedures in West China Second University Hospital from January 2008 to January 2015 . The disease-free survival (DFS) outcomes and potential prognostic factors were evaluated using Kaplan-Meier method and Cox regression analysis, respectively. Furthermore, the fertile outcomes were analyzed using Pearson Χ2 and Fish correlation test. Results A total of 448 patients were included with a median age of 37.1 years and a median follow-up time of 113 months. Forty-two (11.6%) recurrences with the mean recurrence interval 80.2 months and four (0.9%) deaths were observed. One hundred and eighteen (26.3%) patients were underwent staging surgery and the remaining 330 (73.7%) patents underwent unstaged surgery. A total of 233 patients undergoing fertility sparing surgery (FSS) attempted to conceive and 92 (39.48%) of them achieved pregnancy. No statistically significant difference of fertile outcomes were found between staging surgery group or not (P=0.691). In univariate analyse, staging surgery was obviously associated with DFS (HR=2.191 P=0.005), but was not an independent prognostic factor (p=0.600) for DFS on multivariate analysis. The multivariate Cox analysis revealed that advanced FIGO stage (≥stage II), positive ascites\pelvic washings and laparotomy approach were independent prognostic factors for DFS in overall patients, whereas advanced stage (≥stage II), laparotomy approach, cystectomy-included procedure, invasive implants and bilateral tumors were independent prognostic factors for DFS in patients undergoing FSS. In addition, laparoscopy approach had better prognosis than laparotomy in patients of early stage (stage I) with fertility desire. Conclusion Patients with BOT fail to benefit from surgical staging in prognosis and fertile outcomes. Laparoscopy will be recommended to patients of stage I with fertility desire. Patients with fertility desire at advanced stage (≥stage II), invasive implants and bilateral tumors should pay more attention to the risk of recurrence and choose FSS carefully.

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Prognostic Factors for Recurrence After Fertility-Preserving Surgery in Patients With Borderline Ovarian Tumors: A Systematic Review and Meta-analysis of Observational Studies

Abstract: 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.

Cited by 23 publications

References 42 publications

Recurrence rate and associated factors of borderline ovarian tumors in the south of Vietnam

Recurrence rate and associated factors of borderline ovarian tumors in the south of Vietnam

Staging Procedures Fail to Benefit Women with Borderline Ovarian Tumours Who Want to Preserve Fertility: A Retrospective Analysis of 448 cases

Staging Procedures Fail to Benefit to the Fertility-preserved Women with Borderline Ovarian Tumors: A Retrospective Analysis of 448 cases

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