[Oncological and reproductive outcomes after fertility-sparing surgery in patients with stage Ⅱ-Ⅲ borderline ovarian tumor].

G Zheng, Y N Liu, Q Wang, H L Fu, L L Si, T J Lai, R X Guo
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引用次数: 0

Abstract

Objective: To evaluate oncological and reproductive outcomes of women ≤40 years undergoing fertility-sparing surgery (FSS) for stage Ⅱ or Ⅲ borderline ovarian tumor (BOT). Methods: The patients with BOT and ≤40 years old with stage Ⅱ-Ⅲ BOT who underwent FSS enrolled from the First Affiliated Hospital of Zhengzhou University between January 2011 and March 2023 were analyzed retrospectively. The clinical data and follow-up results were obtained and analyzed. The univariate and multivariate Cox proportional hazard regression analysis were used to explore high-risk factors associated with prognosis. Additionally, pregnancy outcomes were also analyzed. Results: (1) A total of 79 patients with stage Ⅱ-Ⅲ BOT who have been treated with FSS were conducted, with an average age of (27.5±6.7) years old. The median tumor maximum diameter were 10.4 cm (range: 4.8-90.0 cm). The International Federation of Gynecology and Obstetrics (FIGO) stage was stage Ⅱ in 45 cases and stage Ⅲ in 34 cases. According to the pathological types, there were 48 cases of serous tumor, 21 cases of mucinous tumor, 1 case of endometrioid tumor, and 9 cases of mixed types. There were 41 cases of unilateral ovarian involvement, 38 cases of bilateral ovarian involvement. There were 5 cases of microinvasion, 17 cases of micropapillary subtype. Extra-ovarian invasive implants were found in 5 cases, and there were 31 cases of merged ascites. (2) Tumor outcomes: the median follow-up time from primary cytoreduction were 58 months (range: 8-146 months). At the end of the observation period, 24 cases (30%, 24/79) recurred, among them 5 cases had two recurrences and 2 cases had three recurrences. There were 2 cases (3%, 2/79) of death and 1 case (1%, 1/79) of survival with tumor. (3) Analysis of prognostic risk factors: the results of univariate analysis showed that mucinous tumor, tumor maximum diameter >13.15 cm, FIGO stage Ⅲ, merged ascites, micropapillary subtype, invasive implantation, and bilateral ovarian involvement were independent risk factors (all P<0.05) for disease-free survival (DFS). FIGO stage Ⅲ (HR=4.555, 95%CI: 1.525-13.607; P=0.007) and micropapillary subtype (HR=2.396, 95%CI: 1.003-5.725; P=0.049) were found to be related to DFS through the multivariable Cox proportional hazard regression analysis. (4) Pregnancy outcomes: among the patients with fertility intentions 36 cases (46%,36/79), 29 cases (81%, 29/36) had successful pregnancies, and 27 cases (75%, 27/36) had successful births. Conclusions: Patients with stage Ⅱ-Ⅲ BOT underwent FSS have favorable survival and pregnancy rates. Micropapillary subtypes and FIGO staging (stage Ⅲ) are the significant risk factors of DFS.

[Ⅱ-Ⅲ期边缘卵巢肿瘤患者保胎手术后的肿瘤学和生殖结局]。
目的评估Ⅱ期或Ⅲ期边界卵巢肿瘤(BOT)患者中接受保胎手术(FSS)的 40 岁以下女性的肿瘤和生殖预后。方法回顾性分析2011年1月至2023年3月期间郑州大学第一附属医院收治的Ⅱ-Ⅲ期BOT患者,年龄≤40岁。获得并分析了临床数据和随访结果。采用单变量和多变量 Cox 比例危险回归分析来探讨与预后相关的高危因素。此外,还对妊娠结局进行了分析。结果:(1) 共有79例Ⅱ-Ⅲ期BOT患者接受了FSS治疗,平均年龄(27.5±6.7)岁。肿瘤最大直径中位数为 10.4 厘米(范围:4.8-90.0 厘米)。国际妇产科联盟(FIGO)分期为Ⅱ期 45 例,Ⅲ期 34 例。病理类型方面,浆液性肿瘤 48 例,粘液性肿瘤 21 例,子宫内膜样肿瘤 1 例,混合型 9 例。单侧卵巢受累 41 例,双侧卵巢受累 38 例。微小浸润 5 例,微乳头亚型 17 例。卵巢外浸润性种植 5 例,合并腹水 31 例。(2)肿瘤结局:自初次细胞减灭术起的中位随访时间为 58 个月(范围:8-146 个月)。观察期结束时,24 例(30%,24/79)复发,其中 5 例复发 2 次,2 例复发 3 次。死亡病例 2 例(3%,2/79),带瘤生存病例 1 例(1%,1/79)。(3)预后危险因素分析:单变量分析结果显示,粘液性肿瘤、肿瘤最大直径>13.15 cm、FIGO Ⅲ期、合并腹水、微乳头亚型、浸润性种植、双侧卵巢受累为独立危险因素(全部PHR=4.555,95%CI:1.525-13.607;P=0.007),通过多变量Cox比例危险回归分析发现微乳头亚型(HR=2.396,95%CI:1.003-5.725;P=0.049)与DFS相关。(4)妊娠结局:在有生育意愿的患者中,36例(46%,36/79)、29例(81%,29/36)成功妊娠,27例(75%,27/36)成功分娩。结论接受 FSS 的Ⅱ-Ⅲ期 BOT 患者的生存率和妊娠率都很高。微乳头亚型和 FIGO 分期(Ⅲ期)是 DFS 的重要风险因素。
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