Trends in the management and prognosis of mucinous borderline ovarian tumors: analysis of 12,766 cases from the JSOG Gynecologic Tumor Registry (2004-2018).
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引用次数: 0
Abstract
Background: Mucinous borderline ovarian tumors (MBOTs) are rare neoplasms with excellent prognosis, yet the optimal surgical extent remains controversial. No large-scale study in Japan has evaluated treatment trends and prognostic factors for MBOTs. This study aimed to clarify their clinicopathological features, management patterns, and survival outcomes using a nationwide registry.
Methods: Data were obtained from the Japan Society of Obstetrics and Gynecology Gynecologic Tumor Registry, including 96,476 ovarian tumors treated between 2004 and 2018. Among them, 12,766 MBOT cases were identified. Surgical procedures-hysterectomy, omentectomy, lymphadenectomy, and adjuvant chemotherapy-were analyzed. Survival analyses of 8564 cases with complete prognostic data were performed using Kaplan-Meier and Cox proportional hazards models.
Results: Over 90% of MBOTs were stage I, and the median age was 52 years. Hysterectomy was performed in 50.8%, omentectomy in 57.9% (2015-2018 subset), and lymphadenectomy in 7.6%. Only 2.6% received adjuvant chemotherapy. The 5-year overall survival exceeded 95%. Multivariate analysis identified age ≥ 50 years (HR 2.5, 95% CI 1.8-3.6) and stage IC (HR 2.7, 95% CI 1.9-3.6) as independent adverse factors. Omentectomy showed a marginal survival benefit (HR 0.6, p = 0.05), whereas hysterectomy, lymphadenectomy, and chemotherapy conferred no advantage. Chemotherapy correlated with poorer outcomes, likely due to confounding by indication.
Conclusions: This nationwide cohort-the largest MBOT series reported to date-demonstrates conservative management with excellent prognosis in Japan. Radical surgery and chemotherapy provide no survival benefit, whereas fertility-sparing surgery appears appropriate for younger patients.
背景：卵巢黏液交界性肿瘤（MBOTs）是一种预后良好的罕见肿瘤，但其最佳手术范围仍存在争议。日本没有大规模研究评估mbot的治疗趋势和预后因素。本研究旨在通过全国登记来阐明其临床病理特征、管理模式和生存结果。方法：数据来自日本妇产科学会妇科肿瘤登记处，包括2004年至2018年期间治疗的96,476例卵巢肿瘤。其中MBOT病例12766例。我们分析了手术方法——子宫切除术、网膜切除术、淋巴结切除术和辅助化疗。采用Kaplan-Meier和Cox比例风险模型对8564例预后资料完整的患者进行生存分析。结果：超过90%的mbot为I期，中位年龄为52岁。子宫切除术占50.8%，网膜切除术占57.9%（2015-2018年亚组），淋巴结切除术占7.6%。只有2.6%的患者接受了辅助化疗。5年总生存率超过95%。多因素分析发现年龄≥50岁（HR 2.5, 95% CI 1.8-3.6）和IC期（HR 2.7, 95% CI 1.9-3.6）是独立的不利因素。网膜切除术显示边际生存获益（HR 0.6, p = 0.05），而子宫切除术、淋巴结切除术和化疗没有优势。化疗与较差的预后相关，可能是由于适应症的混淆。结论：这个全国性的队列——迄今为止报道的最大的MBOT系列——在日本显示了保守治疗和良好的预后。根治性手术和化疗对生存没有好处，而保留生育能力的手术似乎适合年轻患者。
期刊介绍：
The International Journal of Clinical Oncology (IJCO) welcomes original research papers on all aspects of clinical oncology that report the results of novel and timely investigations. Reports on clinical trials are encouraged. Experimental studies will also be accepted if they have obvious relevance to clinical oncology. Membership in the Japan Society of Clinical Oncology is not a prerequisite for submission to the journal. Papers are received on the understanding that: their contents have not been published in whole or in part elsewhere; that they are subject to peer review by at least two referees and the Editors, and to editorial revision of the language and contents; and that the Editors are responsible for their acceptance, rejection, and order of publication.
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