Abstract
ObjectiveThe main goal of fertility-sparing treatment is pregnancy followed by live birth (i.e., successful pregnancy). The principal objective of our study was to evaluate the successful pregnancy rate in patients with borderline ovarian tumors (BOTs) after conservative treatment. The second goal was to evaluate the safety of the conservative approach. Study design110 patients with BOT were retrospectively evaluated. All patients underwent surgical treatment, sparing the uterus and part of at least one ovary. ResultsThe median age was 28 years (range 17–40 years). Serous and mucinous tumors were found in 63 (57%) and 34 (31%) women, respectively. FIGO stage I, II, and III was diagnosed in 101 (91.8%), 3 (2.7%), and 6 (5.5%) patients, respectively. The 3- and 5-year progression-free survival was 82.5% and 78.2%, respectively. Recurrent disease was treated conservatively in 14 women, whereas 3 patients underwent radical surgery. Fifty-six (50.9%) patients got pregnant and had at least one live birth. A total of 83 children were born. A significant difference in the successful pregnancy rate was found in patients diagnosed ≤ 35 years vs. > 35 years old (55.6% vs. 9.1%, respectively; p = 0.003). Surgical approach (laparoscopy vs. laparotomy) did not influence the chance of childbirth. Pre-term delivery constituted 6.25% of all births. ConclusionsFertility-sparing surgery should be proposed to young women wishing to preserve fertility. The rate of spontaneous pregnancy is approximately 50%.The risk of relapse is significant but always of borderline histology and may be successfully treated by the second surgery.
Highlights
Borderline ovarian tumors (BOTs) account for 15–20% of all ovarian tumors [1,2,3]
We demonstrated a strong correlation between patient age and the pregnancy rate after treatment
The results show that use of fertility-sparing surgery (FSS) in advanced stages may constitute an important risk factor for relapse, with a significantly higher recurrence rate of 26.3–53.8% compared to early stages
Summary
Borderline ovarian tumors (BOTs) account for 15–20% of all ovarian tumors [1,2,3]. BOTs are characterized by up-regulated cellular proliferation, the presence of mild to moderate nuclear atypia, cell stratification, and a lack of destructive stromal invasion [1]. The most common histological subtypes are serous and mucinous, which constitute approximately 90% of cases. The serous subtype is more frequent in European and North American populations, whereas the mucinous subtype is prevalent in Asian women. The remaining seromucinous, Brenner, and endometrioid subtypes are uncommon and constitute up to 10% of cases [1,3,5]
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