Recurrence Of Borderline Ovarian Tumors Research Articles

Clinicopathological aspects of patients with recurrence of borderline ovarian tumors

ObjectiveDespite the good prognosis of borderline ovarian tumors (BOTs), a few BOT patients experience the relapse of disease, either borderline or malignant. However, the risk of recurrence of BOTs is somewhat controversial. We intended to find out the specific characteristics and prognosis of the recurrence of BOTs.MethodsBetween 1995 and 2012, 130 women were diagnosed with BOTs at a single institution. Eleven patients diagnosed and treated for the recurrence of BOTs including seven cancerous and four borderline relapses were included for the analysis in this retrospective study. Clinicopathological characteristics and surgical procedures as well as follow-up data with overall survival were assessed. Statistical analyses was performed using the χ2 test, t-test and log-rank test with Cox regression.ResultsOne hundred and thirty patients with mean follow-up of 65.8 months were evaluated, of whom half were below 40 years old at their first diagnosis of BOTs. Among 11 recurrent cases (8.5%), 7 cancerous transformations (5.4%) and 4 borderline recurrences (3.1%) were detected with median time of 6 and 71 months after the primary surgery, respectively. Nine out of 11 recurrences were happened at their equal or below 40-years-old age at the primary diagnosis (P=0.027). Also, all 7 cancerous relapses arose from premenopausal women of median age of 35 years old. Twenty (15%) patients had laparoscopic surgery and they were all treated conservatively. Among those 20, 5 were suffered from relapse of BOTs and laparoscopic approach was proved to be a significant risk factor for disease relapse in our study (P=0.013). Although laparoscopic surgery was revealed had meaningful influence on disease free survival (P=0.024), it was not significant on overall survival (P=0.226).ConclusionLaparoscopic conservative surgery for BOTs can be accepted under close follow-ups. And younger patients should be followed for long period to evaluate recurrence.

Limits of 18F-Fluorodeoxyglucose Positron Emission Tomography in Recurrence Diagnosis of Borderline Ovarian Tumor

Most borderline ovarian tumors (BOT) occur in young women and exhibit a low malignant behavior. Nevertheless, an accurate long-term follow-up is required because, frequently, recurrence arises after many years from primary treatment, especially in patients affected by BOT with invasive peritoneal implants, which have a worse prognosis. We report the case of a pelvic recurrence of serous BOT firstly suspected by physical examination but misdiagnosed by ¹⁸F-fluorodeoxyglucose positron emission tomography and computed tomography and identified only by magnetic resonance imaging, 7 years after primary treatment. We also reviewed the literature concerning the role of ¹⁸F-fluorodeoxyglucose positron emission tomography in the management and follow-up of BOT.

Prognostic factors predicting recurrence in borderline ovarian tumors

Objective We aimed to investigate outcome of borderline ovarian tumors (BOTs) with respect to methods and extent of surgical approach and to evaluate prognostic factors. Methods A retrospective study included consecutive patients with BOT treated from 1984 to 2008. These cases were confirmed by histological review. The influence of clinico-pathological characteristics upon recurrence and death were analyzed by independent sample t test, Chi-square test, logistic regression model, and Cox proportional hazard model. Results A total of 233 patients were enrolled, 214 in Stage I, 11 Stage II and 8 Stage III. There were 21 relapses, only 5 of which died of disease. 5-year and 10-year overall survival were 97.6% and 96.4%, and recurrence-free survival rates (RFS) were 92.7% and 88.2%, respectively. Median follow-up time for survivors was 81 (range, 0.5–295) months. Median time to recurrence was 31 (range, 5.5–181) months. In multivariate analysis, Stage II/III, cystectomy and higher pretreatment serum CA-125 level ( ≥ 144 U/mL) were selected for a model predicting 5-year RFS, where risk factor = 0, 1, and 2–3 had odds ratios of 1, 14.9, and 113.3, respectively ( p < 0.001). Replacing stage with peritoneal implants, the latter two factors along with invasive peritoneal implants were selected. Of the 5 cases died of disease, all had invasive recurrences. Initial laparoscopic or laparotomy approach had no influence on prognosis. Conclusions Although BOT has an excellent prognosis, they are not exempted from a risk of recurrence. Stage II/III (or invasive implants), cystectomy and higher pre-operative serum CA-125 were independent variables predicting recurrence.

A clinicopathologic multivariate analysis affecting recurrence of borderline ovarian tumors

Objective To evaluate the risk factors associated with recurrence of borderline ovarian tumors that may be used as evidence of the efficacy of select preventive procedures. Methods Various clinicopathologic factors of 234 patients with borderline ovarian tumors admitted to our hospital between January 2001 and June 2007 were reviewed. Univariate and multivariate logistic regression models were constructed to evaluate the risk factors for odds ratio (OR) and statistical significance. The survival was assessed by the Kaplan–Meier method and proportional hazards model. Results Recurrence of borderline ovarian tumors was observed in 26 cases and the median time to recurrence was 29.4 months. Of these cases, 5 occurred involving the ipsilateral ovary, 9 involved the contralateral ovary, and 12 spread to the pelvic peritoneum, including 3 patients who had progressed to invasive carcinoma. No tumor-related deaths were reported. The results of the multivariate logistic regression analysis showed that conservative surgical procedures (OR = 2.304; p = 0.024), cyst rupture (OR = 2.213; p = 0.038), advanced FIGO stage (OR = 4.114; p = 0.000), microinvasion (OR = 2.291; p = 0.046), and peritoneal implants (OR = 2.101; p = 0.016) may be independent predictive factors of recurrence. The proportional hazards model identified surgical procedure (relative risk, RR = 3.752, p = 0.007), cyst rupture (RR = 1.985, p = 0.006), FIGO stage (RR = 3.746, p = 0.001), microinvasion (RR = 1.153, p = 0.009) and peritoneal implants (RR = 2.742, p = 0.010), as independently related to disease-free survival. Conclusions Although patients with borderline ovarian tumors have an excellent prognosis, the risk of recurrence remains. Identification of patients with high-risk factors is essential for offering more selective treatments to prevent recurrence.

OC227: Early 3D aspects of recurrence of borderline ovarian tumors

OC227: Early 3D aspects of recurrence of borderline ovarian tumors

Clinical outcome and risk factors for recurrence in borderline ovarian tumors

16020 Background: We investigated the long-term prognosis of borderline ovarian tumors and determined risk factors for recurrence. Methods: One hundred and twenty one borderline ovarian tumors 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. Results: 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 tumor (75.2%), 27 cases of serous tumor (22.3%), and 3 cases of endometrioid tumor. 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 8 cases, but no tumor-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 non-serous (mucinous and endometrioid) types was significant (p&lt;0.05). 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 (p&lt;0.05). In the conservative surgery group, cystectomy and serous tumor were independent risk factors for recurrence. Although recurrence was observed, the long-term prognosis of borderline ovarian tumor was favorable, without tumor-related deaths. Conclusion: Considering the favorable prognosis, conservative surgery can be chosen as far as the patient has a non-serous tumor 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 to 4 folds. No significant financial relationships to disclose.