Obstet Gynecol Sci.  2015 Mar;58(2):98-105. 10.5468/ogs.2015.58.2.98.

Clinicopathological aspects of patients with recurrence of borderline ovarian tumors

• Oh S
• Kim R
• Lee YK
• Kim JW
• Park NH
• Song YS

• KMID: 2314032
• DOI: http://doi.org/10.5468/ogs.2015.58.2.98

Abstract

OBJECTIVE
Despite 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.
METHODS
Between 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 chi2 test, t-test and log-rank test with Cox regression.
RESULTS
One 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).
CONCLUSION
Laparoscopic conservative surgery for BOTs can be accepted under close follow-ups. And younger patients should be followed for long period to evaluate recurrence.

Keyword

Epithelial-mesenchymal transformation; Laparoscopy; Ovarian neoplasms; Recurrence

MeSH Terms

Diagnosis
Disease-Free Survival
Epithelial-Mesenchymal Transition
Female
Follow-Up Studies
Humans
Laparoscopy
Ovarian Neoplasms
Prognosis
Recurrence*
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 Diagram of the borderline ovarian tumor patients in terms of the surgical approach.

• 

  Fig. 2 Survival plot by type of surgery according to Cox proportional hazard model. (A) Disease free survival plot and (B) overall survival plot.

Reference

1. Trimble CL, Kosary C, Trimble EL. Long-term survival and patterns of care in women with ovarian tumors of low malignant potential. Gynecol Oncol. 2002; 86:34–37.

2. Suh-Burgmann E. Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study. Gynecol Oncol. 2006; 103:841–847.

3. Lenhard MS, Mitterer S, Kumper C, Stieber P, Mayr D, Ditsch N, et al. Long-term follow-up after ovarian borderline tumor: relapse and survival in a large patient cohort. Eur J Obstet Gynecol Reprod Biol. 2009; 145:189–194.

4. Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Surgical management of borderline ovarian tumors: the role of fertility-sparing surgery. Gynecol Oncol. 2009; 113:75–82.

5. Obermair A, Tang A, Kondalsamy-Chennakesavan S, Ngan H, Zusterzeel P, Quinn M, et al. Nomogram to predict the probability of relapse in patients diagnosed with borderline ovarian tumors. Int J Gynecol Cancer. 2013; 23:264–267.

6. Tang A, Kondalsamy-Chennakesavan S, Ngan H, Zusterzeel P, Quinn M, Carter J, et al. Prognostic value of elevated preoperative serum CA125 in ovarian tumors of low malignant potential: a multinational collaborative study (ANZGOG0801). Gynecol Oncol. 2012; 126:36–40.

7. Zanetta G, Rota S, Chiari S, Bonazzi C, Bratina G, Mangioni C. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study. J Clin Oncol. 2001; 19:2658–2664.

8. Romagnolo C, Gadducci A, Sartori E, Zola P, Maggino T. Management of borderline ovarian tumors: results of an Italian multicenter study. Gynecol Oncol. 2006; 101:255–260.

9. Romeo M, Pons F, Barretina P, Radua J. Incomplete staging surgery as a major predictor of relapse of borderline ovarian tumor. World J Surg Oncol. 2013; 11:13.

10. Ferrero A, Strada I, Di Marcoberardino B, Maccarini LR, Pozzati F, Rossi M, et al. Clinical significance of microinvasion in borderline ovarian tumors and its impact on surgical management. Int J Gynecol Cancer. 2012; 22:1158–1162.

11. Wu TI, Lee CL, Wu MY, Hsueh S, Huang KG, Yeh CJ, et al. Prognostic factors predicting recurrence in borderline ovarian tumors. Gynecol Oncol. 2009; 114:237–241.

12. Du Bois A, Ewald-Riegler N, de Gregorio N, Reuss A, Mahner S, Fotopoulou C, et al. Borderline tumours of the ovary: a cohort study of the Arbeitsgmeinschaft Gynakologische Onkologie (AGO) Study Group. Eur J Cancer. 2013; 49:1905–1914.

13. Silva EG, Gershenson DM, Malpica A, Deavers M. The recurrence and the overall survival rates of ovarian serous borderline neoplasms with noninvasive implants is time dependent. Am J Surg Pathol. 2006; 30:1367–1371.

14. Desfeux P, Camatte S, Chatellier G, Blanc B, Querleu D, Lecuru F. Impact of surgical approach on the management of macroscopic early ovarian borderline tumors. Gynecol Oncol. 2005; 98:390–395.

15. Maneo A, Vignali M, Chiari S, Colombo A, Mangioni C, Landoni F. Are borderline tumors of the ovary safely treated by laparoscopy? Gynecol Oncol. 2004; 94:387–392.

16. Fauvet R, Boccara J, Dufournet C, Poncelet C, Darai E. Laparoscopic management of borderline ovarian tumors: results of a French multicenter study. Ann Oncol. 2005; 16:403–410.

17. Odegaard E, Staff AC, Langebrekke A, Engh V, Onsrud M. Surgery of borderline tumors of the ovary: retrospective comparison of short-term outcome after laparoscopy or laparotomy. Acta Obstet Gynecol Scand. 2007; 86:620–626.

18. Nam JH. Borderline ovarian tumors and fertility. Curr Opin Obstet Gynecol. 2010; 22:227–234.

19. Nakashima N, Nagasaka T, Oiwa N, Nara Y, Fukata S, Fukatsu T, et al. Ovarian epithelial tumors of borderline malignancy in Japan. Gynecol Oncol. 1990; 38:90–98.

20. Mok JE, Nam JH. Ovarian tumors of low malignant potential. Korean J Gynecol Oncol Colposc. 1993; 4:97–109.