保守手术对交界性卵巢肿瘤预后及生育功能的影响

目的：研究首次行保守手术后交界性卵巢肿瘤（BOT）患者的生育功能和预后。方法：对自1990年1月至2000年5月，在我院住院43例符合研究条件的BOT患者，行问卷调查及回顾性病例分析，采用SAS软件包对数据进行处理。结果：43例患者中，41例患者完成问卷调查。26例为浆液性交界性卵巢肿瘤（SBOT）；17例为粘液性交界性卵巢肿瘤（MBOT）；平均随访时间63个月。术后无肿瘤复发29例，肿瘤复发14例（包括1例死于肿瘤复发，1例死于其它疾病）。平均复发时间为术后39．3个月。卵巢肿瘤剥除术后肿瘤复发率58．3％（7／12），而卵巢切除术后肿瘤复发率22．6％（7／31），两者差异有显著性（Fisher精确概率P＝0．0351）；但保守手术后肿瘤复发死亡率并不高于根治性手术（P＝0．64）。术后24例有生育愿望的妇女，12例获得妊娠。结论：保守手术可作为BOT患者的一种治疗选择；尽管术后肿瘤复发率较高（33％，14／43），尤其是行卵巢肿瘤剥除术的患者，但肿瘤复发死亡率并未增加；术后有妊娠愿望者能够再次妊娠并分娩正常后代。     

Ⅰ期卵巢交界性肿瘤剥除术后复发危险因素分析

目的：探讨年轻卵巢交界性肿瘤患者行肿物剥除术后复发的危险因素。方法回顾性分析49例行卵巢肿瘤剥除术,年龄﹤35岁,术后病理为Ⅰ期的卵巢交界性肿瘤（BOT）患者的临床及随访资料,分析术后复发的危险因素。结果随访患者中共7例复发,5年生存率为100%,无复发生存率为91.8%,不同年龄、分期、是否存在间质浸润患者术后复发情况比较,差异无统计学意义（P﹥0.05）;黏液性肿瘤及微乳头型卵巢交界性肿瘤患者复发比例高于浆液性肿瘤及非微乳头型肿瘤患者,差异有统计学意义（P﹤0.05）。结论Ⅰ期BOT单侧病变患者,若术中冰冻结果为黏液性或微乳头型肿瘤,宜行患侧附件切除术;双侧病变患者,若无上述危险因素可行双侧卵巢肿物剥除术,若存在上述危险因素可行单侧附件切除术+对侧卵巢肿物剥除术。     

儿童和青少年卵巢肿瘤的临床病理特点和治疗

目的研究儿童和青少年卵巢肿瘤的临床病理特点及其治疗方法和预后。方法回顾性分析1995年11月至2003年11月间收治的儿童和青少年卵巢肿瘤34例的临床表现、血清肿瘤标志物、病理类型、治疗方式和预后以及上述参数之间的关系。结果主要症状为腹部肿块(61．8％)和腹痛(29．4％)；34例中良性肿瘤22例，恶性肿瘤11例，交界性肿瘤1例；良性肿瘤预后好，仅1例复发；恶性肿瘤11例复发5例，复发病例挽救治疗成功3例；肿瘤标记物阳性7例(63．6％)，术后化疗后转阴性6例均无复发。结论儿童和青少年腹块和腹痛者应排除卵巢肿瘤的可能；良性肿瘤的治疗以保留生育的肿瘤切除或附件切除为主，生殖细胞恶性肿瘤可采取保留生育的手术切除 术后化疗的方法治疗；肿瘤标记物检测对诊断和病情监测有重要意义。     

妊娠合并卵巢交界性肿瘤4例临床分析

[目的]探讨妊娠合并卵巢交界性肿瘤(BOT)的临床特点、病理特征、诊断及预后等。[方法]对南京市浦口区中心医院2007年1月至2012年12月收治的4例BOT患者的临床表现、手术方式、组织病理结果、随访等进行回顾分析。[结果]本组患者占同期妊娠合并卵巢肿瘤患者的6.4%;临床表现主要为月经不规则、痛经和无痛性肿块;诊断以术后确诊为主;治疗方法为肿瘤剔除保留生育功能;随访4例均存活无复发。[结论]BOT患者术前诊断困难,诊断不全,易造成漏诊,应引起临床警惕。     

术中冰冻切片对卵巢肿瘤诊断的价值

目的：对２４８例卵巢肿瘤的临床诊断及术中冰冻切片（ＦＳ）诊断与石蜡切片诊断进行对比研究。方法：石蜡切片诊断良性肿瘤１１８例，交界性肿瘤８例，恶性肿瘤７２例。临床诊断和石蜡切片符合率为７５．８％（１８８／２４８），良性肿瘤为９６．６％（１１４／１１８），交界性肿瘤为４８．３％（４７／５８），恶性肿瘤为６５．３％（４７／７２）。结果：ＦＳ诊断与石蜡切片的符合率为９０．３％（２２４／２４８），良性肿瘤为     

卵巢交界性肿瘤的进展与预后

意大利米兰大学Ｒｏｔａ等报告研究在１９８２年～１９９７年期间 ,所有因卵巢交界性肿瘤在该院接受第１次手术 ,或在别处手术后３个月内转入该院的患者共３３９例（８３ ４%Ⅰ期、７ ９%Ⅱ期、８ ５%Ⅲ期） ,确诊时的中位年龄为３９岁。其中１５０例患者接受根治性手术 ,１８９例接受保留生育功能手术。术后１８例有镜下残留病灶 ,１３例有肉眼可见残留病灶。４４例病人接受术后化疗。随访期中位数为７０个月 ,７例失访２４例生存 ,无临床肿瘤证据（８例有亚临床种植瘤存留） ,３例生存病人有临床卵巢肿瘤证据 ,３例死于卵巢肿瘤 ,１０例死…     

膀胱内灌注卡介苗预防肿瘤复发35例报告

目的：探讨膀胱内灌注卡介苗对膀胱癌的治疗效果。方法：对15例膀胱癌患者行保留膀胱手术，术后采用卡介苗（BCG）膀胱内灌注。结果：本组25例中1例6月后死于脑血管意外，其余34例随访5年6例；2年－3年20例；1年半8例；复发3例（T2期1例，T3期2例；术后6月1例，术后13月2例），复发率8．57％。结论：BCG膀胱内灌注对浅表性膀胱癌术后疗效好、复发率低，但肌层浸润的肿瘤效果较差。     

隆突性皮肤纤维肉瘤的术后放疗

目的研究放疗在隆突性皮肤纤维肉瘤（DFSP）中的价值。方法回顾性分析1993年1月-2002年12月收治经组织病理学确诊的43例DFSP患者。且手术次数至少1次以上，术后放疗剂量多数为50～60Gy。结果43例患者手术后共复发91次，第一次手术后复发时间多在0．5～7年（39／43），第二次手术后复发时间多在1～24个月（21／39），均行手术＋放疗。中位随访时间37个月，40例（93．0％）达到局部控制，3例（7．0％）局部复发。结论术后放疗能有效降低DFSP的复发率，放疗剂量50-606y较为合适。     

初治颈淋巴结转移喉癌颈清除术后的预后相关因素

目的：探讨颈淋巴结转移（cN＋）喉癌颈清除术后颈部复发相关因素、治疗及预后情况。方法：回顾性研究1992～1999年我院收治的cN＋喉癌行颈清除术53例，对其颈部复发率、复发时间、淋巴结分布、局部治疗、复发影响因素及预后进行探讨。结果：cN＋喉癌颈清除术后颈部复发率为24．53％（13／53）；3和5年生存率为39．62％和35．52％，颈部复发组生存率与无复发组相比，差异无统计学意义，P=0．6717；复发主要位于清除侧颈部（9／13），复发淋巴结位于Ⅱ、Ⅲ和Ⅳ区84．62%（11/13）；颈部复发多在18个月内（12／13）；颈部复发行挽救手术者治疗效果好。病理分化程度（P=0．6717）、病变部位（P=0．966）、临床分期（P=0．244）、初治颈清除术式（P=0．579）、颈清除术后颈部是否放疗（P=0．457）不影响颈部复发率，N分期（P=0．042）影响颈部复发。结论：cN＋喉癌颈清除术后颈部有无复发与生存率无关；复发多位于行颈清除术侧颈部（Ⅱ、Ⅲ和Ⅳ区）；N分期影响颈部复发；出现颈部复发者行挽救手术治疗效果好。     

早期卵巢交界性肿瘤不同手术方式对妊娠结局的影响

目的:观察早期卵巢交界性肿瘤患者保留生育功能的不同手术方式治疗效果及对患者妊娠结局和复发的影响。方法:回顾性分析山西医科大学附属第一医院及运城市中心医院2010年1月至2018年12月收治的190例接受保留生育功能手术的早期卵巢交界性肿瘤患者临床资料,将经腹腔镜手术患者为观察组(95例),常规开腹手术组患者为对照组(95例),对两组患者手术相关指标、术后并发症发生情况、妊娠结局以及术后复发情况进行综合评价。结果:观察组患者手术时间、肛门排气时间及住院时间均短于对照组,术中出血量较对照组少,两组差异有统计学意义(P<0.05);观察组术后并发症发生率为4.21%,与对照组(18.95%)对比,差异有统计学意义(P<0.05);观察组治疗后成功妊娠及足月分娩率均显著高于对照组(P<0.05);两组患者术后复发率比较差异无统计学意义(P>0.05)。结论:早期卵巢交界性肿瘤患者行腹腔镜下保留生育功能手术治疗,安全性高、创伤小,对疾病复发无影响,能够提升患者妊娠结局,降低并发症发生率,值得推广应用。     

Influence of histological subtypes on the risk of an invasive recurrence in a large series of stage I borderline ovarian tumor including 191 conservative treatments

BackgroundThe overall prognosis of stage I borderline ovarian tumors (BOT) is excellent but a small percentage of patients die to their disease. The prognostic factors for such a rare event are still not clearly defined. The aim of this study was to determine these factors for recurrence per se and recurrence in the form of invasive carcinoma in a large series of stage I tumors.MethodsA retrospective review of patients with BOT. Three inclusion criteria were defined: (i) a centralized histological review; (ii) macroscopic stage I tumors; (iii) exclusion of metastatic disease to the ovaries.ResultsFrom 2000 to 2010, 254 patients fulfilled inclusion criteria [140 had mucinous BOT (MBOT) and 114 a serous BOT (SBOT)], and 191 had undergone conservative management. After a median follow-up of 45 months, 43 patients had developed recurrences (31 borderline and 12 invasive).The risks of recurrences were statistically increased after conservative treatment, particularly after a cystectomy, in patients with stage IB and among patients with incompletely staged tumors. In the subgroup of conservatively treated patients (representing 75% of our population), the risks of recurrences were statistically increased in patients affected by a SBOT, in patients who had undergone a cystectomy, in patients with stage IB disease and in patients with a micropapillary pattern (MPP). MBOT and the presence of a MPP were identified as prognostic factors for invasive disease.ConclusionsIn the present series of BOT with the largest number of patients treated conservatively to date, the presence of a MPP and the mucinous subtype were associated with a higher rate of progression to carcinoma after conservative management. These important results suggest that MBOT belong to a ‘high-risk’ group likely to develop an invasive recurrence after fertility-sparing surgery in stage I BOT.     

Infertility treatment after conservative management of borderline ovarian tumors

BACKGROUND: Young patients with ovarian tumors of low malignant potential usually undergo conservative surgery because of the excellent prognosis of these tumors. Patients wishing to conceive after diagnosis occasionally require ovulation induction, but data regarding the safety of assisted reproductive technologies in this situation remains anecdotal. The current study analyzes the outcome of a group of patients who received infertility treatment after the conservative management of borderline ovarian tumors. METHODS: The clinical and pathologic records of 104 patients with a borderline tumor of the ovary who were treated and followed over a 20-year period (1979--1999) were reviewed. Forty-three patients who underwent conservative management were the subjects of the current study. RESULTS: Follow-up was available for 95% of the patients, giving a total of 270 women-years of follow-up. Nine of the 43 patients developed a local recurrence, 8 of which occurred in patients with serous tumors. Five of these 9 patients underwent cystectomy only at the time of recurrence, and all were without evidence of disease at a mean follow-up of 75 months (range, 25--93 months). Nineteen patients delivered a total of 25 healthy children after diagnosis of a borderline ovarian tumor; 7 of these patients were treated with in vitro fertilization (IVF) after diagnosis. Four of these patients developed a recurrence, two patients before the IVF treatment and two patients after the IVF treatment. The latter two patients were without evidence of disease at the time of last follow-up (15 months and 26 months, respectively, after the recurrence). CONCLUSIONS: The results of the current study suggest that ovulation induction may be considered after the diagnosis of a borderline ovarian tumor. Recurrences were observed in two of seven patients, all of which remained histologically borderline.     

Restaging surgery for women with borderline ovarian tumors: results of a French multicenter study

BACKGROUND: The purpose of the current study was to examine the surgical management of women with borderline ovarian tumors and the adequacy of initial staging according to the guidelines of the International Federation of Gynecology and Obstetrics; to evaluate the impact of restaging operations; and to identify risk factors for initial understaging. METHODS: In a retrospective French multicenter study, 54 of 360 women with borderline ovarian tumors underwent a restaging operation. After excluding women with initial complete staging (n = 62), epidemiologic, surgical, and histologic parameters and risk of recurrence were compared between women who underwent restaging (n = 54) and those who did not (n = 244). RESULTS: One hundred fifty (41.6%) of 360 women underwent intraoperative histologic examination, which led to the diagnosis of a borderline tumor in 97 cases (64.7%). Thirty-seven (38.1%) of these 97 women had undergone complete initial staging procedures. A restaging operation was performed for 54 women. A lower median age and a higher rate of conservative treatment were noted in the group that underwent restaging. Eight (14.8%) of the 54 women who underwent restaging had their tumors upstaged: 7 of the 41 cases initially diagnosed as Stage IA tumors were upstaged to Stage IB (n = 3) or to Stage IIA, IIB, IIIA, or IIIC (n = 1 for each); in the eighth case, a Stage IC tumor was upstaged to Stage IIIA. Upstaging tended to be more common in women with serous borderline tumors (P = 0.06) and in women who underwent cystectomy (P = 0.08). There was no difference in recurrence rates according to whether a restaging operation was performed. The recurrence rates after conservative and radical treatment were 15.6% (25 of 160) and 4.5% (9 of 200), respectively (P < 0.001). CONCLUSIONS: Women who initially were diagnosed with Stage IA disease and who had serous borderline tumors or underwent cystectomy appeared to derive the most benefit from restaging surgery. Nonetheless, the indications for restaging surgery remain controversial, as no difference in recurrence rate was observed between women who underwent restaging and those who did not.     

Outcomes after conservative treatment of advanced-stage serous borderline tumors of the ovary

BackgroundThe aim of this study was to assess the outcomes of the largest series of patients treated conservatively for a stage II or III serous borderline ovarian tumor.Materials and methodsFrom 1969 to 2006, 41 patients were treated conservatively for an advanced-stage serous borderline ovarian tumor. Patient outcomes were reviewed.ResultsTwenty patients had undergone a unilateral salpingo-oophorectomy, 18 a unilateral cystectomy and two bilateral cystectomy (unknown for one patient). Three patients had invasive implants. The median duration of follow-up was 57 months (range 4–235). The recurrence rate was high (56%), but overall survival remained excellent (100% at 5 years, 92% at 10 years). One death had occurred due to an invasive ovarian recurrence. Eighteen pregnancies (nine spontaneous) were observed in 14 patients.ConclusionsThis study demonstrates that spontaneous pregnancies can be achieved after conservative treatment of advanced-stage borderline ovarian tumors (with noninvasive implants) but the recurrence rate is high. Nevertheless, this high rate has no impact on survival. Conservative surgery can be proposed to patients with a borderline tumor of the ovary and noninvasive peritoneal implants. Should infertility persist following treatment of the borderline tumor, an in vitro fertilization procedure can be cautiously proposed.     

Conservative surgery in ovarian borderline tumours: A meta-analysis with emphasis on recurrence risk

BackgroundRecent reports have stirred the debate regarding the optimal conservative treatment for both serous and mucinous borderline ovarian tumour (BOT). The aim of this study is to examine the optimal oncological approach of conservative surgery in unilateral BOT (cystectomy (C) versus unilateral salpingo-oophorectomy (USO)) and in bilateral BOT (bilateral C (BC) versus USO + contralateral C (CC)), as well as fertility outcomes.Materials and methodsThe PubMed database and Cochrane Library were searched using the search terms (((Borderline) OR (low malignant potential)) AND (ovarian)) AND ((tumour) OR (cancer)) AND (((fertility sparing) OR (conservative)) AND surgery).ResultsWe analysed 39 studies that included 5105 women (2624 patients with serous-, 2120 patients with mucinous- and the remaining with other types of BOT), 2752 of which underwent conservative surgery (817 underwent C, 89 BC, 1686 USO and 118 USO + CC). Eight studies included only stage I patients, in 14 studies more than 90% of patients were stage I and five studies included only late-stage patients. Seven studies included only patients with serous borderline ovarian tumour (sBOT) and two only mucinous borderline ovarian tumour (mBOT). A total of 296 patients with non-invasive-, 76 patients with invasive- and 50 patients with unspecified implants were pooled. Of the patients undergoing C, BC, USO and USO + CC the pooled recurrence estimates were respectively 25.3%, 25.6%, 12.5% and 26.1%. In meta-analysis, USO was significantly favored over C with an OR for recurrence reduction = 2200, 95% CI = 0.793–2.841 and p < 0.0001. The pooled recurrence estimate as invasive ovarian cancer was 15.4% and the pooled 95% CI was 0.120–0.196. The cumulative pregnancy rate was 55.7% with 45.4% for USO and 40.3.0% for C.ConclusionCystectomy in unilateral serous BOT is significantly associated with a higher recurrence rate, albeit no impact on survival can be demonstrated. Whether this is related to the duration of follow-up, remains to be proven. Nonetheless, recent data seem to suggest that USO is advisable in the case of mucinous BOT. On the contrary, a more conservative approach (BC) should be definitively favored in bilateral BOT, which is almost always serous, because no significant difference is seen in terms of recurrence rate when compared to USO + CC.     

Clinical outcome and risk factors for recurrence in borderline ovarian tumours

We investigated the long-term prognosis of borderline ovarian tumours and determined risk factors for recurrence. One hundred and twenty-one borderline ovarian tumours 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. 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 tumour (75.2%), 27 cases of serous tumour (22.3%), and three cases of endometrioid tumour. 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 eight cases, but no tumour-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<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<0.05). In the conservative surgery group, cystectomy and serous tumour were independent risk factors for recurrence. Although recurrence was observed, the long-term prognosis of borderline ovarian tumour was favourable, without tumour-related deaths. Considering the favourable prognosis, conservative surgery can be chosen as far as the patient has a non-serous tumour 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 2-4-folds.     

Borderline tumours of the ovary and fertility

Standard management of borderline ovarian tumours (BOT) is historically radical and based on hysterectomy, bilateral salpingo-oophorectomy and peritoneal staging. But, as 1/3 of BOTs are diagnosed in patients aged less than 40 years, treatments preserving fertility-potential (with preservation of the uterus and at least part of one ovary) has seen great developments in the last decade. Such treatments increase the rate of recurrences (between 15% and 35% depending on the type of conservative surgery), but without any impact on patient survival as most recurrent diseases are of the borderline type, easily curable and with excellent prognosis. The spontaneous pregnancy rate is nearly 50%. In case of persistent infertility, it seems that the use of ovarian induction or in vitro fertilization procedures could be proposed in selected cases. Follow-up is essential and based on clinical examination and routine ultrasonography. The interest of completion surgery (removal of the retained ovary) in patients who obtained pregnancy remains debated. In conclusion, conservative management of at least part of one ovary and uterus could be safely proposed at least to patients with early stage BOT, in order to preserve fertility-potential. The rate of recurrence is increased but without any impact on survival.     

Clinical outcome after laparoscopic pure management of borderline ovarian tumors: results of a series of 34 patients.

BACKGROUND: The aim of this study was to assess clinical outcome after laparoscopic treatment of borderline ovarian tumor (BOT). PATIENTS AND METHODS: Thirty-four patients treated initially and/or for recurrent disease using a laparoscopic approach for BOT from 1984 to January 2002. RESULTS: Thirty-four patients underwent laparoscopic pure treatment (without conversion by laparotomy and/or reassessment surgery by laparotomy) for BOT. Conservative treatment was performed in 31 (91%) patients. Median follow-up time was 45 months (range 6-228). Six (17%) patients recurred (in the remaining ovary following conservative surgery in five patients and in the peritoneum in one patient). Two port-site metastases were observed. None of the patients had recurrent disease in the form of ovarian carcinoma. Nine spontaneous pregnancies were observed in six patients from a group of 15 patients desiring pregnancy. All patients are alive today and disease-free. CONCLUSION: These results seem to demonstrate that laparoscopic treatment can be safely performed in young patients with early stage BOT. Such a procedure is then feasible, but should be evaluated in patients with BOT and peritoneal implants.