Clinical Analysis Of Risk Factors For Postoperative Recurrence Of Ovarian Borderline Tumor

Objective: In this study,we analyzed the clinicopathological characteristics of borderline ovarian tumors(BOTs)to explore the factors affecting postoperative recurrence and prognosis.At the same time,whether neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR)and systemic immune-inflammation index(SⅡ)could be used as reference basis for predicting postoperative recurrence of BOT and distinguishing the nature of ovarian borderline tumors from benign and malignant tumors before surgery.Methods: The clinical data of patients with ovarian tumor after surgical treatment in the Department of Gynecology Affiliated Hospital of Qingdao University from December2000 to December 2020 were retrospectively analyzed.A total of 352 cases of ovarian borderline tumors were collected in this study,and they were divided into relapse group and non-recurrence group according to whether they had recurrence or not,with a total of38 cases in the relapse group.In the analysis of blood system parameters,352 cases of ovarian benign epithelial tumor and ovarian malignant epithelial tumor were selected as control.The clinical data,blood system parameters and treatment methods of the patients included in the study were evaluated,and an Excel database was established.SPSS26.0statistical software was used for statistical analysis of the collated data.The Chi-square test was used for univariate analysis and the Logistic regression analysis was used for multivariate analysis.P < 0.05 was considered statistically significant.Results:1.Clinical features:Among 352 BOTs patients included in this study,the average age of onset was 41.02 years old,and 38 patients had recurrence during the follow-up period,with a recurrence rate of 10.45%.BOTs patients younger than 40 years old were more likely to relapse(OR=0.188,95%CI= 0.051-0.687),age over 40 years was a protective factor.Compared with M-BOTs,S-BOTs had a higher risk of recurrence(OR=3.626,95%CI= 1.258-10.452).The recurrence rate of patients with FIGO stage II OR above was higher than that of patients with stage I(OR=6.665,95%CI= 3.048-33.241).The recurrence risk of BOTs patients with papillary structures was 12-fold higher than that of BOTS patients without papillary structures(OR=12.828,95%CI=3.845-42.804).2.Treatment methods:The risk of postoperative recurrence in patients undergoing fertile-preserving surgery was increased by 7 times(OR=7.013,95%CI= 5.939-16.948).The recurrence rate of unilateral ovarian involvement in BOTs patients with nursing surgery was 12.94% after ovarian cystectomy,and 9.68% after unilateral oophorectomy.There was no significant difference between the two groups(P=0.491).The recurrence rate of bilateral ovarian cystectomy was 75.00%,and the recurrence rate of bilateral ovarian cystectomy and contralateral cystectomy was 33.33%.The difference between the two groups was statistically significant(P =0.028).In addition,bilateral ovarian involvement was also a risk factor for BOTs recurrence(OR=7.561,95%CI= 2.412-23.699).The survival curve analysis of different treatment methods showed that the recurrence time after conservation surgery was shorter than that of radical surgery,and the recurrence time after bilateral ovarian cystectomy was shorter than that of unilateral oophorectomy + contralateral cystectomy.There was no significant difference in the recurrence time after different surgical approaches(P<0.05).3.Hematological indicators:Univariate analysis of blood system parameters between BOTs recurrence group and non-recurrence group showed that CA125,platelet,NLR,PLR,and SⅡ were statistically significant(P<0.05);When CA125 was 64.31U/m L,NLR was 2.41,PLR was 168.72,SⅡ was 240.14,AUC was the maximum,which was the best threshold point to predict the recurrence of ovarian borderline tumors.The combination of four indicators has a better predictive value for recurrence than any single indicator.The white blood cell count,neutrophil count,platelet,NLR,PLR and SⅡ increased gradually with the increase of malignant degree of ovarian tumor,while the lymphocyte count decreased gradually.There were statistical differences in the comparison of these three groups(P<0.05);There were significant differences in NLR,PLR and SⅡ among the three groups(P<0.05).ROC curve was used to determine the best cut-off values of NLR,PLR and SⅡ in differentiating benign and malignant ovarian tumors.When NLR was 2.77,PLR was 190.73 and SⅡ was 353.64,the AUC was the maximum,which was the best threshold for predicting malignant epithelial ovarian tumors.When NLR was2.21,PLR was 151.93,SⅡ was 191.39,AUC was the maximum value,which was the best threshold for predicting ovarian borderline tumors.SⅡ is more accurate than NLR or PLR in predicting the nature of ovarian tumors.Linear correlation analysis showed that NLR and PLR of ovarian tumors were positively correlated(P<0.05),that is,with the increase of NLR,PLR will also increase,and with the increase of malignant degree of ovarian tumors,NLR and PLR are also increased.Higher NLR,PLR and SⅡ before BOTs mean that the possibility of postoperative recurrence of borderline tumors is increased.High preoperative NLR,PLR and SⅡ in ovarian tumors means that malignant epithelial ovarian tumors are more likely than benign or borderline tumors.Conclusion:1.Age ≤ 40 years,serous tumor,FIGO stage II or higher,papillary structure,bilateral ovarian involvement and conservative surgery are independent risk factors for BOTs recurrence.2.Lymph node dissection,omentectomy and appendectomy do not affect the recurrence and survival rate.3.Recurrence after fertility-preserving surgery is related to the papillary structure of the tumor,bilateral ovarian involvement,and FIGO stage greater than stage I,but not to the surgical approach and range.The postoperative recurrence time of BOTs patients who underwent nursing surgery and bilateral ovarian cystectomy for bilateral affected patients was significantly shorter.4.NLR,PLR,and SⅡ have certain value in predicting postoperative recurrence of BOT and distinguishing the nature of ovarian borderline tumors from benign and malignant tumors before surgery.