Clinical Study Of63Patients With Not Elder Than40-year-old Of Epithelial Borderline Ovarian Tumors After Fertility Preservation Therapy

Objective: To investigate the clinical characteristics of epithelial borderlineovarian tumors patients with not elder than40-year-old; conservative therapies;menstruation，fertility and recurrence results after fertility preservation therapy; Andstudy factors affecting recurrence of borderline ovarian tumors.Methods:63cases of epithelial borderline ovarian tumors patients with not elderthan40-year-old who were treated with conservative therapy in Dalian MaternityHospital from January2003to January2011were analysed retrospectively andfollowed up about the fertility and the recurrence. The average onset age of63patientswas30.21years old.33cases were serous tumors;26cases were mucinous tumors;4cases were other pathological type. There were40cases (63.5%) of stage Ⅰa,5cases(7.9%) of stage Ⅰb,16cases (25.4%) of stage Ⅰc,2cases (3.2%) of stage Ⅲ, withoutstage Ⅳ.36cases underwent laparotomy and27cases underwent laparoscopy.34casesunderwent unilateral oophorectomy (UO),20cases unilateral cystectomy (UC),5casesbilateral cystectomy (BC),4cases UO with contralateral cystectomy (UO+CC).24of63cases were operated with complete staging operation.4cases were treated withadjuvant chemotherapy following conservative surgery. Median follow-up time was48months (4-108months).9of63cases recurred, of which1case died owing to diseaseprogress.23of63cases have fertility wish, of which12cases (52.2%) conceivedspontaneously, and1case underwent ART (Assisted Reproduction Technology)treatment after conservative surgery. Menstrual abnormalities occurred in2patientsafter management. Results:①Most patients of epithelial borderline ovarian tumorsare diagnosed atan early stage,49%hadn’t clinical symptoms and often were found by HealthyCheck-up.②Recurrence rate of chemotherapy group hadn’t significant difference fromnon-chemotherapy group （P＞0.05）， but adjuvant chemotherapy can prolongdisease-free survival time of patients with advanced stage.③Pregnancy rate of UOhadn’t significant difference from UC(P＞0.05), but recurrence rates of two groups hadsignificant difference(P＜0.05), namely recurrence rate of UC was higher than UO;Recurrence and pregnancy rates of BC hadn’t significant difference from UO+CC(P＞0.05).④Compared with laparoscopy, recurrence and pregnancy rates of laparotomyhadn’t significant difference(P＞0.05), but tumors size and incidence of intraoperativecyst rupture between two groups had significant difference(P＜0.05).⑤Recurrencerate of patients who underwent complete staging operation hadn’t significant differencefrom patients who didn’t undergo complete staging operation(P＞0.05), but1case whodidn’t undergo complete staging operation died after disease recurrence.⑥One patientwho was early stage with infertility after conservative surgery underwent4times ARTtreatment during2years after surgery and all didn’t succeed, but during follow-up,recurrence wasn’t found.⑦Recurrence was found in9cases during follow-up, andhistological types of all recurrent tumors were borderline ovarian tumors. Recurrentlesions almost located in the remaining ovary and patients who underwent surgery againcan be successfully salvaged.⑧the Kandall’s Correlate showed conservative surgeryprocedure, cyst rupture, bilateral ovarian tumors, stage and microinvasion were relatedto recurrence of epithelial borderline ovarian tumors.Conclusions:①Regular healthy check-up for women with not elder than40-year-old is extremely important. Physical examination, together with pelvicultrasound and determination of serum tumor markers, can enhance diagnosis rate ofepithelial borderline ovarian tumors before surgery.②Patients of epithelial borderline ovarian tumorswho have fertility wish with not elder than40-year-old can be treated with conservative surgery;Adjuvant chemotherapy isn’t necessary for patients with stage Ⅰafter conservative surgery, but it isbeneficial to patients with stage Ⅱ-Ⅳ or risk factors of recurrence; And close follow-up is required for allpatients of epithelial borderline ovarian tumors, after fertility-sparing surgery, especiallythe first2years.③UO is firstly considered for unilateral ovarian disease, and BC isfirstly considered for bilateral ovarian diseases.④Laparoscopy isn’t appropriate forpatients with bigger size of tumor or possibility of intraoperative cyst rupture.⑤Allpatients should undergo complete staging operation, but if retroperitoneal lymphonodi of patients are normal by intraoperative exploration, lymphadenectomy isn’t consideredfor the patients, especially early-stage patients; It isn’t recommended for patient withnormal appearing contralateral ovary to undergo wedge biopsy of contralateral ovary.⑥Operation again is likely to affect menstruation of patients, therefore, functionalovarian tissues should be conserved as more as possible during fertility-sparing surgery.ART treatment for patients who are early stage with infertility after fertilitysparing-surgery is safe and feasible.⑦If patients have better obedience andfollowing-up conditions, they don’t need to immediately undergo complementaryradical surgery after achieved complete families.⑧Patients with recurrence ofepithelial borderline ovarian tumors can undergo the secondary conservative surgery.