Compared The Recurrence Of Borderline Ovarian Tumors By Laparoscopy And Laparotomy:A Meta-analysis And Clinical Analysis Of 45 Patients

Objective The aim of current study is to systematically review the recurrence of borderline ovarian tumors(BOTs)after laparoscopy or laparotomy and analysis the clinicopathologic features,the risk factors associated with recurrence of 45 BOTs patients.Methods We searched Pub Med,The Cochrane Library(Issue 11,2015),EMBase,Web Of Science,CNKI,Wanfang Data and CBM(from inception to November,2015),and looked up the references of included studies.Studies compared laparoscopy and laparotomy for BOTs were picked out according to the included and excluded criteria.Data extracted and quality of included studies assessed by two reviewers independently.After these meta-analysis was performed by using Rev Man5.3.At the meantime,we reviewed BOT patients treated and diagnosed from Jan 1,2012 to Nov 30,2016 at the first hospital of Lanzhou University.Useful information including age at diagnosis,childbearing history,the longest diameter of tumor,the level of tumor biomarkers before surgery,clinicopathologic features of tumor,treatment and recurrent data were collected.All data were analyzed by using independent-samples t test,one-way analysis of variance(ANOVA),ranksum test or chi-squared test.Results At meta-analysis 547 studies were found out,finally 19 studies,2537 patients included,all of them are cohort studies,and the qualities of them are moderate according to the NewcastleOttawa scale system(10 studies are less than 7 points,while the rest are at least 7 points).The results of Meta-analysis showed that: the recurrence of tumor[OR=1.75,95%CI(1.05,2.91),P=0.03] in laparoscopy was higher than laparotomy,though in the subgroup of conservative surgery and radical surgery the recurrence was not significant difference[OR=1.22,95%CI(0.71,2.08),P=0.47;OR=4.38,95%CI(0.85,22.68),P=0.08],and the diameter of tumor was significant smaller in laparoscopy than laparotomy[MD=-6.88,95%CI(-8.15,-5.61),P<0.05];A higher rate of rupture of tumor[OR=3.99,95%CI(2.54,6.26),P<0.05].At the clinical analysis,47 patients were diagnosed BOT by paraffin sections,2 of them lost to follow-up because of the missing of contact information.Finally,45 patients included in this analysis.The mean of diagnosis age was 41.76±17.45y(range: 17~83y),the patients in fertility-sparing surgery group were younger than radical operation(P=0.001),the nulliparae were younger than who had produced(P=0.000),and the patients with recurrence were younger than those who did not(P=0.003).25 patients of 45(55.56%)were ?40y,nearly half of included patients(44.44%),and 29(64.44%)patients were operated by fertility-sparing surgery,among them 18 patients(64.30%)were unilateral salpingoophorectomy.13 of 45 patients(28.89%)were nulliparae.The most common types of BOT were mucous(55.56%)and serous(33.33%),and 93.33%(42 patients)was diagnosed at ? stage.Pelvic mass as symptom was found in 19 patients(42.22%),the mean diameter was 12.08±4.44 cm,and the patient who the diameter ?10cm accounts 44.44%,the diameter of laparoscopy was smaller than laparotomy(P=0.017).The level of some tumor biomarkers before surgery was up-regulated,there were about 53.49%?21.62%?33.33%?29.73%?10.00%patients showed overexpression of CA125,HE4,CA724,CA199,CA153 respectively.The level of CA125 in mucous,serous and mixed subtype was different(P=0.036).There were 13 patients received chemotherapy after surgery.The results of analysis of risk factors on recurrence showed that nullipara(P=0.035)and advanced stage by FIGO(P=0.027)influence the recurrence of BOT.Conclusion At meta-analysis: laparoscopy used in BOTs,has limitation on the diameter of tumors,and increases the rupture of tumors and recurrence after treatment,but the pooled result is closed to the invalid line,it should be careful when applied to clinic,and we need more high quality,big sample studies to approved it.At clinical analysis,BOTs were common in reproductive age,and pelvic mass was the most common symptom,most patients diagnosed at early stage(?).Surgery was the main treat choose,and the diameter of tumor was smaller in laparoscopy compared with laparotomy,this was the same to the result of former Meta.Nullipara and advanced stage by FIGO were the risk factor of recurrent,while the age at diagnosis,the way of surgery,the scope of surgery,the scope of disease,the substyle of histopathology,the level of tumor biomarkers,the diameter of tumor and chemotherapy or not were not associated with recurrent.