| Research background:Borderline ovarian tumor is a kind of tumor whose pathomorphologic characteristics,biological behavior and prognosis are between benign and malignant tumors,which accounts for 15%-20%of all epithelial ovarian tumors.Its malignancy degree is lower than that of ovarian cancer,and the prognosis is usually better.At present,surgery is the main treatment for BOTs,but the selection of surgical method and scope,the feasibility of reproductive function preservation surgery,and the selection and follow-up of postoperative adjuvant treatment still need further studies to confirm and improve.Research objectives:The information of 126 BOTs patients was retrospectively analyzed,and the clinical characteristics and differences among them were summarized and analyzed.The prognostic factors of 98 patients were studied.Research Methods:The clinical data of 126 patients with borderline ovarian tumor who were initially treated and underwent surgery in Qilu Hospital of Shandong University from January 2009 to December 2019 were collected and analyzed.General information,symptom characteristics,preoperative tumor marker level,ultrasound characteristics,RMI Ⅱ score,intraoperative conditions,pathological characteristics,stage and postoperative adjuvant treatment were included.Postoperative recurrence and fertility of 98 patients were collected.Statistical analysis was conducted to summarize the differences in clinical characteristics and the factors affecting the surgical and pathological stages,recurrence and fertility of the patients.Results:1.126 patients with borderline ovarian tumor ranged in age from 11 to 85 years old,with an average age of 40.15±16.40 years old.Most patients seek medical treatment due to abnormal findings on physical examination.2.44.72%of patients had preoperative Ca125 increased,47.06%had preoperative Ca199 increased,AFP value increased in 1 patient,CEA value increased in 1 patient,and there was no statistical significance between groups.3.The preoperative ultrasound results indicated that the tumors were mostly unilateral,with the diameter of 5-10cm(41.38%)in sBOT and more than 20cm(49.09%)in mBOT(P<0.0001).Multilocular and intracapsular compartments were more common in patients with mBOT(P=0.0125).4.sBOT was more common in patients with RMI Ⅱ)200,and mBOT was more common in patients with RMI<200(P=0.017);Patients with RMI Ⅱ)200 tended to have a higher FIGO stage(P=0.001).5.Surgical exploration findings:compared with mBOT patients,more sBOT patients had bilateral tumors(P=0.003);mBOT tumors were usually≥10cm in diameter,while sBOT tumors were usually<10cm in diameter(P<0.0001).More mBOT patients received open surgical treatment than sBOT patients(P=0.0023);The proportion of lesions detected on the ovarian surface of sBOT(35.00%)was much higher than that of mBOT(5.26%)(P<0.0001).sBOT was more likely to form adhesions than mBOT(P=0.028).6.Preoperative ultrasonography indicated that the patients with large tumor volume preferred open surgery(P<0.0001);Menopause and fertility history may be influencing factors for nonconservative surgery.7.Implant metastasis was more common in SBOT than in mBOT(P=0.041);The coincidence rate of rapid intraoperative pathology and final pathology of MBOT(70.18%)was lower than that of sBOT(88.33%)(P=0.0277).The proportion of I stage patients in mBOT(92.98%)was higher than that in sBOT(71.67%)(P=0.0028).Elevated Ca199 was more common in patients with stage I(P=0.0175);Larger tumors were more common in patients who were more advanced(P=0.0464).8.A total of 9 patients relapsed.The recurrence/malignancy of BOTs patients was related to tumor location(P=0.002),ascites presence(P=0.047),lesion involvement on ovarian surface(P=0.042),and microinvasion(P=0.034).Multivariate analysis showed that tumor location was an independent factor affecting the recurrence of BOTs patients(P=0.037,OR=6.547).9.There were 14 successful pregnancies in the 17 patients with definite fertility requirements,and the time interval of the first pregnancy in the cyst excision group(16.286 months)was shorter than that in the adnexectomy group(37.429 months)(P=0.044).Research Conclusions:1.BOTs are mostly diagnosed in young patients who are in stage I at the time of diagnosis and have a good prognosis.2.Preoperative diagnosis of BOTs is difficult,and rapid pathology has a certain misdiagnosis rate;Ca199 and RMI Ⅱ may have value in predicting FIGO stage and pathological type.3.There is no significant difference in the survival of postoperative recurrence between different surgical approaches and surgical methods.Minimally invasive surgery is advocated.Compared with adnexectomy,tumor excision has a shorter pregnancy interval during conservative surgery,but its safety needs to be further confirmed.There is no evidence to support the benefit of postoperative chemotherapy with BOTs.4.Bilateral tumor,ascites,lesion involvement on the ovarian surface,and microinvasion are risk factors for the recurrence of BOTs.Bilateral tumor may be an independent risk factor for the recurrence of BOTs.Research deficiencies:The conclusion of this study is not exactly the same as that of previous similar studies,which has certain reference value and can further guide clinical practice.This study has some limitations,lack of control with benign ovarian tumors.The sample size of this study is small,and the loss of follow-up rate is high,which has certain bias. |
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