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Abstract
Background
Borderline
ovarian tumours (BOTs) are recognised as a unique entity of ovarian
tumours that do not exert infiltrative destructive growth or stromal
invasion. Prognosis of BOT is much better compared to the more common
invasive epithelial ovarian cancer. Information regarding prognostic
factors is inconclusive and no prospective studies exist that evaluate
therapeutic strategies. We therefore started a retrospective–prospective
cohort study to better understand BOT and identify scenarios in which
future studies could be developed.
Methods
Consecutive
patients with BOT treated between 1998 and 2008 in 24 German centres
were analysed. The retrospective part of the study retrieved patients’
data from hospital records and clinical tumour registries while active
follow-up and an independent central pathology review were carried out
prospectively.
Findings
BOT was
confirmed in 950 patients, two thirds had serous BOT and 30.5% mucinous
BOT. Most were diagnosed in stage I (82.3%); 7.6% and 10.1% had stages
II and III, respectively. Overall, 74 patients (7.8%) experienced
relapse and 43 (4.5%) died within the observation period. Multivariate
analysis revealed higher stage, incomplete staging, tumour residuals,
and organ preservation as independent prognostic factors for disease
recurrence. Neither microinvasion nor micropapillary growth pattern
showed any significant impact. Of 74 relapsed patients, 30% had
malignant transformation to invasive ovarian cancer with five-year
progression-free survival and overall survival of 12% and 50%,
respectively.
Interpretation
Prognosis
of BOT correlates with tumour-related as well as surgery-related
factors. The balance between recurrence risk and organ preservation and
fertility-sparing surgery is an important issue deserving further
research.
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