Do Exophytic and Endophytic Patterns in Borderline Ovarian Tumors Have Different Prognostic Implications? A Large Multicentric Experience (original) (raw)
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Retrospective evaluation of borderline ovarian tumors: single center experience of 183 cases
Archives of Gynecology and Obstetrics, 2014
Purpose Borderline ovarian tumors (BOTs) constitute about a quarter of epithelial ovarian malignancies and require different treatment approaches. The present study aims to document the experience of a single center on the treatment outcome of women who had conservative or comprehensive surgery for BOTs. Methods One hundred eighty-three patients with BOTs, diagnosed and/or treated in our center between January of 2000 and March of 2013, were reviewed retrospectively. Results The mean age at diagnosis was 40.6 years old (range 17-78). Ninety-five patients (51 %) were B40 years. Comprehensive surgical staging and fertility sparing surgery were performed in 49 % (n = 91) and 48 % of patients (n = 89) respectively. A hundred and forty-seven patients had stage IA disease (80 %). The most common type of BOT was serous in histology with 18 % bilateralism. CA-125 and CA-199 levels were increased in 29 (19 %) and 15 (10 %) patients with stage IA disease. Non-invasive tumor implants were diagnosed in 9 patients (4 %) and uterine involvement was 2 % among BOT patients that underwent hysterectomies. The mean post-operative follow-up period was 20.4 months (range 6-78 months). Disease recurrence was seen in 5 patients indicating overall recurrence rate of 2.7 %. Conclusions In our study, we evaluated a large data pool of 183 patients diagnosed with borderline epithelial ovarian tumors. BOTs have a relatively better prognosis than invasive epithelial ovarian cancer. Surgery with proper staging is the cornerstone of treatment. Patients with BOTs at the early stage can undergo fertility sparing surgery with close follow-up.
Borderline Ovarian Tumors: Current Concepts for Prognostic Factors and Clinical Management
Clinical Obstetrics and Gynecology, 2006
Since their original description in 1929, our knowledge of the natural history and molecular pathology of borderline ovarian tumors (BOTs) has advanced most dramatically over the last decade. It has been estimated that at the time of abdominal exploration for a serous ovarian neoplasm, a BOT will be discovered in approximately 15% of cases. These tumors commonly affect women of reproductive age, have an excellent overall prognosis and the majority are cured with surgery. Nevertheless, a subset of patients with these tumors have an adverse clinical outcome and the molecular features of the associated tumor subtype is currently being defined. These data have caused some to place this more aggressive subtype of BOT, called micropapillary serous with invasive extraovarian implants, into the pathologic continuum with frankly invasive carcinomas. This chapter will explore advances in our understanding of the natural history, clinical and pathologic features of BOTs and will conclude with a discussion of the molecular prognostic factors that might be targets for future therapy. A special emphasis will be placed on points of agreement identified during a recent workshop on BOTs sponsored by the National Cancer Institute (NCI).
Borderline ovarian tumors: twenty years of experience at a tertiary center
Anatolian Current Medical Journal
Aims: To investigate whether there is a difference between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well-staged patients with borderline ovarian tumors (BOTs). Methods: Over the past 20 years (January 2001 to January 2021), the results of four tumor markers (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) have been clinically analyzed for for this retrospective cohort study of 156 patients who underwent surgery and were diagnosed with histopathology consistent with a borderline ovarian tumor. Results: The average age of patients with borderline ovarian tumors was determined to be 51.67 (4.726) years. Before the first surgery, high CA 125 levels (>35 U/l) were found in 53 patients (34%), high CEA levels (>4 ng/ml) were found in 24 patients (15.4%), high CA 19-9 levels (>37 U/ml) were found in 29 patients (18.6%), and high CA 15-3 (>30 ng/ml) levels were found in 12 patients ...
Epithelial ovarian tumors of borderline malignancy
Gynecologic Oncology, 1990
80 patients underwent primary surgery at Brigham and Women's Hospital for epithelial ovarian tumors of borderline malignancy. Surgical staging revealed 52 (65%) patients with stage IA, 2 (2.5%) with stage III, 10 (12.5%) with stage IC, 4 (5%) with stage II, 11 (13.8%) with stage III, and 1 (1.2%) with stage IV. All 37 patients with mutinous tumors had stage I disease, whereas 13 (33%) of 39 patients with serous tumors had stage II-IV disease. The mean sizes of mutinous and serous ovarian tumors were 18.7 and 10 cm, respectively. At initial surgery, 48 (60%) patients had a total abdominal hysterectomy with bilateral salphtgo-oophorectomy and 16 (20%) had an oophorectomy. Sixteen (20%) patients underwent cystectomy, 6 (37.5%) of whom subsequently had an oophorectomy. All 10 patients treated by cystectomy alone have remained disease free. CA-125 levels were normal in 5 patients with stage I disease, but were elevated in 6 of 8 patients with more advanced tumors. Current disease status was determined in 72 patients (90%); 69 (95.8%) are alive and disease free, 1 (1.4%) patient is alive with tumor, and 2 (2.8%) patients died, free of disease. o 1990 Academic prrss, hc.
Acta Obstetricia et Gynecologica Scandinavica, 2012
Objective. Preoperative evaluation of ovarian masses has become increasingly important for optimal planning of treatment. The aim of this study was to assess the role of preoperative serum cancer antigen 125 (CA-125) levels in correlation with ultrasonographic features in order to distinguish between borderline ovarian tumors (BOTs) and stage I epithelial ovarian carcinoma (EOC). Design. Retrospective study. Setting. Tertiary University Hospital. Population. We reviewed all women with BOTs and stage I EOC from January 2000 to December 2010. Data from 165 women (66 BOTs and 99 stage I EOC) were analyzed. Methods. Multivariable logistic regression with stepwise selection of variables was used to determine which clinical variables, ultrasound features and CA-125 level were independently associated with invasiveness. Main outcome measures. Utility of ultrasonographic markers and CA-125 in the preoperative differential diagnosis between BOTs and stage I EOC. Results. Women with CA-125 > 100 IU mL À1 had almost three times greater likelihood of belonging in the EOC group [odds ratio (OR) 3.02; confidence interval (CI) 95%: 1.13-8.12]. Furthermore, the presence of large solid component (! 20% of the tumor comprised of solid components) was associated with 4.25 times greater odds of it to representing ovarian cancer rather than a BOT (OR 4.25; 95% CI: 2.05-8.82). In contrast, the presence of papillary projections was associated with a 73% lower likelihood of EOC (OR 0.27; 95% CI: 0.13-0.58). Conclusions. Preoperative CA-125 > 100 IU mL À1 combined with the presence of a large solid component and the absence of papillary projections seems to improve the discriminative ability in favor of stage I EOC. Abbreviations: BOT, borderline ovarian tumor; CA-125, cancer antigen 125; EOC, epithelial ovarian carcinoma; RMI, risk of malignancy index.
Borderline ovarian tumors: clinical characteristics, management, and outcomes - a multicenter study
Journal of Ovarian Research, 2016
Background: The optimal surgical management and staging of borderline ovarian tumors (BOTs) are controversial. Institutions have different surgical approaches for the treatment of BOTs. Here, we performed a retrospective review of clinical characteristics, surgical management and surgical outcomes, and sought to identify variables affecting disease-free survival (DFS) and overall survival (OS) in patients with BOTs. Methods: A retrospective review of ten gynecological oncology department databases in Turkey was conducted to identify patients diagnosed with BOTs. The effects of type of surgery, age, stage, surgical staging, complete versus incomplete staging, and adjuvant chemotherapy were examined on DFS and OS. Results: In total, 733 patients with BOTs were included in the analysis. Most of the staged cases were in stage IA (70.4 %). In total, 345 patients underwent conservative surgeries. Recurrence rates were similar between the conservative and radical surgery groups (10.5 % vs. 8.7 %). Furthermore we did not find any difference between DFS (HR = 0.96; 95 % confidence interval, CI = 0.7-1.2; p = 0.576) or OS (HR = 0.9; 95 % CI = 0.8-1.1; p = 0.328) between patients who underwent conservative versus radical surgeries. There was also no difference in DFS (HR = 0.74; 95 % CI = 0.8-1.1; p = 0.080) or OS (HR = 0.8; 95 % CI = 0.7-1.0; p = 0.091) between complete, incomplete, and unstaged patients. Furthermore, receiving adjuvant chemotherapy (CT) for tumor stage ≥ IC was not an independent prognostic factor for DFS or OS. Conclusions: Patients undergoing conservative surgery did not show higher recurrence rates; furthermore, survival time was not shortened. Detailed surgical staging, including lymph node sampling or dissection, appendectomy, and hysterectomy, were not beneficial in the surgical management oF BOTs.
May increased CA125 in borderline ovarian tumor be indicative of a poor prognosis? A case report
Tumor Biology, 2014
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Pathology of borderline (low malignant potential) ovarian tumours
Best Practice & Research Clinical Obstetrics & Gynaecology, 2002
Recent studies suggest that the borderline group of ovarian tumours can be subclassi®ed into benign and malignant neoplasms. The survival for patients with serous borderline tumours con®ned to the ovaries is virtually 100%. Patients with serous borderline tumours with invasive peritoneal implants, and with micropapillary serous carcinomas (a distinctive neoplasm previously included in the borderline category), have a 30±40% mortality rate and therefore these tumours are classi®ed as carcinomas. After these neoplasms are excluded, the remaining advanced stage serous borderline tumours (those with non-invasive implants) have a survival rate of nearly 100% and should be considered benign. Similarly, nearly all mucinous borderline tumours reported to display aggressive behaviour have been associated with pseudomyxoma peritonei, a condition now known to be of appendiceal origin. The remaining mucinous borderline tumours are always con®ned to the ovaries and have a benign behaviour. Since borderline tumours can now be classi®ed into benign and malignant types, the category has no further utility.