您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2023, Vol. 61 ›› Issue (8): 61-66.doi: 10.6040/j.issn.1671-7554.0.2023.0343

• 临床医学 • 上一篇    

卵巢交界性肿瘤保留生育功能术后肿瘤预后及妊娠结局

刘昶1,2,王倩男1,张悦1,陈忠绍1,褚然1,姚舒1   

  1. 1.山东大学齐鲁医院妇产科, 山东 济南 250012;2.山东大学齐鲁医学院第一临床学院, 山东 济南 250012
  • 发布日期:2023-08-30
  • 通讯作者: 姚舒. E-mail:yaoshu1992@126.com
  • 基金资助:
    中国博士后基金面上项目(2022M711951),中国博士后基金站前特别资助项目(2022TQ0197),山东省自然科学基金青年项目(ZR2022QH035),山东博士后创新计划(SDBX2022007)

Prognosis and fertility outcomes of patients with borderline ovarian tumors undergoing fertility-sparing surgery

LIU Chang1,2, WANG Qiannan1, ZHANG Yue1, CHEN Zhongshao1, CHU Ran1, YAO Shu1   

  1. 1. Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    2. First Clinical Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2023-08-30

PDF (PC)

143

摘要： 目的 探讨卵巢交界性肿瘤(BOT)患者保留生育功能手术(FSS)后的肿瘤预后及生育结局。 方法 回顾性分析山东大学齐鲁医院妇产科2009年1月至2019年12月接受FSS手术治疗的BOT患者临床资料。单因素及多因素Cox比例风险回归算法用于分析影响BOT患者保育术后无病生存期(DFS)的高危因素;单因素及多因素二分类Logistic回归分析患者术后妊娠的影响因素。 结果 共167例BOT患者纳入研究,术后中位随访56(2~143)个月。随访期间,共有25例(15.0%)患者复发。多因素Cox比例风险回归分析结果显示,仅肿瘤位置(双侧HR=3.908,95%CI:1.751~8.721,P=0.001)与患者DFS有关。在有妊娠意愿的72例患者中共记录到39例(54.2%)患者妊娠,其中37例患者成功分娩,2例患者选择终止妊娠。多因素二分类Logistic回归分析结果显示,病理类型为黏液型(OR=3.279,95%CI:1.104~9.739,P=0.032)、手术入路为腹腔镜(OR=4.199,95%CI:1.462~12.058,P=0.008)的BOT患者FSS术后妊娠成功率更高。 结论 接受FSS治疗的BOT患者总体预后良好,肿瘤位置与术后复发具有独立相关性,病理类型及手术入路与患者术后妊娠结局相关。

关键词: 卵巢交界性肿瘤, 保留生育功能手术, 无病生存期, 妊娠结局

Abstract: Objective To explore the clinical prognosis and fertility outcomes in patients with borderline ovarian tumors(BOT)who underwent fertility-sparing surgery(FSS). Methods A retrospective analysis was conducted on BOT patients who received FSS in Qilu Hospital of Shandong University during Jan. 2009 and Dec. 2019. Risk factors associated with disease free survival(DFS)were determined with univariate and multivariate Cox proportional hazard regression analysis. Risk factors related to postoperative fertility outcomes were assessed with univariate and multivariate binary Logistic regression analysis. Results A total of 167 BOT patients were included and followed up for a median of 56(range 2-143)months, during which 25 patients(15.0%)had recurrence. Multivariate Cox proportional hazard regression analysis showed bilateral tumor(HR=3.908, 95%CI: 1.751-8.721, P=0.001)was related to DFS. Among the 72 patients with pregnancy intention, 39(54.2%)had pregnancy, 37 gave birth successfully, and 2 terminated pregnancy. Multivariate binary Logistic regression analysis showed that mucinous tumor(OR=3.279, 95%CI: 1.104-9.739, P=0.032)and laparoscopic surgery(OR=4.199, 95%CI: 1.462-12.058, P=0.008)were associated with successful pregnancy after FSS. Conclusion BOT patients undergoing FSS have a favorable prognosis outcome; bilateral tumors are correlated with poorer DFS; the pathological type and surgical approach may affect the postoperative fertility outcomes.

Key words: Borderline ovarian tumors, Fertility-sparing surgery, Disease free survival, Fertility outcome

中图分类号: 

  • R737.31
[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants [J]. Chin Med J, 2022, 135(5): 584-590.
[3] Wang L, Zhong Q, Tang Q, et al. Second fertility-sparing surgery and fertility-outcomes in patients with recurrent borderline ovarian tumors [J]. Arch Gynecol Obstet, 2022, 306(4): 1177-1183.
[4] Hannibal CG, Huusom LD, Kjaerbye-Thygesen A, et al. Trends in incidence of borderline ovarian tumors in Denmark 1978-2006 [J]. Acta Obstet Gynecol Scand, 2011, 90(4): 305-312.
[5] Morice P, Uzan C, Fauvet R, et al. Borderline ovarian tumour: pathological diagnostic dilemma and risk factors for invasive or lethal recurrence [J]. Lancet Oncol, 2012, 13(3): e103-e115.
[6] Zanetta G, Rota S, Chiari S, et al. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study [J]. J Clin Oncol, 2001, 19(10): 2658-2664.
[7] Falcone F, Malzoni M, Carnelli M, et al. Fertility-sparing treatment for serous borderline ovarian tumors with extra-ovarian invasive implants: analysis from the MITO14 study database [J]. Gynecol Oncol, 2022, 165(2): 302-308.
[8] Daraï E, Fauvet R, Uzan C, et al. Fertility and borderline ovarian tumor: a systematic review of conservative management, risk of recurrence and alternative options [J]. Hum Reprod Update, 2013, 19(2): 151-166.
[9] Yahata T, Banzai C, Tanaka K, et al. Histology-specific long-term trends in the incidence of ovarian cancer and borderline tumor in Japanese females: a population-based study from 1983 to 2007 in Niigata [J]. J Obstet Gynaecol Res, 2012, 38(4): 645-650.
[10] Schuurman MS, Timmermans M, van Gorp T, et al. Trends in incidence, treatment and survival of borderline ovarian tumors in the Netherlands: a nationwide analysis [J]. Acta Oncol, 2019, 58(7): 983-989.
[11] Armstrong DK, Alvarez RD, Backes FJ, et al. NCCN guidelines® insights: ovarian cancer, version 3.2022: featured updates to the NCCN guidelines [J]. J Natl Compr Canc Netw, 2022, 20(9): 972-980.
[12] Mutch DG, Prat J. 2014 FIGO staging for ovarian, fallopian tube and peritoneal cancer [J]. Gynecol Oncol, 2014, 133(3): 401-404.
[13] Fischerova D, Zikan M, Dundr P, et al. Diagnosis, treatment, and follow-up of borderline ovarian tumors [J]. Oncologist, 2012, 17(12): 1515-1533.
[14] Buonomo B, Peccatori FA. Fertility preservation strategies in borderline ovarian tumor recurrences: different sides of the same coin [J]. J Assist Reprod Genet, 2020, 37: 1217-1219.
[15] Sangnier E, Ouldamer L, Bendifallah S, et al. Risk factors for recurrence of borderline ovarian tumors in France: a multicenter retrospective study by the FRANCOGYN group [J]. J Gynecol Obstet Hum Reprod, 2021, 50(4): 101961.
[16] Bourdel N, Huchon C, Abdel Wahab C, et al. Borderline ovarian tumors: Guidelines from the French national college of obstetricians and gynecologists(CNGOF)[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 256: 492-501.
[17] du Bois A, Ewald-Riegler N, de Gregorio N, et al. Borderline tumours of the ovary: a cohort study of the Arbeitsgemeinschaft Gynäkologische Onkologie(AGO)Study Group [J]. Eur J Cancer, 2013, 49(8): 1905-1914.
[18] Lazarou A, Fotopoulou C, Coumbos A, et al. Long-term follow-up of borderline ovarian tumors clinical outcome and prognostic factors [J]. Anticancer Res, 2014, 34(11): 6725-6730.
[19] Chevrot A, Pouget N, Bats AS, et al. Fertility and prognosis of borderline ovarian tumor after conservative management: results of the multicentric OPTIBOT study by the GINECO & TMRG group [J]. Gynecol Oncol, 2020, 157(1): 29-35.
[20] Boivin J, Bunting L, Collins JA, et al. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care [J]. Hum Reprod, 2007, 22(6): 1506-1512.
[21] Plett H, Harter P, Ataseven B, et al. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors [J]. Gynecol Oncol, 2020, 157(2): 411-417.
[22] 张悦, 王倩男, 黄珍, 等. 保留生育功能手术对卵巢交界性肿瘤患者预后及生育结局的影响 [J]. 中华医学杂志, 2022, 102(26): 1999-2004. ZHANG Yue, WANG Qiannan, HUANG Zhen, et al. Prognosis and fertility outcomes of patients with borderline ovarian tumors after fertility-sparing surgery [J]. National Medical Journal of China, 2022, 102(26): 1999-2004.
[23] Uzan C, Muller E, Kane A, et al. Prognostic factors for recurrence after conservative treatment in a series of 119 patients with stage I serous borderline tumors of the ovary [J]. Ann Oncol, 2014, 25(1): 166-171.
[24] Koskas M, Uzan C, Gouy S, et al. Fertility determinants after conservative surgery for mucinous borderline tumours of the ovary(excluding peritoneal pseudomyxoma)[J]. Hum Reprod, 2011, 26(4): 808-814.
[25] Romagnolo C, Gadducci A, Sartori E, et al. Management of borderline ovarian tumors: results of an Italian multicenter study [J]. Gynecol Oncol, 2006, 101(2): 255-260.
[26] Ouldamer L, Bendifallah S, Naoura I, et al. Nomogram to predict live birth rate after fertility-sparing surgery for borderline ovarian tumours [J]. Hum Reprod, 2016, 31(8): 1732-1737.
[1] 李军秀,袁莹莹,黄凌燕,赵君利. 子宫内膜CD38表达对胚胎移植前抗炎治疗的临床价值[J]. 山东大学学报 (医学版), 2023, 61(8): 54-60.
[2] 许月明,张杰,姜蕾,尹力,赵畔,许欣,郝桂敏. 扳机日孕酮升高与获卵数对辅助生殖技术新鲜周期妊娠结局的影响[J]. 山东大学学报 (医学版), 2023, 61(5): 44-50.
[3] 张艺馨,赵玉立,封丽. 超声特征及术前CA-125联合对51例卵巢交界性及Ⅰ期恶性肿瘤的鉴别诊断[J]. 山东大学学报 (医学版), 2022, 60(7): 104-109.
[4] 吴日超,刘红,王泽,高姗姗,李秀芳,石玉华. 40岁及以上女性行体外受精-胚胎移植助孕的妊娠结局分析[J]. 山东大学学报 (医学版), 2022, 60(6): 35-39.
[5] 韩晓婷,高文丽,王婷,赵君利. 扳机日及其后添加重组人促黄体激素对黄体期长方案助孕结局的影响[J]. 山东大学学报 (医学版), 2022, 60(12): 31-38.
[6] 邬晓琳,李萍. 激动剂长方案下促性腺激素使用时长对体外受精胚胎移植妊娠结局的影响[J]. 山东大学学报 (医学版), 2021, 59(7): 32-37.
[7] 张秀清,张敬,蒋琪,李晨,刘畅,李瑞静,冯惠娟,耿玲. 腔内理疗对89例薄型子宫内膜冻融胚胎移植患者妊娠结局的影响[J]. 山东大学学报 (医学版), 2020, 58(5): 62-68.
[8] 宋海霞,袁彩霞,范玲玲. 体质量指数对夫精人工授精妊娠结局的影响[J]. 山东大学学报 (医学版), 2020, 58(1): 49-53.
[9] 周慧梅,杨佳欣,曹冬焱,沈铿,向阳,吴鸣,潘凌亚,黄惠芳,郎景和. 早期宫颈癌保留生育功能手术的治疗效果及妊娠结局[J]. 山东大学学报 (医学版), 2018, 56(5): 18-22.
[10] 杨冬梓,麦卓瑶. 高龄多囊卵巢综合征患者的卵巢储备特点及其助孕结局[J]. 山东大学学报（医学版）, 2017, 55(1): 26-32.
[11] 邓晓惠,徐亚瑄. 高龄女性生育力评估及辅助生育[J]. 山东大学学报（医学版）, 2017, 55(1): 5-10.
[12] 王立葵, 桑洪爱, 马玉燕, 徐银涛, 王琳琳. 66例系统性红斑狼疮患者67次妊娠特点及妊娠结局分析[J]. 山东大学学报（医学版）, 2014, 52(12): 69-72.
[13] . 系统的产前教育和适度产前检查对妊娠结局的影响[J]. 山东大学学报(医学版), 2009, 47(9): 134-136.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发