Fertility preservation in women with borderline ovarian tumors – how does it impact disease outcome? A cohort study

Limor Helpman, Assaf Yaniv, Mario E. Beiner, Sarit Aviel-Ronen, Tamar Perri, Gilad Ben-Baruch, Liat Hogen Ben-David, Ariella Jakobson-Setton, Jacob Korach

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Introduction: Borderline ovarian tumors are typically indolent neoplasms. Since many are diagnosed in younger women, fertility conservation is an important consideration and has been advocated based on retrospective data. The objective of this study was to identify features impacting on recurrence and survival in a series of borderline ovarian tumors, and to assess the safety of a fertility-sparing approach. Material and methods: A historical cohort study of consecutive borderline ovarian tumors cases treated at a single institution over 30 years (1981–2011). Data on surgical approach (fertility-sparing or otherwise), disease stage, CA125 levels, histological features, adjuvant treatment and follow-up data were collected. Recurrence and survival were assessed using the Kaplan–Meier method and associations with the variables of interest were evaluated using a multivariate Cox proportional hazards model. Results: 213 patients were included. Of 132 women age 40 years and below at diagnosis, 112 (85%) had a fertility-sparing procedure and 60 (46%) had conservation of an involved ovary. Fifty patients (24%) developed recurrences; fertility preservation (hazard ratio = 2.57; 95% confidence interval 1.1–6; p = 0.029) and advanced stage (hazard ratio = 4.15; 95% confidence interval 2.3–7.6; p < 0.001) were independently associated with recurrence on multivariate analysis. Eleven (5%) patients died of their disease. Fertility preservation was not associated with compromised survival. Conclusions: Borderline ovarian tumors carry a good prognosis overall. Fertility preservation is associated with a higher risk of disease relapse; however, as most relapses are localized and may be salvaged with surgical treatment, overall survival is not compromised.

Original languageEnglish
Pages (from-to)1300-1306
Number of pages7
JournalActa Obstetricia et Gynecologica Scandinavica
Volume96
Issue number11
DOIs
StatePublished - Nov 2017
Externally publishedYes

Keywords

  • Borderline ovarian tumors
  • cystectomy
  • fertility preservation
  • ovarian cancer
  • ovarian conservation
  • ovarian tumors of low malignant potential

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