1. General condition
Borderline ovarian tumors are more common in young women. According to the study by Flicek et al., the average diagnostic age of mucinous borderline tumors was 39.6 years and that of serous borderline tumors was 38.06 years. Up to one-third of patients with marginal tumors are under the age of 40(8). In this study, 325 BOT patients with an average age of 30.10 years were involved, which was related to the fact that the included samples in this study were young women undergoing fertility-sparing surgery. The vast majority of patients with BOTs have no specific symptoms, and most of them accidentally find pelvic abdominal mass due to physical examination (9–11). Most BOT patients were diagnosed as stage I (6). In 325 patients in this paper, stage I accounted for 94.77% (308/325), which was consistent with the previous research conclusions.
2. Postoperative pregnancy
The prognosis of borderline ovarian tumors is good. One study showed that the 5-year and 10-year survival rates of women with stage I were about 95% – 97% and 70% – 95%. The 5-year survival rate of late-stage ( II-III) can still reach 65% − 87% (12). Because borderline ovarian tumors are more common in women of childbearing age, with a good prognosis, fertility-sparing surgery is the preferred treatment for BOT patients with childbearing needs (13). The fertility rate after fertility-sparing surgery is good. In a systematic evaluation, the pregnancy rate after conservative treatment of early BOT can reach 54%. Another study shows that the pregnancy rate of BOT in stage II and above is similar to that in the early stage, which can reach 33.3% − 75.0% (14). Helmut Plett et al. believed that the recurrence rate of stage II and above BOT was high, and pregnancy and recurrence must be weighed when performing fertility-sparing surgery (15). Among 325 patients undergoing fertility-sparing surgery, 118 had fertility intention and good pregnancy outcomes. 68 cases (57.63% pregnancy rate) were pregnant after surgery, including 57 cases of natural pregnancy (83.82% natural pregnancy rate) and 11 cases of assisted reproduction (16.18%). It is consistent with the pregnancy rate in the relevant literature. A study shows that the fertility rate of childless women is very high, and the probability of their first pregnancy in 15 years can reach 82.5%. Postoperative fertility of multiparous women is related to preoperative fertility, and the pregnancy rate of patients with infertility history or infertility factors after fertility-sparing surgery is low. Therefore, for BOT patients with an infertility history, the feasibility of fertility-sparing surgery is still controversial (16). Therefore, before fertility-sparing surgery, BOT patients should strictly assess their fertility status and formulate a pregnancy plan after treatment. Because of the high recurrence rate and short recurrence interval of BOT, artificial assisted reproductive technology can be used to help patients get pregnant as soon as possible. The pregnancy outcome of patients with BOTs undergoing in vitro fertilization (IVF) after childcare surgery is generally good. Under the same conditions, the IVF pregnancy rate can reach 63.5% (17). In addition, in vitro data show that gonadotropins and large doses of estrogen do not stimulate the proliferation of cultured borderline ovarian cells, thus ensuring the safety and effectiveness of assisted reproductive technology after childcare (18).
Fang C et al. believed that unilateral salpingo-oophorectomy was the first choice for patients with unilateral borderline ovarian tumors to obtain ideal oncological results and a satisfactory pregnancy rate; Bilateral cystectomy is the first choice for patients with bilateral borderline ovarian tumors (16). A retrospective study by Sheng Zheng Jia et al. also showed that there was no significant difference in disease-free survival or pregnancy rate between unilateral salpingo-oophorectomy + contralateral cystectomy and bilateral ovarian cyst resection (19). Adriana Yoshida et al. believed that to better preserve the reproductive function, it is not recommended to perform appendectomy during lymphadenectomy and m-BOT (20). According to the research results in this paper, there is no statistically significant difference in the pregnancy rate after ovarian tumor removal compared with unilateral adnexectomy. To obtain a satisfactory pregnancy rate and reduce recurrence, unilateral BOT recommends the removal of the affected side adnexa and does not recommend the dissection of the opposite side healthy ovary, which may affect the pregnancy rate(21–22). The pregnancy rate after fertility-sparing staging surgery was lower than that after cystectomy or unilateral adnexectomy, with a statistically significant difference (P < 0.05). Therefore, fertility-sparing staging surgery is not recommended.
Of 325 patients, 28 patients recurred after the operation, with the shortest recurrence interval of 7 months and the longest recurrence interval of 84 months. The recurrence rate was 8.62%, lower than the 13% reported in the literature. The disease of borderline ovarian tumor progresses slowly and has a good prognosis. Most of them recur in the long term, and some patients recur 20 years later (23–24).
The limitation of this study is that it is a single-center retrospective study, with limited sample size and short follow-up time. It still needs to be further verified by large sample data from multiple centers in the future.