卵巢交界性肿瘤保留生育功能术后肿瘤预后及妊娠结局

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

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。

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.