Objective: To evaluate oncological and reproductive outcomes of women ≤40 years undergoing fertility-sparing surgery (FSS) for stage Ⅱ or Ⅲ borderline ovarian tumor (BOT). Methods: The patients with BOT and ≤40 years old with stage Ⅱ-Ⅲ BOT who underwent FSS enrolled from the First Affiliated Hospital of Zhengzhou University between January 2011 and March 2023 were analyzed retrospectively. The clinical data and follow-up results were obtained and analyzed. The univariate and multivariate Cox proportional hazard regression analysis were used to explore high-risk factors associated with prognosis. Additionally, pregnancy outcomes were also analyzed. Results: (1) A total of 79 patients with stage Ⅱ-Ⅲ BOT who have been treated with FSS were conducted, with an average age of (27.5±6.7) years old. The median tumor maximum diameter were 10.4 cm (range: 4.8-90.0 cm). The International Federation of Gynecology and Obstetrics (FIGO) stage was stage Ⅱ in 45 cases and stage Ⅲ in 34 cases. According to the pathological types, there were 48 cases of serous tumor, 21 cases of mucinous tumor, 1 case of endometrioid tumor, and 9 cases of mixed types. There were 41 cases of unilateral ovarian involvement, 38 cases of bilateral ovarian involvement. There were 5 cases of microinvasion, 17 cases of micropapillary subtype. Extra-ovarian invasive implants were found in 5 cases, and there were 31 cases of merged ascites. (2) Tumor outcomes: the median follow-up time from primary cytoreduction were 58 months (range: 8-146 months). At the end of the observation period, 24 cases (30%, 24/79) recurred, among them 5 cases had two recurrences and 2 cases had three recurrences. There were 2 cases (3%, 2/79) of death and 1 case (1%, 1/79) of survival with tumor. (3) Analysis of prognostic risk factors: the results of univariate analysis showed that mucinous tumor, tumor maximum diameter >13.15 cm, FIGO stage Ⅲ, merged ascites, micropapillary subtype, invasive implantation, and bilateral ovarian involvement were independent risk factors (all P<0.05) for disease-free survival (DFS). FIGO stage Ⅲ (HR=4.555, 95%CI: 1.525-13.607; P=0.007) and micropapillary subtype (HR=2.396, 95%CI: 1.003-5.725; P=0.049) were found to be related to DFS through the multivariable Cox proportional hazard regression analysis. (4) Pregnancy outcomes: among the patients with fertility intentions 36 cases (46%,36/79), 29 cases (81%, 29/36) had successful pregnancies, and 27 cases (75%, 27/36) had successful births. Conclusions: Patients with stage Ⅱ-Ⅲ BOT underwent FSS have favorable survival and pregnancy rates. Micropapillary subtypes and FIGO staging (stage Ⅲ) are the significant risk factors of DFS.
目的： 探讨接受保留生育功能手术（FSS）的Ⅱ~Ⅲ期卵巢交界性肿瘤（BOT）患者的肿瘤及生育结局。 方法： 回顾性收集2011年1月至2023年3月在郑州大学第一附属医院接受FSS的40岁及以下Ⅱ~Ⅲ期BOT患者的临床病理资料及随访资料，分析其肿瘤结局，采用单因素及多因素Cox比例风险回归模型分析影响患者无病生存（DFS）时间的相关因素；并分析其生育结局。 结果： （1）一般临床病理资料：本研究纳入接受FSS治疗的Ⅱ~Ⅲ期BOT患者共79例，其年龄为（27.5±6.7）岁，中位肿瘤最大径为10.4 cm（范围：4.8~90.0 cm），国际妇产科联盟（FIGO）分期为Ⅱ期45例、Ⅲ期34例，病理类型为浆液性48例、黏液性21例、子宫内膜样1例、混合型9例，肿瘤累及单侧卵巢41例、累及双侧卵巢38例，伴微浸润5例，微乳头亚型17例，卵巢外浸润性种植5例，合并腹水31例。（2）肿瘤结局：中位随访时间为58个月（范围：8~146个月），随访期内24例（30%，24/79）患者复发，其中二次复发5例、三次复发2例；2例（3%，2/79）死亡，1例（1%，1/79）带瘤生存。（3）影响DFS时间的相关因素分析结果：单因素分析显示，病理类型为交界性黏液性肿瘤、肿瘤最大径>13.15 cm、FIGO分期为Ⅲ期、合并腹水、微乳头亚型、卵巢外浸润性种植、累及双侧卵巢均显著影响接受FSS治疗的Ⅱ~Ⅲ期BOT患者的DFS时间（P均<0.05）。多因素分析显示，FIGO分期为Ⅲ期（HR=4.555，95%CI为1.525~13.607）、微乳头亚型（HR=2.396，95%CI为1.003~5.725）是影响接受FSS治疗的Ⅱ~Ⅲ期BOT患者DFS时间的独立危险因素（P均<0.05）。（4）生育结局：随访期内有生育意愿者36例（46%，36/79），其中29例（81%，29/36）成功妊娠，27例（75%，27/36）成功生育健康儿。 结论： Ⅱ~Ⅲ期BOT患者行FSS后有良好的生存率和生育率。FIGO分期为Ⅲ期及微乳头亚型是影响患者DFS时间的独立危险因素。.