Clinical significance of microinvasion in borderline ovarian tumors and its impact on surgical management.

Objective: The aims of this study were to evaluate the rate of recurrences in borderlineovarian tumors (BOTs) with microinvasion and to evaluate the possibility to enlargefertility-sparing surgery in this group of patients.Methods: Between 1985 and 2010, 209 patients with BOTs were retrospectively dividedinto 2 groups: group 1 consisted of 28 women with microinvasiveBOTs; group 2 consistedof 181 with BOTs without microinvasion. All of the patients were submitted to surgicaltreatment: in group 1, 10 patients underwent cystectomy (CYS), 11 patients underwentmonolateral salpingo-oophorectomy (MSO), and 7 patients underwent bilateral oopho-rectomy with or without total hysterectomy (BSO); in group 2, 34 patients underwent CYS,58 patients underwent MSO, and 89 patients underwent BSO. Specific prognostic factorssuchasstage,surgicalapproach,intraoperativespillage,histology,exophytictumorgrowth,and endosalpingiosis were analyzed. Tumor recurrence rate and overall and disease-freesurvivals were evaluated.Results: After a mean follow-up of 53 months, relapses occurred in 21.4% of the cases ingroup 1 and in 12.7% of the cases in group 2 ( P = 0.21). The prognostic factors had no sig-nificantdifferencesinthe2groups.RelapsesafterCYS,MSO,andBSOwereobservedin30%,27.3%,and0%, respectively,in group 1and in29.4%,12.1%, and 6.7%,respectively,in group2.Progression-freesurvivalwassignificantlylongerinBOTscomparedtomicroinvasiveBOTs(P = 0.041), but overall survival did not differ.Conclusions: Althoughexploratory,ourdatasuggestthatBOTswithmicroinvasionpresentearlier relapses, but overall incidence of relapses and overall survival do not differ signifi-cantlyfromBOTswithoutmicroinvasion.Fertility-sparingsurgeryisfeasibleinthisgroupofpatients, but strict follow-up has to be suggested.Key Words: Borderline ovarian tumors, Microinvasion, Surgical managementReceived March 10, 2012, and in revised form April 22, 2012.Accepted for publication May 8, 2012.(Int J Gynecol Cancer 2012;22: 1158Y1162)