title: Prognostic factors for recurrence after conservative treatment in a series of 119 patients with stage I serous borderline tumors of the ovary.
abstract: BACKGROUND
  The aim of this study was to evaluate prognostic factors for recurrence after conservative treatment of a large series of 'apparent' stage I serous borderline ovarian tumors (SBOTs).
  
  
  METHODS
  A review of 119 patients treated conservatively between 2000 and 2009 with follow-up data. All pathological slides were reviewed by the same expert pathologist. Prognostic factors for recurrence were studied (age, histological subtypes and surgical procedure).
  
  
  RESULTS
  Conservative surgical procedures were: unilateral cystectomy (n = 43, 36%); unilateral adnexectomy (UA; n = 50, 42%); bilateral cystectomies (n = 11, 9%) and UA + contralateral cystectomy (n = 15, 13%). Stromal microinvasion and/or a micropapillary pattern was present in 21 (18%) and 13 (11%) patients, respectively. With a median follow-up of 45 months, 38 (32%) patients relapsed (10 also had peritoneal disease in the form of noninvasive implants at the first recurrence). In 2 of these 38 patients, progression-to-invasive disease occurred at the second and third relapse (one patient died to the recurrence). Three prognostic factors for recurrence were identified in the univariate analysis: a young age (< or >30 years old), the type of conservative treatment (adnexectomy versus cystectomy) and tumor bilaterality. In the multivariate analysis, only age remained statistically significant.
  
  
  CONCLUSIONS
  In this series (the largest reported, to date, on recurrences after the conservative management of stage I SBOT), the risk of relapse was not related to tumor histological subtypes (micropapillary and stromal microinvasion) nor to the use of complete staging surgery. Invasive recurrences were very rare in stage I SBOT, but did occur. A young age, tumor bilaterality and the use of a cystectomy were identified as risk factors for recurrence, suggesting that management of fertility preservation (particularly in very young patients) should be associated with a meticulously conducted follow-up.
authors.affiliation: Departments of Gynaecologic Surgery.
authors.forename: C
authors.initials: C
authors.lastname: Uzan
authors.forename: E
authors.initials: E
authors.lastname: Muller
authors.forename: A
authors.initials: A
authors.lastname: Kane
authors.forename: A
authors.initials: A
authors.lastname: Rey
authors.forename: S
authors.initials: S
authors.lastname: Gouy
authors.forename: S
authors.initials: S
authors.lastname: Bendiffallah
authors.forename: P
authors.initials: P
authors.lastname: Duvillard
authors.forename: R
authors.initials: R
authors.lastname: Fauvet
authors.forename: E
authors.initials: E
authors.lastname: Darai
authors.forename: P
authors.initials: P
authors.lastname: Morice
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis
keywords: borderline tumor; conservative treatment; follow-up; ovary; recurrence; serous tumor