title: Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome: results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study.
abstract: BACKGROUND
  Approximately one-third of all borderline ovarian tumours (BOT) are diagnosed in patients with child-bearing potential. Detailed information regarding their specific characteristics and prognostic factors is limited.
  
  
  METHODS
  Clinical parameters of BOT patients treated between 1998 and 2008 in 24 German centres were retrospectively investigated. Central pathology review and prospective follow-up were carried out. Patients <40 versus ≥40 years were analysed separately and then compared regarding clinico-pathological variables and prognosis.
  
  
  RESULTS
  A total of 950 BOT patients with a median age of 49.1 (14.1-91.5) years were analysed [280 patients <40 years (29.5%), 670 patients ≥40 years (70.5%)]. Fertility-preserving surgery was carried out in 53.2% (149 of 280) of patients <40 years with preservation of the primarily affected ovary in 32 of these 149 cases (21.5%). Recurrence was significantly more frequent in patients <40 years (19.0% versus 10.1% 5-year recurrence rate, P < 0.001), usually in ovarian tissue, whereas disease-specific overall survival did not differ between the subgroups. In case of recurrent disease, malignant transformation was less frequent in younger than in older patients (12.0% versus 66.7%, P < 0.001), mostly presenting as invasive peritoneal carcinomatosis. Multivariate analysis for patients <40 years identified advanced International Federation of Gynecology and Obstetrics (FIGO) stage and fertility-sparing approach as independent prognostic factors negatively affecting progression-free survival (PFS) while, for patients ≥40 years, higher FIGO stage and incomplete staging was associated with impaired PFS.
  
  
  CONCLUSIONS
  Despite favourable survival, young BOT patients with child-bearing potential are at higher risk for disease recurrence. However, relapses usually remain BOT in the preserved ovaries as opposed to older patients being at higher risk for malignant transformation in peritoneal or distant localisation. Therefore, fertility-sparing approach can be justified for younger patients after thorough consultation.
authors.affiliation: Department of Gynaecology and Gynaecologic Oncology.
authors.forename: F
authors.initials: F
authors.lastname: Trillsch
authors.affiliation: Department of Gynaecology and Gynaecologic Oncology. Electronic address: s.mahner@uke.uni-hamburg.de.
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authors.initials: S
authors.lastname: Mahner
authors.affiliation: Department of Gynaecology and Gynaecologic Oncology.
authors.forename: L
authors.initials: L
authors.lastname: Woelber
authors.affiliation: Department of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
authors.forename: E
authors.initials: E
authors.lastname: Vettorazzi
authors.affiliation: Department of Coordinating Center for Clinical Trials, Marburg.
authors.forename: A
authors.initials: A
authors.lastname: Reuss
authors.affiliation: Department of Gynaecology and Gynaecologic Oncology, Dr Horst Schmidt Klinik GmbH, Wiesbaden.
authors.forename: N
authors.initials: N
authors.lastname: Ewald-Riegler
authors.affiliation: Department of Gynaecolgy and Obstetrics, Universitätsklinikum Ulm, Ulm.
authors.forename: N
authors.initials: N
authors.lastname: de Gregorio
authors.affiliation: Department of Gynaecolgy, Charité, Campus Virchow Klinikum, Berlin.
authors.forename: C
authors.initials: C
authors.lastname: Fotopoulou
authors.affiliation: Department of Obstetrics and Gynaecolgy, Klinikum Rechts der Isar der Technischen Universität, Munich.
authors.forename: B
authors.initials: B
authors.lastname: Schmalfeldt
authors.affiliation: Department of Obstetrics and Gynaecolgy, Klinikum der Universität München, Munich.
authors.forename: A
authors.initials: A
authors.lastname: Burges
authors.affiliation: Department of Gynaecolgy and Obstetrics, Universitätsklinikum Schleswig-Holstein, Kiel.
authors.forename: F
authors.initials: F
authors.lastname: Hilpert
authors.affiliation: Department of Gynaecolgy and Obstetrics, Universitätsklinikum Tübingen, Tuebingen.
authors.forename: T
authors.initials: T
authors.lastname: Fehm
authors.affiliation: Department of Gynaecolgy and Obstetrics, Evangelisches Krankenhaus, Duesseldorf.
authors.forename: W
authors.initials: W
authors.lastname: Meier
authors.affiliation: Department of Gynaecolgy and Obstetrics, Medizinische Hochschule Hannover, Hannover.
authors.forename: P
authors.initials: P
authors.lastname: Hillemanns
authors.affiliation: Department of Gynaecolgy and Obstetrics, Klinikum der J.W. Goethe-Universität, Frankfurt/M; Department of Gynaecolgy and Obstetrics, Universitätsklinikum Schleswig-Holstein, Luebeck.
authors.forename: L
authors.initials: L
authors.lastname: Hanker
authors.affiliation: Department of Obstetrics and Gynaecolgy, Universitätsklinikum Freiburg, Freiburg.
authors.forename: A
authors.initials: A
authors.lastname: Hasenburg
authors.affiliation: Department of Gynaecolgy and Obstetrics, Universitätsklinikum Halle/S., Halle/S.
authors.forename: H G
authors.initials: HG
authors.lastname: Strauss
authors.affiliation: Department of Gynaecolgy and Obstetrics, Georg-August-Universität Göttingen, Goettingen.
authors.forename: M
authors.initials: M
authors.lastname: Hellriegel
authors.affiliation: Clinic of Gynaecolgy and Obstetrics, Universitätsklinikum Essen, Essen; Department of Gynaecolgy and Obstetrics, Universitätsklinikum Carl Gustav Carus, Dresden.
authors.forename: P
authors.initials: P
authors.lastname: Wimberger
authors.affiliation: Department of Gynaecolgy, Endocrinology and Oncology, Universitätsklinikum Gießen u. Marburg GmbH, Marburg.
authors.forename: K
authors.initials: K
authors.lastname: Baumann
authors.affiliation: Department of Obstetrics and Gynaecolgy, Rheinische Friedrich-Wilhelms-Universität, Bonn.
authors.forename: M D
authors.initials: MD
authors.lastname: Keyver-Paik
authors.affiliation: Department of Gynaecolgy and Obstetrics, Universitätsklinikum Carl Gustav Carus, Dresden.
authors.forename: U
authors.initials: U
authors.lastname: Canzler
authors.affiliation: Department of Gynaecolgy and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg.
authors.forename: K
authors.initials: K
authors.lastname: Wollschlaeger
authors.affiliation: Department of Gynaecolgy and Obstetrics, Sana-Klinikum Remscheid, Remscheid.
authors.forename: D
authors.initials: D
authors.lastname: Forner
authors.affiliation: Department of Gynaecolgy and Obstetrics, Städtisches Klinikum Solingen gGmbH, Solingen; Zentrum für Gynäkologische Onkologie, Kiel.
authors.forename: J
authors.initials: J
authors.lastname: Pfisterer
authors.affiliation: GYNAEKOLOGICUM Bremen, Bremen.
authors.forename: W
authors.initials: W
authors.lastname: Schroeder
authors.affiliation: Department of Obstetrics and Gynaecolgy, Universitätsklinikum Gießen, Gießen.
authors.forename: K
authors.initials: K
authors.lastname: Muenstedt
authors.affiliation: Department of Gynaecology and Obstetrics, Elblandkliniken Meißen-Radebeul GmbH & Co. KG, Radebeul.
authors.forename: B
authors.initials: B
authors.lastname: Richter
authors.affiliation: Institute of Pathology, Referenzzentrum für Gynäkopathologie, Mannheim.
authors.forename: F
authors.initials: F
authors.lastname: Kommoss
authors.affiliation: Department of Gynaecolgy and Obstetrics, Universitätsklinikum Halle/S., Halle/S; Institute of Pathology, Trier-Dueren-Duesseldorf, Dueren.
authors.forename: S
authors.initials: S
authors.lastname: Hauptmann
authors.affiliation: Department of Gynaecolgy and Gynaecolgic Oncology, Kliniken Essen-Mitte, Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: du Bois
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: borderline ovarian tumour; fertility preservation; malignant transformation; recurrence; surgical treatment