Analysis of 114 serous borderline ovarian tumours Vancraeynest E, Moerman Ph, Leunen K, Amant F, Neven P, Vergote I.

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1 Analysis of 114 serous borderline ovarian tumours Vancraeynest E, Moerman Ph, Leunen K, Amant F, Neven P, Vergote I

2 Aanleiding Onderzoek naar aanleiding van 2 artikels: - Uzan et al [5]: onderzocht PF voor invasief herval en de impact op OS van FPS. Geen invloed op OS na FPS. - Trillsch et al [4]: hoger risico op herval bij jongere populatie zonder verhoogd risico op invasief herval. Echter hoger risico op invasief herval bij oudere populatie.

3 Doel van de studie Overall survival (OS) en progression-free interval (PFI) Invloed van fertiliteitssparende (FPS) vs radicale chirurgie (RS) op OS en PFI bij patiënten met sereuze borderline tumoren

4 Sereuze ovariële borderline tumoren 10-20% van ovariële epitheliale tumoren Afwezigheid van destructieve stromale invasie Papillair vs micropapillair 1/3 ≤ 40 jaar 85 % FIGO stadium I OS: 95 % FIGO I, 70-85% FIGO II-IV 11 % herval en 2-4 % invasief herval Lange follow-up gezien laattijdig herval

5 Methode 1993-2013 Retrospectief Primaire diagnose van SBOT (exclusie micro-invasie) Alleen eerste herval 1 patholoog FIGO 2014 classificatie Kaplan-Meier methode voor OS en PFI COX proportional hazards model voor prognostische factoren herval

6

7 Patiënt en tumor karakteristieken 114 patiënten 46% ≤ 40 jaar (53 van 114) Mediane leeftijd 44 jaar (17-77j) Mediane FU: 6 jaar (3,8-11,1j) 66% FIGO stadium I (75 van 114) 33% peritoneale implanten, 9% micropapillair

8 Karakteristieken van behandeling 18% laparoscopie, 82% laparotomie 33% FPS: 76% USO, 16% USO + cystectomie, 8% cystectomie 67% RS: 8% BSO, 87% BSO + HT, 5% USO + HT 71% volledige staging

9 Herval 12% herval (14/114) 1,7% invasief (2/114)10,5% BOT (12/114) 7 ovarieel 5 ipsilateraal 2 contralateraal 2 USO 3 cystectomie2 USO Tijd tot invasief herval : 59 en 83 maanden Tijd tot BOT herval: 33 maanden

10 OS en PFI 5j-OS: 97%5j-PFI: 89%

11 Invloed van FPS vs RS op PFI Risico op progressie is hoger bij patiënten met fertiliteitssparende chirurgie. P=0,0075

12 Invloed van FPS vs RS op OS Geen statistisch significant verschil in overleving tussen FPS en RS P=0,1125

13 Prognostische factoren voor herval 95% confidence interval Variable Hazard Ratio Lower limit Upper limitP-valueN obs.N events Age: >40y vs <=40y0.3070.0960.9810.046411414 Surgery: Conservative vs Radical3.9801.33211.8920.013411414 Cons. surg.: cystectomy vs USO2.3240.5559.7390.2486389 Staging: Complete vs incomplete0.7640.2452.3820.642511213 FIGO: III vs I/II3.9981.39311.4760.010011414 Surg.: Laparoscopy vs Laparotomy0.4980.0643.8490.504011313 Type: micropapillary vs papillary3.6530.98413.5600.052911414 Implants: Yes vs No3.7621.22311.5670.020811313 Bilateral BOT vs unilateral2.8560.9508.5860.061611313 Residual tumor: Yes vs No5.0150.61640.8510.13191088 CA125 preop (+1000 U/l)1.0040.9971.0120.2680768 Binary variables: HR>( (<)1: Higher (lower) risk of progression for higher level

14 Prognostische factoren voor invasief herval Te laag aantal (2) Kenmerken: - Laaggradig - Micropapillaire variant - Niet-invasieve implanten - FIGO III - Levend (88 en 134 maanden na herval)

15 BESLUIT Uitstekende prognose Kleine kans op herval, invasief herval en overlijden => Fertiliteitssparende chirurgie bij jonge patiënten met stadium I is verantwoord.

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