The impact of hysterectomy on oncological outcomes in patients with borderline ovarian tumors: A systematic review and meta-analysis

Recurrence rate and quality of life in women with borderline ovarian tumours, according to surgical approach

OBJECTIVES

To assess the recurrence rate and quality of life (QOL) in women with a history of borderline ovarian tumours (BOTs) based on the type of surgery (conservative vs non-conservative) in Spain.

STUDY DESIGN

A retrospective analysis was conducted of 85 women treated for BOTs between 2007 and 2023 at two hospitals. QOL questionnaires were administered face-to-face to eligible patients. Individuals with dementia, living in an institution, or residing outside the region were excluded from this study.

MAIN OUTCOME MEASURES

General characteristics and the recurrence rate were analysed retrospectively. Three validated questionnaires - European Organisation for Research and Treatment of Cancer (EORTC) core QOL questionnaire for patients with cancer (QLQ-C30), EORTC QOL questionnaire for patients with ovarian cancer (QLQ-OV28) and Menopause Rating Scale II (MRS II) - were used to assess QOL in eligible patients.

RESULTS

The recurrence rate was low (5.9 %) and the disease-specific overall survival rate was high with only two (2.4 %) deaths. International Federation of Gynecology and Obstetrics stage III disease [odds ratio (OR) 58.5, 95 % confidence interval (CI) 6.02-568.53; p < 0.0001] and positive peritoneal cytology (OR 26, 95 % CI 2.68-252.68; p = 0.005] were associated with recurrence. No association was found between the type of surgery (conservative vs non-conservative) and QOL. Older age was associated with poorer sexual function scores on QLQ-OV28.

CONCLUSIONS

This study highlights the need for careful evaluation of each case. The current evidence does not recommend conservative surgery to improve QOL.

Micropapillary pattern in serous borderline ovarian tumor and the risk of extraovarian localization of low-grade serous carcinoma ('invasive implants'): A systematic review and meta-analysis

In serous borderline ovarian tumor (SBOT), a micropapillary (MP) pattern has been considered analogous to intraepithelial low-grade serous carcinoma (LGSC). On this account, it is reasonable to hypothesize that MP-SBOT is more likely to be associated with extraovarian LGSC localizations (also referred to as 'invasive implants') compared to conventional SBOT. The aim of this study was to investigate the potential association between a MP pattern and invasive implants in SBOT. Three electronic databases were searched from 2000 (year of publication of histological criteria for MP-SBOT) to 2023 for all studies assessing the presence of invasive implants in conventional SBOT vs MP-SBOT. Exclusion criteria were sample size <20, overlapping patient data, reviews. The association between MP pattern and invasive implants was assessed by using odds ratio (OR), with a significant p-value<0.05. Seven studies with 1766 SBOT were included, out of which 205 (11.5 %) were MP-SBOT, 462 (26 %) had implants and 62 (3.5 %) had invasive implants. A MP pattern was significantly associated with the presence of invasive implants (OR=7.33, 95 % CI 3.61-14.86) (p<0.001), with low heterogeneity among studies (I2=28 %). In conclusion, a MP pattern in SBOT is significantly associated with extraovarian LGSC localization, supporting that it represents intraepithelial LGSC.

Molecular landscape of borderline ovarian tumours: A systematic review

Borderline ovarian tumours (BOTs) show intriguing characteristics distinguishing them from other ovarian tumours. The aim of the systematic review was to analyse the spectrum of molecular changes found in BOTs and discuss their significance in the context of the overall therapeutic approach. The systematic review included articles published between 2000 and 2023 in the databases: PubMed, EMBASE, and Cochrane. After a detailed analysis of the available publications, we qualified for the systematic review: 28 publications on proto-oncogenes: BRAF, KRAS, NRAS, ERBB2, and PIK3CA, 20 publications on tumour suppressor genes: BRCA1/2, ARID1A, CHEK2, PTEN, 4 on adhesion molecules: CADM1, 8 on proteins: B-catenin, claudin-1, and 5 on glycoproteins: E-Cadherin. In addition, in the further part of the systematic review, we included eight publications on microsatellite instability and three describing loss of heterozygosity in BOT. Molecular changes found in BOTs can vary on a case-by-case basis, identifying carcinogenic mutations through molecular analysis and developing targeted therapies represent significant advancements in the diagnosis and treatment of ovarian malignancies. Molecular studies have contributed significantly to our understanding of BOT pathogenesis, but substantial research is still required to elucidate the relationship between ovarian neoplasms and extraneous disease, identify accurate prognostic indicators, and develop targeted therapeutic approaches.

Bractoppin, a BRCA1 carboxy-terminal domain (BRCT) inhibitor, suppresses tumor progression in ovarian borderline tumor organoids

Borderline ovarian tumors are a special class of ovarian tumors between benign and malignant, which are not sensitive to traditional chemotherapy regimens, and the development of target drugs is limited due to the lack of cell lines. Tumor organoids can well preserve the genetic characteristics of the primary tumor, but there are only a few reports of application in borderline tumors. In this study, we successfully generated 13 ovarian borderline tumor organoids and tested the antitumor activity of Bractoppin, a BRCA1 carboxy-terminal domain (BRCT) inhibitor. Bractoppin promotes organoid apoptosis. Mechanistically, Bractoppin can inhibit organoid cell cycle progression, inhibit the repair of DSB damage and promote tumor cell apoptosis. In addition, Bractoppin can also promote the apoptosis of ovarian cancer cell lines and inhibit the HR and NHEJ repair ability of tumor cells. We demonstrate the value of ovarian borderline tumor organoids in the exploration of molecular therapy drugs, and Bractoppin may be a valuable small molecule drug in the treatment of BOT.

Case report: Spontaneous remission of synchronous endometrial and ovarian cancers following pregnancy

Introduction

Endometrial cancer is one of the most common malignancies affecting women. It is uncommonly diagnosed in young women, particularly in the absence of abnormal vaginal bleeding symptoms.

Case presentation

A 28-year-old woman was referred to our department with lower abdominal pain. Transvaginal ultrasound showed a complex right adnexal mass with mixed echogenicity. Magnetic resonance imaging (MRI) identified a right-sided, torted, cystic solid ovarian mass, and a polypoid lesion in the uterine cavity.

Diagnosis

Following multidisciplinary team advice, hysteroscopic transcervical resection of endometrial polypoid mass and laparoscopic right salpingo-oophorectomy was performed. Histopathologic assessment of the endometrial tissue showed changes consistent with grade 1 endometrioid endometrial carcinoma, while the right ovarian mass showed a well-differentiated endometrioid carcinoma.

Intervention

The patient underwent hormonal treatment and surveillance whilst making a final decision regarding further surgical management. However, the patient stopped hormonal treatment after 2 weeks, went abroad and absconded from treatment for 8 months. On her return, she had conceived naturally and was in the first trimester of pregnancy. Further management was postponed until the patient was 7 weeks postnatal. The patient was not keen on any further surgical management and opted for close surveillance with ultrasound scans and hysteroscopies with endometrial biopsies. All subsequent endometrial biopsies showed normal endometrium, with no evidence of hyperplasia or malignancy.

Outcome

To date, the patient remains on a 6-monthly surveillance plan and is considered to have had complete natural remission of her endometrial and ovarian cancers following pregnancy.

Conclusion

This unique case demonstrates a natural phenomenon, in which the complete, natural remission of endometrial and ovarian cancers occurred following pregnancy and childbirth. The aetiology may be related to the high progesterone levels occurring in pregnancy.

The impact of hysterectomy on oncological outcomes in postmenopausal patients with borderline ovarian tumors: A multicenter retrospective study

Data about the oncological outcomes in women with borderline ovarian tumor (BOT) undergoing uterine-sparing surgery without ovarian preservation are poor. We aimed to assess the oncological outcomes in women with BOT undergoing uterine-sparing surgery without ovarian preservation. A multi-center observational retrospective cohort study was performed including all consecutive postmenopausal patients who underwent surgical treatment for BOT at three tertiary level referral centers for gynecologic oncology from January 2005 to December 2016. Patients were divided into two groups for comparisons: patients undergoing hysterectomy (hysterectomy group) and patients undergoing uterine-sparing surgery (no hysterectomy group). Study outcomes were disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS) and surgical complications rate. Ninety-eight patients were included: 44 in the hysterectomy group and 54 in the no hysterectomy group. The 5- and 10-year DFS rates were 97.7% (95% CI: 84.9-99.7) and 92.3% (95% CI: 69.7-98.2), in the hysterectomy group, and 86.8% (95% CI: 74.3-93.5) and 86.8% (95% CI: 74.3-93.5), in the no hysterectomy group, respectively, without significant differences (p=0.16). Hazard ratio for DFS was 0.26 (95% CI: 0.06-1.68) for the hysterectomy group. The 5- and 10-year OS rates were 100.0% (95% CI: -) and 100.0% (95% CI: -), in the hysterectomy group, and 98.2% (95% CI: 87.6-99.7) and 94.4% (95% CI: 77.7-98.7), in the no hysterectomy group, respectively, without significant differences (p=0.23). No significant difference in complication rate was reported among the groups (p=0.48). As hysterectomy appears to not impact survival outcomes of women with BOT, it might be avoided in the surgical staging.

Borderline ovarian tumors: a retrospective cohort study on single institution experience, practice patterns and outcomes

Borderline ovarian tumours (BOTs) commonly affect young nulliparous women, thus making fertility-preserving approaches more desirable. Women who opt for conservative management should be counselled about disease recurrence. In this retrospective study, the medical records of 57 women with BOT treated at the American University of Beirut Medical Centre between January 1986 and May 2018 were reviewed. Clinical, pathologic, and demographic data were collected and analysed to identify variables associated with poor clinical outcomes including advanced disease and risk of recurrence. Younger and nulliparous women were more likely to undergo fertility-sparing surgery. The open approach was adopted for women with larger adnexal masses and was associated with more blood loss with a mean difference of 172 mL (95% CI [110-235], p-value < .001) but no significant difference in operative time and length of hospital stay compared to the laparoscopic approach. CA-125 correlated with an advanced International Federation of Gynaecology and Obstetrics (FIGO) stage (p = .004). The recurrence rate was found to be 7% with a median recurrence time of 41.5 months.IMPACT STATEMENTWhat is already known on this subject? BOTs are common in young nulliparous women who often desire fertility-sparing procedures. Prognostic factors associated with disease severity and recurrence remain controversial.What do the results of this study add? This study presents an opportunity to understand the disease behaviour and compare local practices and outcomes to what was reported in the literature. CA-125 appears to be a useful marker in predicting the stage of BOT.What are the implications of these findings for clinical practice and/or further research? Future research should focus on exploring whether BOTs with micropapillary features represent an aggressive histologic subtype more prone to recurrence.