Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: A prospective study

Purpose: Borderline tumors account for 10% to 20% of epithelial ovarian tur ners, and their prognosis is outstanding; nevertheless, a mortality of up t o 20% has been reported, particularly in earlier reports, There is a rack o f information about the actual mortality and the rate of progression into i nvasive carcinoma in large and prospectively accrued populations. Patients and Methods: All women with borderline ovarian tumors undergoing p rimary surgery in our department or referred within 3 months from surgery p erformed elsewhere from 1982 to 1997 were prospectively accrued and observe d. Results: We studied 339 women (83.4% stage I, 7.9% stage II, and 8.5% stage III). The median age at diagnosis was 39 years. A total of 150 women under went radical surgery, and 789 underwent fertility-sparing surgery, After su rgery, 13 women had macroscopic residual disease. With a median follow-up o f 70 months, 317 women are alive with no clinical disease (eight with docum ented subclinical persistence of implants), three are alive with clinical d isease, two died of disease, 10 died of other reasons, and seven women have been lost ta follow-up. The recurrence of disease was higher after fertili ty-sparing surgery (35 of 189 cases) than after radical surgery (seven of 1 50 cases); nevertheless, all but one woman with recurrence of borderline tu mor or progression to carcinoma after conservative surgery were salvaged. W e observed seven progressions (2.0%) into invasive carcinoma, five in serou s tumors (2.4%), and two in mucinous tumors (1.6%), the disease-free surviv al is 99.6% in stage I patients, 95.8% in stage II, and 89% in stage III. Conclusion: The survival of patients with borderline tumors is higher than previously described in some retrospective studies, Conservative surgery is safe and may be proposed to several patients with early and disseminated d isease after thorough discussion of all therapeutic options. Progression to carcinoma is approximately 2% and moly be observed in both mucinous and se rous tumors.