Ovarian Tumors of Low Malignant Potential.
- Author:
Jung Eun MOK
;
Joo Hyun NAM
- Publication Type:Multicenter Study ; Original Article
- MeSH:
Drug Therapy;
Female;
Fertility;
Follow-Up Studies;
Humans;
Hysterectomy;
Incidence;
Japan;
Korea;
Mucins;
Peritoneal Cavity;
Prospective Studies;
Recurrence
- From:Korean Journal of Gynecologic Oncology and Colposcopy
1993;4(4):97-109
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Ouarian tumors of low malignant potential(OTLMP) or borderline tumors account for approximately 10% of all ovarian neaplasms. Borderline tumors have some but not all of the histologic characteristics af ma lignancy : stratification of epitheliial cells, with some degree of nuclear atypia a,nd inereased mitotic actitity but. without stromal invasion. We reviwed 20 published Rnglish written articlea from 1978 to 1992 and Korean gynecologic cancer regestry of 1990. In this review, we tried to concentrate on several debating is sues in OTLMP: 1) What kind of surgery is needed for each stages?, 2) Is postoperative adjuvant t.herapy needed?, 3) Jf needed, which type? Following result were obtained from the besis of 1516 patients with OTLMP. Patients withh OTLMIP are younger than those with invasive ovarian cancers', mean age was in their forties. The majority of patients(74.5%) had stage I disease, and the incidence dropped ahruptly to 9.4% for stage ll, 15.7% for stage III and 0.4% for stage IV. The most cammon histologic subtype was serous(56.7%), followed by muci noua(38.1%), However, interestingly in Korea and Japan, the mucinous type was the most common one. The primary treatment for OTLMP was surgery, and the conservative surgery to preserve fertility in young women was sufficient for stage I disease with careful follow-up. The majority of patients(79.1%) with stage I disease were treated by surgery alone. Adjuvant such as chemotherapy (CT) and/or radiotherapy(RT) could prolong the recurrence of disease a little later, but failed to increase diaease-free survival significantly in stage I disease. In stageII disease, the surgery should be a total abdominal hysterectomy and bilateral salpingo-oophorectomy with multiple sampling of the peritoneal cavity. About a third of patients with stageII disease received no adjuvant therapy and the others received CT and/or RT, however, there was no difference in outcome of recurrence and survival. In advanced stage. 15% of patients received no adjuvant therapy after initial debulking surgery, and the rest of patients received CT and/or RT. No differences in recurrence and survival between each groups were noticed , too. The status of second-look laparotomy(SLL) did not depend on the stage of the disease. Positive rate of SLL for stage I diaease was not statistically different from that for the combined stages II-IV. Survival for stage I at 5 years was reported to range from 80 to 100%, and even stage III had survival ranging from 64 to 96%. Long-term survival at 15~20 years was also good. Although it is quite difficult to make conclusions because of the lack of prospective randomized studies from this review, it appears clear that surgical removal of the tumor and careful follow-up of patients are all that are necessary in stage I disease and further multi-center prospective study for the effect of adjuvant therapy in advanced disease is definitely needed.
