Borderline ovariumtumoren; hoe voorspel je het klinisch beloop?

Borderline ovarian tumours; how to predict clinical behaviour? Introduction. Identification of prognostic parameters in borderline ovarian tumours (BOT, also called ovarian tumours of low malignant potential) remains an important issue. Despite an excellent 10-year survival in lower stage borderline tumours (99%), the prognosis for patients with stage III or IV disease is less favourable. In addition, the recurrence rate of 15-40% after conservative surgery and 3-13% after radical surgery, is relatively high, necessitating a long follow-up of patients. Morphometrical features appeared to be of prognostic value in BOT in previous studies and have been used to direct clinical management of these tumours. In this paper the role of morphometry and DNA cytometry in BOT and the results of subsequent clinical management are being evaluated. Methods. Ninety-three serous and mucinous BOT diagnosed between 1989 and 2002 (with follow-up through 2004) were studied. Age, FIGO stage, DNA ploidy, mitotic activity index and volume percentage of epithelium, treatment, recurrence rate and survival were compared. Results. Serous borderline ovarian tumours present at a younger age, with smaller tumour volumehigher FIGO stage, and were more frequently bilateral compared to mucinous BOT. Assessment of morphometric characteristics did not identify the tumours with worse clinical behaviour, and had no additional value in predicting prognosis. DNA cytometry was of potential prognostic value. Conclusion. Conservative surgical management is recommended in young patients with low stage BOT. Higher stage and recurrent disease should be treated by full surgical staging to remove all visible tumour. There is no place for chemotherapy in treatment of BOT. Clinical follow-up (including ultrasound and serum marker tests) should be performed during at least five years. The prognostic power of morphometry seems to be limited and can therefore not be used to direct clinical management. However, the fact that most morphometrically unfavourable patients were treated by full staging is a potential confounder here.