Oncofertility outcomes after fertility-sparing surgery for borderline ovarian tumors: results of a large retrospective study

BACKGROUND: Fertility-sparing surgery (FSS) is a key therapeutic strategy for borderline ovarian tumors (BOTs) in young women. However, the optimal surgical approaches and the prognostic significance of clinicopathological features remain a subject of debate. This study aimed to evaluate the oncological safety and reproductive outcomes following FSS in a large cohort of young BOT patients. METHODS: We retrospectively reviewed 533 patients (aged 20-40 years) diagnosed with BOTs who underwent FSS at a single academic medical center between 2010 and 2021. Survival outcomes were estimated using the Kaplan-Meier method. To identify independent prognostic factors for recurrence, variable selection was performed using the Least Absolute Shrinkage and Selection Operator regression, followed by multivariable Cox proportional hazards analysis with backward elimination. RESULTS: Over a median follow-up of 61.90 months (range: 1.03-176.53months), 85 (15.95%) patients experienced recurrence, comprising 77 (14.45%) borderline recurrences and 8 (1.50%) invasive transformation. The 5-year and 10-year disease-free survival rates were 82.0% and 75.9%, respectively. Multivariable analysis identified bilateral ovarian lesions (HR 2.07, p = 0.017), exophytic growth (HR 3.66, p < 0.001), intraepithelial carcinoma (HR 4.23, p = 0.004), and FIGO stage III (HR 2.23, p = 0.014) as independent prognostic risk factors for recurrence. Notably, peritoneal biopsy was associated with a significantly lower recurrence risk (HR 0.42, p = 0.004). Histological stratification revealed that for serous BOTs, exophytic growth (HR 4.05, p < 0.001), cystectomy (HR 3.03, p = 0.008), FIGO stage III (HR 2.46, p = 0.011) were risk factors, while peritoneal biopsy (HR 0.44, p = 0.018) remained protective. For MBOT, intraoperative chromotubation was identified as a risk factor (HR 8.62, p < 0.001). Among 176 patients attempting conception, the live birth rate was 70.45%. In those utilizing assisted reproductive technology (n = 31), the pregnancy and live birth rates were 77.42% and 48.39%, respectively. CONCLUSIONS: FSS is oncologically safe and offers favorable reproductive outcomes for young women with BOTs. The identified prognostic factors were instrumental in tailoring individualized surveillance and management strategies.