Monozentrische retrospektive Analyse der Patientinnen mit Borderline Ovarialtumor für die ROBOT Studie (Retrospective Outcome Survey of Borderline Ovarian Tumors) der Arbeitsgemeinschaft Gynäkologische Onkologie

Borderlinetumore des Ovars zeichnen sich durch bestimmte histologische Unterschiede im Vergleich zu benignen und malignen Ovarialtumoren aus. Sie sind nicht invasiv, können jedoch peritoneale Implantate setzen und als Borderline- oder invasive Karzinome rezidivieren. Die Prognose ist bei adäquater T...

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Bibliographic Details
Main Author: Huber, Tobias
Contributors: Wagner, Uwe (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2012
Online Access:PDF Full Text
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Borderline ovarian tumors differ in certain histological characteristics from malignant and benign ovarian tumors. They are not invasive but are able to produce peritoneal implants and can also recidivate as either borderline or invasive tumors. The prognosis is excellent with adequate therapy and depends on surgical staging, a clear histological differentiation from ovarian cancer and a long-term follow-up as recurrent disease can occur late after initial diagnosis. Since borderline tumors of the ovary occur in younger women compared to invasive carcinoma fertility sparing treatment is of greater importance. There is a huge difference for the patient between benign disease with a simple cystectomy, a borderline tumor with fertility sparing surgery or conservative treatment and invasive carcinoma with the necessity of adjuvant chemotherapy. Due to these consequences and the rareness of the disease a second opinion by a reference pathologist is often used to confirm the diagnosis of the local department of pathology. Until now the guidelines of AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) and AGO (Arbeitsgemeinschaft Gynäkologische Onkologie) do not demand this kind of reference pathology. In this monocentric retrospective study the data of patients with borderline ovarian tumors from 2000 to 2009 at the university hospital of Marburg, Germany, were evaluated. The data will be included in the multicentric “Retrospective Outcome Survey of Borderline Ovarian Tumors” (ROBOT). Data was collected with a given form of the AGO and certain extra parameters. Data analysis was performed with SPSS Statistics. Due to a low number of cases at the university hospital of Marburg, Germany, with a total of 40 patients only limited statistical statements concerning operative outcome can be made. The most important result of this monocentric analysis is an implementation of the guidelines of 100% since their publication and a high rate of performed reference pathologies. This took place in 54.1% of cases and there were differences between local pathology and reference opinion in four cases. One invasive carcinoma was diagnosed by the reference 84 center which resulted in the application of adjuvant chemotherapy. The other three discrepancies were diagnosed with benign tumors by the reference pathologist. This implicates that these patients were over-treated. Initially 40% of premenopausal patients underwent fertility sparing treatment which equates 27.5% of all patients. During re-staging procedures only about half of these patients were treated with the preservation of fertility. In conclusion 15% of all patients were treated with fertility sparing surgery. There was one case with recurrent disease and progression to invasive carcinoma after fertility sparing surgery. With the data of the multicentric ROBOT-Study of the AGO it will be possible to make statements about operative outcome, recurrent disease and progression to invasive carcinoma. Thus it will have an enormous influence on the development of the sk3 guideline “diagnostics and therapy of ovarian tumors”. It is possible, that a reference pathology will be recommended then. It is also conceivable that it will be recommended to postpone definite surgical treatment until after clear histological diagnosis to prevent women with child wish from possibly unnecessary radical surgery. In addition to these impacts on clinical practice the multicentric data may have influence on health care politics regarding the creation of competence centers.