Objective Borderline tumors of the ovary are a rare group of ovarian neoplasms with distinctive histological features. Considering their favorable prognosis and occurrence at a younger age, fertility-sparing surgery may be considered. Several risk factors have been identified as contributing to a higher recurrence rate, while the impact of pathohistological features varies in the literature. This study aimed to analyze risk factors for recurrence in patients with borderline tumors of the ovary. Methods Analysis included patients treated with first diagnosis of a borderline tumor at our center between January 1997 and December 2022 to analyze disease-free survival and to identify the role of fertility-sparing surgery, defined as preservation of at least one ovary, pathohistological features, and other prognostic factors for relapse. All stages classified according to the International Federation of Gynecology and Obstetrics (FIGO) were included. Results Among 507 patients, 26 patients (5.2%) had a recurrence, with 21 (4.1%) showing borderline histology and 5 (1%) with invasive relapses. Recurrence rate was higher following fertility-sparing surgery (p<0.0001). Median follow-up period was 49.2 (range 42.0–57.6) months. Among 153 patients (30.2%) who had fertility-sparing surgery, 21 (13.7%) experienced a recurrence (including one invasive relapse). Fertility-sparing surgery (HR 20; 95% CI 6.9 to 60; p<0.001), FIGO stage I with bilateral presence of tumor (HR 6.4; 95% CI 1.3 to 31; p=0.020), FIGO stage II (HR 15; 95% CI 3.4 to 68; p<0.001), FIGO stages III-IV (HR 38; 95% CI 10 to 140; p<0.001) in comparison with FIGO stage I with unilateral tumor, microinvasion (HR 8.6; 95% CI 2.7 to 28; p<0.001), and micropapillary growth patterns (HR 4.4; 95% CI 1.8 to 10; p=0.001) were identified as independent risk factors for recurrence in multivariate analysis. None of these factors were associated with an increased risk of disease-related death. Conclusions Our study showed that although a fertility-preserving approach is associated with increased recurrence rates of a borderline tumor, it does not affect overall survival and can therefore be regarded as oncologically safe for patients desiring to preserve fertility. Additionally, presence of micropapillary patterns and microinvasion were identified as prognostic risk factors. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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保留生育能力手术在卵巢交界性肿瘤中的作用和进一步的预后因素

目的卵巢交界性肿瘤是一类罕见的卵巢肿瘤，具有独特的组织学特征。考虑到其良好的预后和发生在较年轻的年龄，可以考虑保留生育能力的手术。一些危险因素已被确定为导致较高复发率的因素，而文献中病理组织学特征的影响各不相同。本研究旨在分析卵巢交界性肿瘤患者复发的危险因素。方法分析包括 1997 年 1 月至 2022 年 12 月期间在我们中心首次诊断为交界性肿瘤的患者，以分析无病生存率并确定保留生育力手术的作用，保留生育力手术的定义是保留至少一个卵巢、病理组织学特征、以及其他复发的预后因素。包括根据国际妇产科联合会 (FIGO) 分类的所有阶段。结果 507 名患者中，26 名患者（5.2%）出现复发，其中 21 名（4.1%）表现为边界性组织学，5 名（1%）表现为侵袭性复发。保留生育能力手术后复发率较高（p<0.0001）。中位随访时间为 49.2（范围 42.0-57.6）个月。在 153 例（30.2%）接受保留生育手术的患者中，21 例（13.7%）出现复发（包括 1 例侵袭性复发）。保留生育能力手术（HR 20；95% CI 6.9 至 60；p<0.001），FIGO I 期，双侧存在肿瘤（HR 6.4；95% CI 1.3 至 31；p=0.020），FIGO II 期（HR 15） ；95% CI 3.4 至 68；p<0.001），FIGO III-IV 期（HR 38；95% CI 10 至 140；p<0.001）与单侧肿瘤微侵袭的 Figo I 期（HR 8.6；95%）相比在多变量分析中，CI 2.7 至 28；p<0.001）和微乳头状生长模式（HR 4.4；95% CI 1.8 至 10；p=0.001）被确定为复发的独立危险因素。这些因素均与疾病相关死亡风险增加无关。结论 我们的研究表明，虽然保留生育能力的方法与交界性肿瘤的复发率增加有关，但它不会影响总生存期，因此对于希望保留生育能力的患者来说可以被视为肿瘤学上安全的。此外，微乳头模式和微侵袭的存在被确定为预后危险因素。与研究相关的所有数据都包含在文章中或作为补充信息上传。