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Objectives <p>This study’s main goal was to evaluate long-term fertility outcomes, including 5-year fertility rates, in patients with borderline ovarian tumors (BOTs) following conservative surgery. Secondary objectives included summarizing the clinical characteristics of BOTs, assessing the outcomes of different surgical interventions, and identifying factors associated with pregnancy and prognosis.</p> Methods <p>We conducted a retrospective analysis of 667 patients with BOTs who underwent surgical treatment at the Women’s Hospital, Zhejiang University School of Medicine, from August 2013 to July 2023. Propensity score matching (PSM) was performed to balance baseline characteristics between the fertility-sparing surgery (FSS) and radical surgery groups. Statistical analyses were performed using chi-square and t-tests and logistic regression. Recurrence risk factors were analyzed using Cox regression, and fertility outcomes were assessed using logistic regression.</p> Results <p>The mean age was 29.7 ± 5.7&#xa0;years in the fertility-sparing surgery (FSS) group and 49.7 ± 8.2&#xa0;years in the radical surgery group. Overall, 83.8% were premenopausal, and the majority (83.8%) were diagnosed at FIGO stage I. The pathological distribution included 52% serous and 28.6% mucinous tumors. Recurrence occurred in 90 patients (13.5%), with no reported deaths during follow-up. One case exhibited a malignant transformation after recurrence. After 1:2 propensity score matching, univariate Cox regression analysis identified FIGO stage,Age,Affected ovarian preservation, lymphadenectomy, Hysterectomy, omentectomy, and FSS as significant recurrence factors. Multivariate Cox regression analysis in the matched cohort identified FIGO stage (HR = 2.60, 95% CI 1.71–3.95, <i>P</i> &lt; 0.001) and FSS (HR = 15.06, CI 4.90–46.26, <i>P</i> &lt; <i>0.001</i>) as independent predictors of recurrence. Among 149 patients who maintained fertility desire after FSS, 100 achieved live birth after surgery, mainly via natural conception. Among patients who underwent FSS, unilateral salpingo-oophorectomy (USO) was associated with the lowest recurrence rate (14.0%) and the highest live birth rate (76.5%).</p> Conclusions <p>FSS was associated with a higher risk of recurrence compared with radical surgery but achieved favorable live birth rates among patients who actively attempted pregnancy. In the propensity score-matched cohort, FSS and advanced FIGO stage were identified as independent predictors of recurrence. Among FSS patients, unilateral salpingo-oophorectomy (USO) was associated with the lowest recurrence rate and the highest live birth rate. These findings may inform surgical decision-making for young BOT patients desiring fertility preservation.</p>

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Navigating fertility preservation in borderline ovarian tumor patients: the impact of surgical choices in a decade

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月30日

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  • Mi Lei,
  • Shenglong Wu,
  • Simin Xiang,
  • Junfen Xu

摘要

Objectives

This study’s main goal was to evaluate long-term fertility outcomes, including 5-year fertility rates, in patients with borderline ovarian tumors (BOTs) following conservative surgery. Secondary objectives included summarizing the clinical characteristics of BOTs, assessing the outcomes of different surgical interventions, and identifying factors associated with pregnancy and prognosis.

Methods

We conducted a retrospective analysis of 667 patients with BOTs who underwent surgical treatment at the Women’s Hospital, Zhejiang University School of Medicine, from August 2013 to July 2023. Propensity score matching (PSM) was performed to balance baseline characteristics between the fertility-sparing surgery (FSS) and radical surgery groups. Statistical analyses were performed using chi-square and t-tests and logistic regression. Recurrence risk factors were analyzed using Cox regression, and fertility outcomes were assessed using logistic regression.

Results

The mean age was 29.7 ± 5.7 years in the fertility-sparing surgery (FSS) group and 49.7 ± 8.2 years in the radical surgery group. Overall, 83.8% were premenopausal, and the majority (83.8%) were diagnosed at FIGO stage I. The pathological distribution included 52% serous and 28.6% mucinous tumors. Recurrence occurred in 90 patients (13.5%), with no reported deaths during follow-up. One case exhibited a malignant transformation after recurrence. After 1:2 propensity score matching, univariate Cox regression analysis identified FIGO stage,Age,Affected ovarian preservation, lymphadenectomy, Hysterectomy, omentectomy, and FSS as significant recurrence factors. Multivariate Cox regression analysis in the matched cohort identified FIGO stage (HR = 2.60, 95% CI 1.71–3.95, P < 0.001) and FSS (HR = 15.06, CI 4.90–46.26, P < 0.001) as independent predictors of recurrence. Among 149 patients who maintained fertility desire after FSS, 100 achieved live birth after surgery, mainly via natural conception. Among patients who underwent FSS, unilateral salpingo-oophorectomy (USO) was associated with the lowest recurrence rate (14.0%) and the highest live birth rate (76.5%).

Conclusions

FSS was associated with a higher risk of recurrence compared with radical surgery but achieved favorable live birth rates among patients who actively attempted pregnancy. In the propensity score-matched cohort, FSS and advanced FIGO stage were identified as independent predictors of recurrence. Among FSS patients, unilateral salpingo-oophorectomy (USO) was associated with the lowest recurrence rate and the highest live birth rate. These findings may inform surgical decision-making for young BOT patients desiring fertility preservation.