Value exploration of multi-disciplinary team for fertility preservation in patients with borderline ovarian tumors_West China Medical Journal

Authors：

CHEN Qiaowei ^1,2 ,  LIN Wei ^1,2

1. Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIN Wei, Email: weilinhuaxi@163.com

Keywords：

borderline ovarian tumor; multi-disciplinary team; fertility protection

DOI：

10.7507/1002-0179.202310028

Video：

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Objective To explore the value of multi-disciplinary team (MDT) for fertility preservation in patients with borderline ovarian tumor (BOT). Methods BOT patients who underwent MDT at West China Second University Hospital of Sichuan University between January 2020 and December 2022 were selected as the MDT group, while BOT patients who underwent surgery but did not undergo MDT during the same period were selected as the control group in a 1∶2 histological ratio. The clinical case data of two groups were retrospectively analyzed. The fertility assessment, implementation of fertility protection measures, and reproductive outcomes of two groups of patients were compared. Results A total of 24 patients were included in the MDT group, while 48 patients were included in the control group. There was no statistically significant difference in age of onset, marital status, preoperative carbohydrate antigen 199, carbohydrate antigen 125, surgical pathway, and International Federation of Gynecology and Obstetrics staging between the two groups of patients (P>0.05). The proportion of bilateral tumor involvement in the MDT group during the first surgery was higher than that in the control group (50.0% vs. 22.9%, P<0.05). In terms of fertility assessment, there was no statistically significant difference in the proportion of patients who underwent preoperative measurement of anti-Müllerian hormone between the two groups (P>0.05). The proportion of patients who underwent postoperative measurement of anti-Müllerian hormone in the MDT group was higher than that in the control group (100.0% vs. 37.5%, P<0.05). The proportion of patients in the MDT group who took fertility protection measures was higher than that in the control group (62.5% vs. 29.2%, P<0.05). There was no statistically significant difference in the proportion of successful pregnancies between the two groups of patients who were married (28.6% vs. 25.9%, P>0.05). Conclusion MDT is beneficial for improving the fertility assessment rate of BOT patients of childbearing age, providing personalized treatment plans, and taking timely measures to protect their fertility.

Citation： CHEN Qiaowei, LIN Wei. Value exploration of multi-disciplinary team for fertility preservation in patients with borderline ovarian tumors. West China Medical Journal, 2024, 39(1): 11-16. doi: 10.7507/1002-0179.202310028 Copy

1.	Poulain M, Vandame J, Tran C, et al. Fertility preservation in borderline ovarian tumor patients and survivors. Horm Mol Biol Clin Investig, 2020, 43(2): 179-186.
2.	龔子元. 卵巢交界性腫瘤保留生育功能可行性及復發危險因素的薈萃分析. 北京: 中國醫學科學院北京協和醫學院, 2019.
3.	中華醫學會婦產科學分會絕經學組. 早發性卵巢功能不全的臨床診療專家共識(2023 版). 中華婦產科雜志, 2023, 58(10): 721-728.
4.	Raad J, Rolland L, Grynberg M, et al. Borderline ovarian tumours: CNGOF guidelines for clinical practice - fertility. Gynecol Obstet Fertil Senol, 2020, 48(3): 330-336.
5.	Mutch DG, Prat J. 2014 FIGO staging for ovarian, fallopian tube and peritoneal cancer. Gynecol Oncol, 2014, 133(3): 401-404.
6.	Pastore LM, Christianson MS, Stelling J, et al. Reproductive ovarian testing and the alphabet soup of diagnoses: DOR, POI, POF, POR, and FOR. J Assist Reprod Genet, 2018, 35(1): 17-23.
7.	卵巢儲備功能減退臨床診治專家共識專家組, 中華預防醫學會生育力保護分會生殖內分泌生育保護學組. 卵巢儲備功能減退臨床診治專家共識. 生殖醫學雜志, 2022, 31(4): 425-434.
8.	Broer SL, Broekmans FJ, Laven JS, et al. Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications. Hum Reprod Update, 2014, 20(5): 688-701.
9.	Tal R, Seifer DB. Ovarian reserve testing: a user’s guide. Am J Obstet Gynecol, 2017, 217(2): 129-140.
10.	Huchon C, Bourdel N, Abdel Wahab C, et al. Borderline ovarian tumors: French guidelines from the CNGOF. Part 1. Epidemiology, biopathology, imaging and biomarkers. J Gynecol Obstet Hum Reprod, 2021, 50(1): 101965.
11.	曹麗潔, 林仲秋. 年輕交界性和惡性卵巢腫瘤患者保留生育功能的相關問題. 中國婦產科臨床雜志, 2022, 23(5): 449-451.
12.	梁靚, 吳郁, 楊蕊, 等. 卵巢交界性腫瘤患者進行輔助生育治療的研究進展. 中華生殖與避孕雜志, 2021, 41(4): 367-371.
13.	Bourdel N, Huchon C, Abdel Wahab C, et al. Borderline ovarian tumors: French guidelines from the CNGOF. Part 2. Surgical management, follow-up, hormone replacement therapy, fertility management and preservation. J Gynecol Obstet Hum Reprod, 2021, 50(1): 101966.
14.	Haward RA. The calman-hine report: a personal retrospective on the UK’s first comprehensive policy on cancer services. Lancet Oncol, 2006, 7(4): 336-346.
15.	中國抗癌協會婦科腫瘤專業委員會, 中國抗癌協會腫瘤多學科診療(MDT)專業委員會, 中國醫師協會腫瘤多學科診療專業委員會. 婦科惡性腫瘤多學科診療中國專家共識(2022 年版). 中國癌癥雜志, 2022, 32(8): 747-756.
16.	蘇德慧, 楊欣. 婦科手術對卵巢儲備功能的影響. 中國實用婦科與產科雜志, 2023, 39(9): 887-890.
17.	Li N, Gou J, Li L, et al. Staging procedures fail to benefit women with borderline ovarian tumours who want to preserve fertility: a retrospective analysis of 448 cases. BMC Cancer, 2020, 20(1): 769.
18.	王穩, 王興國, 劉淑娟, 等. 交界性卵巢腫瘤診治中國專家共識(2022 年版). 中國實用婦科與產科雜志, 2022, 38(12): 1185-1194.
19.	Raimond E, Bourdel N. Borderline ovarian tumours: CNGOF guidelines for clinical practice - surgical management of advanced stages of borderline ovarian tumours. Gynecol Obstet Fertil Senol, 2020, 48(3): 304-313.
20.	Falcone F, Malzoni M, Carnelli M, et al. Fertility-sparing treatment for serous borderline ovarian tumors with extra-ovarian invasive implants: analysis from the MITO14 study database. Gynecol Oncol, 2022, 165(2): 302-308.
21.	Sobiczewski P, Piatek S, Michalski W, et al. Obstetric outcomes after conservative management of ovarian borderline tumors in women of reproductive age: a single center experience. Eur J Obstet Gynecol Reprod Biol, 2022, 269: 126-131.
22.	Wang L, Zhong Q, Tang Q, et al. Second fertility-sparing surgery and fertility-outcomes in patients with recurrent borderline ovarian tumors. Arch Gynecol Obstet, 2022, 306(4): 1177-1183.
23.	Johansen G, Dahm-K?hler P, Staf C, et al. Reproductive and obstetrical outcomes with the overall survival of fertile-age women treated with fertility-sparing surgery for borderline ovarian tumors in Sweden: a prospective nationwide population-based study. Fertil Steril, 2021, 115(1): 157-163.
24.	梁婷婷. 卵巢交界性腫瘤生育力保存策略. 中國微創外科雜志, 2021, 21(12): 1104-1107.
25.	朱躍蒙. 卵巢惡性腫瘤保留生育功能術后不孕患者促排卵治療的安全性分析. 國際生殖健康/計劃生育雜志, 2018, 37(5): 401-404.
26.	Li S, Lin H, Xie Y, et al. Live births after in vitro fertilization with fertility-sparing surgery for borderline ovarian tumors: a case series and literature review. Gynecol Obstet Invest, 2019, 84(5): 445-454.
27.	王霞, 朱姝, 張會媛, 等. 輔助生殖技術對卵巢惡性和交界性腫瘤致病風險的研究進展. 國際婦產科學雜志, 2021, 48(2): 148-153.
28.	Kanat-Pektas M, Ozat M, Gungor T, et al. Fertility outcome after conservative surgery for borderline ovarian tumors: a single center experience. Arch Gynecol Obstet, 2011, 284(5): 1253-1258.
29.	Masciangelo R, Bosisio C, Donnez J, et al. Safety of ovarian tissue transplantation in patients with borderline ovarian tumors. Hum Reprod, 2018, 33(2): 212-219.
30.	Santaballa A, Márquez-Vega C, Rodríguez-Lescure á, et al. Multidisciplinary consensus on the criteria for fertility preservation in cancer patients. Clin Transl Oncol, 2022, 24(2): 227-243.
31.	馬聰, 鄒慧娟, 王建業, 等. 自體卵巢組織冷凍在女性腫瘤患者生育力保存中的應用. 生殖醫學雜志, 2020, 29(5): 663-667.
32.	Vidal Urbinati AM, Iacobone AD, Di Pace RC, et al. Borderline ovarian tumor in pregnancy: can surgery wait? A case series. Arch Gynecol Obstet, 2021, 304(6): 1561-1568.

1. Poulain M, Vandame J, Tran C, et al. Fertility preservation in borderline ovarian tumor patients and survivors. Horm Mol Biol Clin Investig, 2020, 43(2): 179-186.
2. 龔子元. 卵巢交界性腫瘤保留生育功能可行性及復發危險因素的薈萃分析. 北京: 中國醫學科學院北京協和醫學院, 2019.
3. 中華醫學會婦產科學分會絕經學組. 早發性卵巢功能不全的臨床診療專家共識(2023 版). 中華婦產科雜志, 2023, 58(10): 721-728.
4. Raad J, Rolland L, Grynberg M, et al. Borderline ovarian tumours: CNGOF guidelines for clinical practice - fertility. Gynecol Obstet Fertil Senol, 2020, 48(3): 330-336.
5. Mutch DG, Prat J. 2014 FIGO staging for ovarian, fallopian tube and peritoneal cancer. Gynecol Oncol, 2014, 133(3): 401-404.
6. Pastore LM, Christianson MS, Stelling J, et al. Reproductive ovarian testing and the alphabet soup of diagnoses: DOR, POI, POF, POR, and FOR. J Assist Reprod Genet, 2018, 35(1): 17-23.
7. 卵巢儲備功能減退臨床診治專家共識專家組, 中華預防醫學會生育力保護分會生殖內分泌生育保護學組. 卵巢儲備功能減退臨床診治專家共識. 生殖醫學雜志, 2022, 31(4): 425-434.
8. Broer SL, Broekmans FJ, Laven JS, et al. Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications. Hum Reprod Update, 2014, 20(5): 688-701.
9. Tal R, Seifer DB. Ovarian reserve testing: a user’s guide. Am J Obstet Gynecol, 2017, 217(2): 129-140.
10. Huchon C, Bourdel N, Abdel Wahab C, et al. Borderline ovarian tumors: French guidelines from the CNGOF. Part 1. Epidemiology, biopathology, imaging and biomarkers. J Gynecol Obstet Hum Reprod, 2021, 50(1): 101965.
11. 曹麗潔, 林仲秋. 年輕交界性和惡性卵巢腫瘤患者保留生育功能的相關問題. 中國婦產科臨床雜志, 2022, 23(5): 449-451.
12. 梁靚, 吳郁, 楊蕊, 等. 卵巢交界性腫瘤患者進行輔助生育治療的研究進展. 中華生殖與避孕雜志, 2021, 41(4): 367-371.
13. Bourdel N, Huchon C, Abdel Wahab C, et al. Borderline ovarian tumors: French guidelines from the CNGOF. Part 2. Surgical management, follow-up, hormone replacement therapy, fertility management and preservation. J Gynecol Obstet Hum Reprod, 2021, 50(1): 101966.
14. Haward RA. The calman-hine report: a personal retrospective on the UK’s first comprehensive policy on cancer services. Lancet Oncol, 2006, 7(4): 336-346.
15. 中國抗癌協會婦科腫瘤專業委員會, 中國抗癌協會腫瘤多學科診療(MDT)專業委員會, 中國醫師協會腫瘤多學科診療專業委員會. 婦科惡性腫瘤多學科診療中國專家共識(2022 年版). 中國癌癥雜志, 2022, 32(8): 747-756.
16. 蘇德慧, 楊欣. 婦科手術對卵巢儲備功能的影響. 中國實用婦科與產科雜志, 2023, 39(9): 887-890.
17. Li N, Gou J, Li L, et al. Staging procedures fail to benefit women with borderline ovarian tumours who want to preserve fertility: a retrospective analysis of 448 cases. BMC Cancer, 2020, 20(1): 769.
18. 王穩, 王興國, 劉淑娟, 等. 交界性卵巢腫瘤診治中國專家共識(2022 年版). 中國實用婦科與產科雜志, 2022, 38(12): 1185-1194.
19. Raimond E, Bourdel N. Borderline ovarian tumours: CNGOF guidelines for clinical practice - surgical management of advanced stages of borderline ovarian tumours. Gynecol Obstet Fertil Senol, 2020, 48(3): 304-313.
20. Falcone F, Malzoni M, Carnelli M, et al. Fertility-sparing treatment for serous borderline ovarian tumors with extra-ovarian invasive implants: analysis from the MITO14 study database. Gynecol Oncol, 2022, 165(2): 302-308.
21. Sobiczewski P, Piatek S, Michalski W, et al. Obstetric outcomes after conservative management of ovarian borderline tumors in women of reproductive age: a single center experience. Eur J Obstet Gynecol Reprod Biol, 2022, 269: 126-131.
22. Wang L, Zhong Q, Tang Q, et al. Second fertility-sparing surgery and fertility-outcomes in patients with recurrent borderline ovarian tumors. Arch Gynecol Obstet, 2022, 306(4): 1177-1183.
23. Johansen G, Dahm-K?hler P, Staf C, et al. Reproductive and obstetrical outcomes with the overall survival of fertile-age women treated with fertility-sparing surgery for borderline ovarian tumors in Sweden: a prospective nationwide population-based study. Fertil Steril, 2021, 115(1): 157-163.
24. 梁婷婷. 卵巢交界性腫瘤生育力保存策略. 中國微創外科雜志, 2021, 21(12): 1104-1107.
25. 朱躍蒙. 卵巢惡性腫瘤保留生育功能術后不孕患者促排卵治療的安全性分析. 國際生殖健康/計劃生育雜志, 2018, 37(5): 401-404.
26. Li S, Lin H, Xie Y, et al. Live births after in vitro fertilization with fertility-sparing surgery for borderline ovarian tumors: a case series and literature review. Gynecol Obstet Invest, 2019, 84(5): 445-454.
27. 王霞, 朱姝, 張會媛, 等. 輔助生殖技術對卵巢惡性和交界性腫瘤致病風險的研究進展. 國際婦產科學雜志, 2021, 48(2): 148-153.
28. Kanat-Pektas M, Ozat M, Gungor T, et al. Fertility outcome after conservative surgery for borderline ovarian tumors: a single center experience. Arch Gynecol Obstet, 2011, 284(5): 1253-1258.
29. Masciangelo R, Bosisio C, Donnez J, et al. Safety of ovarian tissue transplantation in patients with borderline ovarian tumors. Hum Reprod, 2018, 33(2): 212-219.
30. Santaballa A, Márquez-Vega C, Rodríguez-Lescure á, et al. Multidisciplinary consensus on the criteria for fertility preservation in cancer patients. Clin Transl Oncol, 2022, 24(2): 227-243.
31. 馬聰, 鄒慧娟, 王建業, 等. 自體卵巢組織冷凍在女性腫瘤患者生育力保存中的應用. 生殖醫學雜志, 2020, 29(5): 663-667.
32. Vidal Urbinati AM, Iacobone AD, Di Pace RC, et al. Borderline ovarian tumor in pregnancy: can surgery wait? A case series. Arch Gynecol Obstet, 2021, 304(6): 1561-1568.

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