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.	龚子元. 卵巢交界性肿瘤保留生育功能可行性及复发危险因素的荟萃分析. 北京: 中国医学科学院北京协和医学院, 2019.
3.	中华医学会妇产科学分会绝经学组. 早发性卵巢功能不全的临床诊疗专家共识(2023 版). 中华妇产科杂志, 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.	卵巢储备功能减退临床诊治专家共识专家组, 中华预防医学会生育力保护分会生殖内分泌生育保护学组. 卵巢储备功能减退临床诊治专家共识. 生殖医学杂志, 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.	曹丽洁, 林仲秋. 年轻交界性和恶性卵巢肿瘤患者保留生育功能的相关问题. 中国妇产科临床杂志, 2022, 23(5): 449-451.
12.	梁靓, 吴郁, 杨蕊, 等. 卵巢交界性肿瘤患者进行辅助生育治疗的研究进展. 中华生殖与避孕杂志, 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.	中国抗癌协会妇科肿瘤专业委员会, 中国抗癌协会肿瘤多学科诊疗(MDT)专业委员会, 中国医师协会肿瘤多学科诊疗专业委员会. 妇科恶性肿瘤多学科诊疗中国专家共识(2022 年版). 中国癌症杂志, 2022, 32(8): 747-756.
16.	苏德慧, 杨欣. 妇科手术对卵巢储备功能的影响. 中国实用妇科与产科杂志, 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.	王稳, 王兴国, 刘淑娟, 等. 交界性卵巢肿瘤诊治中国专家共识(2022 年版). 中国实用妇科与产科杂志, 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-Kähler 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. 卵巢交界性肿瘤生育力保存策略. 中国微创外科杂志, 2021, 21(12): 1104-1107.
25.	朱跃蒙. 卵巢恶性肿瘤保留生育功能术后不孕患者促排卵治疗的安全性分析. 国际生殖健康/计划生育杂志, 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, 张会媛, 等. 辅助生殖技术对卵巢恶性和交界性肿瘤致病风险的研究进展. 国际妇产科学杂志, 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.	马聪, 邹慧娟, 王建业, 等. 自体卵巢组织冷冻在女性肿瘤患者生育力保存中的应用. 生殖医学杂志, 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. 龚子元. 卵巢交界性肿瘤保留生育功能可行性及复发危险因素的荟萃分析. 北京: 中国医学科学院北京协和医学院, 2019.
3. 中华医学会妇产科学分会绝经学组. 早发性卵巢功能不全的临床诊疗专家共识(2023 版). 中华妇产科杂志, 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. 卵巢储备功能减退临床诊治专家共识专家组, 中华预防医学会生育力保护分会生殖内分泌生育保护学组. 卵巢储备功能减退临床诊治专家共识. 生殖医学杂志, 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. 曹丽洁, 林仲秋. 年轻交界性和恶性卵巢肿瘤患者保留生育功能的相关问题. 中国妇产科临床杂志, 2022, 23(5): 449-451.
12. 梁靓, 吴郁, 杨蕊, 等. 卵巢交界性肿瘤患者进行辅助生育治疗的研究进展. 中华生殖与避孕杂志, 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. 中国抗癌协会妇科肿瘤专业委员会, 中国抗癌协会肿瘤多学科诊疗(MDT)专业委员会, 中国医师协会肿瘤多学科诊疗专业委员会. 妇科恶性肿瘤多学科诊疗中国专家共识(2022 年版). 中国癌症杂志, 2022, 32(8): 747-756.
16. 苏德慧, 杨欣. 妇科手术对卵巢储备功能的影响. 中国实用妇科与产科杂志, 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. 王稳, 王兴国, 刘淑娟, 等. 交界性卵巢肿瘤诊治中国专家共识(2022 年版). 中国实用妇科与产科杂志, 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-Kähler 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. 卵巢交界性肿瘤生育力保存策略. 中国微创外科杂志, 2021, 21(12): 1104-1107.
25. 朱跃蒙. 卵巢恶性肿瘤保留生育功能术后不孕患者促排卵治疗的安全性分析. 国际生殖健康/计划生育杂志, 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, 张会媛, 等. 辅助生殖技术对卵巢恶性和交界性肿瘤致病风险的研究进展. 国际妇产科学杂志, 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. 马聪, 邹慧娟, 王建业, 等. 自体卵巢组织冷冻在女性肿瘤患者生育力保存中的应用. 生殖医学杂志, 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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