| 摘要: |
| 目的 比较浆液性与黏液性交界性卵巢肿瘤（BOT）患者在保留生育功能手术（FSS）后接受体外受精/卵胞浆内单精子注射（IVF/ICSI）助孕的促排卵反应、胚胎学与妊娠结局，并评估促排治疗相关的复发安全性。
方法 回顾性分析2010年5月至2023年5月在本中心行IVF/ICSI治疗的FSS术后BOT患者临床资料，按术后病理分为浆液性组（SBOT）与黏液性组（MBOT）。为降低混杂偏倚，采用逆概率加权（IPTW）平衡年龄、基础窦卵泡数及手术方式等关键基线差异。比较促排指标（促排天数、Gn用量、获卵数等）、胚胎学指标（2PN受精数/率、优质胚胎数/率、可移植胚胎数/率）与妊娠结局（每起始周期活产率）。随访记录肿瘤复发情况，并以多因素Logistic回归分析复发相关因素。
结果 IPTW校正后，两组在促排卵天数、Gn用量、获卵数、2PN受精数、优质胚胎数及可移植胚胎数等方面差异均无统计学意义。每起始周期活产率SBOT为27.1%，MBOT为11.3%，差异无统计学意义。随访期内共发生复发5例：SBOT复发率10.53%（4/38），MBOT复发率5.56%（1/18），两组差异无统计学意义（P=0.542）。多因素分析提示病理类型并非复发的独立危险因素。
结论 FSS术后SBOT与MBOT患者接受IVF/ICSI助孕的促排反应、胚胎学表现及妊娠结局总体相当；在规范手术与随访管理前提下，促排卵治疗未显示增加不同病理类型BOT复发风险的证据。临床决策不宜仅依据病理类型限制ART，应综合肿瘤分期、手术彻底性及个体卵巢储备制定个体化助孕与随访策略。 |
| 关键词: 浆液性卵巢交界性肿瘤 黏液性卵巢交界性肿瘤 保存生育手术 体外受精胚胎移植 肿瘤复发 |
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| Outcomes of IVF/ICSI Cycles and Recurrence in Borderline Ovarian Tumor Patients of Different Histological Types After Fertility-Sparing SurgeryYujie Li1, Jialin Wu1, Wenchao Sun2, Jingjie Li1 |
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The Sixth Affiliated Hospital of Sun Yat-sen University
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| Abstract: |
| Objective To compare ovarian stimulation response, embryological outcomes, and pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in patients with serous versus mucinous borderline ovarian tumors (BOTs) after fertility-sparing surgery (FSS), and to evaluate the safety of ovarian stimulation with respect to tumor recurrence.
Methods We retrospectively reviewed clinical data of BOT patients who underwent IVF/ICSI after FSS at our center between May 2010 and May 2023. Patients were classified into a serous BOT (SBOT) group and a mucinous BOT (MBOT) group according to postoperative pathology. To reduce confounding, inverse probability of treatment weighting (IPTW) was applied to balance key baseline characteristics, including age, antral follicle count, and surgical procedure. Ovarian stimulation parameters (stimulation duration, gonadotropin dose, number of oocytes retrieved), embryological outcomes (number/rate of two-pronuclear [2PN] fertilization, number/rate of high-quality embryos, number/rate of transferable embryos), and pregnancy outcomes (live birth rate per started cycle) were compared. Recurrence during follow-up was recorded, and multivariable logistic regression was performed to identify factors associated with recurrence.
Results After IPTW adjustment, no significant differences were observed between the two groups in stimulation duration, total gonadotropin dose, number of oocytes retrieved, number of 2PN fertilizations, number of high-quality embryos, or number of transferable embryos. The live birth rate per started cycle was 27.1% in the SBOT group and 11.3% in the MBOT group, with no statistically significant difference. During follow-up, five recurrences occurred: the recurrence rate was 10.53% (4/38) in the SBOT group and 5.56% (1/18) in the MBOT group, with no significant difference between groups (P=0.542). Multivariable analysis indicated that histological type was not an independent risk factor for recurrence.
Conclusions Among BOT patients undergoing IVF/ICSI after FSS, SBOT and MBOT showed comparable ovarian stimulation responses, embryological performance, and pregnancy outcomes. Under standardized surgical management and follow-up, ovarian stimulation did not appear to increase recurrence risk across histological types. Therefore, histological subtype alone should not be used to restrict assisted reproductive technology (ART); clinical decisions should integrate tumor stage, surgical completeness, and individual ovarian reserve to develop personalized fertility treatment and follow-up strategies. |
| Key words: serous borderline ovarian tumor mucinous borderline ovarian tumor fertility-sparing surgery in vitro fertilization and embryo transfer tumor recurrence |
