Predictive factors for recurrence of ovarian mature cystic teratomas after surgical excision

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Abstract

Objective

To study the recurrence rate and predictive factors for recurrence after surgical excision of ovarian mature cystic teratomas (MCT).

Study design

Retrospective study of 382 patients who underwent surgical excision of MCT and whose post-surgical follow-up data were available over six months. Patients who underwent concomitant oophorectomy or had a history of oophorectomy were excluded. Medical records were reviewed for evidence of recurrence. The Cox-hazard model was used for the estimation of predictive factors for recurrence. Categorical data were compared using the Chi-square and Fisher's exact tests.

Results

There were 16 recurrences within a mean follow-up period of 43.0 months, with a recurrence rate of 4.2%. Young age (<30 years old, Y) (hazard ratio (HR) 2.98; 95% confidence interval (CI) 1.04–8.62, P = 0.043), large cyst (≥8 cm in diameter, L) (HR 2.75; 95% CI 1.03–7.37, P = 0.044), and bilaterality (B) (HR 2.88; 95% CI 1.07–7.76, P = 0.036) were shown to be significant predictive factors. When a patient had all these three factors, the recurrence rate was 21.0%, otherwise 3.4% (P < 0.01). Patients with Y + L, Y + B, and B + L also showed significantly higher recurrence rate (21.4%, 15.9%, and 11.4%, respectively).

Conclusion

The long-term recurrence rate after surgical excision of MCT in this study is 4.2%. A patient with young age (<30 years old) or large cyst (≥8 cm in diameter) or bilateral cysts is at high risk of recurrence, which is even higher when a patient has more than one of these factors.

Introduction

Mature cystic teratomas (MCT), also called dermoid cysts, are the most common ovarian neoplasms, accounting for 30% of benign tumors [1]. They typically affect women of reproductive age, making conservative ovarian surgery, i.e. excision of the MCT, the first-line management.

A few reports have shown the rate of post-surgical recurrence of MCT. It appears to be around 3–4% according to Anteby et al. (3/91 cases, 3.3%), Lakkis et al. (4/118, 3.4%), and Chapron et al. (2/48, 4.1%), although the backgrounds vary, including both oophorectomy and excision of the MCT [2], [3], [4]. These figures imply the importance of post-surgical check-up and early detection of the recurrence. Predictive factors, if any, would therefore be clinically very useful since MCT is a relatively frequent disease.

The risk factors, however, are poorly known at the moment. Anteby et al. suggested that the risk of developing a subsequent MCT was higher in patients with bilateral or multiple MCT because two out of three cases with recurrence had bilateral or multiple MCT at the initial surgery [2]. Laberge et al. compared 95 laparoscopy- and 150 laparotomy-treated cases, and found a 7.6% recurrence at two years in the laparoscopy group and 0% in the laparotomy group, suggesting laparoscopic treatment as a risk factor [5]. These two papers were the only existing reports in the English literature providing us some information about the patients with high risk of recurrence. The evidence level of the former one [2] is very low, however, because in the analysis of risk factors they looked at only three patients with recurrence without any controls. The latter study [5] provides only information on the surgical procedure. To provide appropriate information on the risk of recurrence for patients undergoing excision of MCT, the existing evidence was insufficient. We therefore investigated the predictive factors for recurrence of MCT after surgical excision in a larger number of cases.

Section snippets

Materials and methods

We analyzed the recurrence of MCT retrospectively, reviewing the hospital charts of all patients who underwent surgery for MCT in the University of Tokyo Hospital between January 1991 and December 2010. The diagnosis of MCT was confirmed by a surgical pathology report. Patients who underwent oophorectomy or those who had a history of oophorectomy were excluded from the present study. Among 605 patients who met this criterion, those without follow-up data over six months after surgery were

Results

Table 1 shows the patients’ characteristics. Among 382 patients, 161 (42%) were young and 107 (28%) had a large cyst. Eighty-seven patients (23%) had bilateral, 152 (40%) had right-sided and 143 (37%) had left-sided MCTs. Multiple MCTs were detected in 108 patients (28%). Multiple MCTs included two types: (type 1) one unilocular cyst in each ovary, and (type 2) more than one multilocular cyst in either or both ovaries. Seventy-nine patients had type 1 and 29 patients had type 2 multiple MCTs.

Comment

In this series of 382 patients who underwent surgical excision of MCT, the recurrence rate was 4.2%, a similar rate to previous smaller series [2], [3], [4]. Young age, large cyst, and bilaterality were significant risk factors for recurrence. Any combination of these three factors showed a clear relationship with recurrence. This study analyzes predictive factors for post-surgical recurrence of MCT with a larger series of cases than any previous study.

Multiplicity showed a marginal effect on

Conflict of interest statement

The authors report no conflict of interest.

Funding

None.

Acknowledgement

We thank Dr. Hiroshi Ohtsu of Department of Clinical Trial Data Management, Graduate School of Medicine, University of Tokyo, for his statistical advice.

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