Returning to this great editorial (2011) that (in my mind at least) really does sum up the frustration and confusion of all who engage with BOTs, including the researchers themselves. Fortunately for us, “research suggests that some of the time, confusion can actually be a good thing — an important step toward learning.”
I like Martin Schwartz.
Turning my (ongoing) confusion into some (ongoing) learning through Importantly Feeling Stupid is, I hope, a positive way to engage with BOTs…. see below for some snippets from this editorial that, I think, are super-useful in helping untangle some of the often confusing BOT evidence.
Some key messages that stand out for me:
– micropapillary pattern in the ovary without invasive implants does not suggest a worse prognosis
– invasive implants are the strongest predictor of a worse prognosis, regardless of whether a micropapillary pattern was found in the original tumour or not
– even so, important to recognise that the term “worse prognosis” needs to interpreted carefully. In the words of the author of this article “There were so few deaths that overall survival could not be compared” (when comparing individuals with invasive and non-invasive implants and micropapillary patterns).
– chemotherapy does not affect outcomes and is not required for BOTs
– a reminder that we need to read research cautiously: “ Great care must be taken not to overinterpret results from mostly referral and consultation-based centers. These series can be strongly influenced and skewed, because cases with an already unfavorable outcome are the ones being seen at such centers. Patients with straightforward pathologic interpretations who do well often will have no need to seek treatment or consultation at a specialized referral center.”
Some key quotes from the editorial:
“These not-so-aggressive but not-quite-benign tumors of the ovary have been struggling for a name ever since FIGO recognized them as a distinct entity in the 1970s. The various names used to identify the same tumor can often confuse clinicians, leading to inappropriate and unnecessary treatment approaches to patients with these tumors. The unfortunate patient will have the words “malignant” or “carcinoma” tagged to her tumor, resulting in associated lifelong anxiety, extra exposure to radiation to make sure the tumor hasn’t returned, and, in the very unfortunate, toxic therapies to make sure their tumor won’t return. The most unfortunate of all patients are those who are young and have not yet started or completed their family. And so, I prefer the term “borderline.”
“A micropapillary pattern in the ovary in the absence of extraovarian disease (stage I) does not confer a worse prognosis.“
“The only consistent adverse prognostic factor has been the presence of invasive extraovarian implants whether there is a micropapillary pattern in the primary ovarian tumor or not.”
“Uzan and colleagues [5] report on the largest series, to my knowledge, of advanced ovarian borderline tumors comparing those with a micropapillary pattern with typical borderline tumors. Smith Sehdev et al. [7] had the largest series of patients with micropapillary tumors but they did not compare them with patients with typical borderline tumors [7]. The authors used strict modern pathologic criteria. There were so few deaths that overall survival could not be compared.”
“What’s in a name? In terms of borderline tumors? A lot! From a clinical standpoint, we must be extremely careful of the names we give these tumors. All that can result from “names” is iatrogenic bad outcomes in this cohort of patients. Continued understanding of these tumors, however, is of utmost importance to identify treatments that will have an impact on the outcome of the small minority of patients who will unfortunately be affected by the aggressive variants of ovarian borderline tumors.”
jozi-ovari 
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