J Gynecol Oncol.  2024 May;35(3):e39. 10.3802/jgo.2024.35.e39.

Prognostic factors of adult granulosa cell tumors of the ovary: a Turkish retrospective multicenter study

• Oktar O
• Korkmaz V
• Tokalıoğlu A
• Öztürk
• Erdoğan
• Uçar Y
• Koca Yıldırım HE
• Hanedan C
• Kılıç F
• Ersak B
• Yalçın N
• Özmen F
• Kahraman A
• Esen SA
• Baş S
• Özdaş ED
• Selçuk
• Uçar G
• Koçak
• Çakır C
• Koç S
• Kılıç
• Cömert GK
• Üreyen I
• Toptaş T
• Narin MA
• Taşçı T
• Taşkın S
• Boran N
• Sancı M
• Köş FT
• Tekin
• Üstün YE
• Ortaç F
• Turan T

• KMID: 2564901
• DOI: http://doi.org/10.3802/jgo.2024.35.e39

Abstract

Objective
To define the clinical, histopathological features and the prognostic factors affecting survival in patients with adult granulosa cell tumors of the ovary (AGCT).
Methods
A 322 patients whose final pathologic outcome was AGCT treated at nine tertiary oncology centers between 1988 and 2021 participated in the study.
Results
The mean age of the patients was 51.3±11.8 years and ranged from 21 to 82 years. According to the International Federation of Gynecology and Obstetrics 2014, 250 (77.6%) patients were stage I, 24 (7.5%) patients were stage II, 20 (6.2%) patients were stage III, and 3 (7.8%) were stage IV. Lymphadenectomy was added to the surgical procedure in 210 (65.2%) patients. Lymph node involvement was noted in seven (3.3%) patients. Peritoneal cytology was positive in 19 (5.9%) patients, and 13 (4%) had metastases in the omentum. Of 285 patients who underwent hysterectomy, 19 (6.7%) had complex hyperplasia with atypia/ endometrial intraepithelial neoplasia, and 8 (2.8%) had grade 1 endometrioid endometrial carcinoma. It was found that 93 (28.9%) patients in the study group received adjuvant treatment. Bleomycin, etoposide, cisplatin was the most commonly used chemotherapy protocol. The median follow-up time of the study group was 41 months (range, 1–276 months). It was noted that 34 (10.6%) patients relapsed during this period, and 9 (2.8%) patients died because of the disease. The entire cohort had a 5-year disease-free survival (DFS) of 86% and a 5-year disease-specific survival of 98%. Recurrences were observed only in the pelvis in 13 patients and the extra-abdominal region in 7 patients. The recurrence rate increased 6.168-fold in patients with positive peritoneal cytology (95% confidence interval [CI]=1.914–19.878; p=0.002), 3.755-fold in stage II–IV (95% CI=1.275–11.063; p=0.016), and 2.517-fold in postmenopausal women (95% CI=1.017–6.233; p=0.046) increased.
Conclusion
In this study, lymph node involvement was detected in 3.3% of patients with AGCT. Therefore, it was concluded that lymphadenectomy can be avoided in primary surgical treatment. Positive peritoneal cytology, stage, and menopausal status were independent prognostic predictors of DFS.

Keyword

Granulosa Cell; Disease-Free Survival; Prognostic Factors; Ovarian Carcinoma