Adult-Type Ovarian Granulosa Cell Tumour: Treatment Outcomes From a Single-Institution Experience

Abstract

Objectives: Ovarian granulosa cell tumour is rare. This study aims to report the clinical characteristics and long-term outcomes of adult-type ovarian granulosa cell tumour (AOGCT) at King Faisal Specialist Hospital and Research Centre (KFSH&RC) and to determine the prognostic factors affecting relapse and survival.Methods: We retrospectively reviewed patients with AOGCT, from 1988 to 2014, who were treated at our institution. Baseline characteristics, pathological findings, and outcomes were analysed and reported.Results: Sixty-one patients with AOGCT were identified with a median age of 49 years. Median follow-up was 5.0 years (range 2.1-8.2 years). 74% of patients were FIGO (International Federation of Gynecology and Obstetrics) stage I, whereas 7% were stage II, 5% were stage III, and unknown in 14% of the cases. The most common presenting symptoms included abdominal pain (43%) and vaginal bleeding (43%). The majority of patients (38 patients, 62%) were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Five (8%) patients received adjuvant chemotherapy. Sixteen patients (26%) relapsed with a median time to relapse of 5.5 years (0.7-8.1 years). Half of the recurrences (eight patients, 50%) occurred after five years of diagnosis. Five-year overall survival and disease-free survival (DFS) were 93% and 84%, respectively. Factors associated with a high risk of recurrence were the presence of ascites (p=0.000) and elevated preoperative CA 125 level (p=0.048). The overall survival was significantly influenced by the menopausal status (premenopausal 100% vs. postmenopausal 84%; p=0.02), preoperative CA 125 (normal 100% vs. elevated 64%; p=0.005), ascites (present 33% vs. absent 100%; p=0.000), and age (<55 years 100% vs. ≥ 55 years 77%; p= 0.002). Conclusion:This study confirms a good outcome for patients with AOGCT. They require long-term follow-up as late recurrences can occur many years post definitive therapy. The presence of ascites and elevated preoperative CA 125 levels were associated with a higher risk of recurrence and poor prognosis. Outcomes appear unaffected by fertility-sparing surgery or adjuvant chemotherapy.

Identification of prognostic factors and construction of nomogram to predict cancer‐specific survival for patients with ovarian granulosa cell tumors

“…According to the fifth edition World Health Organization (WHO) classification of female genital tumors, OGCTs encompass adult ovarian granulosa cell tumors (aOGCTs) and juvenile ovarian granulosa cell tumors (jOGCTs), representing 95% and 5%, respectively 2 . OGCTs are characterized by slow progression and relatively favorable prognosis, with 78–91% of women being detected at early‐stage, and its 5‐year overall survival (OS) rate ranging between 75%–95% 1,3 . This suggests that OGCTs exhibit an indolent character.…”

“…2 OGCTs are characterized by slow progression and relatively favorable prognosis, with 78–91% of women being detected at early‐stage, and its 5‐year overall survival (OS) rate ranging between 75%–95%. 1 , 3 This suggests that OGCTs exhibit an indolent character. Nonetheless, 20%–30% of them still relapse after treatment, some even after 10 years or more.…”

Defining the relationship between ovarian adult granulosa cell tumors and synchronous endometrial pathology: Does ovarian tumor size correlate with endometrial cancer?

“…5,6 However, fertility-sparing surgery is appropriate for selected patients. 7 The main feature of AGCTs is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. 8 Exposure of the endometrium to high levels of estrogen produced by granulosa cells is responsible for the development of various types of endometrial pathology.…”

“…Cytoreductive surgery includes bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy, endometrial biopsy, peritoneal biopsies and the removal of any suspicious lesions [5,6]. However, fertility-sparing surgery is appropriate for selected patients [7].…”