Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases

Abstract

Objective: Ovarian granulosa cell tumors are rare malignancies with a relatively favorable prognosis. However, patients still suffer from disease-related mortality. Therefore, the prognostic factors should be clarified. The purpose of this study was to investigate the clinical and pathologic characteristics related with disease recurrence and mortality in adult type ovarian granulosa cell tumors. Methods: Eighty surgically staged patients with granulosa cell ovarian tumor treated at the Hacettepe University Hospital between 1982 and 2006 were retrospectively reviewed. Clinical and pathological characteristics were analyzed. Results: Granulosa cell ovarian tumors accounted for 4.3% of malignant ovarian neoplasms. Mean age was 47.6 years. The most common presenting symptom was abnormal uterine bleeding (53.7%). Endometrial pathology was detected in 51.2% of patients preoperatively. Seventy percent of patients were diagnosed at stage I, and 53.8% of patients received adjuvant treatment. Mean follow-up was 67.5 months. Overall 5-year and 10-year survival was 91% and 86%, respectively. Mean survival was 147.1 months. Recurrence rate was 11.2%. In univariate analysis, advanced stage, advanced age, residual disease after surgery, and need for adjuvant treatment were associated with disease-related mortality and advanced stage disease and absence of initial staging surgery were associated with disease recurrence. However, in multivariate analysis, only initial stage was found to be a significant prognostic factor. Conclusion: Initial stage seems to be the single most important prognostic factor in ovarian granulosa cell tumors. Therefore, a comprehensive staging surgery should be attempted to document the real extent of disease and to estimate the oncologic outcome more accurately.

Clinical and Pathologic Features of Patients with Rare Ovarian Tumors: Multi-Center Review of 167 Patients by the Anatolian Society of Medical Oncology

“…The cure rates of early stage GCTs approach 100%, and even in the advanced stage of the disease, surgery and the BEP regimen result in cure rates of approximately 75% (Gershenson, 2007;Parkinson et al, 2011;Matei et al, 2013). SCSTs of the ovary are considered low grade malignancies with a relatively more favorable prognosis and are generally treated more often with repeat surgeries compared to epithelial ovarian cancers (Young, 2005;Ayhan et al, 2009). Their natural history is unclear, and the prognostic factors that impact survival remain to be clarified.…”

“…They have different biological behaviors with a variety of histopathological subtypes; in addition, they have curative potential with different treatment approaches compared with much more commonly encountered epithelian ovarian cancers (Quirk and Natarajan, 2005;Young, 2005;Ayhan et al, 2009;Koulouris and Penson, 2009;Colombo et al, 2012;Penson, 2013;Takeuchi et al, 2013). The cure rates of early stage GCTs approach 100%, and even in the advanced stage of the disease, surgery and the BEP regimen result in cure rates of approximately 75% (Gershenson, 2007;Parkinson et al, 2011;Matei et al, 2013).…”

“…The authors indicated that advanced stage, advanced age, the presence of residual tumor after initial surgery, and the requirement of adjuvant treatment were found to be important prognostic factors by univariate analysis. However, multivariate analysis showed that only the initial disease stage was an important prognostic indicator for survival (Ayhan et al, 2009).…”

“…Thus, trials with respect to the ROTs to date tend to consist of too few patients to detect prognostic factors clearly. Of the ROTs, some prognostic factors have been documented in SCSTs, especially granulosa cell tumors (Jamieson et al, 2008;Ayhan et al, 2009;Li et al, 2009;Fotopoulou et al, 2010;Suri et al, 2013). Ayhan et al (2009) analyzed 80 patients with granulosa cell tumor (Ayhan et al, 2009).…”

“…Because these tumors are rarely encountered in clinical practice, randomized clinical trials to evaluate the effects of proposed treatment regimens are limited in the literature. On the other hand, in SCSTs, especially granulosa cell tumors, the stage of disease and age at the time of diagnosis, the presence of residual tumor after the initial surgery, and the number of mitoses and nuclear atypia have been found to be important prognostic factors (Ayhan et al, 2009;Li et al, 2009;Suri et al, 2013).…”