Clinicopathological characteristics and prognosis of adult ovarian granulosa cell tumor: a single-institution experience in China

Abstract

Objectives: We aimed to demonstrate the clinical characteristics and risk factors associated with recurrence of adult granulosa cell tumor (AGCT), as well as the pregnancy and long-term outcomes among patients in a single institution in China.

Patients and methods: We reviewed 141 patients with AGCT in Peking Union Medical College Hospital between January 1983 and September 2015.

Results: The mean patient age was 45.1 years (16-78 years), and the mean tumor size was 8.8 cm (1-40 cm). The most common symptom was irregular menstruation (31.9%, n=45). The disease distribution was stage I in 136 patients, stage II in three patients, and stage III in two patients. Eighty-seven patients (61.7%) underwent radical surgery, while 54 (38.3%) underwent fertility-sparing surgery, of whom five subsequently had a total of five pregnancies. Fifty-two patients underwent pelvic and/or paraaortic lymphadenectomy, and none of them showed lymph node metastasis. The median follow-up period was 72.7 months (8.9-344 months). Twenty-six patients (18.4%) developed recurrence during the study period, with a median time to recurrence of 68 months (7-312 months). Initial stage (stage IC vs IA) and nonstaging surgery were independent risk factors for recurrence in both univariate and multivariate analyses for stage I AGCT patients.

Conclusion: Tumor stage is an independent risk factor for recurrence in patients with AGCT. Staging surgery is recommended for patients with AGCT, though lymphadenectomy may be omitted. Complete tumor resection is important for patient survival in patients with AGCT recurrence. Long-term follow-up is required, even in early-stage AGCT patients.

Keywords: granulosa cell tumor; ovary; pregnancy; recurrence.

Figure 1

Disease-free survival in stage I AGCT patients according to FIGO stage (A) and surgical method (B). Abbreviations: AGCT, adult granulose cell tumor; FIGO, International Federation of Gynecology and Obstetrics.