Analysis of Outcomes and Prognostic Factors after Fertility-Sparing Surgery in Patients with Early Stage Juvenile Granulosa Cell Tumor of the Ovary: Experience from a Tertiary Center

Abstract

Study objective: The objective of the study was to analyze the oncological outcomes and prognostic factors in patients with early-stage juvenile granulosa cell tumor (JGCT) who underwent fertility-sparing surgery.

Design, setting, and participants: All patients with early-stage JGCT who underwent fertility-sparing surgery between January 1995 and December 2017 were reviewed retrospectively.

Interventions: None.

Main outcome measures: The risk factors for recurrence and death in patients with early-stage JGCT were identified.

Results: Thirty-five patients were eligible for the current study. The median age was 17 years (range: 4-30 years), and 10 patients were premenarchal. Nine patients were International Federation of Obstetrics and Gynecology stage IA, and 26 were stage IC. Eight subjects underwent complete staging, whereas 28 had no staging at their initial surgery. In those without initial staging, 3 patients who received initial unilateral salpingo-oophorectomy (USO) and 6 with initial cystectomy underwent secondary surgery for staging or USO with staging, respectively. At the time of the secondary staging operation, 1 of the subjects (treated with USO at initial surgery) was found to be stage III and was excluded from this study. Therefore, 8 patients underwent secondary staging surgery performed by laparoscopic surgery, and none of them suffered recurrence during follow-up. Fourteen of the 16 patients with complete staging surgery underwent lymphadenectomy, and none of them had lymph node metastasis. Thirty-one patients received adjuvant chemotherapy after surgery. Eight patients had disease recurrence after a median follow-up time of 51 months (range: 6-229 months), with a median time to recurrence of 4.5 months (range: 2-52 months). Six patients died of their disease. The 5-year disease-free and overall survival rates were 74.8% and 84.3%, respectively. Univariate analysis showed that incomplete staging surgery was associated with increased risk of recurrence (P = 0.029). Adjuvant chemotherapy was not associated with disease-free survival. Four patients had a total of 6 pregnancies, resulting in 6 live births.

Conclusion: Complete surgical staging is recommended for early-stage JGCT, but lymph node dissection can be omitted. Laparoscopic restaging surgery is feasible for patients with incomplete staging at initial surgery. However, the prognosis of patients with relapsed JGCT remains poor.

Keywords: Fertility-sparing surgery; Juvenile granulosa cell tumor; Ovary; Prognosis.