title: Predictors of recurrence of ovarian granulosa cell tumors.
abstract: OBJECTIVE
  The prognosis of granulosa cell tumors (GCTs) is overall favorable, but a proportion of patients will experience recurrence. We report one of the largest series of patients with GCT for whom clinical, morphologic, and immunohistochemical markers have been assessed for their roles as predictors of recurrence.
  
  
  METHODS
  Patients with the diagnosis of GCT were identified at 2 hospitals from 1974 to 2004; a detailed chart analysis was performed. Tissue blocks were analyzed immunohistochemically for mitotic index, luteinization, inhibin staining, epidermal growth factor receptor, and Ki67 expression. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Sixty-seven patients were identified. Follow-up data up to 30 years were available. The mean age at diagnosis was 48.1 years. Twenty-five patients experienced recurrence. A statistically significant correlation (P < 0.05) was observed for age at diagnosis, with earlier age being an adverse factor (43.6 vs 50.9, P < 0.01), and use of adjuvant chemotherapy postoperatively (24% vs 40% in the nonrecurrence group). Luteinization and the immunohistochemical markers, such as inhibin, Ki67, and epidermal growth factor receptor, seemed to significantly increase the risk of recurrence if expressed. A multivariate analysis model confirmed that younger age at diagnosis and higher expression of inhibin and Ki67 are significant risk factors of GCT recurrence.
  
  
  CONCLUSIONS
  Identification of patients who are at a high risk for recurrence of GCT is critical. Routine treatment for all patients with cytotoxic chemotherapy is not justified. We report a set of predictors of recurrence for GCT that identified subsets of patients who may benefit from prolonged surveillance and/or adjuvant systemic chemotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, UCLA David Geffen School of Medicine, Los Angeles, CA 90046, USA. vbnosov@gmail.com
authors.forename: Vladimir
authors.initials: V
authors.lastname: Nosov
authors.forename: Ivaldo
authors.initials: I
authors.lastname: Silva
authors.forename: Fattaneh
authors.initials: F
authors.lastname: Tavassoli
authors.forename: Leiva
authors.initials: L
authors.lastname: Adamyan
authors.forename: Robin
authors.initials: R
authors.lastname: Farias-Eisner
authors.forename: Peter E
authors.initials: PE
authors.lastname: Schwartz
mesh_terms: D015331:Cohort Studies; D005260:Female; D006106:Granulosa Cell Tumor / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors