title: Factors associated with an increased risk of recurrence in women with ovarian granulosa cell tumors.
abstract: BACKGROUND
  Studies demonstrate that patient factors such as race, body composition, medical co-morbidities, and medications may be associated with cancer related outcomes independent of the patient's malignancy and related therapies for the cancer. The goal of this study is to determine demographic and prognostic factors affecting disease recurrence in women with early stage ovarian granulosa cell tumors (GCT).
  
  
  METHODS
  This study used a dual-institution retrospective analysis of women diagnosed with GCT between 1995 and 2010. Demographics including age, race, body mass index (BMI), stage, diabetes (DM), adjuvant treatment, and progression-free survival (PFS) were extracted. Hazard ratios for recurrence were estimated by univariate and multivariate Cox regression models.
  
  
  RESULTS
  One hundred and four women were identified with a median age of 50 years (range 12-87 years). Fifty-five (58.5%) were Caucasian, 29 (30.9%) African American, and 10 (10.2%) others. Median BMI was 29 kg/m(2) (range 12-57 kg/m(2)). Twenty-one patients had DM. The majority of women had clinical stage I disease (95.0%), 5 (6.4%) had stage II/III disease, and 5 were unstaged. In univariate analysis among early stage disease, DM showed the strongest association with recurrence (HR=3.37, 95% CI=1.38-8.20). In multivariate analysis, DM was associated with an HR of 3.19 for recurrence (95% CI=1.08-9.44).
  
  
  CONCLUSIONS
  Our results emphasize that diabetes is one of the strongest predictors of recurrent disease in patients with ovarian GCTs. As this disease is characterized by long disease-free intervals prior to recurrence, this may serve as a potential chemopreventive strategy in patients felt to be at higher risk for recurrence.
authors.affiliation: Division of Gynecologic Oncology, The University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Anuj
authors.initials: A
authors.lastname: Suri
authors.forename: Ebony B
authors.initials: EB
authors.lastname: Carter
authors.forename: Neil
authors.initials: N
authors.lastname: Horowitz
authors.forename: Sheri
authors.initials: S
authors.lastname: Denslow
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006106:Granulosa Cell Tumor / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology*; D009657:North Carolina / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Diabetes; Granulosa cell tumor; Obesity; Ovary