title: Prognostic predictors and spread patterns in adult ovarian granulosa cell tumors: a multicenter long-term follow-up study of 108 patients.
abstract: OBJECTIVE
  To identify prognostic predictors and spread patterns in adult ovarian granulosa cell tumors (OGCTs).
  
  
  METHODS
  Available retrospective data of 108 OGCT patients managed at three centers between January 1, 1991 and December 31, 2010 were abstracted and analyzed.
  
  
  RESULTS
  Stage distributions at diagnosis for stage I, II and III OGCT were 84.3, 5.4, and 9.3 %, respectively. Optimal cytoreduction with no macroscopically visible disease was achieved in 99/108 (91.6 %) patients. The median disease-free interval to first recurrence was 61 months. The overall 5- and 10-year survival rates were 93.3 and 90.9 %, respectively. Disease recurred in 18 (16.6 %) patients, and 8 (7.4 %) patients died of their disease. The first recurrence sites included the pelvic peritoneum (n = 10), liver/liver-capsule (n = 5), rectosigmoid colon (n = 4), retroperitoneal lymph nodes (n = 3), omentum (n = 3), small bowel mesenterium (n = 2), and vaginal cuff (n = 2). Multiple-site recurrence was observed in 9/18 (50 %) patients. Secondary cytoreduction requiring extensive surgery was performed in 14 patients with an optimality rate of 71.4 %. The remaining four patients received only chemotherapy. Multivisceral approaches, including pelvic peritonectomy (n = 9; 64.2 %), rectosigmoid resection (n = 3; 21.4 %), and segmental liver capsule resection (n = 2; 14.2 %) were performed more frequently during the secondary surgery. Definitive retroperitoneal lymph node metastasis rates at the initial and recurrent settings were 5.1 % (3/58) and 21.4 % (3/14), respectively. Both stage and residual tumor status were significantly associated with recurrence in univariate and multivariate analyses.
  
  
  CONCLUSIONS
  Stage and residual tumor status are predictors of recurrence. Pelvic peritoneal, nodal and hepatic involvement, and multiple-site spread patterns requiring extensive cytoreductive surgery are likely associated with recurrence of OGCTs.
authors.affiliation: Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Gaziler Street, 35120, Izmir, Turkey, drertas@gmail.com.
authors.forename: Ibrahim Egemen
authors.initials: IE
authors.lastname: Ertas
authors.forename: Kemal
authors.initials: K
authors.lastname: Gungorduk
authors.forename: Salih
authors.initials: S
authors.lastname: Taskin
authors.forename: Levent
authors.initials: L
authors.lastname: Akman
authors.forename: Aykut
authors.initials: A
authors.lastname: Ozdemir
authors.forename: Rifat
authors.initials: R
authors.lastname: Goklu
authors.forename: Mustafa Cosan
authors.initials: MC
authors.lastname: Terek
authors.forename: Aydin
authors.initials: A
authors.lastname: Ozsaran
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Dikmen
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yildirim
authors.forename: Firat
authors.initials: F
authors.lastname: Ortac
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006106:Granulosa Cell Tumor / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis