title: Clinical characteristics and survival of patients with an adult-type ovarian granulosa cell tumor: a 56-year single-center experience.
abstract: OBJECTIVE
  The objective of this study was to evaluate clinical prognostic factors and survival of patients with ovarian granulosa cell tumors (GCTs) in a long-term follow-up study.
  
  
  METHODS
  A total of 240 adult-type GCTs diagnosed in Helsinki University Central Hospital from 1956 to 2012 were histologically reevaluated. Data were analyzed for several clinical factors in relation to major developments in imaging, surgery, and chemotherapy: the old era (1956-1983) and the new era (1984-2012). Prognostic factors for survival were evaluated in the univariate and multivariate analyses.
  
  
  RESULTS
  The original diagnosis was confirmed in 187 (77.9%) patients. The International Federation of Gynecology and Obstetrics stage I disease was present in 89.2%; stage II, in 7.0%; stage III, in 3.8%; and stage IV, in 0% of cases. The mean age at diagnosis (52.9 years) and the mean tumor size (10.8 cm) did not change significantly over time. The most common presenting symptom was abnormal bleeding, but 14% were asymptomatic. The mean follow-up period was 15.7 years. Recurrence rate was similar in both eras. The GCT-specific 5-, 10-, and 20-year survival rates were 95.6%, 88.1%, and 79.8% in the old era as well as 97.2%, 94.8%, and 94.8% in the new era, respectively. In the univariate analyses, old era, patient age older than 60 years, tumor size greater than 10 cm, advanced stage, residual tumor, and use of hormonal adjuvant treatment were associated with GCT-related deaths. Prior use of oral contraceptives and history of infertility improved survival rates. In the multivariate analysis, stage was the only independent prognostic factor for GCT-specific survival.
  
  
  CONCLUSIONS
  An accurate histological diagnosis of GCT is essential. Stage IV disease is an extreme rarity. However, tumor stage overcomes other possible clinical prognostic factors for GCT-specific survival. Fertility-sparing surgery, the use of oral contraceptives, or hormonal replacement therapy seems not to be risk factors for survival.
authors.affiliation: *Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, †Children's Hospital, University of Helsinki and Helsinki University Central Hospital, and ‡Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Central Hospital, Helsinki, Finland; and §Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO.
authors.forename: Saara
authors.initials: S
authors.lastname: Bryk
authors.forename: Anniina
authors.initials: A
authors.lastname: Färkkilä
authors.forename: Ralf
authors.initials: R
authors.lastname: Bützow
authors.forename: Arto
authors.initials: A
authors.lastname: Leminen
authors.forename: Markku
authors.initials: M
authors.lastname: Heikinheimo
authors.forename: Mikko
authors.initials: M
authors.lastname: Anttonen
authors.forename: Annika
authors.initials: A
authors.lastname: Riska
authors.forename: Leila
authors.initials: L
authors.lastname: Unkila-Kallio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006106:Granulosa Cell Tumor / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality*; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult