title: Maximum surgical effort is warranted for recurrent adult granulosa cell tumors of ovary.
abstract: OBJECTIVE
  Adult granulosa cell tumor (AGCT) of ovary is a rare tumor and usually has a benign course. Due to its indolent nature, recurrences are observed in a wide period and data on management of recurrences in AGCT are relatively sparse. We aimed to evaluate the clinical features, management, and survival of patients with recurrent AGCT.
  
  
  METHODS
  The data of 144 patients with AGCT treated in Etlik Zubeyde Hanim Teaching and Research Hospital between 1990 and 2013 were retrospectively evaluated. Patients with radiologic or pathologic recurrences were included in the analysis.
  
  
  RESULTS
  A total of 18 patients (12.5%) with recurrent AGCT were included. Median follow-up was 97.5 months (range 6-255 months). A total of 16 patients underwent salvage surgery and maximal debulking was achieved in 13 patients. Ten patients had unifocal and 8 had multifocal tumors. Maximal debulking could be achieved in all patients with unifocal recurrence. On the other hand, maximal debulking could only be obtained in 3 patients (37%) with multifocal recurrence (p = 0.031). Multifocality of recurrent disease and the presence of residual tumor after surgery were associated with diminished progression-free survival and overall survival (31 vs 207 months, p = 0.031; and 22 vs 220 months, p = 0.005, respectively).
  
  
  CONCLUSIONS
  Multifocal recurrence and suboptimal surgery were related with poor survival outcomes in patients with AGCT recurrence. Surgical treatment of recurrent AGCT should aim to achieve no visible disease.
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Karalok
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Isin
authors.initials: I
authors.lastname: Ureyen
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Tasci
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Derman
authors.initials: D
authors.lastname: Basaran
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Turkmen
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Nurettin
authors.initials: N
authors.lastname: Boran
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Derya Akdag
authors.initials: DA
authors.lastname: Cirik
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Gunsu
authors.initials: G
authors.lastname: Kimyon
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Tulunay
authors.affiliation: Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara - Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Turan
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006106:Granulosa Cell Tumor / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome