Prognostic factors for recurrence in early stage adult granulosa cell tumor of the ovary.
Adult granulosa cell tumors (AGCTs) account for less than 5 % of all ovarian malignancies, whereas the majority (95 %) occurs after the age of 30 (adult-type) and present at an early stage. Aim of this study is to identify clinical and pathological risk factors for recurrence in early stage AGCTs.



Retrospective review of patients with AGCT of the ovary, treated surgically at our institution from 1996 to 2011. Clinical, pathological and follow-up data were collected. Systematic analysis was performed to determine variables for predicting recurrence.



In total, 43 patients were identified. The mean age at diagnosis was 54.3 years and 65.1 % of them were postmenopausal. All patients underwent surgical staging and intraoperative rupture of the tumor occurred in four of them (9.3 %). The majority of the cases were staged as IA (72.1 %) while 10 (23.3 %) were staged as IC and only two patients as IIB. Mitotic index was 4 or more in 34.9 % of the patients and nuclear atypia was moderate to high in 60.5 %. During follow-up period (mean 9.2 years), recurrence occurred in three patients (7 %) with no deaths recorded so far. The cumulative recurrence free rate for the first 2 years was 97.6 % (SE = 2.4 %), for 5 years 94.9 % (SE = 3.5 %) and for 10 years 91.0 % (SE = 5.1 %).Tumor size, stage and mitotic index proved to be independent predictors for recurrence at the multivariate analysis.



Recurrence in early stage AGCT seems to be associated with stage, tumor size and mitotic index. All the above should be taken into consideration when tailored postoperative management is planned.
1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece. thomakir@hotmail.com.
Nikolaos
N
Thomakos
1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece.
Ioannis
I
Biliatis
1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece.
Ioanna
I
Koutroumpa
Pathology Department, "Alexandra" Hospital, Athens, Greece.
Maria
M
Sotiropoulou
Department of Clinical Therapeutics, University of Athens, "Alexandra" Hospital, Athens, Greece.
Aris
A
Bamias
Department of Clinical Therapeutics, University of Athens, "Alexandra" Hospital, Athens, Greece.
Michalis
M
Liontos
1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece.
Georgios
G
Vlachos
1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece.
Alexandros
A
Rodolakis
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006106:Granulosa Cell Tumor / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies
Early stage; Granulosa tumor; Ovarian cancer; Prognostic factors