Adjuvant chemotherapy does not improve disease-free survival in FIGO stage IC ovarian granulosa cell tumors: The MITO-9 study.
OBJECTIVE
Evidence-based management of granulosa cell tumors of the ovary (GCT) has been not yet standardized: surgery, including fertility-sparing procedures for young women, has been traditionally the standard treatment; on the other hand, chemotherapy has been used for treatment of advanced and/or recurrent disease. However, very limited experience, has been selectively focused on the role of adjuvant chemotherapy in stage IC patients. The objective of this retrospective study was to assess the efficacy of first line postoperative chemotherapy in patients with stage IC treated at the Italian Centers involved in the MITO (Multicenter Italian Trials in Ovarian cancer) Group.


METHODS
A retrospective multi-institutional review of patients with GCT of the ovary at FIGO stage IC treated or referred to MITO centers was conducted. Surgical outcome, pathological findings and follow-up data were analysed. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors factors for disease free survival.


RESULTS
A total of 40 patients with primary GCT of the ovary at FIGO stage IC were identified. The median follow-up period was 96months (range 7-300). At multivariate analysis, surgical treatment outside MITO centers and incomplete surgical staging were independent poor prognostic indicators for recurrence; adjuvant chemotherapy did not retain significant predictive value for recurrence.


CONCLUSIONS
This study raises the question about the value of adjuvant chemotherapy in stage IC GCT: a comprehensive evaluation of a larger series is urgently needed in order to characterize stage IC substages who can be spared treatment toxicity.
Gynecology Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: mangili.giorgia@hsr.it.
G
G
Mangili
Gynecology Department, San Raffaele Scientific Institute, Milan, Italy.
J
J
Ottolina
Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
G
G
Cormio
Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
Vera
V
Loizzi
Department of Gynecologic Oncology, S. Orsola-Malpighi University Hospital, Bologna, Italy.
P
P
De Iaco
Medical Oncology Division, National Cancer Institute Regina Elena, Rome, Italy.
D A
DA
Pellegrini
Gynecology Department, San Raffaele Scientific Institute, Milan, Italy.
M
M
Candiani
Gynecologic Oncology Department, Centro di riferimento Oncologico (CRO) National Cancer Institute, Aviano, Italy.
G
G
Giorda
Obstetrics and Gynecology Department, IRCCS Foundation Policlinico Mangiagalli Regina Elena Hospital, Milan, Italy.
G
G
Scarfone
Uro-Gynecological Oncology, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy.
S C
SC
Cecere
Gynecology Department, Riuniti di Bergamo Hospital, Bergamo, Italy.
L
L
Frigerio
Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, Pisa University, Pisa, Italy.
A
A
Gadducci
Department of Gynecology, Obstetrics and Urology, Umberto I, "Sapienza" University of Rome, Rome, Italy.
C
C
Marchetti
Department of Health Sciences and Medicine, University of Molise, Campobasso/Gynecologic Oncology Unit, Policlinico Universitario "Agostino Gemelli", Rome, Italy.
G
G
Ferrandina
D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006106:Granulosa Cell Tumor / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies
Adjuvant chemotherapy; Granulosa cell tumors of the ovary; MITO; Prognostic factors; Relapse; Stage IC