Clinical and pathological insights from 164 patients with ovarian granulosa cell tumors: An 18-year real-world study from China.

Abstract

e17553 Background: Granulosa cell tumors (GCTs) are the most common type of sex-cord stromal tumors of the ovary. The incidence of this disease is low, and current research mainly consists of studies with small sample sizes. Consequently, there is limited evidence and experience regarding optimal treatment. Furthermore, the necessity of lymphadenectomy and chemotherapy remains a topic of controversy. Methods: The clinicopathological data of patients diagnosed as GCTs who underwent surgery at West China Second University Hospital from January 2001 to January 2018 were collected. This study explored potential factors that might influence the prognosis of this disease through real-world data. Results: This study included 164 patients with GCTs, comprising 146 with adult-type GCTs (AGCTs) and 18 with juvenile-type GCTs (JGCTs). The mean age of the cohort was 44.24±15.13 years. According to FIGO staging, 132 patients (80.49%) were classified as Stage I, 16 (9.76%) as Stage II, 5 (3.05%) as Stage III, and 1 (0.61%) as Stage IV. A total of 48 patients underwent comprehensive staging surgery with fertility preservation, while 88 patients underwent pelvic lymphadenectomy, none of whom exhibited lymph node metastasis. Immunohistochemical analysis of tumor samples from 138 patients revealed that α-inhibin (94.93%), vimentin (97.92%), and calretinin (92.0%) are crucial for the diagnosis and differential diagnosis of GCTs. Postoperative chemotherapy was administered to 78 patients (47.56%), while 86 patients (52.44%) did not receive chemotherapy. After a follow-up period of 19 to 146 months, 4 patients (2.44%) died, and 10 patients (6.10%) experienced recurrence. FIGO staging (P<0.001) was identified as a significant risk factor for recurrence, whereas pathological type, age, tumor size, fertility-sparing surgery, pelvic lymphadenectomy, and postoperative chemotherapy did not significantly affect the recurrence rate. Univariate analysis indicated that tumor diameter (P=0.026), pathological type (P<0.001), FIGO staging(P<0.001), and pelvic lymphadenectomy(P=0.021) were risk factors influencing survival in GCTs. The Cox model further demonstrated that FIGO staging(P=0.003) was an independent risk factor for overall survival. Conclusions: This 18-year real-world study demonstrates that GCTs are frequently diagnosed at an early stage, leading to favorable prognosis. Pelvic lymphadenectomy may be unnecessary during staging surgery. FIGO staging has been identified as an independent risk factor for recurrence and mortality. The impact of postoperative chemotherapy on survival warrants further investigation, requiring larger sample sizes and extended follow-up periods.