Effects of obesity and adjuvant chemotherapy regimens on progression free survival in patients with ovarian granulosa cell tumors

Background: Because reports on the management of recurrent granulosa cell tumor have been sparse, a consensus as to which patients should undergo surgical resection and which patients should be considered for chemotherapy has not been established. Methods: A total of 21 tumor recurrences in eight patients with granulosa cell tumor were reviewed. Results: Surgery was performed as the main treatment for 13 recurrences, while chemotherapy was chosen as the main treatment for eight recurrences. Complete tumor resection could be accomplished in 13 of 16 surgeries (81.3%), which include all the ten recurrences without involvement of liver or diaphragm and without ascites. The number of recurrent masses was significantly higher in the early recurrence group (progression free survival < 2 years) than in the late recurrence (progression free survival > 2 years). All cases with a solitary recurrent tumor at an extra-peritoneal site presented a significantly longer progression free survival. Conclusions: For patients with recurrent granulosa cell tumor, surgery may provide the best disease control. In cases with complete resection, the number of recurrent masses was the predictive factor for the next recurrence, and adjuvant chemotherapy might be considered in such cases.

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Factors associated with an increased risk of recurrence in women with ovarian granulosa cell tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5063 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5063-5063

Author(s):

Anuj Suri ◽

Neil S. Horowitz ◽

Ebony B. Carter ◽

Sheri Denslow ◽

Paola A. Gehrig

Keyword(s):

Adjuvant Chemotherapy ◽

Granulosa Cell ◽

Diabetic Patients ◽

White Race ◽

Risk Of Recurrence ◽

Factors Associated ◽

Granulosa Cell Tumors ◽

Ovarian Granulosa Cell ◽

Increased Risk ◽

Risk Of Cancer

5063 Background: There is emerging data in different malignancies, including gynecologic cancers, demonstrating factors independent of a patient’s tumor characteristics, which are associated with an increased risk of cancer recurrence. The goal of this study is to determine demographic and prognostic factors affecting recurrence of disease (RD) in women with ovarian granulosa cell tumors (GCT). Methods: A dual-institution retrospective analysis of patients diagnosed with GCT between 1995 and 2010. Demographics including age, race, BMI, stage, diabetes (DM), adjuvant treatment, and progression free survival (PFS) were extracted. Hazard ratios for recurrence were estimated by univariate and multivariate Cox regression models Results: One hundred nine women identified with a median age of 50 (range 12-87). Fifty-six (57.1%) were Caucasian, 32 (32.7%) African American, and 10 (10.2%) were other. Median BMI was 29 (range 12-57). Twenty-one patients had DM. The majority of women had stage I disease (89.0%), 7 (6.4%) had stage II/III disease, and 5 were unstaged. In univariate analysis, DM showed the strongest association with recurrence (HR 3.56, 95% CI: 1.57-8.11). Non-white race was also associated with higher risk of RD, though the association was not statistically significant (HR 1.74, 95% CI: 0.78-3.87). The association between DM and RD was also found in multivariate analysis controlling for all factors including non-white race and BMI (HR 2.99, 95% CI: 1.11-8.08). Only 19 (17%) patients received adjuvant chemotherapy consisting of one of two different adjuvant chemotherapy regimens bleomycin, etoposide, and cisplatin or paclitaxel and carboplatin, however there was no difference in outcome based on chemotherapy regimen (p=0.24). Conclusions: This is the largest study analyzing factors associated with risk of recurrence in women with ovarian GCT. Studies have demonstrated higher morbidity among diabetic patients with breast and colon cancer and this may be modifiable with metformin. Our results emphasize that diabetes is one of the strongest predictors of recurrent disease in patients with ovarian GCT. Further studies are necessary to evaluate the effect of other factors such as adjuvant chemotherapy.

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Combination of bleomycin, etoposide, and cisplatin for the treatment of advanced ovarian granulosa cell tumors

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.01049.x ◽

2008 ◽

Vol 18 (3) ◽

pp. 446-452 ◽

Cited By ~ 35

Author(s):

P. Pautier ◽

M. Gutierrez-Bonnaire ◽

A. Rey ◽

I. Sillet-Bach ◽

C. Chevreau ◽

...

Keyword(s):

Granulosa Cell ◽

Overall Response Rate ◽

Response Rate ◽

Complete Response ◽

Event Free Survival ◽

First Line ◽

Free Survival ◽

Granulosa Cell Tumors ◽

Ovarian Granulosa Cell

The objective is to investigate the activity and toxicity of bleomycin, etoposide, and cisplatin (BEP) regimen in ovarian granulosa cell tumors (OGCTs). Twenty consecutive patients with initial metastatic (5 patients) or recurrent (15 patients) OGCT were treated; BEP regimen: B: 30 mg intravenously or intramurally on days 1, 8, and 15; E: 100 mg/m2/day on days 1–5; and P: 20 mg/m2/day on days 1–5. Median age: 42 years (range: 17–60); median follow-up: 45 months (range: 3–112). The overall response rate is 90% (nine clinical complete response [CR], nine clinical partial response) with a median duration of 24 months (range: 4–77). A second-look laparotomy performed in 11 patients showed a pathologic CR in 7 cases and microscopic disease in 1 case. Seven patients remain free of disease (at 4–84 months); 11 patients relapsed (median: 24 months, range: 13–58), 12 patients are still alive, and 9 patients are without disease (2 patients in second CR). At 4 years, overall survival and event-free survival are respectively 58% and 30%. Toxicity is evaluable for 19 patients (48 cycles). A grade 4 neutropenia occurred in 15% of cycles (in seven patients) with a febrile neutropenia in four patients. Five patients experienced a low bleomycin pulmonary toxicity. BEP regimen appears to be an active regimen for OGCT in first-line chemotherapy.

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