Adult-type ovarian granulosa cell tumour: Treatment Outcomes from a Single Institutional Experience

Background: Ovarian granulosa cell tumour is rare. This study aim is to report the clinical characteristics and long-term outcomes of adult-type OGCT (AOGCT) at King Faisal Specialist Hospital and Research Centre ( KFSH&RC) and to determine the prognostic factors affecting relapse and survival. we retrospectively reviewed patients with AOGCT, from 1988 to 2014, who were treated at our institution. Baseline characteristics, pathological findings, and outcomes were analysed, and reported. RESULTS: Sixty-one patients with AOGCT were identified with a median age of 49 years. Median follow-up was 5.0 years (range 2.1 -8.2 years). 74% of patients were FIGO stage I, whereas 7% stage II, 5% stage III and unknown in 14%. The most common presenting symptoms included abdominal pain (43%) and vaginal bleeding (43%). The majority of patients (38 patients, 62%) were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Five (8%) patients received adjuvant chemotherapy. Sixteen patients (26%) relapsed with a median time to relapse of 5.5 years (0.7-8.1 years). Half of the recurrences (8 patients, 50%) occurred after 5 years of diagnosis. Five-year overall survival and disease-free survival were 93% and 84%, respectively. Factors associated with high risk of recurrence were presence of ascites (p=0.000) and elevated preoperative CA 125 level (p=0.048). The overall survival was significantly influenced by the menopausal status (premenopausal 100% vs. postmenopausal 84%; p=0.02), preoperative CA 125 (normal 100% vs. elevated 64%; p=0.005), Ascites (present 33% vs. absent 100%; p=0.000), and age (<55 years 100% vs. ≥ 55 years 77%; p= 0.002). CONCLUSION: This study confirms a good outcome of patients with AOGCT. They require long-term follow-up because the recurrence can occur many years post the definitive therapy. The presence of ascites and elevated preoperative CA 125 levels were associated with a higher risk of recurrence and poor prognosis. The outcome seems not to be affected by fertility-sparing surgery and/or adjuvant chemotherapy.