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abstract
Highlights
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- Tumor rupture is the strongest predictive factor for AGCT recurrence.
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- AGCT requires active follow up for ten to fifteen years after primary diagnosis.
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- Recurrences may develop asymptomatically and in multiple anatomical locations.
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- Recurrences significantly increase disease-related mortality.
Objective
Adult-type
ovarian granulosa cell tumors (AGCTs) have an unpredictable tendency to
relapse. In a carefully validated patient cohort, we evaluated the
prognostic factors related to AGCT recurrence.
Methods
We
identified all patients diagnosed with AGCT during 1956–2014 in
Helsinki University Hospital, with a minimum follow-up of one year
(n = 240). After a histological review supplemented with FOXL2 (402C-G) mutation status analysis, we analyzed the clinical data for association with relapse.
Results
The
final cohort included 164 (68%) molecularly defined AGCTs (MD-AGCTs).
The majority of the women were postmenopausal (63%), and 92% of tumors
were stage I. The median follow-up time was 15.5 years. Fifty-two (32%)
patients developed tumor recurrence, of whom 55% had successive
recurrences. Multiple-site recurrences were common, and nearly half of
the recurrences were asymptomatic. The median time to the first relapse
was 7.4 years, and 75% of relapses occurred within ten years after
primary diagnosis. The median disease-free survival was 11.3 years.
Premenopausal status at initial diagnosis, FIGO stage Ic versus Ia, and
tumor rupture associated with relapse. However, tumor rupture was the
only independent predictive factor. Of the relapsed patients, 48% died
of AGCT in a median time of 15.3 years.
Conclusion
Tumor
rupture is the strongest predictive factor for recurrence, and these
patients might benefit from a more aggressive initial treatment
approach. AGCT requires active follow up for 10 to 15 years after
primary diagnosis, since recurrences may develop late, asymptomatically
and in multiple anatomical locations.
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