Recurrence of Adult Granulosa Cell Tumors: The Factors Affecting Secondary Recurrence and Survival After Recurrence.
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Ege Hasan Volkan, Başaran Derman, Gültekin Murat, Özgül Nejat, Boran Nurattin, Koç Sevgi, Üstün Yaprak, Çakır Caner, Yüksel Dilek, Oktar Okan, Ege Gökçen, Tokalıoğlu Abdurrahman Alp, Şahin Mustafa, Uçar Yeşim, Kılıç Fatih, Aytekin Okan, Ersak Burak, Ünsal Mehmet, Tekin Özlem Moraloğlu, Kılıç Çiğdem, Koçak Özgür, Öztürk Çağatayhan, Taşkın Salih, Ortaç Fırat, Üreyen Işın, Toptaş Tayfun, Baş Sevda, Narin Mehmet Ali, Taşçı Tolga, Uçar Gökhan, Şendur Mehmet Ali, Civelek Burak, Uncu Doğan, Erdoğan Özgür, Sancı Muzaffer, Yalçın Hakan Raşit, Selçuk İlker, Turan Taner
Аннотация
METHODS: This multicenter retrospective study included 52 patients with recurrent AGCTs identified among 484 patients treated between 2000 and 2023. Clinical characteristics, treatment modalities, and outcomes were analyzed, with a particular focus on factors associated with secondary recurrence and survival after first recurrence. Recurrence-free survival and overall survival after first recurrence (OS-FR) were evaluated using Kaplan-Meier analysis.
RESULTS: The mean follow-up duration was 99.2 ± 61.5 months. Secondary recurrence occurred in 17 patients (32.7%). A serum CA-125 level >35 U/mL at the time of first recurrence was significantly associated with an increased risk of secondary recurrence (p=0.01). Factors significantly associated with improved OS-FR included a CA-125 level ≤35 U/mL at initial diagnosis and at first recurrence, absence of residual disease following surgery for the first recurrence, and administration of salvage chemotherapy (all p<0.05). In subgroup analysis, salvage chemotherapy was associated with improved OS-FR in patients with residual disease or those who did not undergo surgery (p < 0.01), but not in patients who achieved complete cytoreduction (p = 0.67).
CONCLUSIONS: Secondary recurrence remains a significant clinical challenge in AGCTs. Serum CA-125 levels, surgical outcomes at first recurrence, and the use of salvage chemotherapy may help management strategies in recurrent disease.