Clinico-pathological characteristics of adult granulosa cell tumors of the ovary and the role of staging surgery: A national database study.

OBJECTIVE

The role of staging surgery in women with Adult Ovarian Granulosa Cell Tumors (AGCT) remains uncertain. This study aimed to assess if omitting secondary staging surgery is safe amongst women who were incompletely staged at primary surgery using recurrence rate as the primary outcome. Furthermore, we sought to identify risk factors for recurrence which may be informative for selection of patients for conservative treatment.

METHODS

Women diagnosed with AGCT between 2005 and 2019 were identified using data from nationwide Danish Databases (DGCD and NPR). Patients undergoing primary staging surgery, those undergoing incomplete staging surgery with secondary staging and those undergoing incomplete staging not followed by secondary staging. Adjusted binary logistic regression and Cox analyses were used to assess recurrence risk and recurrence free survival.

RESULTS

We identified 223 cases with AGCT in Denmark. The recurrence rates were 17%, and 4.8% in patients undergoing complete and incomplete primary staging surgery, respectively (p < 0.015). FIGO Stage (1A vs. ≥IC), tumor size, and high mitotic activity were identified as risk factors of recurrence. The risk of recurrence among patients who were conservatively treated after incomplete primary staging surgery was very low (4.8%), which could be explained by a low-risk profile (high proportion of stage IA, small tumors, and low/moderate mitotic activity) among these patients.

CONCLUSION

In a real-world setting, omitting secondary staging surgery seems safe in primary incompletely staged patients with a low-risk recurrence profile. We confirmed that FIGO stage, tumor size, and mitotic activity are all significantly associated with the risk of recurrence in incompletely staged patients.