Journal of gynecologic oncology · 2025
Does delayed surgery affect survival in recurrent ovarian adult-type granulosa cell tumor? A retrospective study from a high-volume medical center.
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Zhang Kezhen, Zong Xuan, Zheng Jing, Cao Dongyan, Wu Ming, Xiang Yang, Yang Jie, Yang Jiaxin
Аннотация
OBJECTIVE: To evaluate the clinical characteristics, treatment outcomes, and the impact of delayed debulking surgery in recurrent adult-type granulosa cell tumors (AGCTs).
METHODS: This retrospective cohort study analyzed patients diagnosed with recurrent AGCT between January 2003 and December 2023 at Peking Union Medical College Hospital. Kaplan-Meier analysis, along with univariate and multivariate Cox proportional hazards models, were utilized to identify factors associated with progression-free survival following the first, second, and third recurrences, as well as overall survival (OS).
RESULTS: The study included 92 patients with recurrent AGCT, with approximately 90% of tumors initially staged as stage I. The median follow-up time was 136.0 months (range, 30.0-402.0 months). Extra-pelvic and multifocal lesions were common in recurrent cases. Most patients underwent tumor cytoreductive surgery (CRS) at each recurrence. A time interval from recurrence to CRS of ≥6 months had no adverse impact on OS (multivariate hazard ratio [HR]=1.53; 95% confidence interval [CI]=0.33-7.05; p=0.582), but significantly prolonged the interval between relapses after the first (median interval not reached in the ≥6-month group vs. 40.0 months in the <6-month group; log-rank p=0.023) and second recurrence (median interval, 65.0 vs. 25.0 months; log-rank p<0.001). Gross residual disease after CRS was associated with poorer OS (multivariate HR=7.44; 95% CI=1.95-28.46; p=0.003).
CONCLUSION: Delaying CRS by ≥6 months can prolong the time to the next recurrence without compromising OS, while gross residual disease remains an independent risk factor for poor survival.
METHODS: This retrospective cohort study analyzed patients diagnosed with recurrent AGCT between January 2003 and December 2023 at Peking Union Medical College Hospital. Kaplan-Meier analysis, along with univariate and multivariate Cox proportional hazards models, were utilized to identify factors associated with progression-free survival following the first, second, and third recurrences, as well as overall survival (OS).
RESULTS: The study included 92 patients with recurrent AGCT, with approximately 90% of tumors initially staged as stage I. The median follow-up time was 136.0 months (range, 30.0-402.0 months). Extra-pelvic and multifocal lesions were common in recurrent cases. Most patients underwent tumor cytoreductive surgery (CRS) at each recurrence. A time interval from recurrence to CRS of ≥6 months had no adverse impact on OS (multivariate hazard ratio [HR]=1.53; 95% confidence interval [CI]=0.33-7.05; p=0.582), but significantly prolonged the interval between relapses after the first (median interval not reached in the ≥6-month group vs. 40.0 months in the <6-month group; log-rank p=0.023) and second recurrence (median interval, 65.0 vs. 25.0 months; log-rank p<0.001). Gross residual disease after CRS was associated with poorer OS (multivariate HR=7.44; 95% CI=1.95-28.46; p=0.003).
CONCLUSION: Delaying CRS by ≥6 months can prolong the time to the next recurrence without compromising OS, while gross residual disease remains an independent risk factor for poor survival.