Various prognostic factors are reported worldwide for granulosa cell tumor ovary.
Data of all biopsy proven granulosa cell tumor patients with age >18years were retrospectively collected from the Institute Registry between Jan 2011 and May 2022. The chemotherapy was given if capsule breached, size >10cm,>10/10HPF in tumor or > FIGO stage IA/IB. Variables like age, stage, size of tumor(T), mitotic rate, metastatic sites, treatment modality, chemotherapy regimen and response to therapy were collected.
Objectives To find-out overall survival (OS) and event-free survival (EFS) and identify prognostic factors influencing them. Prognostic factors were analysed by univariate and multivariate cox regression. Survival curves were plotted via Kaplan Meier.
There were 57 patients. Fifty-five were diagnosed and treated in this Institute while two of them presented at recurrence. Median age group was 47years (yrs). Median follow up was 48 months. Median OS and EFS were not reached (NR) at the time of analysis. Out of 55 one died due to disease progression and 10 relapsed (18.2%). Peritoneum was the most common recurrence site. Patients who presented with recurrence survived >5years after secondary cytoreductive surgery (CRS) and chemotherapy.
The 5yr OS rate was 100% for stages I-III, T size >10cm, age ≥40 yrs, ≤ 10/10 HPF and complete CRS. Similarly, 5yr EFS rates were >65% except for stage IV (0%) and fertility sparing surgery (FSS) (63.2%). Univariate analysis showed significant OS benefit for stage I-III vs IV (p=0.022) and EFS benefit for CRS vs FS (p = 0.047). Multivariate analyses found significant EFS benefits for stage I-III vs stage IV (p= 0.033), CRS (p= 0.005), and mitotic rate >10/10HPF (p=0.042). However, no factors showed statistically significant OS outcome.
The present study showed significant EFS benefits for stage I-III, mitotic rate >10/10HPF and CRS modality. But nonsignificant favourable OS outcomes were seen with T size >10cm, age ≥40 yrs compared to literature review. Need prospective evidence on combined modality in overcoming prognostic factors.