ArticleFrontiers in oncology2025
Clinical characteristics and prognostic factors of ovarian granulosa cell tumors: a retrospective cohort study.
Article in Frontiers in oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Ovarian granulosa cell tumors (OGCTs) are rare sex cord-stromal tumors comprising distinct histopathological entities: adult-type and juvenile-type GCTs. Comparative data on clinical characteristics and outcomes between these subtypes remain limited. Methods: A retrospective analysis was performed on 29 patients diagnosed with OGCTs (26 adult-type and 3 juvenile-type) from January 2008 to December 2024. Clinical data, tumor markers, pathological features, surgical approaches, and survival outcomes were assessed. Relapse-free survival (RFS) was evaluated using Kaplan-Meier analysis. Given the small juvenile cohort (n=3) with zero recurrence events during follow-up and distinct biological characteristics, prognostic factor analysis using Cox regression was restricted to adult-type GCTs (n=26, 3 recurrence events). Results: OGCTs exhibited distinct age-related patterns, with adult-type tumors primarily affecting postmenopausal women (median age 50.5 years) and juvenile-type tumors occurring in pediatric patients (median age 13.0 years) (p = 0.005). Most patients (89.7%) presented with FIGO stage I disease, with stage IC being the most common (55.2%). Abdominal mass was the most frequent presenting symptom (51.7%). Immunohistochemically, both subtypes showed high positivity for inhibin-α (93.1%), calretinin (92.3%), and CD99 (95.0%). Fertility-sparing surgery was performed in all juvenile-type cases (100%) compared to 19.2% of adult-type cases (p = 0.018). Recurrence occurred in three patients (10.3%), all of whom had adult-type tumors. In adult-type GCTs, advanced FIGO stage (IC-III) was the only independent prognostic factor for RFS in multivariate analysis (HR 13.57, 95% CI 1.19-154.3, P = 0.035). Preoperative CA125 showed a trend (HR 1.04 per U/mL, P = 0.079) that did not reach statistical significance. Conclusions: Within the constraints of limited follow-up (median 60 months) and small sample size, early-stage OGCTs demonstrate favorable short- to intermediate-term outcomes, with FIGO stage as the primary prognostic determinant in adult-type disease. Fertility-sparing surgery appears feasible in early-stage disease, particularly for juvenile-type tumors. However, the short follow-up duration likely underestimates true long-term recurrence rates in adult-type GCTs, which characteristically recur late. Limitations: Small sample size (particularly juvenile cohort, n=3), single-center design, relatively short follow-up (median 60 months; 72% <8 years), and absence of GCT-specific tumor markers (Inhibin B, AMH) limit generalizability and assessment of long-term outcomes.
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