A 20 Years’ Experience on Granulosa Cell Tumour

Abstract

BACKGROUND The prognostic factors and the recurrent nature of Granulosa cell tumour is unclear. Chemotherapy has a compelling role in locally advanced cases, inoperable cases and metastatic cases. This retrospective study results elucidate the need for chemotherapy in advanced cases which then translates to a better overall survival benefit, increased disease free survival and delay in progression. The prognostic factors and the recurrent nature of Granulosa cell tumour is unclear and unpredictable added to the fact that these tumours are rare and have an indolent course. There is only a scarce data on the optimum treatment for this group of patient. The aim of this study was to pursue the clinico-pathological features and prognostic factors for the recurrence patterns and the optimal management of these cases. MATERIALS AND METHODS This is a descriptive study with secondary data from records. A retrospective multi-institutional review of patients with GCTs of the ovary treated or referred were analysed. Surgical outcome, pathological details, chemotherapy details, follow-up details, relapse pattern and the treatment of the relapse disease were analysed. Kaplan-Meier survival analysis was used to determine the prognostic and predictive markers for survival. RESULTS This is an analysis of the survival rate and the treatment results of Granulosa cell tumour between 1995 and 2015 over a period of 20 years. We have analysed the results of 126 patients, of which 53 patients (42%) were premenopausal and 73 patients (58%) were postmenopausal. Out of the 126 patients 84 patients had complete surgical staging which constitutes transabdominal hysterectomy and bilateral salpingo-oophorectomy and a staging laparotomy, 35 patients had incomplete or suboptimal surgery, 7 patients had fertility sparing operation. The 67 patients who had complete surgery and early stage disease with no risk factors were on observation. These patients have not had relapse. A dataset of 34 relapsed granulosa cell tumour patients were analysed. Out of these, 19 patients have survived cancer. Out of 34 cases, 10 patients had complete surgery and 15 patients had incomplete surgery including fertility preserving surgery. Kaplan-Meier survival analysis results show that cancer was cured by complete surgery followed in chemotherapy wherever high-risk factors were present, whereas the survival rate drastically declined in the cases of incomplete surgery without adjuvant chemotherapy. For patient's stage of cancer size of the tumour, type of surgery done, tumour spill, histopathology and chemotherapy in positive high-risk parameters have relatively more effect on survival chance. CONCLUSION Granulosa cell tumours are known for their rarity. Chemotherapy has a compelling role in locally advanced cases, inoperable cases, metastatic cases, in cases with tumour spill or rupture, certain histopathological variants (such as juvenile granulosa cell tumour, yolk sac tumour) and tumours > 9 cm. Other factors which do contribute to the prognosis would be age at dia...