Can adjuvant chemotherapy improve the prognosis of adult ovarian granulosa cell tumors?

Abstract

Adult granulosa cell tumors (aGCTs) are rare ovarian neoplasms with a relatively favorable prognosis. They follow an indolent course, characterized by a prolonged natural history and a tendency to late recurrences, Around a quarter of patients develop recurrence and More than 70% of women with recurrence die from their disease, The percentage of patients received chemotherapy increases over time, whether adjuvant chemotherapy improve the prognosis of aGCTs is equivocal? The purpose of this review is to summarize the previously published evidence to evaluate whether adjuvant chemotherapy improve the prognosis of aGCTs to provide guidance for clinical practice. EMBASE, PubMed, Web of Science, WanFang Data and Chinese National Knowledge Infrastructure are searched up to December 2020, used the search strategy of ovar * and granulosa cell * and (tumor * or tumour * or malignan * or cancer * or carcinom * or neoplasm * ) and chemotherapy. The screening process was conducted strictly based on inclusion and exclusion criteria. Clinical studies based on human including randomized controlled trial, quasi-randomised controlled trials, nonrandomised trials cohort study and case control study were included without restriction of time. The percentage of patients received chemotherapy increases over time, but the benefit of adjuvant chemotherapy is lack of high-grade evidence of prospective study, based on the current retrospective studies, we still do not have the evidence to confirm the survival benefit of adjuvant chemotherapy in early stage, advanced stage or recurrent aGCT with no residual tumor, but for inoperable disseminated disease or disease with suboptimal cytoreduction, adjuvant chemotherapy maybe an Optable options. Multinational prospective randomised controlled trials are urgently needed to validate the role of adjuvant chemotherapy. Further research on molecular mechanisms and developing novel targeted medicines may improve the survival of aGCTs.Abbreviations: ACG = adjuvant chemotherapy group, aGCTs = adult granulosa cell tumors, BEP = bleomycin, etoposide, and cisplatin, CR = complete response, DFS = disease-free survival, FIGO = Federation International of Gynecology and Obstetrics, FOXL2 = fork head box protein L2, GCTs = granulosa cell tumors, GOG = Gynecologic Oncology Group, KMT2D = histone-lysine Nmethyltransferase 2D, HER = human epidermal growth factor receptors, NCCN = National Comprehensive Cancer Network, OS = overall survival, PFS = progression-free survival, PR = partial response, PVB = cisplatin, vinblastine, and bleomycin, RCTs = randomized controlled trials, TERT = telomerase reverse transcriptase, TP53 = tumor protein p53.

The Experıance Of Tertıary Center For Adult Granulosa Cell Tumor: Whıch Factors Predıct Survival ?

“…Recurrences in AGCT are usually focal and localized in one region. 16,33 In the study we presented, 66.6% of recurrences were focal and 33.3% were multifocal. This facilitates to avoid leaving residual tumor in salvage cytoreduction.…”

Identification of prognostic factors and construction of nomogram to predict cancer‐specific survival for patients with ovarian granulosa cell tumors

“…Of course, we need to further confirm this result by subgroup analysis in the future study. According to NCCN guidelines, platinum‐based chemotherapy is suggested to OGCTs patients with stage I with high‐risk factors (ruptured or poorly differentiated tumor), as well as those at stage II to IV with category 2B recommendations 7,8,38,39 . Based on the available current studies, the value of adjuvant chemotherapy is uncertain even in stage I with high‐risk factors (ruptured or poorly differentiated tumor), or advanced stage, or recurrent OGCTs without residual tumor after surgery 17,40–42 .…”

“…With the increase of relapse frequency, surgical intervention became extremely difficult owing to extensive adhesion and tumor invasion. Therefore, the treatment for recurrent disease is challenging and 70% of women with relapse eventually die of the disease 8 . Though some cohort studies have demonstrated the risk factors for relapse of OGCTs, 9,10 few literatures are available on the factors predicting the survival outcomes and on a large populations‐based predictive model for OGCTs.…”

“…Therefore, the treatment for recurrent disease is challenging and 70% of women with relapse eventually die of the disease. 8 Though some cohort studies have demonstrated the risk factors for relapse of OGCTs, 9 , 10 few literatures are available on the factors predicting the survival outcomes and on a large populations‐based predictive model for OGCTs. Therefore, the present study, exploiting the Surveillance, Epidemiology, and End Results (SEER) database, was designed to dig out the prognostic factors of cancer specific survival (CSS) and construct an individualized nomogram that can predict of 5‐ and 10‐year CSS among OGCTs patients, which may provide clinicians with valuable evidence on decision‐making, especially regarding optimal treatment plans and personalized prognosis.…”

The Prognostic Significance of Adjuvant Chemotherapy in Adult Ovarian Granulosa Cell Tumors: A Systematic Review and Meta-analysis

“…Some retrospective studies have suggested that adjuvant CT may be associated with prolonged disease-free survival (DFS) and possibly overall survival (OS) in AOGCT. However, most studies, including the latest study with the largest sample size based on the National Cancer Database (NCD) 18 and a preliminary narrative review by our team, 19 found that CT was not associated with improved survival rates. Whether adjuvant CT can improve the survival of patients with AOGCT remains unknown.…”