Surgical staging and adjuvant chemotherapy in the management of patients with adult granulosa cell tumors of the ovary

Objective. To analyze the role of surgical staging and adjuvant chemotherapy in patients with adult type granulosa cell tumor (GCT) of the ovary. Methods. Patients were divided into those with early-stage (stages I-II, n = 93) and advanced-stage (stages III-IV n = 13) GCT and analyzed separately in this retrospective study. Results. Of the 93 patients with early-stage GCT, 30 were completely staged and 25 underwent lymph node dissection. After surgery, 17 patients received adjuvant chemotherapy with blweomycin/etoposide/cisplatin (BEP). None had lymph node metastasis. Completely staged patients had no recurrence or deaths. However, recurrences were observed in 9 of 63 patients (14.3%) who did not undergo complete staging, with four (6.3%) dying due to disease. The 5-year disease-free survival (DFS) rates of groups with and without complete staging were 100% and 84%, respectively (P = 0.037). Adjuvant chemotherapy was not significantly associated with DFS (P = 0.193). All patients with advanced-stage GCT underwent optimal cytoreduction and received adjuvant chemotherapy with BEP. None of the 6 patients who completed 6 cycles of BEP had recurrence, whereas 5 of the 7 patients (71.4%) who received fewer than 6 cycles of BEP had recurrences and 3 (42.9%) died due to disease. The 5-year DFS rates of these two groups were 100% and 50%, respectively (P = 0.022), with cycles of chemotherapy being the only significant factor for DFS in patients with advanced-stage GCT. Conclusions. Complete surgical staging is recommended, but lymph node removal is not recommended for early-stage GCT. Optimal debulking followed by six cycles of BEP chemotherapy is recommended for advanced-stage GCT. (C) 2011 Elsevier Inc. All rights reserved.