Is it time to abandon staging surgery and prolonged follow-up in patients with primary adult-type granulosa cell tumor?

Geertruid J Brink ¹, Jolijn W Groeneweg ², Ariane A Sickinghe ²

¹Department of Gynecologic Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands. g.j.brink-7@umcutrecht.nl.
²Department of Gynecologic Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
³Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.
⁴Department of Gynecological Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁵Department of Gynecological Oncology, Center of Gynecologic Oncology, Amsterdam, The Netherlands.
⁶Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands.
⁷Department of Gynecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
⁸Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
⁹Department of Obstetrics and Gynecology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.
¹⁰Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
¹¹Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.

⁰Department of Gynecologic Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands. g.j.brink-7@umcutrecht.nl.

Journal of Ovarian Research +

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February 22, 2025

View abstract on PubMed

Summary

Additional staging surgery does not improve recurrence-free survival for adult-type granulosa cell tumors. Patients with this rare cancer can likely stop follow-up care after five years, simplifying management.

Area Of Science

Gynecologic Oncology
Reproductive Endocrinology
Surgical Oncology

Background

Limited data exists for adult-type granulosa cell tumor (aGCT) management guidelines.
Uncertainty surrounds the necessity of post-primary surgery staging and optimal follow-up duration.
Identifying recurrence risk factors is crucial for patient care.

Purpose Of The Study

To evaluate the impact of additional staging surgery on recurrence in aGCT patients.
To determine the appropriate duration for standard follow-up in aGCT.
To identify significant risk factors associated with aGCT recurrence.

Main Methods

A national multicenter prospective study involving 208 aGCT patients.
Data collection included retrospective and prospective information on staging, follow-up, and risk factors.
Statistical analyses utilized Cox regression and Kaplan-Meier methods over a median follow-up of 5.5 years.

Main Results

Additional staging surgery did not decrease recurrence risk.
Median time to first recurrence was 4.2 years, with many recurrences detected asymptomatically.
No significant difference in overall survival was observed between patients with detected recurrence during follow-up versus symptomatic presentation after follow-up cessation.

Conclusions

Staging surgery offers no benefit for recurrence-free survival in adult-type granulosa cell tumors.
Discharging patients from follow-up after five years appears safe and feasible for aGCT management.

Keywords:

Follow-up Granulosa cell tumor Ovarian cancer Rare disease Staging surgery