Granulosa cell tumors: Initial surgical approach and recurrence

Granulosa cell tumors account for 3-5% of ovarian cancers with a risk of recurrence of 10-25% in those with stage I disease. Our objective was to evaluate clinical factors associated with disease recurrence, with special attention to the role of initial surgical approach (minimally invasive vs. open abdominal) in recurrence risk.

All patients treated for GCT at University of Washington between 1980 and 2020 were included in the study. Retrospective review of demographic, medical/family/history, treatment and recurrence was performed. Descriptive statistical analysis of clinical and pathologic features, Kaplan-Meier curves, and Cox proportional hazards regression were performed.

174 patients were evaluated and 62 were eliminated due to incomplete data. 112 patients were included in the analysis sample with a median follow up time of 126 months (range 12-482 months) and median age of 46 years (IQR 37-55). Stage at diagnosis was primarily IA or IC. Surgical approach was open in 59% (N = 66), laparoscopic in 34% (N = 38), and robotic in 5% (N = 5) of patients. Tumor rupture was more common among the minimally invasive surgical approaches, compared to an open approach. Stage, need for adjuvant chemotherapy, and tumor rupture were associated with an increased risk of recurrence during the follow up period. Among patients with tumor rupture, 55% of patients had a recurrence event during the follow up period.

Tumor rupture at the time of surgery is a significant risk factor for recurrence. There is a higher risk of tumor rupture with minimally invasive surgery. Care should be taken to avoid iatrogenic tumor rupture.