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Clinical Characteristics and Survival of Patients With an Adult-Type Ovarian Granulosa Cell Tumor: A 56-Year Single-Center Experience
  1. Saara Bryk, MD*,,
  2. Anniina Färkkilä, MD, PhD*,,
  3. Ralf Bützow, MD, PhD,
  4. Arto Leminen, MD, PhD*,
  5. Markku Heikinheimo, MD, PhD,§,
  6. Mikko Anttonen, MD, PhD*,,
  7. Annika Riska, MD, PhD* and
  8. Leila Unkila-Kallio, MD, PhD*
  1. *Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital,
  2. Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, and
  3. Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Central Hospital, Helsinki, Finland; and
  4. §Department of Pediatrics, Washington University School of Medicine, St Louis Children’s Hospital, St Louis, MO.
  1. Address correspondence and reprint requests to Leila Unkila-Kallio, MD, PhD, Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, PO Box 140, 00290 Helsinki, Finland. E-mail: leila.unkila-kallio{at}


Objective The objective of this study was to evaluate clinical prognostic factors and survival of patients with ovarian granulosa cell tumors (GCTs) in a long-term follow-up study.

Methods A total of 240 adult-type GCTs diagnosed in Helsinki University Central Hospital from 1956 to 2012 were histologically reevaluated. Data were analyzed for several clinical factors in relation to major developments in imaging, surgery, and chemotherapy: the old era (1956–1983) and the new era (1984–2012). Prognostic factors for survival were evaluated in the univariate and multivariate analyses.

Results The original diagnosis was confirmed in 187 (77.9%) patients. The International Federation of Gynecology and Obstetrics stage I disease was present in 89.2%; stage II, in 7.0%; stage III, in 3.8%; and stage IV, in 0% of cases. The mean age at diagnosis (52.9 years) and the mean tumor size (10.8 cm) did not change significantly over time. The most common presenting symptom was abnormal bleeding, but 14% were asymptomatic. The mean follow-up period was 15.7 years. Recurrence rate was similar in both eras. The GCT-specific 5-, 10-, and 20-year survival rates were 95.6%, 88.1%, and 79.8% in the old era as well as 97.2%, 94.8%, and 94.8% in the new era, respectively. In the univariate analyses, old era, patient age older than 60 years, tumor size greater than 10 cm, advanced stage, residual tumor, and use of hormonal adjuvant treatment were associated with GCT-related deaths. Prior use of oral contraceptives and history of infertility improved survival rates. In the multivariate analysis, stage was the only independent prognostic factor for GCT-specific survival.

Conclusions An accurate histological diagnosis of GCT is essential. Stage IV disease is an extreme rarity. However, tumor stage overcomes other possible clinical prognostic factors for GCT-specific survival. Fertility-sparing surgery, the use of oral contraceptives, or hormonal replacement therapy seems not to be risk factors for survival.

  • Granulosa cell tumor
  • Ovarian cancer
  • Survival
  • Prognostic factors

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  • Supported by Sladjana M. Crosley Fund for GCT Research as well as the Sigrid Juselius Foundation and Helsinki University Central Hospital Research Funds.

  • The authors declare no conflicts of interest.