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Adult ovarian granulosa cell tumors: analysis of outcomes and risk factors for recurrence
  1. Helmut Plett1,2,3,
  2. Enzo Ricciardi4,5,
  3. Vlad Vacaru3,6,
  4. Jan Philipp Ramspott2,7,
  5. Nicoletta Colombo5,8,
  6. Jalid Sehouli3,
  7. Andreas du Bois2,
  8. Annalisa Garbi5,
  9. Rolf Richter3,
  10. Beyhan Ataseven2,9,
  11. Giovanni Aletti5,10,
  12. Elena Braicu3,
  13. Florian Heitz2,3,
  14. Rosalba Portuesi5,11,
  15. Mustafa-Zelal Muallem3,12,
  16. Timoleon Dagres2,
  17. Gabriella Parma5,
  18. Eva Roser3,
  19. Alexander Traut2,
  20. Francesco Multinu5 and
  21. Philipp Harter2
  1. 1 Department of Gynecology, University Hospital Leipzig, Leipzig, Germany
  2. 2 Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
  3. 3 Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
  4. 4 Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Ospedale Sandro Pertini, Rome, Italy
  5. 5 Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
  6. 6 Division of Gynecology, Vivantes Humboldt-Klinikum, Berlin, Germany
  7. 7 Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
  8. 8 Faculty of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
  9. 9 Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
  10. 10 Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
  11. 11 IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
  12. 12 Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
  1. Correspondence to Dr Helmut Plett, Leipzig University, Leipzig, Sachsen, Germany; pletth{at}


Objective Adult granulosa cell tumors represent less than 5% of all ovarian malignancies. The aim of this study was to analyze the clinicopathological parameters and their impact on progression-free and overall survival.

Methods Patients with primary adult granulosa cell tumors treated in three international referral centers between July 1999 and December 2018 were included. The following data were anonymously exported from the prospective database: age at diagnosis, International Federation of Gynecology and Obstetrics (FIGO) stage, adjuvant therapy, surgical procedures, progression-free survival, and overall survival. Descriptive statistical analysis regarding tumor and treatment characteristics was performed. Survival analyses included Kaplan–Meier functions and Cox proportional hazard ratios (HR).

Results A total of 168 patients with primary adult granulosa cell tumors were included. Median age was 50 years (range 13–82). With regard to stage distribution, 54.2% (n=91) of patients were FIGO stage IA, 1.2% (n=2) were stage IB, 26.8% (n=45) were stage IC, and 17.9% (n=30) were FIGO stage II–IV. 66.7% (n=112) of patients underwent surgical restaging, of whom 17.9% (n=20) were moved to a higher stage. In addition, 36 (21.4%) patients underwent fertility-sparing surgery. After a median follow-up of 61 months (range 0–209), 10.7% of patients (n=18) had recurrent disease and 4.8% (n=8) died of disease. Five-year progression-free survival was 86.1% and estimated overall survival was 95.7%. Five-year progression-free survival was worse for patients with advanced stages (FIGO stage IA/B vs IC: HR 5.09 (95% CI 1.53 to 16.9); FIGO stage IA/B vs II–IV: HR 5.62 (95% CI 1.58 to 19.9)). Nineteen patients receiving adjuvant chemotherapy had lower estimated 5-year progression-free survival compared with patients not receiving chemotherapy (49.7% vs 91.1%, p<0.001; HR 9.15 (95% CI 3.62 to 23.1)).

Conclusion The prognosis of patients with primary adult granulosa cell tumors is mainly determined by FIGO stage. The outcome of patients with FIGO stage IC is comparable to those with advanced stages. Fertility-sparing surgery seems to be a safe procedure in stage IA. Our data do not support the use of adjuvant chemotherapy in early and advanced stages of adult granulosa cell tumors.

  • granulosa cell tumor
  • surgical oncology
  • laparotomy
  • gynecologic surgical procedures

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Twitter @Giovanni Aletti, @Fmultinu

  • Correction notice This article has been corrected since it was published Online First to correct author name Jan Philipp Ramspott.

  • Contributors HP: Study conception and design, data acquisition, analysis and interpretation of data, manuscript writing. ER: Data collection, critical revision of manuscript. JPR: Analysis and interpretation of data, drafting and critical revision of manuscript. VV and RR: Data collection. NC, JS, AdB, AG, RR, BA, GDA, EIB, FH, RP, MZM, TD, GP, ER, and FM: Analysis and interpretation of data, critical revision of manuscript. AT: Data acquisition, analysis, and interpretation of data. PH: Study conception and design, analysis and interpretation of data, critical revision of manuscript, guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.