Introduction To describe the clinicopathological characteristics of recurrent adult granulosa cell tumor (AGCT) and identify the risk factors for recurrence.
Methods Seventy recurrent AGCT patients between 2000–2020 were retrospectively reviewed (figure 1). The primary outcomes were progression free survival after first recurrence (PFS-R), overall survival after first recurrence (OS-R) and recurrence frequency. The Kaplan-Meier (KM) analysis, Cox proportional hazard analysis, and the Prentice, Williams and Peterson counting process (PWP-CP) model were adopted.
Results The 5-year PFS-R was 29.3%, and the 5-year OS-R was 94.9%. KM analysis demonstrated that patients with distant recurrence and PFS1 ≤60 months had worse PFS-R (P<0.05), and patients with PFS-R ≤ 33 months had worse OS-R (P=0.023). PFS1≤60 months (hazard ratio, HR 1.9, 95% confidence interval, CI, 1.1–3.4, P=0.028) was an independent risk factor for PFS-R, and local lesion at recurrence (HR 0.488, 95%CI 0.3–0.9, P=0.027) was an independent protective factor for PFS-R. PFS-R ≤33 months (HR 5.5, 95%CI 1.2–25.3, P=0.028) was an independent risk factor for OS-R (table 1). The PWP-CP analysis showed laparoscopic operation could significantly increase recurrence times (P=0.002, HR=3.4), and R0 at each recurrence operation could significantly decrease recurrence frequency (P < 0.001, HR < 0.001).
Conclusion/Implications The present study is the largest report of patients with recurrent AGCT. It demonstrated that PFS1 ≤60 months and distant lesion at recurrence are independent risk factors for PFS-R, and PFS-R ≤33 months is an independent risk factor for OS-R. The PWP-CP model showed that the transabdominal approach and surgery reaching R0 could significantly decrease recurrence frequency.
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