Introduction The role of complete staging surgery in women with Adult Ovarian Granulosa Cell Tumors (AOGCTs) remains uncertain. This study aimed to identify risk factors of recurrence and assess the impact of secondary staging surgery on recurrence risk among women who were incompletely staged at primary surgery.

Methods Women diagnosed with AOGCT between 2005 and 2018 were identified using data from the Danish Gynaecological Cancer Database and the Danish National Patient Registry. Adjusted binary logistic regression and Cox analyses were used to access risk of recurrence and to examine the safety of omitting staging surgery in patients who were incompletely staged at primary surgery.

Results We identified 238 cases with AOGCT in Denmark between January 2005 and September 2019. The recurrence rates were 26.7%, 16.9%, and 11.4% in patients undergoing fertility sparring surgery, primary complete staging surgery and incomplete primary staging surgery, respectively (p < 0.015). Increasing FIGO Stage (1A vs. ≥IC), tumor size > 5 cm and high mitotic activity were risk factors of recurrence. The risk of recurrence in patients who did not undergo complete primary or secondary staging was very low (4%), which could be explained by a low risk profile (a high proportion of stage IA, small tumors and low/moderate mitotic activity).

Conclusion/Implications We confirmed that FIGO stage, tumor size and mitotic activity are all significantly associated with risk of recurrence in AOGCT. In a real world setting omitting staging surgery in primary incomplete staged patients with a low risk profile of recurrence seems safe.