Abstract
BackgroundTo evaluate the association between adjuvant chemotherapy and clinical outcomes in patients with stage IC adult granulosa cell tumor (AGCT).MethodsWe performed a retrospective study of patients with stage IC AGCT diagnosed at our hospital from January 1985 to September 2015. We analyzed descriptive statistics, and performed univariate and multivariate and Kaplan–Meier survival analyses.ResultsSixty stage IC AGCT patients were identified, including 28 in the no adjuvant chemotherapy group (NACG) and 32 in the adjuvant chemotherapy group (ACG). The median follow-up time was 88 months (range: 9–334 months). Sixteen patients developed recurrences, including nine in the NACG and seven in the ACG groups. Univariate analysis identified incomplete surgical staging and initial treatment place as associated with disease-free survival (DFS) (P = 0.003 and 0.038, respectively). Incomplete surgical staging remained a risk factor for recurrence in multivariate analysis (hazard ratio (HR) = 3.883, 95% confidence interval (CI): 1.123–13.430, P = 0.032). The 5-year DFS rates in the NACG and ACG groups were 76.3% and 87.5% respectively (P = 0.197). Adjuvant chemotherapy was thus not associated with improved DFS. Furthermore, the number of chemotherapy cycles was not associated with recurrence rate (≤3 cycles vs. > 3 cycles, HR = 0.613, 95% CI: 0.112–3.351, P = 0.572).ConclusionAdministration of adjuvant chemotherapy does not improve DFS in patients with stage IC AGCT. Further studies with larger samples involving multi-institutional collaboration are needed to validate new treatment regimens for this disease.
Highlights
To evaluate the association between adjuvant chemotherapy and clinical outcomes in patients with stage IC adult granulosa cell tumor (AGCT)
Surgery is the cornerstone of treatment for AGCT, and patients with stage I AGCT have a favorable prognosis following surgical treatment alone, though the National Comprehensive Cancer Network guidelines (NCCN) recommend adjuvant chemotherapy for patients with advanced stage disease, or stage I disease with high risk factors
The definition of what constitutes a high risk factor remains unclear, and current evidence regarding the use of adjuvant chemotherapy in women with early stage AGCT is conflicting
Summary
To evaluate the association between adjuvant chemotherapy and clinical outcomes in patients with stage IC adult granulosa cell tumor (AGCT). Most GCTs are adult GCTs (AGCTs), based on their clinical presentation and histological findings. AGCT comprises a clinically and molecularly unique subtype of ovarian malignancy with different behavior from other histological subtypes. The majority of AGCTs are diagnosed at an early stage and have a good prognosis, with 5- and 10-year overall survival rates of 98% and 84%, Surgery is the cornerstone of treatment for AGCT, and patients with stage I AGCT have a favorable prognosis following surgical treatment alone, though the National Comprehensive Cancer Network guidelines (NCCN) recommend adjuvant chemotherapy for patients with advanced stage disease, or stage I disease with high risk factors. The definition of what constitutes a high risk factor remains unclear, and current evidence regarding the use of adjuvant chemotherapy in women with early stage AGCT is conflicting. Some studies have suggested that women might benefit from adjuvant chemotherapy [3, 4], while others failed
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