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Stage I granulosa cell tumours: A management conundrum? Results of long-term follow up.
Gynecol Oncol 2015; 138(2):285-91GO

Abstract

Optimal management of women with early stage granulosa cell tumours (GCT) presents a management conundrum - they have excellent prognosis but a third will relapse. Advances uncovering the molecular characteristics of GCT have not been matched by improvements in our understanding and treatment.

METHODS

Stage I GCT patients referred to Auckland City Hospital (1955-2012) and Princess Margaret Cancer Centre (1992-2012) were identified. Baseline characteristics, histopathology and outcomes were recorded retrospectively.

RESULTS

One hundred and sixty stage I GCT patients were identified with a median age of 49 years. Median follow-up was 7.0 years (range 0.1-44.2 years). Fifty-one patients (32%) relapsed with a median time to relapse (TTR) of 12.0 years (1.3-17.7 years) - 20 initial relapses occurred 10 years post-diagnosis. Higher relapse rates (43% vs. 24% p=0.02) and shorter TTR (10.2 vs. 16.2 years p=0.007) were seen with stage Ic versus stage Ia disease. Cyst rupture was associated with increased relapse (p=0.03). Surgery was the main therapeutic modality at relapse. Eighty six percent of patients received non-surgical management at least once post-relapse. Clinical benefit rate was 43% with chemotherapy, 61% with hormonal therapy and 86% with radiation. Five- and 10-year overall survival (OS) were 98.5 and 91.6%, respectively. Median OS was similar in patients with (24.3 years) and without relapse (22.3 years).

CONCLUSION

Surgery remains fundamental at diagnosis and relapse. Caution should be exercised in recommending adjuvant chemotherapy at initial diagnosis given median OS was greater than 20 years even with relapse. Hormonal therapy at relapse appears encouraging but needs further assessment. Novel treatment strategies need exploration with international collaboration essential for this.

Authors+Show Affiliations

Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Canada; Department of Medical Oncology, Auckland City Hospital, New Zealand.Department of Medical Oncology, Auckland City Hospital, New Zealand.Department of Medical Oncology, Auckland City Hospital, New Zealand.Department of Medical Oncology, Auckland City Hospital, New Zealand.Faculty of Medical and Health Sciences, University of Auckland, New Zealand.Department of Pathology, Auckland City Hospital, New Zealand.Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Canada.Department of Statistics, Princess Margaret Cancer Centre, Canada.Department of Surgical Oncology, Princess Margaret Cancer Centre, Canada.Department of Pathology, Princess Margaret Cancer Centre, Canada.Department of Radiation Oncology, Princess Margaret Cancer Centre, Canada.Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Canada. Electronic address: amit.oza@uhn.ca.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26003143

Citation

Wilson, Michelle K., et al. "Stage I Granulosa Cell Tumours: a Management Conundrum? Results of Long-term Follow Up." Gynecologic Oncology, vol. 138, no. 2, 2015, pp. 285-91.
Wilson MK, Fong P, Mesnage S, et al. Stage I granulosa cell tumours: A management conundrum? Results of long-term follow up. Gynecol Oncol. 2015;138(2):285-91.
Wilson, M. K., Fong, P., Mesnage, S., Chrystal, K., Shelling, A., Payne, K., ... Oza, A. M. (2015). Stage I granulosa cell tumours: A management conundrum? Results of long-term follow up. Gynecologic Oncology, 138(2), pp. 285-91. doi:10.1016/j.ygyno.2015.05.011.
Wilson MK, et al. Stage I Granulosa Cell Tumours: a Management Conundrum? Results of Long-term Follow Up. Gynecol Oncol. 2015;138(2):285-91. PubMed PMID: 26003143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stage I granulosa cell tumours: A management conundrum? Results of long-term follow up. AU - Wilson,Michelle K, AU - Fong,Peter, AU - Mesnage,Soizick, AU - Chrystal,Kathryn, AU - Shelling,Andrew, AU - Payne,Kathryn, AU - Mackay,Helen, AU - Wang,Lisa, AU - Laframboise,Stephane, AU - Rouzbahman,Marjan, AU - Levin,Wilfred, AU - Oza,Amit M, Y1 - 2015/05/21/ PY - 2015/02/12/received PY - 2015/05/14/accepted PY - 2015/5/25/entrez PY - 2015/5/25/pubmed PY - 2015/10/16/medline KW - FOXL2 KW - Granulosa cell tumours KW - Multi-centre review KW - Ovary KW - Stromal cell ovarian cancer SP - 285 EP - 91 JF - Gynecologic oncology JO - Gynecol. Oncol. VL - 138 IS - 2 N2 - UNLABELLED: Optimal management of women with early stage granulosa cell tumours (GCT) presents a management conundrum - they have excellent prognosis but a third will relapse. Advances uncovering the molecular characteristics of GCT have not been matched by improvements in our understanding and treatment. METHODS: Stage I GCT patients referred to Auckland City Hospital (1955-2012) and Princess Margaret Cancer Centre (1992-2012) were identified. Baseline characteristics, histopathology and outcomes were recorded retrospectively. RESULTS: One hundred and sixty stage I GCT patients were identified with a median age of 49 years. Median follow-up was 7.0 years (range 0.1-44.2 years). Fifty-one patients (32%) relapsed with a median time to relapse (TTR) of 12.0 years (1.3-17.7 years) - 20 initial relapses occurred 10 years post-diagnosis. Higher relapse rates (43% vs. 24% p=0.02) and shorter TTR (10.2 vs. 16.2 years p=0.007) were seen with stage Ic versus stage Ia disease. Cyst rupture was associated with increased relapse (p=0.03). Surgery was the main therapeutic modality at relapse. Eighty six percent of patients received non-surgical management at least once post-relapse. Clinical benefit rate was 43% with chemotherapy, 61% with hormonal therapy and 86% with radiation. Five- and 10-year overall survival (OS) were 98.5 and 91.6%, respectively. Median OS was similar in patients with (24.3 years) and without relapse (22.3 years). CONCLUSION: Surgery remains fundamental at diagnosis and relapse. Caution should be exercised in recommending adjuvant chemotherapy at initial diagnosis given median OS was greater than 20 years even with relapse. Hormonal therapy at relapse appears encouraging but needs further assessment. Novel treatment strategies need exploration with international collaboration essential for this. SN - 1095-6859 UR - https://www.unboundmedicine.com/medline/citation/26003143/Stage_I_granulosa_cell_tumours:_A_management_conundrum_Results_of_long_term_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-8258(15)00916-6 DB - PRIME DP - Unbound Medicine ER -