Ten-Year Real-World Outcomes and Clinicopathologic Predictors of Recurrence in Adult Granulosa Cell Tumors: A Turkish Single-Center Experience.

Abstract

Adult granulosa cell tumors (AGCT) are rare ovarian neoplasms with typically indolent behavior but potential for late recurrence. This study aimed to evaluate long-term outcomes and identify clinicopathological predictors of disease-free survival (DFS) in patients with AGCTs. This retrospective cohort study included patients with histologically confirmed AGCTs who were treated or followed at Ege University Faculty of Medicine between January 2012 and 2023. Survival outcomes were analyzed using Kaplan-Meier and Cox regression methods. Among 55 patients with a median follow-up of 113.7 months, the median DFS was 92.3 months, and the median overall survival (OS) was 113.7 months. The 5-year DFS and OS rates were 84.5% and 93.9%, respectively. Recurrence occurred in 23.6% of patients and was significantly linked to advanced FIGO stage, atypical endometrial pathology, and bleomycin-etoposide-cisplatin (BEP)/etoposide-cisplatin (EP)-based adjuvant chemotherapy. Larger tumor size (>10 cm) and stage III disease were also associated with shorter DFS. Univariate analysis showed that stage III disease (HR 7.14, p = 0.006) and tumor size >10 cm (HR 3.59, p = 0.025) were associated with significantly shorter DFS, while absence of endometrial pathology was protective (HR 0.34, p = 0.022). In multivariate analysis, stage III disease remained the only independent predictor of recurrence (HR 4.45, p = 0.046). Advanced-stage disease is an independent predictor of recurrence and should be considered a high-risk feature requiring prolonged follow-up.