Clinical and pathologic prognostic factors in adult granulosa cell tumors of ovary
Division of Surgical Oncology and Department of Pathology, Cancer Institute (WIA), Adyar, Madras, India. International Journal of Gynecological Cancer
(Impact Factor: 1.95).
12/2007; 18(5):929-33. DOI: 10.1111/j.1525-1438.2007.01154.x
The objective of this study was to determine the clinicopathologic prognostic factors in adult granulosa cell tumors of the ovary. A retrospective review of the records of patients of granulosa tumors who were treated at our institute over a period of 10 years (1995-2005) was done. Clinical, pathologic, and follow-up data were collected. A total of 34 patients who were treated during this period were subjected to analysis. Cox univariate analysis and Wilcoxon's test for multivariate analysis were used as part of the SPSS software for examining the data. It was found that optimal cytoreduction (P = 0.02), presence of nuclear atypia (P < 0.001), and increased mitoses (P = 0.03) were the three factors that impacted significantly on survival. Age, stage of the tumor, parity, and size of the tumor had no significant effect on survival. Patients who received chemotherapy had a better median disease-free survival than those who did not (60 vs 48 months), but this did not reach statistical significance (P = 0.08). Optimal cytoreduction, nuclear atypia, and increased mitoses are the statistically significant prognostic factors and may be used for selecting patients for adjuvant therapy.
Available from: Ewoud Schuit
- "Of other factors, such as cytologic atypia, information was not available from our data. Residual disease was a potential prognostic variable that was described in various other reports     . Although residual disease was significantly associated with recurrent disease in univariable analysis, this was not the case in multivariable analysis. "
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Models to predict the probability of recurrence free survival exist for various types of malignancies, but a model for recurrence free survival in individuals with an adult granulosa cell tumor (GCT) of the ovary is lacking. We aimed to develop and internally validate such a prognostic model.
We performed a multicenter retrospective cohort study of patients with a GCT. Demographic, clinical and pathological information were considered as potential predictors. Univariable and multivariable analyses were performed using a Cox proportional hazards model. Using backward stepwise selection we identified the combination of predictors that best predicted recurrence free survival. Discrimination (c-statistic) and calibration were used to assess model performance. The model was internally validated using bootstrapping techniques to correct for overfitting. To increase clinical applicability of the model we developed a nomogram to allow individual prediction of recurrence free survival.
We identified 127 patients with a GCT (median follow-up time was 131 months (IQR 70-215)). Recurrence of GCT occurred in 81 out of 127 patients (64%). The following four variables jointly best predicted recurrence free survival; clinical stage, Body Mass Index (BMI), tumor diameter and mitotic index. The model had a c-statistic of 0.73 (95% CI 0.66-0.80) and showed accurate calibration.
Recurrence free survival in patients with an adult GCT of the ovary can be accurately predicted by combination of BMI, clinical stage, tumor diameter and mitotic index. The introduced nomogram could facilitate in counselling patients and may help to guide patients and caregivers in joint decisions on post-treatment surveillance.
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ABSTRACT: To determine the clinicopathologic prognostic factors in adult granulosa cell tumors (GCTs) of the ovary.
This retrospective study was carried out over a period of 10 years (1995-2005) in the Gynecology Department of Shengjing Hospital, China Medical University, Shenyang, China. Forty-six patients with GCT were enrolled in this study. Demographic data, pathologic findings, treatments, and survival time were reviewed and analyzed for prognostic significance.
It was found that International Federation of Gynecology and Obstetrics (FIGO) stage (p=0.0003), presence of nuclear atypia (p=0.036), and increased mitoses (p=0.002) were the 3 factors that impacted significantly on survival. Age, residual tumor disease, parity, and size of the tumor had no significant effect on survival. The only factor associated with risk of recurrence was rupture of the tumor (p=0.038). Patients who received chemotherapy had a better median disease-free survival than those who did not (105 versus 78 months), however, this did not reach statistical significance (p=0.080).
The FIGO stage, nuclear atypia, and increased mitoses are the statistically significant prognostic factors, and may be used for selecting patients for adjuvant therapy. A prolonged follow-up is necessary due to risk of recurrences, late, and exceptional for the adult ovarian GCT, especially when the tumor ruptured before, or at operation.
Available from: Nayeli Martinez Consuegra
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