Granulosa cell tumors: A SEER data review of prognostic parameters in 1815 patients.
Sakr S, Al-Wahab Z, Abdulfatah E, Rosen BP, Morris RT, Munkarah AR, and Ali-Fehmi R. Granulosa cell tumors: A SEER data review of prognostic parameters in 1815 patients. Gynecol Oncol 2017; 145:127.
Objective: To identify the clinicopathological variables affecting prognosis and survival outcomes in patients with granulosa cell tumors. Method: The Surveillance, Epidemiology and End Results (SEER) database was searched for patients diagnosed with adult (AGCT) and juvenile (JGCT) granulosa cell tumors. Demographic characteristics and prognostic factors including age, race, marital status, FIGO stage, surgery, tumor size, and lymphadenectomy were analyzed using log rank and Kaplan-Meier curves for overall survival (OS) and Cox regression analysis. Results: There were 1,794 and 21 patients identified with AGCT and JGCT, respectively. Of all the AGCT patients, 1,081 (60.2%) were unstaged, 395 (22%) stage I, 80 (4.5%) stage II, 158 (8.8%) stage III, and 80 (4.5%) stage IV. Patients with AGCT older than 50 years had better 10-year OS than patients younger than 50 years (85.3% vs 63.8%, P b 0.05; HR = 2.4, P =0.003), whereas patients with JGCT had a 3-year OS of 63.4%. Surgically staged I-II patients had better survival compared to nonstaged and advanced-stage III-IV patients (HR =10.6, P= 0.0005; 10-year OS = 93.8%, 69.9%, and 49.4%, respectively, P b 0.05). No survival difference was noted between stages IA, IB, and IC nor between Caucasians and African-Americans. Patients with tumors greater than 5 cm had significantly worse 10-year OS (98.1% vs 85.1%, P b 0.05). Lymphadenectomy in AGCT was associated with significantly better OS (89.8% vs 71.2%, P b 0.05). Regression analysis revealed that older age (N50 years), early stage, and lymphadenectomy were independently associated with better OS (HR = 0.41, 0.01, and 0.49, respectively, P b 0.05). Clinically apparent stage I (unstaged) patients had worse 10-year OS, 70.3%, compared to surgical stage I patients, 89.3% (P b 0.05). (See Fig. 1.) Conclusion: Patients with clinical early-stage disease had significantly shorter OS compared to those with surgically confirmed earlystage disease. Age, stage, and lymphadenectomy were independent predictors of survival outcome.