| Objective: To analysis the clinical features of granulosa cell tumor(GCT)retrospectively and investigate the prognostic factors of it.To compare the efficacy of chemotherapy with surgery alone for GCT with stage Ⅰ.Methods: 42 patients with stage Ⅰ GCT admitted to the First Affiliated Hospital of Guangxi Medical University between January 2009 and June 2019 were reviewed.SPSS26.0 software was used to establish the database and conduct statistical analysis.Literatures related to the study were retrieved from Pubmed,Cochrane library,Medline,Web of science,CNKI,Wanfang database and Chongqing VIP database.2 researchers screened the literatures according to inclusion and exclusion criteria.Revman and STATA softwares were used for statistical analysis.Results: The average age of 42 patients with GCT was 41.6±15.4years old(2-75 years old).There were 38 cases(90.5%)of adult granulosa cell tumor(AGCT)and 4 cases(9.5%)of juvenile granulosa cell tumor(JGCT).All the patients received surgical treatment,30 patients(71.4%)underwent laparotomy,and 12 patients(28.6%)underwent laparoscopic surgery.15 patients(35.7%)underwent fertility sparing surgery and 27 patients(64.3%)underwent non-fertility sparing surgery.In 42 patients with stage Ⅰ GCT,27 cases were ⅠA cases(64.3%),15 cases were Ⅰ C(35.7%).All the lymph nodes were negative.Among the 42 patients with stage Ⅰ GCT,13(31.0%)patients received postoperative chemotherapy with 3-6 cycles,chemotherapy regimens included BEP,TC,PC,etc.The mean duration for follow-up of 42 patients with GCT was 51.3±28.7 months(7-128 months),and 16 patients(38.1%)were followed up for 5 years.During the follow-up period,4 patients(9.5%)had recurrence,with an average recurrence interval of 26.8±22.5 months(1-48months),and 3 patients(6.98%)died of the disease.Risk factor analysis of recurrence showed that pathological type and tumor size were statistical significance(P < 0.05),Logistic regression analysis showed that tumor size was the independent risk factor of recurrence(P= 0.034).5-year overall survival and disease-free survival of stage Ⅰ GCT patients were 97.6% and 86.4%.Log-rank analysis showed that pathological type,tumor size and disease-free survival had statistical significance(P < 0.05).Cox multivariate analysis showed that pathological type was the risk factor of disease-free survival of stage Ⅰ GCT patients(P = 0.008).Nearly no adverse reactions of postoperative chemotherapy were mentioned in the literatures,the safety of chemotherapy did not be evaluated in this study.A total of 615 English literatures and 171 Chinese literatures were retrieved from the above databases,and finally 3 English literatures and 5 Chinese literatures were selected,all of which were retrospective studies.Including the42 cases in this study,a total of 766 patients with stage I GCT were included in the study,including 292 patients in the postoperative chemotherapy group and474 patients in the surgery group.The results of meta-analysis showed that the recurrence rate [OR=1.01,95%ci(0.53,1.91),P= 0.98],5-year overall survival[OR=0.40,95%ci(0.07,2.30),P= 0.30] and 5-year disease-free survival[OR=0.59,95%ci(0.03,9.96),P= 0.71] between the two groups were not statistically significant.Conclusions: Major clinical symptoms of stage I GCT included abnormal uterine bleeding,abdominal pain and pelvic masses.Fertility sparing surgery can be performed with part of the patients in stage I GCT who deseire preservation of fertility.Tumor size was an independent risk factor for the recurrence of stageⅠ GCT,pathological types and tumor size were related to the disease-free survival of stage I GCT.Postoperative chemotherapy could not improve the prognosis of patients in stage Ⅰ GCT. |
