| Objectives(1)To retrospectively analyze the clinical characteristics,treatment and prognosis of 92 GCT patients at the first diagnosis and recurrence,and try to explore the prognostic risk factors of GCT patients.(2)To analyze whether there are significant differences in clinicopathological characteristics at initial treatment and re-recurrence risk between patients with early and late recurrent patients of ovarian granulosa cell tumors.MethodsCollected the clinicopathological data and follow-up of 92 GCT patients in Qilu Hospital from January 2005 to December 2019,retrospectively analyzed their clinical characteristics,and statistically analyzed the patient’s medical records.SPSS 26.0 was used to analyze the data statistically.Mann-Whitney rank sum test was used to analyze the preoperative CA125 level differences in GCT patients with different stage,and the chi-square test and Fisher exact probability method were used to determine the risk of recurrence and the different type of recurrence.Kaplan-Meier survival curve was used to describe the survival of the patients.Besides,Using Log-rank method to test whether there are significant differences between different groups,and to explore the prognostic factors of ovarian granulosa cell tumors.Results1.Age and clinical manifestationsAmong the 92 GCT patients collected in this study,the average age of GCT patients was 42.19 years(2-80 years).The median age of GCT patients was 41 years.There were 59 cases(64.13%)before menopause,including 2 cases of prepubertal patients,and 33 cases(35.87%)after menopause.Most GCT patients have pelvic mass and abnormal vaginal bleeding as the first symptoms.Clinical manifestations include:irregular vaginal bleeding(28 cases,30.43%),including 15 cases of postmenopausal bleeding;lower abdominal distension,and pain(29 cases,31.52%);pelvic mass(27 cases,29.35%);secondary amenorrhea(18 cases,19.57%),etc.2.FIGO staging and pathological typesAmong the 92 patients with ovarian granulosa cell tumor collected in this study,the pathological type was AGCOT in 80 cases(86.96%)and JGCOT in 12 cases(13.04%).The FIGO staging was as follows:79 cases(85.87%)in stage I,2 cases in stage Ⅱ(2.17%),and 11 cases in stage Ⅲ(11.96%).3.Assistant examination90 patients(97.83%)had granulosa cell tumors on one side of the ovary,and 2 patients(2.17%)had bilateral tumor.69 patients received serum CA-125 examination before the first operation,and 25 patients(36.23%)had a serum CA125 test value>35u/ml,including:19 patients with stage I and 6 patients with stage Ⅲ.There was a statistically significant difference in CA125 levels between early(Ⅰ/Ⅱ)and late(stageⅢ)patients before the first operation(P=0.003<0.05).Preoperative ultrasound of 92 patients can detect unilateral or bilateral pelvic masses,with different manifestations,cystic,cystic or solid,and usually with clear boundaries.4.TreatmentAll 92 patients underwent surgical treatment,of which 27 patients underwent fertility-sparing surgery;34 patients underwent pelvic lymphadenectomy.55 patients received postoperative adjuvant therapy,all of which were combined chemotherapy,including 44 patients with AGCOT and 11 patients with JGCOT.The chemotherapy regimen was as follows:22 patients received TP regimen;26 patients received PEB regimen;2 patients received PE regimen;3 patients received PVB regimen;1 JGCOT patient received docetaxel+nedaplatin regimen;1 case of AGCOT received CAF regimen.5.Postoperative pathologyThere were 50 cases with tumor diameter<10cm,and 42 cases with tumor diameter≥10cm.Of the 66 collected endometrial tissues,16(24.24%)were associated with endometrial disease,including 10 with endometrial polyps,5 with simple endometrial hyperplasia,and 1 with complicated endometrial hyperplasia,all from AGCOT patients.34 patients underwent pelvic lymph node dissection,and no lymphatic metastasis was found in postoperative pathology.6.Follow-upA total of 85 patients with granulosa cell tumor of the ovary were followed up,including 73 patients with AGCOT and 12 patients with JGCOT.Twenty-three patients(27.06%)relapsed,including 22 AGCOT patients and 1 JGCOT patient.The recurrence interval(time from first operation to recurrence)of 23 recurring GCT patients was 12-204 months after surgery,and the median recurrence interval was 82 months.Among them,14(60.87%)patients with late recurrence(recurrence interval≥ 5 years)were all AGCOT patients,and 9 patients(39.13%)with ovarian GCT who had early recurrence(recurrence interval<5 years),including 1 JGCOT patient and 8 AGCOT patients.The FIGO staging of relapsed patients was 16 cases in stage I and 7 cases in stage Ⅲ.Of the 85 GCT patients,3 patients(3.53%)died,including 1 JGCOT patient and 2 AGCOT patients.The 3 dead patients were all FIGO stage Ⅲ patients.Of the 25 patients who underwent fertility preservation surgery,4 patients relapsed(16%)and no patients died.Among them,23 patients had fertility requirements,and 4 patients(17.39%)had normal pregnancy and delivery,including 2 AGCOT patients and 2 JGCOT patients.7.Prognosis7.1 GCT FIGO staging(P=0.002)and pelvic lymph node dissection(P=0.048)are risk factors which influence the recurrence of ovarian granulosa cell tumor.The other clinical and pathological factors of GCT patients had no significant effect(P<0.05).7.2 FIGO staging is an independent prognostic factor that affects the survival rate of patients with ovarian GCT(P<0.001).The other clinical and pathological factors of GCT patients had no significant effect on the survival rate of patients(P<0.05).8 There was no significant difference between early recurrent group and late recurrent group of GCT in age(P=0.433),menopause(P=0.495),fertility(P=0.142),miscarriage(P=0.247),FIGO staging(P=0.582),tumor size(P=0.433),pathological type(P=0.391),with or without fertility-sparing surgery(P=0.668),with or without ruptured tumor in stage Ⅰ(P=0.182),with or without lymph node dissection(P=0.517),surgical approach(P=0.391),with or without chemotherapy after surgery in stage Ⅰ(P=0.182).There was no significant difference in the risk of recurrence between late recurrence and early recurrence(P=0.505>0.05).Conclusion1.Ovarian GCT patients usually have irregular vaginal bleeding and pelvic mass as the first symptoms,and most of them are stage Ⅰ when found,the prognosis of granulosa cell tumor of the ovary is generally good;2.The prognosis of patients with ovarian granulosa cell tumor is closely related to the pathological stage of surgery;3.For young stage Ⅰ GCT patients,fertility-preserving surgery is feasible;4.but it has the characteristics of late recurrence and requires long-term follow-up,included upper abdominal examination. |
