# Stage IA and IC adult granulosa cell tumors: Clinical features, long-term outcomes and prognostic factors in a 333-patient cohort over three decades

## TL;DR

This study examines 333 cases of early-stage adult granulosa cell tumors to identify factors affecting recurrence and survival, finding that stage IC and incomplete surgery are key predictors.

## Contribution

The study provides new insights into prognostic factors and treatment strategies for stage I adult granulosa cell tumors using a large, long-term cohort.

## Key findings

- Stage IC AGCT patients had significantly higher recurrence rates than stage IA patients.
- Incomplete staging surgery and adjuvant chemotherapy were independent predictors of increased recurrence.
- Complete staging surgery improved disease-free survival in stage IC patients.

## Abstract

Adult granulosa cell tumors (AGCTs) are rare low-grade malignant ovarian tumors, with 80–90% diagnosed at FIGO stage I. This study aimed to identify prognostic factors and refine management for stage I AGCT.

In this 30-year retrospective cohort study, patients with stage I AGCT between January 1988 and January 2024 were selected and reviewed in total cohort and subgroups according to tumor stage.

This retrospective study analyzed 333 eligible AGCT cases, including 196 patients (58.9%) with FIGO stage IA and 137 (41.1%) with stage IC. After a median follow-up of 138.5 ± 108.0 months, recurrence occurred in 55 patients (40.1%) in the IC group, significantly higher than that in the IA group (38 patients, 19.4%; P < 0.001, FDR = 0.005). Approximately half of recurrences in both groups were intra-abdominal, with comparable median recurrence intervals. Multivariate logistic regression identified stage IC (P = 0.001), incomplete staging surgery (P = 0.015) and adjuvant chemotherapy (P = 0.002) independent predictors of increased recurrence. In the propensity-matched cohort (n = 188), adjuvant chemotherapy showed no significant association with recurrence (P = 0.067). Cox multivariate analysis revealed stage IC and incomplete staging surgery as independent prognostic factors for worse DFS in early-stage disease (P = 0.001 and 0.012, respectively). Notably, complete staging surgery was associated with improved DFS specifically in stage IC patients (P = 0.016).

Unilateral salpingo-oophorectomy instead of simple cystectomy demonstrated a favorable safety profile in reproductive patients with stage I AGCT. Comprehensive surgical staging without lymphadenectomy should be considered as a viable treatment strategy, especially in the stage IC disease, manifesting a significantly higher recurrence rate and shorter DFS compared to stage IA counterparts.

The online version contains supplementary material available at 10.1007/s10147-025-02897-w.