# Recurrence of Adult Granulosa Cell Tumors: The Factors Affecting Secondary Recurrence and Survival After Recurrence

## TL;DR

This study identifies factors affecting recurrence and survival in patients with adult-type granulosa cell tumors after their first relapse.

## Contribution

The study provides new insights into factors influencing secondary recurrence and survival after recurrence in AGCTs.

## Key findings

- Secondary recurrence occurred in 32.7% of patients with recurrent AGCTs.
- A CA-125 level >35 U/mL at first recurrence was linked to increased secondary recurrence risk.
- Salvage chemotherapy improved survival in patients with residual disease or no surgery after recurrence.

## Abstract

Adult-type granulosa cell tumors (AGCTs) are rare ovarian neoplasms with a low overall incidence of recurrence, and also data on secondary recurrence and survival after relapse remain limited. This study aimed to identify factors associated with secondary recurrence and survival after recurrence in patients with recurrent AGCTs.

This multicenter retrospective study included 52 patients with recurrent AGCTs identified among 484 patients treated between 2000 and 2023. Clinical characteristics, treatment modalities, and outcomes were analyzed, with a particular focus on factors associated with secondary recurrence and survival after first recurrence. Recurrence-free survival and overall survival after first recurrence (OS-FR) were evaluated using Kaplan-Meier analysis.

The mean follow-up duration was 99.2 ± 61.5 months. Secondary recurrence occurred in 17 patients (32.7%). A serum CA-125 level >35 U/mL at the time of first recurrence was significantly associated with an increased risk of secondary recurrence (p=0.01). Factors significantly associated with improved OS-FR included a CA-125 level ≤35 U/mL at initial diagnosis and at first recurrence, absence of residual disease following surgery for the first recurrence, and administration of salvage chemotherapy (all p<0.05). In subgroup analysis, salvage chemotherapy was associated with improved OS-FR in patients with residual disease or those who did not undergo surgery (p < 0.01), but not in patients who achieved complete cytoreduction (p = 0.67).

Secondary recurrence remains a significant clinical challenge in AGCTs. Serum CA-125 levels, surgical outcomes at first recurrence, and the use of salvage chemotherapy may help management strategies in recurrent disease.