Prognostic factors in sex cord stromal tumors of the ovary

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Achraf Hadiji
Tarak Damak
Lamia Charfi
Jamel Ben Hassouna
Riadh Chargui
Khaled Rahal

Keywords

Sex cord stromal tumors, Sertoli-Leydig tumors, Granulosa cell tumors, Ovary.

Abstract

Aim: To evaluate prognostic factors impacting on the survival of 70 women with ovarian sex cord stromal tumors (SCST). Study Design: A retrospective single-institution review of all patients with SCST from 1982 to 2008 at our own service. Data were collected on patient characteristics, clinical findings, and all treatments received. Kaplan–Meier and Cox proportional hazard analyses were used to determine the predictors for survival. Results: SCST constituted 5.8% of all ovarian cancers in our institution during the study period. The median age was 51 years (range 15–95). Adult granulosa cell tumors (n=52) were the most frequent histological subtype. In addition, there were 14 patients with Sertoli-Leydig cell tumors, two with Juvenile granulosa cell tumors, one with sex cord tumor with annular tubules, and one with steroid cell tumor. The median follow-up period was 58 months (range 1–362). Fifty cases were stage I, two stage II, 15 stage III and three stage IV. There were two cases of persistent disease following surgery, 18 cases of recurrence and six cases of disease-related death. The median time to relapse was 75 months (range: 18–208). The 5-year overall and disease-free survivals were 76% and 68%, respectively. By univariate analysis, factors affecting recurrence were FIGO stage (p=0.02) and postoperative residual tumor (p=0.002), while age, tumor size, extent of surgery (standard staging/conservative staging), lymphadenectomy, histology and grade were not. On multivariate analysis, only postoperative residual tumor (p=0.002) remained significant prognostic factors for improved disease-specific survival. Conclusion: Postoperative residual tumor and early-stage disease are important predictors for improved disease-free survival in patients with SCST. If there are no residuals, fertility-sparing surgery for early staged patients with SCST wishing to preserve fertility appears to be a safe alternative.
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