Prognostic factors responsible for recurrence in granulosa cell tumor of the ovary

S90

Abstracts / Gynecologic Oncology 125 (2012) S3–S167

218 Prognostic factors responsible for recurrence in granulosa cell tumor of the ovary S. Shim, D. Kim, S. Lee, J. Park, J. Kim, Y. Kim, Y. Kim, J. Nam. Asan Medical Center, Seoul, Republic of Korea.

doi:10.1016/j.ygyno.2011.12.217

217 Is CA-125 an additional marker to ultrasonographic features for distinguishing between borderline ovarian tumors and stage I ovarian cancer? D. Zacharakis1, N. Thomakos1, A. Rodolakis1, M. Simou1, D. Haidopoulos1, G. Vlachos1, A. Bamias2, A. Antsaklis1. 11st Department of Obstetrics & Gynecology, University of Athens, Athens, Greece, 2Department of Clinical Therapeutics, University of Athens, Athens, Greece. Objective: The accurate characterization of an ovarian mass before surgery has become increasingly important for optimal planning of treatment. When the likelihood of malignancy of an ovarian mass is perceived to be high, referral to a tertiary oncology unit is mandatory in order to optimize the treatment outcome. The aim of this study was to assess the role of preoperative serum CA-125 levels in correlation to that of ultrasonographic features in order to distinguish between borderline ovarian tumors (BOTs) and stage I ovarian cancer (OC) in view of the increasing frequency of laparoscopic surgeries performed for these findings. Methods: Patients were identified from the tumour boards database. We retrospectively reviewed all patients with BOTs and OC during January 2000 through December 2010. Ultrasonographic features including size of tumor, presence of papillary projections (PPs), solid components (SCs), septum, ascites and color score evaluation were collected. Preoperative CA 125 was also recorded. Multivariable logistic regression analysis was performed to examine which parameters were independently associated with invasiveness. Results: Data from 165 participants were analyzed (66 BOTs and 99 OC). Women with CA-125 N100 IU/mL had almost three times greater likelihood to belong in the OC group. Furthermore, SCs were found to be associated with 4.25 times greater odds to represent OC rather than a BOT. In contrast, presence of PPs was associated with 73% less likelihood for OC. SCs were more frequent in women with CA-125 N100 IU/mL (85.0% vs. 50.4%, p b 0.001). The addition of SCs and PPs in the model with CA-125 showed a significantly improvement in the discriminative ability (p = 0.004) with areas under the curve (AUC) equal to 0.78 (95% CI: 0.71-0.85). Conclusions: A very characteristic feature of BOTs is the presence of PPs. In our study 50% of the BOTs presented as unilocular cysts with intracystic PPs or as cystic lesions with septa demonstrating intra-cystic PPs or as predominantly solid lesions displaying exophytic PPs. The rest 50% of BOTs appeared predominantly as multiseptate cystic lesions with or without SCs. On contrary, OCs were associated with marked vascularization and a greater amount of SC (74,7%), while only 21.2% presented PPs. Preoperative CA-125 N100 IU/ml combined with the presence of solid components and the absence of papillary projections seems to improve our discriminative ability in favour of early stage OC. doi:10.1016/j.ygyno.2011.12.218

Objective: Granulosa cell tumor(GCT) of the ovary is an uncommon type of ovarian neoplasm and limited data are available in the literature to guide optimal treatment and follw-up protocol. The goal of this study was to evaluate clinicopathologic findings, surgical procedures, and prognostic factors for recurrence in GCT. Methods: Between 1989 and 2011, 89 cases of GCT were treated in our institution. Patients' clinicopathologic characteristics and followup information were collected from hospital charts and clinic records retrospectively. Kaplan-Meier and Cox proportional hazards analyses were used to identify the predictors for recurrence. Receiver operating curve (ROC) analysis was used to determine the cutoff value of continuous variables for predicting recurrence. Results: GCT constituted 3% of all ovarian cancers in our institution during the study period. The median age was 45 (range 4–85) years. The median follow-up period was 42 (range 1–228) months. Eighty were stage I, 3 stage II, and 6 stage III. There were 14 cases of recurrence and 5 cases of disease-related death. The median time to relapse was 33 (3–100) months. In univariate analysis, factors affecting the recurrence were FIGO stage(P b 0.05), tumor size (P b 0.05) and postoperative residual tumor(P b 0.05), while intraoperative rupture of tumor, adjuvant chemotherapy and surgical staging including pelvic lymphadenectomy were not. Twenty-eight of 80 stage I patients underwent fertility sparing surgery with three recurrences. In multivariate analysis, tumor size and postoperative residual tumor remained as independent risk factors for recurrence. The area under the ROC plot for discriminating recurrence of tumor size using the cutoff value of 120mm was 0.728. Conclusions: Recurrence in GCT might be associated with tumor size and postoperative residual tumor. If there are no residuals, fertility sparing surgery for early staged patients with GCT wishing to preserve fertility appears to be a safe alternative.

Table 1 Multivariate Cox proportional hazards model for recurrence. Variable Residual tumor Tumor size

No Yes

Hazard Ratio

95% CI

1 24.906 1.012

5.366 1.003

p-value 115.606 1.022

b 0.0001 0.0108

Fig. 1. Disease free survival according to residual tumor and tumor size.

doi:10.1016/j.ygyno.2011.12.219