Abstract

Objective: About 30% of Adult type granulosa cell tumors of the ovary (AGCTs) are diagnosed in fertile age. In stage I, conservative surgery (fertility-sparing surgery, FSS), either unilateral salpingo-oophorectomy (USO) or cystectomy are possible options. The aim of this study is to compare oncological outcomes of FSS and radical surgery (RS) in apparently stage I AGCTs treated within the MITO group (Multicenter Italian Trials in Ovarian cancer). Methods: Survival curves were calculated using the Kaplan-Meier method and compared with log-rank test. The role of clinicopathological variables as prognostic factors for survival was assessed using Cox's regression. Results: Two-hundred and twenty-nine patients were included; 32.6% received FSS, 67.4% RS. In the FSS group, 62.8% underwent USO, 16.7% cystectomy, 20.5% cystectomy followed by USO. After a median follow up of 84 months, median DFS was significantly worse in the FSS-group (10 yr DFS 50% vs 74%, in FSS and RS group, p = 0.006). No significant difference was detected between RS and USO (10 yr DFS 75% vs 70%, p = 0.5).Cystectomy-group showed a significantly worse DFS compared to USO (10 yr DFS 16% vs 70%, p < 0.001). Patients receiving cystectomy and subsequent USO showed a better prognosis, even though significantly worse compared to USO (10 yr DFS 41% vs 70%, p = 0.05). Between FSS and RS, no difference in OS was detected. At multivariate analysis, FIGO stage IC and cystectomy retained significant predictive value for worse survival. Conclusions: This study supports the oncological safety of FSS in stage I AGCTs, provided that cystectomy is avoided; USO should be the preferred approach.

Original languageEnglish
JournalGynecologic Oncology
DOIs
Publication statusPublished - Jan 1 2019

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Ovariectomy
Cystectomy
Fertility
Granulosa cell tumor of the ovary
Survival
Ovarian Neoplasms
Multicenter Studies
Multivariate Analysis
Safety

Keywords

  • Cystectomy
  • Fertility sparing surgery
  • Granulosa cell tumors
  • Ovary
  • Unilateral oophorectomy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

@article{826f6e2d50954afe8a79c2b0381d93ed,
title = "Conservative surgery in stage I adult type granulosa cells tumors of the ovary: Results from the MITO-9 study",
abstract = "Objective: About 30{\%} of Adult type granulosa cell tumors of the ovary (AGCTs) are diagnosed in fertile age. In stage I, conservative surgery (fertility-sparing surgery, FSS), either unilateral salpingo-oophorectomy (USO) or cystectomy are possible options. The aim of this study is to compare oncological outcomes of FSS and radical surgery (RS) in apparently stage I AGCTs treated within the MITO group (Multicenter Italian Trials in Ovarian cancer). Methods: Survival curves were calculated using the Kaplan-Meier method and compared with log-rank test. The role of clinicopathological variables as prognostic factors for survival was assessed using Cox's regression. Results: Two-hundred and twenty-nine patients were included; 32.6{\%} received FSS, 67.4{\%} RS. In the FSS group, 62.8{\%} underwent USO, 16.7{\%} cystectomy, 20.5{\%} cystectomy followed by USO. After a median follow up of 84 months, median DFS was significantly worse in the FSS-group (10 yr DFS 50{\%} vs 74{\%}, in FSS and RS group, p = 0.006). No significant difference was detected between RS and USO (10 yr DFS 75{\%} vs 70{\%}, p = 0.5).Cystectomy-group showed a significantly worse DFS compared to USO (10 yr DFS 16{\%} vs 70{\%}, p < 0.001). Patients receiving cystectomy and subsequent USO showed a better prognosis, even though significantly worse compared to USO (10 yr DFS 41{\%} vs 70{\%}, p = 0.05). Between FSS and RS, no difference in OS was detected. At multivariate analysis, FIGO stage IC and cystectomy retained significant predictive value for worse survival. Conclusions: This study supports the oncological safety of FSS in stage I AGCTs, provided that cystectomy is avoided; USO should be the preferred approach.",
keywords = "Cystectomy, Fertility sparing surgery, Granulosa cell tumors, Ovary, Unilateral oophorectomy",
author = "A. Bergamini and G. Cormio and G. Ferrandina and D. Lorusso and G. Giorda and G. Scarfone and L. Bocciolone and F. Raspagliesi and S. Tateo and C. Cassani and A. Savarese and E. Breda and {De Giorgi}, U. and F. Mascilini and M. Candiani and A. Kardhashi and N. Biglia and Perrone, {A. M.} and S. Pignata and G. Mangili",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ygyno.2019.05.029",
language = "English",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Conservative surgery in stage I adult type granulosa cells tumors of the ovary

T2 - Results from the MITO-9 study

AU - Bergamini, A.

AU - Cormio, G.

AU - Ferrandina, G.

AU - Lorusso, D.

AU - Giorda, G.

AU - Scarfone, G.

AU - Bocciolone, L.

AU - Raspagliesi, F.

AU - Tateo, S.

AU - Cassani, C.

AU - Savarese, A.

AU - Breda, E.

AU - De Giorgi, U.

AU - Mascilini, F.

AU - Candiani, M.

AU - Kardhashi, A.

AU - Biglia, N.

AU - Perrone, A. M.

AU - Pignata, S.

AU - Mangili, G.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: About 30% of Adult type granulosa cell tumors of the ovary (AGCTs) are diagnosed in fertile age. In stage I, conservative surgery (fertility-sparing surgery, FSS), either unilateral salpingo-oophorectomy (USO) or cystectomy are possible options. The aim of this study is to compare oncological outcomes of FSS and radical surgery (RS) in apparently stage I AGCTs treated within the MITO group (Multicenter Italian Trials in Ovarian cancer). Methods: Survival curves were calculated using the Kaplan-Meier method and compared with log-rank test. The role of clinicopathological variables as prognostic factors for survival was assessed using Cox's regression. Results: Two-hundred and twenty-nine patients were included; 32.6% received FSS, 67.4% RS. In the FSS group, 62.8% underwent USO, 16.7% cystectomy, 20.5% cystectomy followed by USO. After a median follow up of 84 months, median DFS was significantly worse in the FSS-group (10 yr DFS 50% vs 74%, in FSS and RS group, p = 0.006). No significant difference was detected between RS and USO (10 yr DFS 75% vs 70%, p = 0.5).Cystectomy-group showed a significantly worse DFS compared to USO (10 yr DFS 16% vs 70%, p < 0.001). Patients receiving cystectomy and subsequent USO showed a better prognosis, even though significantly worse compared to USO (10 yr DFS 41% vs 70%, p = 0.05). Between FSS and RS, no difference in OS was detected. At multivariate analysis, FIGO stage IC and cystectomy retained significant predictive value for worse survival. Conclusions: This study supports the oncological safety of FSS in stage I AGCTs, provided that cystectomy is avoided; USO should be the preferred approach.

AB - Objective: About 30% of Adult type granulosa cell tumors of the ovary (AGCTs) are diagnosed in fertile age. In stage I, conservative surgery (fertility-sparing surgery, FSS), either unilateral salpingo-oophorectomy (USO) or cystectomy are possible options. The aim of this study is to compare oncological outcomes of FSS and radical surgery (RS) in apparently stage I AGCTs treated within the MITO group (Multicenter Italian Trials in Ovarian cancer). Methods: Survival curves were calculated using the Kaplan-Meier method and compared with log-rank test. The role of clinicopathological variables as prognostic factors for survival was assessed using Cox's regression. Results: Two-hundred and twenty-nine patients were included; 32.6% received FSS, 67.4% RS. In the FSS group, 62.8% underwent USO, 16.7% cystectomy, 20.5% cystectomy followed by USO. After a median follow up of 84 months, median DFS was significantly worse in the FSS-group (10 yr DFS 50% vs 74%, in FSS and RS group, p = 0.006). No significant difference was detected between RS and USO (10 yr DFS 75% vs 70%, p = 0.5).Cystectomy-group showed a significantly worse DFS compared to USO (10 yr DFS 16% vs 70%, p < 0.001). Patients receiving cystectomy and subsequent USO showed a better prognosis, even though significantly worse compared to USO (10 yr DFS 41% vs 70%, p = 0.05). Between FSS and RS, no difference in OS was detected. At multivariate analysis, FIGO stage IC and cystectomy retained significant predictive value for worse survival. Conclusions: This study supports the oncological safety of FSS in stage I AGCTs, provided that cystectomy is avoided; USO should be the preferred approach.

KW - Cystectomy

KW - Fertility sparing surgery

KW - Granulosa cell tumors

KW - Ovary

KW - Unilateral oophorectomy

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U2 - 10.1016/j.ygyno.2019.05.029

DO - 10.1016/j.ygyno.2019.05.029

M3 - Article

AN - SCOPUS:85067067462

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

ER -