Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.