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-Meiermethod and comparedwith 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 b 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. Atmultivariate 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
- Fertility sparing surgery
- Granulosa cell tumors
- Unilateral oophorectomy