The role of systemic chemotherapy in the management of granulosa cell tumors

• We reviewed the records of 154 ovarian sex cord stromal tumor (SCST) patients.
• Adjuvant chemotherapy did not improve outcomes, regardless of disease stage.
• The incidence of breast cancer was higher than expected and is worthy of further study.

ObjectiveGranulosa cell tumors (GCTs) are rare, and the role of chemotherapy in their management is not clearly defined.MethodsWe performed a retrospective cohort study of GCT patients diagnosed from January 1996 through June 2013 at the Memorial Sloan Kettering Cancer Center, comparing those who received adjuvant chemotherapy to those who did not. Differences between groups were assessed using the log-rank test. Statistical significance was set at p < 0.05.ResultsOf 118 patients, 10 (8%) received adjuvant chemotherapy (1 [1%] of 103 stage I and 9 [60%] of 15 stage II–IV patients). Thirty-two patients (27%) experienced disease recurrence. Four patients had residual disease after initial surgery, and all received adjuvant chemotherapy; each recurred within 24.3 months (median PFS, 8.2 months). The time to first recurrence was longer in patients who did not receive adjuvant chemotherapy. For patients with recurrent disease, receiving chemotherapy after surgery for first recurrence did not seem to improve time to second recurrence versus surgery alone (HR 0.98; p = 0.965). Additionally, 12 patients (10%) had a previous diagnosis of breast cancer—an incidence rate 3.22 times higher than Surveillance, Epidemiology, and End Results (SEER) data predicts (p < 0.001).ConclusionsAlthough the numbers were small, in this analysis chemotherapy was not found to improve the recurrence-free interval of patients with GCTs, a finding that requires prospective validation. Residual disease after surgery was associated with poor prognosis. Finally, there was a significantly higher than expected incidence of antecedent breast cancer in this population, an association that deserves further exploration.