Ten-Year Real-World Outcomes and Clinicopathologic Predictors of Recurrence in Adult Granulosa Cell Tumors: A Turkish Single-Center Experience

Background: Adult granulosa cell tumors are rare ovarian neoplasms with typically indolent behavior but potential for late recurrence. This study aimed to evaluate long-term outcomes and identify clinicopathological predictors of disease-free survival in patients with adult granulosa cell tumors. Methods: This retrospective cohort study included patients with histologically confirmed adult granulosa cell tumors who were treated or followed at Ege University Faculty of Medicine between January 2012 and 2023. Survival outcomes were evaluated using Kaplan–Meier analysis and multivariable regression models. A p-value < 0.05 was considered statistically significant. Results: A total of 55 patients were included, with a median follow-up of 113.7 months. The median disease-free survival and overall survival were 92.3 and 113.7 months, respectively. The estimated five-year disease-free survival and overall survival rates were 84.5% (95% CI: 74.5–94.5%) and 93.9% (95% CI: 87.2–100.0%), respectively. Recurrence occurred in 23.6% of patients and was significantly associated with advanced International Federation of Gynecology and Obstetrics (FIGO) stage (p = 0.045), atypical endometrial pathology (p = 0.025), and bleomycin-etoposide-cisplatin or etoposide-cisplatin based adjuvant chemotherapy (p = 0.008). Tumor size >10 cm and stage III disease were also associated with shorter disease-free survival (p = 0.017 and p = 0.001, respectively). In univariate regression analysis, stage III disease (HR: 7.14, p = 0.006), tumor size >10 cm (HR: 3.59, p = 0.025), and absence of endometrial pathology (HR: 0.343, p = 0.022) were significantly associated with recurrence. In multivariate regression analysis, only stage III disease remained an independent predictor (HR: 4.45, p = 0.046). Conclusion: Advanced-stage disease independently predicted recurrence, underscoring the need for individualized risk stratification and extended follow-up in these patients.