Stage IA and IC Adult Granulosa Cell Tumors: Clinical Features, Long-Term Outcomes and Prognostic Factors in a 333-Patient Cohort Over Three Decades

Background Adult granulosa cell tumors (AGCTs) are rare low-grade malignant ovarian tumor, 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, comprising 196 patients (58.9%) with FIGO stage IA and 137 (41.1%) with stage IC. After a follow-up of 138.5 ± 108.0 months, 55 cases experienced recurrence in the IC group (59.1%), significantly higher than the IA group (38 cases, 40.9%; P  < 0.001). Both groups had nearly half of recurrences localized to the intra-abdominal cavity, with comparable median recurrence intervals (P = 0.932). Multivariate logistic regression identified stage IC (P = 0.001) and adjuvant chemotherapy (P = 0.002) as significant negative predictors of higher recurrence rates. Cox multivariate analysis revealed stage IC and incomplete staging surgery as independent prognostic factors for poorer DFS in early-stage disease (P = 0.001 and 0.012, respectively). Notably, staging surgery was associated with DFS only in stage IC patients (P = 0.016). Conclusions FSS was a favorable safety profile in 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.