A 30-year study of 355 cases with adult-type ovarian granulosa cell tumors in a tertiary center: Clinical features and factors predicting recurrence

Background This retrospective study aims to evaluate the clinicopathological features of adult granulosa cell tumors (AGCT) and identify prognostic factors influencing disease recurrence. Methods We reviewed patients with pathologically confirmed AGCT treated at a tertiary center between January 1988 and June 2024. Comprehensive data on disease-free survival (DFS), overall survival (OS), recurrence rates, and prognostic factors were analyzed. Results A total of 355 patients were analyzed. With a median follow-up time of 72 months (range 2–435), recurrence occurred in 101 cases (28.4%), with a median time to first recurrence of 67 months (range 2–246). Survival analysis demonstrated 5- and 10-year DFS rates of 86.2% and 75.1%, respectively, and 5- and 10-year OS rates of 100% and 97.5%. Multivariate analysis identified tumor size > 9 cm (odds ratio (OR) = 3.6, p < 0.001), laparoscopic approach (OR = 2.1, p = 0.002), FIGO stages IC–IV (OR = 2.3, p = 0.032), and tumor rupture (OR = 2.5, p = 0.006) as independent predictors of reduced DFS. Conclusions AGCT demonstrates favorable long-term survival, though recurrence remains a significant concern. Poorer DFS is associated with tumor size (> 9 cm), laparoscopic surgery, tumor rupture, and advanced FIGO stage. FIGO stage IC warrant intensified surveillance due to higher recurrence risk. Fertility-sparing surgery might be feasible and safe in early-stage cases, while complete staging surgery and adjuvant chemotherapy fail to affect DFS.