Prognostic Factors In Ovarian Adult Granulosa Cell Tumour

摘要

From our review of the literature, it appears that the only universally agreed prognostic factor in AGCTs is tumour stage and it is probable that advanced-stage neoplasms (stage II-IV) should receive adjuvant therapy, once the diagnosis is firmly established. However, since a sizeable majority of neoplasms are stage I at presentation, we wanted to identify independent factors that predict tumour recurrence within this group. Unfortunately, the literature is conflicting and not proven with regard to the main parameters. Some of the variations between studies may be partly explained by the subjective nature of several of the criteria, such as nuclear atypia and mitotic count. However, objective variables such as age, tumour size, Ki-67 labelling indices and DNA ploidy also yield conflicting results. There are likely to be many reasons behind this, with some studies adjusting for stage while others do not. Due to the relatively uncommon nature of AGCTs, many studies are based on relatively small numbers of cases and thus statistical analysis is often inadequate. An important factor is the indolent nature of these neoplasms, with recurrences sometimes occurring many years after initial removal; for this reason, a prolonged follow-up period, probably in excess of 20 years, is required to ensure most recurrences are included. The older literature often divided AGCTs into benign and malignant categories using the various parameters discussed. However, since there are no features that reliably predict malignant behaviour, all AGCTs should be considered low-grade malignant neoplasms with a potential for recurrence or metastasis. At present, there are no features that predict with any reliability which stage I AGCTs are likely to recur and which would be candidates for adjuvant therapy following surgical removal; as such, there is no support for inclusion of these parameters as prognostic factors which should influence management. The one possible exception is tumour rupture, which has not been widely investigated as a prognostic indicator but, which in the few studies where its significance has been examined, has been shown to be a factor predicting tumour recurrence or survival. Large multicentre studies are required to investigate whether the other parameters discussed are of value in predicting recurrence in stage I AGCTs.