Prognostic factors responsible for survival in sex cord stromal tumors of the ovary—A multivariate analysis

Abstract

Objective.

To evaluate prognostic factors that impacts the survival of women with sex cord stromal tumors of the ovary (SCST).

Methods.

Cases were identified from tumor registry databases at three academic institutions between 1975 and 2003. Patient characteristics, surgical treatment, adjuvant therapy, pathologic and follow-up information were collected from hospital charts and clinic records. Kaplan–Meier and Cox proportional hazards analyses were used to identify predictors of outcome.

Results.

Eighty-three women (median age: 49 years) with SCST of the ovary, including 73 with granulosa and 10 with Sertoli–Leydig cell tumors were identified. Fifty-one were stage I, 8 stage II, 10 stage III, 3 stage IV, and 11 patients were unstaged. The median and 5-year disease-specific survival of women with stage I–II vs. III–IV was 180 months and 85% compared to 58 months and 48%, respectively (P = 0.012). Furthermore, age <50 (P = 0.003), premenopausal status (P = 0.013), tumor size < 10 cm (P = 0.003), lack of lymph node invasion (P < 0.0005), and absence of residual disease (P = 0.002) were all significant predictors for improved survival. Of the patients who received adjuvant treatment, chemotherapy did not impact survival (P = 0.11). Twelve of 51 stage I patients underwent fertility-sparing surgery with three recurrences. In multivariate analysis, age <50, smaller tumor size, and absence of residual disease remained as independent prognostic factors. The median follow up was 58 months (range: 1–310).

Conclusions.

Age <50, smaller tumor size, and absence of residual disease are important predictors for improved survival in patients with SCST of the ovary.

Introduction

Adult ovarian sex cord stromal tumors (SCST) are uncommon malignancies, accounting for approximately 5% of all ovarian tumors [1], [2]. SCST are generally considered to have a low malignant potential with a favorable prognosis. Since most women with these tumors are diagnosed before menopause, some may present with endocrinologic manifestations secondary to steroid production [3].

Prognostic factors associated with SCST include age [4], [5], stage of disease [1], [4], [6], [7], tumor size [4], [5], [6], extent of surgery [1], [8], and other histologic parameters [9], [10]. Surgical intervention has been generally accepted as the primary treatment upon initial presentation. However, there is no standard adjuvant treatment for patients with high-risk disease [11]. Previous reports have recommended the use of chemotherapy for extensive residual disease, inoperable recurrences, and metastases [12], [13], [14], [15]. Furthermore, radiotherapy may have a role in prolonging disease-free survival in advanced or recurrent disease [10], [16], [17]. With the relative infrequency with which these cancers occur, the opportunity to develop therapeutic evidence regarding treatment via randomized controlled trials is limited.

In this retrospective study, we report on the treatment and outcome of 83 women diagnosed with SCST. Furthermore, the clinical and pathologic prognostic factors that influence survival were analyzed.