Background: Sex cord-stromal (SCS) ovarian tumours, a rare subset of ovarian tumours, require tailored surgical approaches. Whilst surgery is the cornerstone of treatment for these tumours, patterns of management in Australia have not been previously documented. In this study, we aimed to examine surgical patterns of care for SCS tumours using data extracted from the National Gynae-Oncology Registry (NGOR).
Methods: Data from the NGOR's 'Rare Ovarian Tumour Module' were analysed for patients newly diagnosed with malignant ovarian SCS tumours between April 2017 and December 2022. Eligible patients received care at 15 hospitals across Victoria, New South Wales, Tasmania and Western Australia. Demographic and clinical data, including tumour stage, histological diagnosis, surgical procedures, and treatment details, were extracted from medical records. Data were summarised via descriptive statistics.
Results: As of January 2023, a total of 96 patients with SCS ovarian tumours had complete data for analysis. The mean age at diagnosis was 53.2 years (SD=15.0), ranging from 19 to 85 years. Predominantly, patients resided in Victoria (n=53, 55.2%), followed by New South Wales (n=26, 27.1%). Adult granulosa cell tumours (AGCT) emerged as the most prevalent histological type, accounting for 83.3% (n=80) of cases, followed by sex cord-stromal tumour, not otherwise specified (n=10, 10.4%). The majority of patients were diagnosed with early stage disease: FIGO stage IA, 54.2% (n = 52); IB, 1.0% (n = 1); IC, 21.9% (n = 21); II, 9.4% (n = 9); III, 4.2% (n = 4); not documented, 10.4% (n = 10).
The majority of patients (n=63, 65.6%) had their first surgical treatment performed by a gynaecologic oncologist at a hospital with a specialist gynaecological oncology unit (SGOU). Smaller percentages of first surgical resections were conducted by other surgeons at a hospital with an SGOU (n=12, 12.5%), and at a non-SGOU regional (n=11, 11.5%) or metropolitan (n=6, 6.3%) hospital. Of the 29 patients who had their first operation performed by a surgeon without subspecialty training, all were subsequently referred to an SGOU, discussed at a multidisciplinary team meeting, and 13 of 29 (44.9%) underwent a second primary surgery overseen by a gynaecologic oncologist. Most patients only underwent one surgical episode as part of first-line treatment (n=76, 79.2%), though 17.7% (n=17) underwent two and 3.1% (n=3) underwent three first-line surgical procedures.
Fertility-sparing first-line surgery (defined herein as conservation of the uterus and one ovary and fallopian tube) was performed in 20 of 83 cases (24.1%) where these gynaecological structures had not been previously removed. Amongst those aged under 50, 18 of 35 (51.4%) received fertility-sparing first-line surgery. Approximately equal percentages of patients underwent initial laparotomy (n=50, 52.1%) and initial laparoscopy (n=46, 47.9%). Omentectomy or omental biopsy was performed in 57.3% (n=55) of cases during initial surgery, with a smaller proportion (n=9, 9.4%) undergoing omental resection at their second or third first-line surgical procedure. Rates of intraoperative adverse events (n=8, 8.3%) and 30-day postoperative adverse events (n=11, 11.5%) were low. None of the cases of 30-day postoperative adverse events were classified as severe (≥ Grade IIIA Clavien-Dindo).
Conclusions: Data sourced from the NGOR has provided valuable insight into the patterns of surgical care for patients with sex cord-stromal tumours in Australia. Of note is the predominance of gynaecologic oncologists and gynaecologic oncology centres involved in performing these surgical procedures and the variability in fertility-sparing approaches. There is scope to optimise care by ensuring access to gynaecologic oncologists, promoting standardised surgical approaches, and enhancing the provision of fertility-sparing options. These results may inform clinical practice guidelines and improve the management of patients with SCS tumours in the future.