Systematic Review Of Prognosis Factors And Efficacy After The Preserve Fertility Surgery In Ovarian Sertoli-leydig Cell Tumor

Objective:To evaluate the prognosis factors and efficacy after fertility preservation operation in patients with ovarian Sertoli-Leydig Cell Tumor(SLCT). Investigating its unique clinical features and providing evidence based medicine for diagnosis and treatment.Methods: A systematic review of clinical trials of fertility preservation surgery with SLCTs in recent ten years was performed.Trials were identified by searching for Medline,Pubmed,CNKI,Wan Fang database.Select articles according to the inclusion and exclusion criteria and qualitative assessment the final included.Extract data and record them in SPSS13.0 software. Kaplan-Meier survival analysis was applied to calculate survival rates and log-rank test was applied to compare the differences between groups.A multivariable proportional hazard model(Cox) was applied to assess the prognostic factors.Results:We identified Forty retrospective trials involving 106 patients.The analysis results:1. We found out that the patients ranged in age from 9 months to 38 years(the average age 21,median age 20),and 99% of the tumors were unilateral. The representative characteristics of the disease are endocrine manifestations in 68.9% of patients, including virilization(49.1%) and defeminization(17.9%).2. The five-year survival rate of the comprehensive staging surgery group,the oophorectomy group and the tumor resection group respectively were 95.5%、91.9%、100%,without significant differenc(P>0.05);Meanwhile, the pregnancy rate and birth rate of the three groups were no significant differences(P=0.579,P=0.570).3. Univariate analysis suggested that differentiation grade,FIGO stage and tumor rupture were all significant predictors of survival for fertility preservation operation in patients with ovarian SLCTs.4. The 5-year survival rates were 100%、90.1%、87% and 78.6%for patients with well、intermediate、poorly differentiated and retiform elements or heterologous components tumor, with significant difference(P<0.05).5. The 3-year survival rates for patients with stage IA,IC,II-IV disease were 94.9%、92.9% and 66.7% respectively with significant difference(P<0.05).6. The 3-year survival rates of patients with tumor rupture and without it were no significant differences(P<0.05).7. The differentiation grade( HR=2.856,P<0.05) was independent prognostic factor influencing survival in the final multivariate Cox proportional hazard model. Patients with worse differentiation had a poorer prognosis.Conclusion:1.The representative characteristics of the LSCTs are endocrine manifestations especially virilization and defeminization.2. Fertility preserving surgery is safe and feasible for the LSCTs, which has a favorable survival rate,pregnancy rate and birth rate.3. The prognosis of ovarian LSCTs patients is influenced by FIGO stage, differentiation grade and tumor rupture,while differentiation grade is the independent prognostic factor.