Clinical Characteristics And Prognosis Related Factors Of Patients With Ovarian Sertoli-Leydig Cell Tumor

Objective To evaluate the clinical pathological characteristics and prognosis related factors of patients with ovarian Sertoli-Leydig cell tumor(SLCT).Methods Detail clinical data,including clinical characteristics,recrudescence,death and menstruation and fertility states,of 72 SLCT patients treated in Peking Union Medical College Hospital were retrospectively reviewed,since December 27th 1966 to March 31st 2017.Results Median age is 28.5 years(range 6～73 years)in 72 patients.The mean tumor diameter was 9.3 cm(range 2～34 cm).Forty three cases(59.7%)showed androgenic manifestations,while 13 cases(18.1%)showed estrogenic manifestations and 16 cases(22.2%)had no endocrine symptoms.Fifty one cases(71.8%)were at stage Ia,1 case(1.4%)at stage Ib,17 cases(23.9%)at stage Ic,1 case(1.4%)was at stage IIIc,1 case(1.4%)was at stage IV;Four(5.6%)tumors were well differentiated,22(31%)were intermediately differentiated and 45(63.4%)were poorly differentiated.Five tumors had a retiform pattern,another 5 had heterologous elements(4 sarcomas and 1 carcinoid).Four cases(5.6%)were undertaken cystectomy,47 cases(65.3%)were undertaken adnexectomy,21 cases(29.2%)were undertaken hysterectomy and bilateral adnexectomy ± staging surgery.Thirty nine(54.2%)patients received systematic chemotherapy(1-4 courses)after the initial surgery.The median follow-up period was 43.5 months;7 cases recurred,5 cases died,in whom 4 cases died after recurrence,one patient with late stage disease died one month after diagnosis.The recurrent rate(5/21,23.8%VS.2/49,4.1%,P = 0.022)and mortality rate(5/21,23.8%VS.0/49,0%,P = 0.002)were higher in patients with tumor ≥ 10cm than tumor<10cm.The recurrent rate(2/43,4.7%VS.5/16,31.3%,P =0.013)and mortality rate(0/43,0%VS.5/16,31.3%,P=0.001)of patients without endocrine manifestations were significantly higher than those of the patients with androgenic manifestations.The recurrent rate(5/17,29.4%VS.1/51,2.0%,P =0.003)and mortality rate(4/17,23.5%VS.0/51,0%,P=0.006)of stage Ic were significantly higher than those of stage Ia.None of well differentiated tumor recurred or died,2 intermediately differentiated tumors recurred,and 1 died,5 poorly differentiated tumors recurred,and all died.There was no significant difference in the recurrence rate(5/39,12.8%VS.2/33,6.1%,P =0.442)and mortality rate(3/39,7.7%VS,2/33,6.1%,P=1.000)between the chemotherapy group and the non-chemotherapy group after the initial surgery.Fertility-preserving procedures didn’t affect the recurrent rate,either.Conclusions SLCT is a rare type of sex cord-stromal tumor of the ovary.Most SLCT patients have androgenic manifestations and abdominal masses.Tumors without endocrine changes might indicate more aggressive biological behaviors.The prognosis was correlated with tumor size and clinical stage,and probably the degree of differentiation.Conservative surgery is acceptable for young patients wishing to preserve fertility,and postoperative adjuvant chemotherapy and long-term follow up are recommended to those with high-risk factors of recurrence.