Header

UZH-Logo

Maintenance Infos

Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data


Fankhauser, Christian D; Grogg, Josias B; Hayoz, Stefanie; Wettstein, Marian S; Dieckmann, Klaus-Peter; Sulser, Tullio; Bode, Peter-Karl; Clarke, Noel W; Beyer, Joerg; Hermanns, Thomas (2019). Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data. Journal of Urology:Epub ahead of print.

Abstract

AIMS
Leydig cell tumors (LCTs) are rare but the most common non-germ cell testicular tumors. Only limited evidence exists for reliably differentiating between benign and malignant LCTs and for optimally managing the different types and stages of this rare disease. This review aims to synthesize the available evidence regarding the clinical presentation and clinicopathological characteristics associated with LCT malignancy and management.
METHODS
We analyzed published case series with LCTs patients. The association between clinicopathological variables and the presence of metastatic disease was assessed using regression analyses.
RESULTS
We included 357 reports, reviewing available data from 1,375 patients (median age: 34y). Testis-sparing surgery (TSS) was performed in 463 patients. Local recurrence after TSS occurred in 8 of 121 (7%) patients with available follow-up information. Metastases were found in 101 patients and were most often located in the retroperitoneal lymph nodes (60%), lungs (38%), and/or liver (29%). The multivariable models with or without multiple imputation predicting metastatic disease included older age, larger tumor size, the presence of any adverse factor (larger tumor diameter, necrosis, angiolymphatic invasion, pleomorphism, high mitotic index, atypia), and any protective factor (Reinke crystals, lipofuscin pigments, gynecomastia) with model AUCs of 0.93. Durable remission after resection of metastases or platinum-based chemotherapy was rarely seen.
CONCLUSION
Our risk tables using clinicopathological parameters can help identify patients harboring malignant tumors. These patients should undergo staging and either be followed or receive further treatment. In metastatic disease surgical and systemic treatment might result in disease control in in some patients.

Abstract

AIMS
Leydig cell tumors (LCTs) are rare but the most common non-germ cell testicular tumors. Only limited evidence exists for reliably differentiating between benign and malignant LCTs and for optimally managing the different types and stages of this rare disease. This review aims to synthesize the available evidence regarding the clinical presentation and clinicopathological characteristics associated with LCT malignancy and management.
METHODS
We analyzed published case series with LCTs patients. The association between clinicopathological variables and the presence of metastatic disease was assessed using regression analyses.
RESULTS
We included 357 reports, reviewing available data from 1,375 patients (median age: 34y). Testis-sparing surgery (TSS) was performed in 463 patients. Local recurrence after TSS occurred in 8 of 121 (7%) patients with available follow-up information. Metastases were found in 101 patients and were most often located in the retroperitoneal lymph nodes (60%), lungs (38%), and/or liver (29%). The multivariable models with or without multiple imputation predicting metastatic disease included older age, larger tumor size, the presence of any adverse factor (larger tumor diameter, necrosis, angiolymphatic invasion, pleomorphism, high mitotic index, atypia), and any protective factor (Reinke crystals, lipofuscin pigments, gynecomastia) with model AUCs of 0.93. Durable remission after resection of metastases or platinum-based chemotherapy was rarely seen.
CONCLUSION
Our risk tables using clinicopathological parameters can help identify patients harboring malignant tumors. These patients should undergo staging and either be followed or receive further treatment. In metastatic disease surgical and systemic treatment might result in disease control in in some patients.

Statistics

Citations

Dimensions.ai Metrics

Altmetrics

Downloads

54 downloads since deposited on 06 Feb 2020
55 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Pathology and Molecular Pathology
04 Faculty of Medicine > University Hospital Zurich > Urological Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:17 December 2019
Deposited On:06 Feb 2020 08:19
Last Modified:12 Feb 2020 11:30
Publisher:Elsevier
ISSN:0022-5347
OA Status:Green
Publisher DOI:https://doi.org/10.1097/JU.0000000000000705
PubMed ID:31845841

Download

Green Open Access

Download PDF  'Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data'.
Preview
Content: Supplemental Material
Filetype: PDF (Table 1 patient characteristics)
Size: 113kB
Download PDF  'Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data'.
Preview
Filetype: PDF (Table 2 univar regression analysis)
Size: 108kB
Download PDF  'Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data'.
Preview
Content: Supplemental Material
Filetype: PDF (Table 3 multivar regression analysis)
Size: 79kB
Download PDF  'Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data'.
Preview
Content: Supplemental Material
Filetype: PDF (Figure 1 flow diag)
Size: 397kB
Download PDF  'Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data'.
Preview
Content: Supplemental Material
Filetype: PDF (Figure 2 metastatic spread)
Size: 844kB
Download PDF  'Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data'.
Preview
Content: Supplemental Material
Filetype: PDF (Figure 3 imputed dataset predictors)
Size: 20kB
Download PDF  'Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data'.
Preview
Content: Supplemental Material
Filetype: PDF (key abbreviations)
Size: 62kB
Download PDF  'Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data'.
Preview
Content: Supplemental Material
Filetype: PDF (figure legends)
Size: 96kB