Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
Institute of Pathology and Molecular Pathology, University Hospital, University of Zurich, Zurich, Switzerland.
Oncologist. 2020 Jul;25(7):585-590. doi: 10.1634/theoncologist.2019-0692. Epub 2020 Feb 11.
Sertoli cell tumors (SCTs) of the testes are rare, and the literature provides only weak evidence concerning their clinical course and management. The objective of this study was to summarize evidence on SCTs' clinical presentation, clinicopathological risk factors for malignancy, treatment options, and oncological outcomes.
Data sources included Medline, Embase, Scopus, the Cochrane Database of Systematic Reviews, and Web of Science. Published case reports, case series, and cohorts were included. Data on clinicopathological variables, treatment of local or metastatic disease, site of metastasis, or survival were extracted from each study considered in this paper, and associations between clinicopathological variables and metastatic disease were analyzed. Whenever feasible, data on individual patients were collected.
Of the 435 patients included, only one (<1%) showed local recurrence after testis-sparing surgery (TSS). Three patients underwent adjuvant retroperitoneal lymphadenectomy. Fifty patients presented with metastases, located in the retroperitoneal lymph nodes (76%), lungs (36%), and bones (16%); median time to recurrence was 12 months. Risk factors for metastatic disease included age, tumor size, necrosis, tumor extension to the spermatic cord, angiolymphatic invasion, and mitotic index. Patients with metastases had a median life expectancy of 20 months. In six patients, metastasectomy resulted in complete remission.
Our findings suggest that few local recurrences result after TSS, and no adjuvant therapy can be regarded as a standard of care. Several risk factors are predictive of metastatic disease. Surgery leads to remission in metastatic disease, whereas systemic treatment alone does not result in long-term remission.
Testicular Sertoli cell tumors usually present without metastatic disease and show low local recurrence rates after testis-sparing surgery; no adjuvant therapy option can be regarded as a standard of care. Patients with risk factors should undergo staging investigations. Those with metastatic disease have poor prognoses, and metastasectomy may be offered in selected cases.
睾丸支持细胞瘤（SCT）是一种罕见的疾病，文献中关于其临床过程和治疗方法的证据很少。本研究的目的是总结 SCT 的临床表现、恶性肿瘤的临床病理危险因素、治疗选择和肿瘤学结局的证据。
数据来源包括 Medline、Embase、Scopus、Cochrane 系统评价数据库和 Web of Science。纳入的研究包括已发表的病例报告、病例系列和队列研究。从每篇纳入的研究中提取与临床病理变量、局部或转移性疾病治疗、转移部位或生存相关的数据，并分析临床病理变量与转移性疾病之间的关系。在可行的情况下，收集了个体患者的数据。
在纳入的 435 名患者中，只有 1 名（<1%）患者在保留睾丸手术后出现局部复发。3 名患者接受了辅助腹膜后淋巴结清扫术。50 名患者出现转移，转移部位包括腹膜后淋巴结（76%）、肺部（36%）和骨骼（16%）；中位复发时间为 12 个月。转移疾病的危险因素包括年龄、肿瘤大小、坏死、肿瘤向精索延伸、血管淋巴管浸润和有丝分裂指数。有转移的患者中位预期寿命为 20 个月。在 6 名患者中，转移瘤切除术导致完全缓解。
我们的研究结果表明，保留睾丸手术后很少出现局部复发，并且没有辅助治疗可以被视为标准治疗。一些危险因素可以预测转移疾病。手术可以使转移性疾病缓解，而单独使用全身治疗并不能使患者获得长期缓解。
睾丸支持细胞瘤通常在没有转移疾病的情况下出现，保留睾丸手术后局部复发率较低；没有辅助治疗方法可以被视为标准治疗。有危险因素的患者应进行分期检查。有转移疾病的患者预后较差，在某些情况下可考虑进行转移瘤切除术。
