45MO Management of stage I ovarian Sertoli-Leydig cell tumors: Prognostic factors from a multicenter international retrospective study

Sertoli-Leydig cell tumors (SLCT) are extremely rare, thus evidence regarding optimal management is limited. According to European guidelines, fertility sparing surgery (FSS) is recommended for stage IA and adjuvant chemotherapy in stage >IA or in G3. The aim of this study was to assess the prognostic factors in the management of SLCT. Retrospective data on patients diagnosed with stage I SCLT between January 1980 and March 2024 within MITO group (Multicenter Italian Trials in Ovarian cancer) and Charing Cross Hospital, London were collected. Statistical analyses were carried out using the SPSS Statistics. Clinicopathological variables were evaluated for association with relapse. 72 patients were included. Median age was 36.4 years (range 5-81). Stage was IA in 59 (81.9%), IB in 1(1.3%) and IC in 12 patients (16.7%). Tumor grade was G1, G2 and G3 in 20 (27.8%), 33 (45.8 %) and 19 (26.4%) patients, respectively. FSS was performed in 49 patients (68.0%), with laparoscopic approach in 56.9%. Peritoneal staging was done in 63.9% of patients. Most patients (86.1%) received surveillance postoperatively. After a median follow up time of 87 months (range 70-103), 12 patients (16.7%) recurred and 4 (5.5%) died of disease. Relapse rates in G1,2,3 tumors were 5%, 24.2% and 31.6%, respectively. Among patients with stage IA and IC, relapse rate was 17% and 41.7% (p=0.06). There was no statistically significant difference in relapse rates between FSS and non-FSS (24.5% vs 13%, p=0.26), nor between laparoscopic and open surgery (19.5% vs 22.6%, p=0.75). No statistically significant difference in recurrence rate was detected between G3 cases receiving or not chemotherapy (33% vs 30%). At multivariable analysis, the only factors associated with relapse were grade (G2-3 vs G1, OR 9.08 [95%CI 1.04-79.23]) and absence of peritoneal surgical staging (OR 3.58 [95% CI 1.03-12.45]). These findings support conservative surgery as a safe approach for patients affected by stage I SLCT, provided that surgical staging is performed. More data deriving from international multicenter collaborations are needed to clarify the role of adjuvant chemotherapy in this setting.