Abstract：
Steroid cell tumors (SCTs) of the ovary are rare and understudied, and as such, uncertainties remain about their malignant potential, as well as clinicopathologic predictors of patient outcome. Based on a multi-institutional cohort of cases, we present findings from the largest study of SCT reported to date. Clinicopathologic data were documented on 115 cases of SCT that were assembled from 17 institutions. The median patient age was 55 years (range: 9 to 84). When measured, preoperative androgen levels were elevated in 84.2% (48/57) of patients. A total of 111 (96.5%) cases were classified as stage I (103 stage IA; 2 stage IB; 6 stage IC). The stage distribution for the remaining 4 patients was as follows: stage II (n = 1), III (n = 3; 1 IIIA, 1 IIIB, 1 IIIC). The median tumor size was 3 cm (range: 0.2 to 22). Cytologic atypia, microscopic tumor necrosis, microscopic tumor hemorrhage, and a mitotic index of >1 mitotic figure/10 high-power fields were present in 52% (60/115), 9.6% (11/115), 37% (43/115), and 19% (22/115) of cases, respectively. Of 115 patients, 7 (6.1%) recurred postexcision, 4 (3.5%) ultimately died of disease, and 10 (8.7%) either recurred, died of disease, or were advanced stage at presentation. The median duration to recurrence postresection was 33 months (range: 23 to 180). Four of the 7 recurrences were stage IA at baseline. Tumor size >4 cm, International Federation of Gynecology and Obstetrics (FIGO) stage ≥IB, tumor necrosis, and tumor hemorrhage were each significantly associated with reduced recurrence-free survival in log-rank tests and univariable Cox models, with age older than 65 years being of marginal significance (hazard ratio [HR]: 5.4, 95% CI: 1.0-30.0, P = 0.05). Multivariable analyses suggested that FIGO stage ≥IB (HR: 27.5, 95% CI: 2.6-290.5), and age older than >65 years (HR: 21.8, 95% CI: 1.6-303.9) were the only parameters that were independently associated with recurrence. Cross-section analyses showed that tumor necrosis, tumor hemorrhage, and larger tumor size were significantly associated with a FIGO stage ≥IB status, which bolstered the conclusion that they are not independent predictors of recurrence. In summary, <10% of SCTs are clinically malignant, a substantially lower frequency than has previously been reported in the literature. Clinicopathologic predictors of patient outcomes that are prospectively applicable in practice could not be definitively established. Recurrences may occur many years (up to 15 y in this study) after primary resection, even in stage IA cases.
摘要：
卵巢的类固醇细胞肿瘤（SCT）很少见，研究不足，因此，他们的恶性潜力仍然不确定，以及患者预后的临床病理预测因子。基于多机构案例队列，我们介绍了迄今为止报道的规模最大的SCT研究的结果.记录了来自17个机构的115例SCT的临床病理数据。患者年龄中位数为55岁（范围：9至84岁）。测量时，84.2%(48/57)的患者术前雄激素水平升高.共有111例（96.5％）被分类为I期（103期IA；2期IB；6期IC）。其余4例患者的分期分布如下：II期（n=1），III(n=3；1IIIA，1IIIB,1IIIC）。中位肿瘤大小为3cm（范围：0.2至22）。细胞学异型性,显微肿瘤坏死，显微肿瘤出血，52%(60/115)的有丝分裂指数>1个有丝分裂图/10个高倍场，9.6%（11/115），37%（43/115），19%(22/115)的病例，分别。115名患者中,7例（6.1%）切除术后复发，4人（3.5%）最终死于疾病，10人(8.7%)复发，死于疾病,或者是演讲的高级阶段。切除术后复发的中位持续时间为33个月（范围：23至180）。7次复发中有4次是基线的IA期。肿瘤大小>4厘米，国际妇产科联合会（FIGO）分期≥IB，肿瘤坏死,在对数秩检验和单变量Cox模型中，肿瘤出血均与无复发生存率降低显著相关，年龄大于65岁具有边际意义（风险比[HR]：5.4，95％CI：1.0-30.0，P=0.05）。多变量分析表明，FIGO分期≥IB（HR：27.5，95%CI：2.6-290.5），年龄>65岁(HR:21.8,95%CI:1.6-303.9)是与复发独立相关的唯一参数.横截面分析表明肿瘤坏死，肿瘤出血,较大的肿瘤大小与FIGO分期≥IB状态显着相关，这支持了它们不是复发的独立预测因子的结论。总之,<10%的SCT是临床恶性的，频率大大低于文献中先前报道的频率。无法明确确定患者预后的临床病理预测因子在实践中具有前瞻性。复发可能会发生多年（在本研究中长达15年）后，即使在IA阶段的情况下。
