title: Pathologic Risk Factors for Metastatic Disease in Postpubertal Patients With Clinical Stage I Testicular Stromal Tumors.
abstract: To systematically review the existing literature to analyze the impact of previously identified pathologic risk factors on harboring occult metastatic disease (OMD) in patients with Clinical Stage I testicular stromal tumors (TSTs).
  
  
  
  A literature search using PubMed was conducted using the following terms: "testicular stromal tumors," "testicular Leydig cell tumors," "testicular Sertoli tumors," "testicular interstitial tumors," "testicular granulosa tumor," and "testicular sex cord tumors." For analysis, we included only studies with data on available recurrence, survival, and time-to-event. We hypothesized that patients with ≥2 risk factors would experience lower 5-year OMD-free survival (OMDFS) than those with <2 risk factors.
  
  
  
  Two hundred ninety-two patients from 47 publications were included with a median age at diagnosis of 35 years (range 12-76). Five-year OMDFS and overall survival in patients with Stage I TSTs were 91.2% and 93.2%, respectively. When comparing those who harbored OMD to those who did not, we observed an increased risk of OMD for each additional risk factor (P < .001). Five-year OMDFS was 98.1% for those with <2 risk factors vs 44.9% for those with ≥2 risk factors (P < .001).
  
  
  
  The existing literature on pathologic risk factors for OMD in this population is insufficient to make broad clinical recommendations. However, these factors appear to risk-stratify patients and may be useful for future research investigating adjuvant therapy in higher-risk patients. This review indicates that such a stratification system has a rational basis.
authors.affiliation: Department of Surgery, Division of Urology, University of Colorado, Aurora, CO.
authors.forename: Kyle O
authors.initials: KO
authors.lastname: Rove
authors.affiliation: Department of Surgery, Division of Urology, University of Colorado, Aurora, CO.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Maroni
authors.affiliation: Department of Pediatrics, Division of Pediatric Oncology, University of Colorado, Aurora, CO.
authors.forename: Carrye R
authors.initials: CR
authors.lastname: Cost
authors.affiliation: Department of Biostatistics and Informatics, University of Colorado, Aurora, CO.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Fairclough
authors.affiliation: Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia", Udine, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
authors.affiliation: Department of Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Harris
authors.affiliation: Department of Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.
authors.forename: Kris Ann P
authors.initials: KA
authors.lastname: Schultz
authors.affiliation: Department of Surgery, Division of Urology, University of Colorado, Aurora, CO. Electronic address: nicholas.cost@ucdenver.edu.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Cost
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009919:Orchiectomy / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D018310:Sertoli-Leydig Cell Tumor / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult