Introduction:

Leydig cell tumors are a rare type of sex-cord stromal tumor that comprise 1-3% of all testicular neoplasms. Due to its rarity, limited data is available to guide treatment and management. Using the National Cancer Data Base (NCDB), we sought to determine the association of pathological characteristics, retroperitoneal lymph node dissection (RPLND), and overall survival. 

Methods:

We identified 309 patients from the National Cancer Database diagnosed with Leydig cell tumor from 2004 to 2015. Patients who did not receive orchiectomy were excluded. Pathologic characteristics and use of RPLND were determined. Overall survival was analyzed by Kaplan-Meier method for tumor size, pathologic tumor stage, and AJCC stage.

Results:

Of the 66,042 cases of testicular cancer between 2004 and 2015, 309 (0.47%) were Leydig cell tumors. The median patient age of diagnosis was 47 years (IQR, 34-59) with a median follow-up of 51 months. Of the 309 patients, 75.7% were White, 19.1% were Black, and 5.2% were made up of other ethnic backgrounds. The majority of patients were Stage I (94.22%), with the remaining patients in Stage II (2.89%) and Stage III (2.89%). OS at 3 years was 97.1% (95% CI, 93.7-98.7), 60% (95% CI, 12.6-88.2), and 33.3% (95% CI, 4.61-67.6), respectively (p <0.0001). Median tumor size was 1.8 cm (IQR, 0.9 – 3.5). OS at 5 years for tumor sizes <=2.5 cm, >2.5 cm to <=5 cm, and >5 cm were 96.4% (95% CI, 91.4-98.5), 87.5% (95% CI, 73.6-94.3) and 73.5% (95% CI, 56.2-84.8), respectively (p < 0.0001). In patients with pTis/pT1, the 5 year OS is 96.1% (95% CI, 91.2-98.3) compared with pT2 OS of 45.9% (95% CI, 20.0-68.8) and pT3 OS of 40% (95% CI, 5.2%-75.3%) (p < 0.0001). Two of 7 patients with positive margins died. Twenty-seven patients received RPLND, of which 10 patients were node positive. The 3 year OS for patients who were N0 and N+ at the time of RPLND was 92.3% (95% CI, 56.6-98.9) and 50% (95% CI,11.1-80.4), respectively (p < 0.05). Four of 6 patients with metastatic disease died within 2 and 19 months. 

Conclusion:

Larger tumor size and higher pathological T stage were indicators of poorer overall survival in patients with Leydig cell tumors. Patients who received a retroperitoneal lymph node dissection had worse outcomes compared to those who did not. Further investigation is required to determine the optimal treatment for patients with these tumors. 

Funding: N/A