The oncology and fertility outcomes in patients with ovarian steroid cell tumors: a single center experience

Ovarian steroid cell tumor (SCT) is a rare ovarian neoplasm with uncertain malignant potential. This study aimed to evaluate the oncologic and reproductive outcomes of patients with ovarian SCTs. We retrospectively reviewed patients with ovarian SCTs who underwent surgery at Peking Union Medical College Hospital between January 2008 and August 2025. Patients were classified into fertility-sparing surgery (FSS) and non-FSS groups according to surgical approach. Clinical features, oncologic outcomes, hormonal recovery, and reproductive outcomes were analyzed. Thirty patients were included, with 19 in the FSS group and 11 in the non-FSS group. The median age of patients was 27 (range: 4–42) in the FSS group and 55 (range: 25–80) in the non-FSS group ( P < 0.001). In the FSS group, 63.2% (12/19) of patients had FIGO stage IA disease, 26.3% (5/19) had stage IC1 disease, and 10.5% (2/19) had stage II disease, whereas all patients in the non-FSS group had FIGO stage IA disease ( P = 0.029). Elevated serum testosterone levels with virilizing manifestations were observed in all FSS patients and in 45.5% of non-FSS patients. No recurrence was observed among patients with FIGO stage IA disease in either group. Recurrences occurred in a patient with stage IC who underwent ovarian cystectomy and in two patients with stage II in the FSS group, one of whom died of disease. At the last follow-up, only one patient clearly reported an active desire for childbearing and subsequently achieved a spontaneous twin pregnancy with live birth. Median follow-up was 61 months (range: 6–184) in the FSS group and 67 months (range: 4–160) in the non-FSS group. Ovarian SCTs confined to FIGO stage IA were associated with favorable oncologic outcomes in our cohort, whereas recurrence occurred in patients with stage IC or II disease. For patients with stage IA disease desiring fertility preservation, unilateral salpingo-oophorectomy (USO) may be considered. Fertility preservation in stage IC or II disease should be individualized with caution. Long-term follow-up and multi-institutional studies are needed to better define both oncologic and reproductive outcomes.