Racial Disparities in Uterine Clear Cell Carcinoma: A Multi-Institution Study

ObjectiveThe aim of this study was to evaluate the impact of race on the overall survival (OS) and progression-free survival (PFS) of white and African-American patients with uterine clear cell carcinoma (UCCC).MethodsA retrospective review was conducted of all primary UCCC cases treated at 1 of 4 major gynecologic cancer centers between 1982 and 2012. Patients and tumor characteristics were retrieved from the cancer databases of the respective institutions and based on a retrospective review of the medical records. Differences in the OS and PFS between African-American and white women were compared using the Kaplan-Meier curves and log-rank test for univariate analysis. Cox regression models for the multivariate analyses were built to evaluate the relative impact of the various prognostic factors.ResultsOne hundred seventy women with UCCC were included in the study, including 118 white and 52 African-American women. Both groups were comparable with respect to age (P= 0.9), stage at diagnosis (P= 0.34), angiolymphatic invasion (P= 0.3), and depth of myometrial invasion (P= 0.84). In the multivariate analyses for known prognostic factors, OS and PFS were significantly different between white and African-American patients in the early-stage disease (hazard ratio [HR], 5.4; 95% confidence interval [CI], 1.2–23.2;P= 0.023 and HR, 3.5; 95% CI, 1.60–7.77;P= 0.0016, respectively) but not in the advanced-stage disease (HR, 0.83; 95% CI, 0.40–1.67;P= 0.61 and HR, 1.5; 95% CI, 0.84–2.78;P= 0.15, respectively).ConclusionsIn the current study, African-American patients have a prognosis worse than that of white patients in early-stage UCCC. We could not prove the same difference in advanced-stage disease.

Download Full-text

Patterns of Care, Predictors, and Outcomes of Adjuvant Therapy for Early- and Advanced-Stage Uterine Clear Cell Carcinoma: A Population-Based Analysis

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000661 ◽

2016 ◽

Vol 26 (4) ◽

pp. 697-704 ◽

Cited By ~ 1

Author(s):

Allison A. Gockley ◽

J. Alejandro Rauh-Hain ◽

Amber M. Anders ◽

Larissa A. Meyer ◽

Joel Clemmer ◽

...

Keyword(s):

Overall Survival ◽

Adjuvant Therapy ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Advanced Stage ◽

Combined Chemotherapy ◽

Stage Disease ◽

Disease Stages ◽

Uterine Clear Cell Carcinoma

ObjectiveThe aim of the study was to examine the patterns of care and the impact of chemotherapy and radiation on survival in women diagnosed with uterine clear cell carcinoma (UCCC). The primary outcomes of this analysis were receipt of treatment within 6 months of diagnosis and overall survival.Methods and MaterialsWomen diagnosed with UCCC from 2003 to 2011 were identified through the National Cancer Data Base. Standard univariate and multivariable analyses with logistic regression were performed. Kaplan-Meier survival analysis was used to generate overall survival data. Factors predictive of outcome were evaluated using the log-rank test and Cox proportional hazards model.ResultsA total of 3212 patients were identified. Chemotherapy, radiation, and combination chemotherapy and radiation were administered in 23.3%, 19.7%, and 11.1% of women, respectively. After adjusting for age, race, socioeconomic status, facility type, stage, surgery, lymph node dissection, comorbidity index, period of diagnosis, and registry location, there was an association between combined chemotherapy and radiation (hazard ratio, 0.74; 95% confidence interval, 0.61–0.90) with improved survival. Adjuvant therapy was not associated with improved survival among patients with early-stage disease (stages I and II). Both chemotherapy and combined chemotherapy and radiation were associated with significantly improved survival among patients with advanced-stage disease (stages III and IV).ConclusionsIn patients with early-stage UCCC, adjuvant therapy was not associated with significantly improved survival. Chemotherapy and combination of chemotherapy and radiation were associated with improved survival in patients with advanced-stage UCCC.

Download Full-text

Prognostic factors and treatment outcomes for patients with surgically staged uterine clear cell carcinoma focusing on the early stage: A Taiwanese Gynecologic Oncology Group study

Gynecologic Oncology ◽

10.1016/j.ygyno.2014.07.005 ◽

2014 ◽

Vol 134 (3) ◽

pp. 516-522 ◽

Cited By ~ 14

Author(s):

Keng-Fu Hsu ◽

Hung-Hsueh Chou ◽

Chia-Yen Huang ◽

Hung-Chun Fu ◽

An-Jen Chiang ◽

...

Keyword(s):

Prognostic Factors ◽

Treatment Outcomes ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Gynecologic Oncology ◽

Gynecologic Oncology Group ◽

Oncology Group ◽

Oncology Group Study ◽

Uterine Clear Cell Carcinoma

Download Full-text

Uterine Clear Cell Carcinoma: Does Adjuvant Chemotherapy Improve Outcomes?

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000839 ◽

2016 ◽

Vol 27 (1) ◽

pp. 69-76 ◽

Cited By ~ 3

Author(s):

Julie M.V. Nguyen ◽

Geneviève Bouchard-Fortier ◽

Marcus Q. Bernardini ◽

Eshetu G. Atenafu ◽

Guangming Han ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Stage I ◽

High Rate ◽

Advanced Stage ◽

Early Stage Disease ◽

Uterine Clear Cell Carcinoma

ObjectivesWomen with uterine clear cell carcinoma (UCCC) are at high risk of relapse. Adjuvant chemotherapy (CT) is often recommended, although its effectiveness remains controversial. Our objective was to evaluate treatment-related outcomes of patients with UCCC, particularly those treated with adjuvant CT.MethodsIn this retrospective cohort study, patients diagnosed with UCCC at 2 academic cancer centers from 2000 to 2014 were included. Clinical, surgical, and pathological data were collected. Survival estimates were obtained using the Kaplan-Meier method and compared by log rank test. Multivariable analysis was used to determine the effect of CT and radiation therapy (RT) on overall survival (OS) and progression-free survival (PFS).ResultsWe included 146 patients with UCCC, with a median follow-up of 27 months (range, 1–160). Ninety-five (65%) patients presented with stage I to II disease and 51 (35%) with stage III to IV disease. Forty-six percent of patients with clinical stage I were upstaged after surgery: 29% were upstaged to stages III and IV. Thirty-one percent of patients with early-stage disease and 70% with advanced-stage received CT. Among recurrences, the majority had distant relapse in both early-stage (61.5%) and advanced-stage (96.3%) diseases. In both patients with early-stage and advanced-stage diseases, adjuvant CT did not improve OS or PFS. On multivariate analysis, CT was not a significant factor associated with improved PFS (hazard ratio [HR], 1.37; 95% confidence interval [CI], 0.69–2.71;P= 0.37) or OS (HR, 0.58; 95% CI, 0.24–1.38;P= 0.22), whereas RT was associated with improved PFS (HR, 0.51; 95% CI, 0.29–0.90;P= 0.02) and OS (HR, 0.19; 95% CI, 0.09–0.42;P< 0.001).ConclusionsThe high rate of upstaging after surgery highlights the importance of lymph node assessment. The high rate of distant recurrence questions the effectiveness of current CT regimens and warrants the development of novel systemic approaches. The role of adjuvant RT deserves further study.

Download Full-text

Comparison of outcomes in early-stage uterine clear cell carcinoma and serous carcinoma

Brachytherapy ◽

10.1016/j.brachy.2018.08.015 ◽

2019 ◽

Vol 18 (1) ◽

pp. 38-43 ◽

Cited By ~ 3

Author(s):

Minsi Zhang ◽

T. Jonathan Yang ◽

Neil B. Desai ◽

Deborah DeLair ◽

Marisa A. Kollmeier ◽

...

Keyword(s):

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Serous Carcinoma ◽

Uterine Clear Cell Carcinoma

Download Full-text

Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study

Journal of Gynecologic Oncology ◽

10.3802/jgo.2017.28.e49 ◽

2017 ◽

Vol 28 (4) ◽

Cited By ~ 4

Author(s):

Mustafa Erkan Sarı ◽

Mehmet Mutlu Meydanlı ◽

Osman Türkmen ◽

Günsü Kimyon Cömert ◽

Ahmet Taner Turan ◽

...

Keyword(s):

Prognostic Factors ◽

Treatment Outcomes ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Gynecologic Oncology ◽

Gynecologic Oncology Group ◽

Oncology Group ◽

Oncology Group Study ◽

Non Invasive ◽

Uterine Clear Cell Carcinoma

Download Full-text

An evaluation of survival of ovarian cancer patients with clear cell carcinoma versus serous carcinoma treated with platinum therapy: A Gynecologic Oncology Group experience.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5534 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5534-5534 ◽

Cited By ~ 1

Author(s):

John H. Farley ◽

William E. Brady ◽

Michael J. Birrer ◽

David Marc Gershenson ◽

Gini F. Fleming ◽

...

Keyword(s):

Ovarian Cancer ◽

Prognostic Factors ◽

Epithelial Ovarian Cancer ◽

Cell Carcinoma ◽

Treatment Effect ◽

Late Stage ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Performance Status

5534 Background: We examined disparities in prognosis between patients with ovarian clear cell carcinoma (OCCC) and serous epithelial ovarian cancer (SOC). Methods: Data from stage I-IV epithelial ovarian cancer (EOC) patients who participated in 12 randomized GOG protocols using platinum-based chemotherapy were reviewed. Proportional hazards models adjusted for age and stratified by protocol, treatment arm, stage, performance status (PS), and race were used to compare progression-free survival (PFS) and overall survival (OS) by cell type (clear cell versus serous). Results: There were 10,803 patients enrolled, 1272 were not eligible: leaving 9,531, of whom 544 (6%) had OCCC, 7,054 (74%) had SOC, and 1,933 (20%) had other; only the OCCC and SOC are considered here. OCCC were significantly younger, more often of Asian race, stage I, good PS, and optimally surgically debulked than SOC patients. Prior to adjustment, OCCC had better PFS and OS due to better prognostic factors. There was no significant difference in PFS or OS for early stage OCCC patients compared to high-grade (HG) SOC patients. For late stage patients, OCCC had poorer PFS and OS compared to SOC, OS HR= 1.66 (1.43, 1.91; p < 0.001). For both optimal, HR = 1.34 (1.10, 1.63; p = 0.003) and suboptimal, HR = 3.18 (2.13, 4.75; p < 0.001) OCCC had a significantly poorer OS than SOC. After adjusting for age and stratified by protocol and treatment arm, stage, performance status, and race, OCCC had a significantly decreased OS, HR= 1.53 (1.33,1.76; p < 0.001). In early stage cases, there was a significantly decreased treatment effect on PFS for consolidative therapy with weekly taxol versus observation in SOC compared to OCCC (p = 0.048). Conclusions: This is one of the largest analyses to date of OCCC treated in a uniform manner . OCCC patients have better PFS and OS compared to SOC; this, is due to their better prognostic factors. There was no observed difference in PFS or OS for early stage OCCC versus HGSOC. In late-stage patients, OCCC was significantly associated with decreased OS which was true for both optimal and suboptimally debulked patients. Finally, treatment effect was influenced by histology.

Download Full-text

169 Uterine papillary serous and clear cell carcinoma: analysis of the impact of pelvic radiation therapy in early stage disease

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(03)90202-3 ◽

2003 ◽

Vol 1 (5) ◽

pp. S54

Author(s):

B. Kim ◽

R. Vongtama ◽

M. Lee ◽

M. Amneus ◽

C. Walsh ◽

...

Keyword(s):

Radiation Therapy ◽

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Early Stage Disease ◽

Pelvic Radiation ◽

Stage Disease ◽

The Impact

Download Full-text

Outcomes in patients with early stage uterine clear cell carcinoma treated with chemotherapy and radiotherapy: A systematic review and meta-analysis

10.21203/rs.2.20417/v1 ◽

2020 ◽

Author(s):

Xia Yin ◽

Jie Cheng ◽

Yi Zhang ◽

Chee Wai Chua ◽

Cheng Zhou ◽

...

Keyword(s):

Systematic Review ◽

Cell Carcinoma ◽

Odds Ratio ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Meta Analysis ◽

Treatment Strategies ◽

Progression Free Survival ◽

Uterine Clear Cell Carcinoma

Abstract Background : Uterine clear cell carcinoma (UCCC) is a rare histological type of endometrial cancer with poor prognosis and high risk of tumor relapse. Although adjuvant chemotherapy (CT) and/or radiotherapy (RT) are often recommended for early stage UCCC patients, the effectiveness of these treatment strategies remains unclear. Methods : Systematic review and meta-analysis were applied to evaluate treatment-related outcomes of stage I-II UCCC patients. Search strategy was applied using electronic databases until June 1st, 2019. Inclusion criteria were retrospective, observational and prospective studies that reported outcome of UCCC patients receiving adjuvant therapy. Clinical endpoints like overall survival (OS) and progression-free survival (PFS) were evaluated. Data were extracted by two independent reviewers and a meta-analysis was performed. Results : 13 articles with a total of 3967 patients were analyzed. Overall, adjuvant CT after surgery could improve 5 year-OS significantly compared to patients without CT (odds ratio 0.75, 95% confidence interval [CI] 0.58-0.96; p=0.02). In comparison, RT could also improve OS in UCCC patients of early stage (odds ratio 0.58, 95% CI 0.44-0.77; p=0.0002) compared to the patients without RT, especially in US and Europe patients. Lastly, when comparing the patients undergoing both CT and RT with those receiving CT or RT alone, no further improvement in OS was observed (odds ratio 1.12, 95% CI 0.63-1.99; P=0.70). Conclusions : Either CT or RT after surgery could improve the OS of early stage of UCCC patients. However, combinatorial CT and RT treatment did not improve the OS compared with CT or RT treatment alone.

Download Full-text