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

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.

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

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000068 ◽

2014 ◽

Vol 24 (3) ◽

pp. 541-548 ◽

Cited By ~ 4

Author(s):

Zaid R. Al-Wahab ◽

Sanjeev Kumar ◽

David G. Mutch ◽

Sean C. Dowdy ◽

Sharon A. Hensley ◽

...

Keyword(s):

African American ◽

Prognostic Factors ◽

Retrospective Review ◽

Clear Cell ◽

Multivariate Analyses ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Advanced Stage ◽

Stage Disease ◽

Uterine Clear Cell Carcinoma

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.

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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.

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Impact of adjuvant therapy on oncologic outcomes in early-stage uterine clear cell carcinoma

Gynecologic Oncology ◽

10.1016/j.ygyno.2020.05.591 ◽

2020 ◽

Vol 159 ◽

pp. 325

Author(s):

S. Pedra Nobre ◽

B. Ataseven ◽

A.D. Bois ◽

V. Makker ◽

K. Alektiar ◽

...

Keyword(s):

Adjuvant Therapy ◽

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Early Stage ◽

Oncologic Outcomes ◽

Uterine Clear Cell Carcinoma

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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

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Should Albumin Be Considered a Prognostic Factor For Brazilian Patients Diagnosed With Classical Hodgkin Lymphoma

Blood ◽

10.1182/blood.v122.21.5049.5049 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5049-5049

Author(s):

Guilherme Fleury Perini ◽

Egyla M Cavalcante ◽

Joao Garibaldi Rezende ◽

Davimar Miranda Borducchi ◽

Fernanda Cunha Vieira ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factor ◽

Partial Response ◽

Early Stage ◽

Progression Free Survival ◽

Refractory Disease ◽

Advanced Stage ◽

Classical Hodgkin Lymphoma ◽

Free Survival ◽

Stage Disease

Abstract Introduction In 1998, Hasenclever et al published the International Prognostic Factor for patients with advanced stage classical Hodgkin lymphoma (cHL). Since then, the IPS has been considered the most important prognostic score for cHL and has been validated in different populations, and also in early stage cHL. From the seven factors analyzed in the IPS, albumin is the only that can be influenced by environmental, economic and nutritional status. We hypothesized if, in developing countries, albumin should still be a prognostic factor, and if so, what is the ideal cutoff value. Objectives To assess if albumin at diagnosis of cHL patients in Brazil was prognostic for overall survival (OS) and progression free survival (PFS) and what would be the best cutoff. Patient and Methods This is a retrospective multicenter study conducted by the Universidade Federal de São Paulo, São Paulo, Brazil. Only confirmed cases of cHL, diagnosed between April 1996 To January 2013, with clinical, epidemiological and laboratorial parameters available after a thorough chart review were included in this study. Response was defined as complete (CR) or less than CR (partial response or refractory disease). Event was defined as treatment related mortality, progression (defined as time for initiation of salvage therapy) or relapse. Advanced stage disease was defined as stage I or II with B symptoms and/or bulky disease and stage III or IV. Patients with conflicted data or loss of follow up were excluded from the analysis. Results A total of 179 patients were selected for this study. Nodular sclerosis subtype was diagnosed in 125 (68.9%) of all patients. Median age at diagnosis was 28 years old (ranging from 13-76). Only 22.9% of patients presented with early stage disease. ABVD chemotherapy protocol was the initial therapy in 91% of patients. Consolidation radiotherapy was done in 48.6%. Median serum albumin was 3.74 (range: 1.34 – 5.52). Median albumin for patients treated in private hospital was 3.6 (range: 2.7 – 4.7) in contrast to patients treated in public hospitals with a median level of 3.0 (range: 1.34 – 5.52), although this difference was not statistically different. Overall responses were: CR in 90%, Partial response/Refractory disease in 10%; one patient died due to treatment-related toxicity. Overall Survival (OS) for the entire group was 93% in 5 years (CI95% 87-96%), with a progression free survival (PFS) of 79% (CI95% 73-86%). When applying the cutoff of 4g/dL, albumin was not related to OS (91% vs 98%, p=ns) or PFS (85 vs 77%, p=ns). However, an albumin value greater than 2g/dL was related to a better OS (94% vs 71%, p=0.01). Conclusions Prognostic factors may differ from different studied populations. This is particularly truth for albumin, which is the only IPS factor influenced by the environment. In our study, however, albumin was not significantly related to OS or PFS, unless when a cutoff of 2g/dL was used. Disclosures: No relevant conflicts of interest to declare.

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Neuroendocrine carcinoma of the cervix: A single institution’s experience.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15585 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15585-e15585

Author(s):

Megan Preston ◽

Georgia Anne-Lee McCann ◽

David M. O'Malley ◽

Christina Boutsicaris ◽

Larry J. Copeland ◽

...

Keyword(s):

Adjuvant Therapy ◽

Metastatic Disease ◽

Survival Data ◽

Early Stage ◽

Stage I ◽

Stage Ii ◽

Advanced Stage ◽

Single Institution ◽

Early Stage Disease ◽

Stage Disease

e15585 Background: Neuroendocrine carcinomas (NEC) of the cervix comprise only 2% of all cervical cancers. As a result, prospective data is limited and treatment guidelines rely on literature from lung NEC. The objective of this study was to examine and report on our experience in the management of this rare, aggressive disease. Methods: This was an IRB-approved, single-institution, retrospective review. Study criteria included patients with cervical NEC diagnosed between 1990-2011. Demographic, treatment and survival data was collected. Progression-free survival (PFS) and overall survival (OS) was defined as the time from date of initial treatment until progression or death respectively, or date of last contact. Results: A total of 24 patients met inclusion criteria. The median age at diagnosis was 43. Median PFS was 13.6 months and median OS was 16.4 months. The majority of patients had advanced-stage disease (61% stage II-IV, 39% stage I). Of the 9 patients with stage I disease, 4 were treated with platinum + etoposide-based neoadjuvant chemotherapy and 5 were treated with initial radical surgery. Seven of the 9 patients had post-operative adjuvant therapy consisting of chemotherapy, chemo-radiation or radiation only. Seven of the 9 patients (78%) were alive at last follow-up. Of the two patients who were deceased, one had metastatic disease found at surgery and the other declined adjuvant therapy and died of recurrence. Patients with stage II-IV disease (n=15) had a median PFS and OS of 11.5 and 12.1 months, respectively. Only 2 had no evidence of disease at last encounter. The remainder died without achieving remission. Patients with metastatic disease had significantly worse survival when compared to those with loco-regional disease with a median OS of 8 vs. 28 months (p = .03), respectively. Conclusions: We report one of the largest single-institution experiences of neuroendocrine cervical cancer. Advanced-stage patients had a poor prognosis regardless of therapy. However, multi-modality therapy in early-stage disease resulted in an excellent prognosis (78% survival) for these rare, highly aggressive tumors. These findings support the goal of curative intent for early-stage disease using multi-modality therapy.

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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

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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.

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