Uterine Clear Cell Carcinoma: Does Adjuvant Chemotherapy Improve Outcomes?

2016 ◽  
Vol 27 (1) ◽  
pp. 69-76 ◽  
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.

Significance of Ovarian Endometriosis on the Prognosis of Ovarian Clear Cell Carcinoma

2018 ◽  
Vol 28 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Jeong-Yeol Park ◽  
Dae-Yeon Kim ◽  
Dae-Shik Suh ◽  
Jong-Hyeok Kim ◽  
Yong-Man Kim ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Early Stage ◽  
Stage I ◽  
Ovarian Clear Cell Carcinoma ◽  
Ovarian Endometriosis ◽  
Early Stage Disease ◽  
Group 2 ◽  
Group 1

IntroductionThe aim of this study was to evaluate the significance of ovarian endometriosis on the prognosis of ovarian clear cell carcinoma (OCCC).MethodsPatients with OCCC were divided into 2 groups according to the presence of ovarian endometriosis: group 1, no coexisting ovarian endometriosis; group 2, clear cell carcinoma arising from ovarian endometriosis or the presence of ovarian endometriosis elsewhere in the ovary. Clinicopathologic characteristics, disease-free survival (DFS), and overall survival (OS) were compared between the 2 groups.ResultsOf 155 patients with OCCC, 77 were categorized into group 1 and 78 into group 2. Group 2 patients were younger than group 1 (median age, 48 vs 51 years; P = 0.005) and had higher incidence of early-stage disease (stage I, 77% vs 58%; P = 0.001) and lower incidence of lymph node metastasis (4% vs 17%; P = 0.008). Group 2 patients were observed to have a significantly higher 5-year DFS (P < 0.001) and OS (P = 0.001) compared with group 1. In stage I disease, group 2 had a significantly higher 5-year DFS (P = 0.004) and OS (P = 0.016) than did group 1. In the multivariate analysis, coexisting endometriosis and advanced International Federation of Obstetrics and Gynecology stage were significant factors for both DFS and OS rates.ConclusionsOvarian clear cell carcinoma with endometriosis was found more frequently in younger women and had a higher incidence of early-stage disease and a lower incidence of lymph node metastasis compared with OCCC without endometriosis. Ovarian endometriosis was associated with improved prognostic factors and a better DFS and OS even in stage I disease. Ovarian endometriosis was an independent prognostic factor for OCCC.

Adjuvant chemotherapy and radiation improve survival of surgical stage I uterine clear cell carcinoma patients

2019 ◽  
Vol 154 ◽  
pp. 204-205
Author(s):  
S. Chow ◽  
J.K. Chan ◽  
L. Delic ◽  
D.S. Kapp ◽  
A.K. Mann ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Stage I ◽  
Uterine Clear Cell Carcinoma

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

Brachytherapy ◽  
2019 ◽  
Vol 18 (1) ◽  
pp. 38-43 ◽  
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

Adjuvant Chemotherapy for Stage I Ovarian Clear Cell Carcinoma: Is it Necessary for Stage IA?

2012 ◽  
Vol 22 (7) ◽  
pp. 1143-1149 ◽  
Author(s):  
Mika Mizuno ◽  
Hiroaki Kajiyama ◽  
Kiyosumi Shibata ◽  
Kimio Mizuno ◽  
Osamu Yamamuro ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Stage I ◽  
Surgical Staging ◽  
Recurrence Free Survival ◽  
Ovarian Clear Cell Carcinoma ◽  
Free Survival ◽  
Stage Ia

BackgroundIt is controversial whether patients with stage I ovarian clear cell carcinoma (CCC) benefit from postoperative chemotherapy. This study was designed to evaluate the postoperative outcomes associated with the inclusion or exclusion of adjuvant therapy in these patients.MethodsA total of 185 patients who were treated for stage I CCC between 1991 and 2007 were retrospectively evaluated. All of the patients had received comprehensive surgical staging, and their condition had been diagnosed by a central pathological review system. Only one patient with stage IB was excluded from this study.ResultsMedian follow-up time was 62 months (range 7–191 months). Median age was 52 years (30–75 years). There were 41, 93, and 50 patients in stage IA, intraoperative capsule ruptured IC (rupture-IC), and all other-IC groups, respectively. The 5-year recurrence-free survival rates for the substage were 97.6%, 87.8%, and 70.4% (P < 0.001), respectively. Among 134 patients consisting of those in the stage IA and rupture-IC groups, 91 patients received adjuvant chemotherapy (AC) and 43 patients did not (non-AC). There was no significant survival difference in each substage group between the non-AC and AC groups in 5-year recurrence-free survival rate (stage IA, 100% vs 93.8%; rupture-IC, 94.1% vs 86.6%). Multivariate analysis demonstrated that there was no significant prognostic factor for both recurrence and survival among the IA and rupture-IC groups. Postoperative therapy, regimen, and chemotherapy cycles were not significantly affected.ConclusionsThis study indicates that adjuvant chemotherapy does not contribute to the improving prognosis of stage IA ovarian CCC. Whereas the histological type is CCC, the routine adjuvant chemotherapy after comprehensive surgical staging may be unnecessary for patients with at least stage IA.

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

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.

scholarly journals Clear cell carcinoma of the ovary: a clinical and molecular perspective

2020 ◽  
pp. ijgc-2020-001656
Author(s):  
Yasushi Iida ◽  
Aikou Okamoto ◽  
Robert L Hollis ◽  
Charlie Gourley ◽  
C Simon Herrington
Keyword(s):  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Early Stage ◽  
Molecular Characteristics ◽  
Specific Gene ◽  
Tumor Type ◽  
Early Stage Disease ◽  
Platinum Based Chemotherapy ◽  
Carcinoma Of The Ovary

Clear cell carcinoma of the ovary has distinct biology and clinical behavior. There are significant geographical and racial differences in the incidence of clear cell carcinoma compared with other epithelial ovarian tumors. Patients with clear cell carcinoma are younger, tend to present at an early stage, and their tumors are commonly associated with endometriosis, which is widely accepted as a direct precursor of clear cell carcinoma and has been identified pathologically in approximately 50% of clear cell carcinoma cases. The most frequent and important specific gene alterations in clear cell carcinoma are mutations of AT-rich interaction domain 1A (ARID1A) (~50% of cases) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) (~50% cases). More broadly, subgroups of clear cell carcinoma have been identified based on C-APOBEC (apolipoprotein B mRNA editing enzyme, catalytic polypeptide-like) and C-AGE (age-related) mutational signatures. Gene expression profiling shows upregulation of hepatocyte nuclear factor 1-beta (HNF1β) and oxidative stress-related genes, and has identified epithelial-like and mesenchymal-like tumor subgroups. Although the benefit of platinum-based chemotherapy is not clearly defined it remains the mainstay of first-line therapy. Patients with early-stage disease have a favorable clinical outcome but the prognosis of patients with advanced-stage or recurrent disease is poor. Alternative treatment strategies are required to improve patient outcome and the development of targeted therapies based on molecular characteristics is a promising approach. Improved specificity of the histological definition of this tumor type is helping these efforts but, due to the rarity of clear cell carcinoma, international collaboration will be essential to design appropriately powered, large-scale clinical trials.

Adjuvant Chemotherapy for Stage I Clear Cell Carcinoma of the Ovary

2012 ◽  
Vol 22 (4) ◽  
pp. 573-578 ◽  
Author(s):  
Toshio Takada ◽  
Haruko Iwase ◽  
Chiaki Iitsuka ◽  
Hidetaka Nomura ◽  
Kimihiko Sakamoto ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Stage I ◽  
Carcinoma Of The Ovary

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

2014 ◽  
Vol 24 (3) ◽  
pp. 541-548 ◽  
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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