The oncological outcome of the patients with ovarian clear cell cancer: Platinum-based adjuvant chemotherapy is not suitable

Abstract

Background/Aim: Ovarian clear cell cancer (OCCC) is one of the rare histological subtypes of epithelial ovarian cancer with different tumoral biology and prognosis. This study aimed to evaluate the clinical and pathological data of OCCC and define the prognostic factors. Methods: Sixty-three patients with OCCC were included in this retrospective cross-sectional study. Patients with mixed-type clear cell carcinoma were excluded. Response to chemotherapy was assessed according to the WHO criteria. The survival analysis was performed using the Kaplan-Meier method and survival curves were compared with the log-rank test. Cox proportional hazards model was used in the multivariate analysis. Results: The mean age of patients was 54.6 (10.7) years. Twenty-three (36.5%) patients were stage III&IV. Systematic lymphadenectomy was performed in 55 (87.3%) patients and 13 (23.6%) had lymph node metastasis. Maximal cytoreduction was performed in 57 (90.5%) patients, optimal cytoreduction, in 1 (1.6%) patient, and suboptimal cytoreduction was performed in 2 (3.2%) patients via primary cytoreductive surgery. The complete clinical response rate following adjuvant treatment was 61.1% in stages III&IV. Five-year failure-free survival was 63% in the entire cohort. According to the multivariate analysis, the stage was an independent risk factor for treatment failure. The probability of recurrence increased 24 times in stages III and IV (95% Confidence interval: 5.561-104.421; P<0.001). Conclusion: The stage of the disease is a prognostic factor for OCCC. The response to platinum-based chemotherapy in OCCC is very low.

Keywords

• Ovarian clear cell cancer
• Recurrence
• Stage
• Survival

References

1. 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34.
2. 2. Zhou H, Liu Q, Shi X, Liu Y, Cao D, Yang J. Distinct gene expression profiles associated with clinical outcomes in patients with ovarian clear cell carcinoma and high-grade serous ovarian carcinoma. J Ovarian Res. 2020;13(1):38.
3. 3. Kuroda T, Kohno T. Precision medicine for ovarian clear cell carcinoma based on gene alterations. Int J Clin Oncol. 2020;25(3):419-24.
4. 4. Hogen L, Vicus D, Ferguson SE, Gien LT, Nofech-Mozes S, Lennox GK, et al. Patterns of recurrence and impact on survival in patients with clear cell ovarian carcinoma. Int J Gynecol Cancer. 2019;29(7):1164-9.
5. 5. Jang JYA, Yanaihara N, Pujade-Lauraine E, Mikami Y, Oda K, Bookman M, et al. Update on rare epithelial ovarian cancers: based on the Rare Ovarian Tumors Young Investigator Conference. J Gynecol Oncol. 2017;28(4):e54.
6. 6. Fujiwara K, Shintani D, Nishikawa T. Clear-cell carcinoma of the ovary. Ann Oncol. 2016;27 Suppl 1:i50-i2.
7. 7. Liu H, Xu Y, Ji J, Dong R, Qiu H, Dai X. Prognosis of ovarian clear cell cancer compared with other epithelial cancer types: A population-based analysis. Oncol Lett. 2020;19(3):1947-57.
8. 8. Ye S, Yang J, You Y, Cao D, Huang H, Wu M, et al. Comparison of Clinical Characteristic and Prognosis between Ovarian Clear Cell Carcinoma and Serous Carcinoma: A 10-Year Cohort Study of Chinese Patients. PLoS One. 2015;10(7):e0133498.

9. 9. Organization WH. WHO handbook for reporting results of cancer treatment 1979.
10. 10. Ledermann JA, Raja FA, Fotopoulou C, Gonzalez-Martin A, Colombo N, Sessa C. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv259.
11. 11. Anglesio MS, Carey MS, Kobel M, Mackay H, Huntsman DG. Clear cell carcinoma of the ovary: a report from the first Ovarian Clear Cell Symposium, June 24th, 2010. Gynecol Oncol. 2011;121(2):407-15.
12. 12. Chang LC, Huang CF, Lai MS, Shen LJ, Wu FL, Cheng WF. Prognostic factors in epithelial ovarian cancer: A population-based study. PLoS One. 2018;13(3):e0194993.
13. 13. Lee HY, Hong JH, Byun JH, Kim HJ, Baek SK, Kim JY, et al. Clinical Characteristics of Clear Cell Ovarian Cancer: A Retrospective Multicenter Experience of 308 Patients in South Korea. Cancer Res Treat. 2020;52(1):277-83.
14. 14. Zhao T, Shao Y, Liu Y, Wang X, Guan L, Lu Y. Endometriosis does not confer improved prognosis in ovarian clear cell carcinoma: a retrospective study at a single institute. J Ovarian Res. 2018;11(1):53.
15. 15. Tang H, Liu Y, Wang X, Guan L, Chen W, Jiang H, et al. Clear cell carcinoma of the ovary: Clinicopathologic features and outcomes in a Chinese cohort. Medicine (Baltimore). 2018;97(21):e10881.
16. 16. Itamochi H, Kigawa J, Terakawa N. Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma. Cancer Sci. 2008;99(4):653-8.
17. 17. Webber K, Friedlander M. Chemotherapy for epithelial ovarian, fallopian tube and primary peritoneal cancer. Best Pract Res Clin Obstet Gynaecol. 2017;41:126-38.
18. 18. Grabowski JP, Harter P, Heitz F, Pujade-Lauraine E, Reuss A, Kristensen G, et al. Operability and chemotherapy responsiveness in advanced low-grade serous ovarian cancer. An analysis of the AGO Study Group metadatabase. Gynecol Oncol. 2016;140(3):457-62.
19. 19. Hess V, A'Hern R, Nasiri N, King DM, Blake PR, Barton DP, et al. Mucinous epithelial ovarian cancer: a separate entity requiring specific treatment. J Clin Oncol. 2004;22(6):1040-4.
20. 20. Bogani G, Ditto A, Lopez S, Bertolina F, Murgia F, Pinelli C, et al. Adjuvant chemotherapy vs. observation in stage I clear cell ovarian carcinoma: A systematic review and meta-analysis. Gynecol Oncol. 2020;157(1):293-8.
21. 21. Takano M, Tsuda H, Sugiyama T. Clear cell carcinoma of the ovary: is there a role of histology-specific treatment? J Exp Clin Cancer Res. 2012;31(1):53.
22. 22. Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, et al. NCCN Guidelines Insights: Ovarian Cancer, Version 1.2019. J Natl Compr Canc Netw. 2019;17(8):896-909.
23. 23. Oseledchyk A, Leitao MM, Jr., Konner J, O'Cearbhaill RE, Zamarin D, Sonoda Y, et al. Adjuvant chemotherapy in patients with stage I endometrioid or clear cell ovarian cancer in the platinum era: a Surveillance, Epidemiology, and End Results Cohort Study, 2000-2013. Ann Oncol. 2017;28(12):2985-93.
24. 24. Sugiyama T, Okamoto A, Enomoto T, Hamano T, Aotani E, Terao Y, et al. Randomized Phase III Trial of Irinotecan Plus Cisplatin Compared With Paclitaxel Plus Carboplatin As First-Line Chemotherapy for Ovarian Clear Cell Carcinoma: JGOG3017/GCIG Trial. J Clin Oncol. 2016;34(24):2881-7.
25. 25. Kawaguchi W, Itamochi H, Kigawa J, Kanamori Y, Oishi T, Shimada M, et al. Simultaneous inhibition of the mitogen‐activated protein kinase kinase and phosphatidylinositol 3′‐kinase pathways enhances sensitivity to paclitaxel in ovarian carcinoma. Cancer Science. 2007;98(12):2002-8.
26. 26. Fujimura M, Hidaka T, Saito S. Selective inhibition of the epidermal growth factor receptor by ZD1839 decreases the growth and invasion of ovarian clear cell adenocarcinoma cells. Clinical Cancer Research. 2002;8(7):2448-54.
27. 27. Ye S, Zhou S, Chen W, Xiang L, Wu X, Yang H. Recurrence Patterns and Survival Outcomes in Chinese Patients with Surgically Treated Recurrent Ovarian Clear Cell Carcinoma: A Single Institutional Analysis of 45 Cases. Cancer Manag Res. 2020;12:913-9.
28. 28. Takano M, Kikuchi Y, Yaegashi N, Kuzuya K, Ueki M, Tsuda H, et al. Clear cell carcinoma of the ovary: a retrospective multicentre experience of 254 patients with complete surgical staging. Br J Cancer. 2006;94(10):1369-74.
29. 29. Anglesio MS, Yong PJ. Endometriosis-associated Ovarian Cancers. Clin Obstet Gynecol. 2017;60(4):711-27.
30. 30. Ye S, Yang J, You Y, Cao D, Bai H, Lang J, et al. Comparative study of ovarian clear cell carcinoma with and without endometriosis in People's Republic of China. Fertil Steril. 2014;102(6):1656-62.