Optimal cytoreduction is the only independent prognostic factor for survival in women with ovarian clear cell carcinoma

Öz

Objective: To evaluate the clinicopathological characteristics, treatment methods, survival, and prognosis of ovarian clear-cell carcinoma (OCCC).

Material and Methods: All patients with OCCC who were treated between January 1998 and October 2012 were retrospectively reviewed. After the exclusion criteria, a total of 39 women were included in the present study. Univariate and multivariate analyses were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS).

Results: The majority of the patients were at stage I disease (n=21 [24.3%]). All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Additionally only pelvic, and pelvic plus para-aortic lymphadenectomy was done in 8 (20.5%) and 19 (48.8%) women, respectively. Optimal cytoreductive surgery was achieved in 26 (66.7%) patients. Recurrences occurred in 11 (28.2%) patients. The median follow-up period was 51 months (range 4 – 132 months). The 5-year PFS and OS rates were 47% and 54%, for all patients. The 5-year OS rates for women with early (stage I and II) and advanced (stage III and IV) stage disease were 56.4% and 38.1%, respectively. Multivariate analysis confirmed optimal cytoreduction as the only independent predictor of OS [Odds ratio (OR) 21.212, 95% confidence interval (CI) 5.259–85.556, (p<0.001)]

Conclusion: Optimal cytoreductive surgery is the only independent good prognostic factor for survival in patients with OCCC.

Anahtar Kelimeler

• ovarian clear-cell carcinoma, survival, optimal cytoreduction, chemotherapy

Optimal cytoreduction is the only independent prognostic factor for survival in women with ovarian clear cell carcinoma

Öz

Kaynakça

1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10–29.
2. Anglesio MS, Carey MS, Köbel M, Mackay H, Huntsman DG; Vancouver Ovarian Clear Cell Symposium Speakers. Clear cell carcinoma of the ovary: a report from the first Ovarian Clear Cell Symposium, June 24th, 2010. Gynecol Oncol. 2011;121:407-15
3. del Carmen MG, Birrer M, Schorge JO. Clear cell carcinoma of the ovary: a review of the literature. Gynecol Oncol. 2012;126:481-90.
4. Schiller W. Mesonephroma ovarii. Am J Cancer 1939;35:1-21
5. Goff BA, Sainz de la Cuesta R, Muntz HG, Fleischhacker D, Ek M, Rice LW,et al. Clear cell carcinoma of the ovary: a distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy in stage III disease. Gynecol Oncol. 1996;60:412-7
6. Kennedy A W, Biscotti C V, Hart W R, Webster D. Ovarian clear cell adenocarcinoma. Gynecol Oncol. 1989;32:342-9.
7. Czernobilsky B, Silverman BB, Enterline HT. Clear-cell carcinoma of the ovary. A clinicopathologic analysis of pure and mixed forms and comparison with endometrioid carcinoma. Cancer. 1970;25:762-72.
8. Jenison EL, Montag AG, Griffiths CT, Welch WR, Lavin PT, Greer J, et al. Clear cell adenocarcinoma of the ovary: a clinical analysis and comparison with serous carcinoma. Gynecol Oncol. 1989;32:65-71

9. Crozier MA, Copeland LJ, Silva EG, Gershenson DM, Stringer CA. Clear cell carcinoma of the ovary: a study of 59 cases. Gynecol Oncol. 1989;35:199-203.
10. Pectasides D1, Fountzilas G, Aravantinos G, Kalofonos C, Efstathiou H, Farmakis D, et al. Advanced stage clear-cell epithelial ovarian cancer: the Hellenic Cooperative Oncology Group experience. Gynecol Oncol. 2006;102:285-291.
11. Timmers PJ, Zwinderman AH, Teodorovic I, Vergote I, Trimbos JB. Clear Cell Carcinoma Compared to Serous Carcinoma in Early Ovarian Cancer Same Prognosis in a Large Randomized Trial. Int J Gynecol Cancer. 2009;19: 88-93
12. Doshi N, Tobon H. Primary clear cell carcinoma of the ovary. An analysis of 15 cases and a review of the literature. Cancer. 1977;39:2658-2664.
13. Fine G, Clarke HD, Horn RC. Mesonephroma of the ovary. A clinical, morphological, and histogenic appraisal. Cancer. 1973;31:398-410.
14. Kita T, Kikuchi Y, Kudoh K, Takano M, Goto T, Hirata J, et al. Exploratory study of effective chemotherapy to clear cell carcinoma of the ovary. Oncol Rep. 2000;7:327-331.
15. Aure JC, Hoeg K, Kolstad P. Mesonephroid tumors of the ovary: clinical and histopathologic studies. Obstet Gynecol. 1971;37:860-867.
16. Russel P. The pathologic assessment of ovarian neoplasms. Introduction to the common ‘epithelial’ tumors and analysis of benign ‘epithelial’ tumors. Pathology. 1979;11:5-26.
17. Yoonessi M, Weldon D, Satchidand SK, Crickard K. Clear cell ovarian adenocarcinoma. J Surg Oncol. 1984;27:289-97.
18. O'Brien ME, Schofield JB, Tan S, Fryatt I, Fisher C, Wiltshaw E. Clear cell epithelial ovarian cancer (mesonephroid): bad prognosis only in early stages. Gynecol Oncol. 1993;49:250-54.
19. Behbakht K, Randall TC, Benjamin I, Morgan MA, King S, Rubin SC. Clinical characteristics of clear cell carcinoma of the ovary. Gynecol Oncol. 1998;70: 255-58.
20. Mizuno M, Kikkawa F, Shibata K, Kajiyama H, Ino K, Kawai M, et al. Long-Term Follow-Up and Prognostic Factor Analysis In Clear Cell Adenocarcinoma of The Ovary. Journal of Surgical Oncology 2006;94:138 – 143.
21. Fisken J, Leonard RC, Stewart M, Beattie GJ, Sturgeon C, Aspinall L, et al. The prognostic value of early CA125 serum assay in epithelial ovarian carcinoma. Br J Cancer 1993;68:140–145.
22. Parker D, Bradley C, Bogle SM, Lay J, Masood M, Hancock AK, et al. Serum albumin and CA125 are powerful predictors of survival in epithelial ovarian cancer. Br J Obstet Gynaecol 1994;101:888–893.
23. Omura GA, Brady MF, Homesley HD, Yordan E, Major FJ, Buchsbaum HJ, et al. Long-term follow up and prognostic factor analysis in advanced ovarian carcinoma: The Gynecologic Oncology Group experience. J Clin Oncol 1991;9:1138–1150.
24. Hoskins WJ, Bundy BN, Thigpen JT, Omura GA. The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: A Gynecologic Oncology Group study. Gynecol Oncol 1992;47:159–166.
25. Hoskins WJ, McGuire WP, Brady MF, Homesley HD, Creasman WT, Berman M, et al. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 1994;170:974–980.
26. Gorai I, Nakazawa T, Miyagi E, Hirahara F, Nagashima Y, Minaguchi H. Establishment and characterization of two human ovarian clear cell adenocarcinoma lines from metastatic lesions with different properties. Gynecol Oncol. 1995;57:33-46.