J Gynecol Oncol.  2017 Jul;28(4):e49. 10.3802/jgo.2017.28.e49.

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

• Sarı ME
• Meydanlı
• Türkmen O
• Cömert GK
• Turan AT
• Karalök A
• Åžahin H
• Haberal A
• Kocaman E
• Akbayır O
• Erdem B
• NumanoÄŸlu C
• Güngördük K
• Sancı M
• Gökçü M
• Özgül N
• Salman MC
• Boyraz G
• Yüce K
• Güngör T
• TaÅŸkın S
• Altın D
• Ortaç UF
• Ayık HA
• ÅžimÅŸek T
• Arvas M
• Ayhan A

• KMID: 2413433
• DOI: http://doi.org/10.3802/jgo.2017.28.e49

Abstract

OBJECTIVE
To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy.
METHODS
A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected.
RESULTS
A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060).
CONCLUSION
Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.

Keyword

Radiotherapy, Adjuvant; Chemotherapy, Adjuvant; Endometrium; Neoplasm Invasiveness; Adenocarcinoma, Clear Cell; Uterine Diseases

MeSH Terms

Adenocarcinoma, Clear Cell/*secondary/*therapy
Adult
Aged
Aged, 80 and over
Aorta
Chemoradiotherapy, Adjuvant
Chemotherapy, Adjuvant
Disease-Free Survival
Female
Humans
Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Neoplasm Invasiveness
Omentum/*pathology/surgery
Pelvis
Peritoneal Neoplasms/*secondary/therapy
Radiotherapy, Adjuvant
Retrospective Studies
Survival Rate
Treatment Outcome
Turkey
Uterine Neoplasms/*pathology/*therapy