Pure-type clear cell carcinoma of the ovary as a distinct histological type and improved survival in patients treated with paclitaxel-platinum-based chemotherapy in pure-type advanced disease
Introduction
Clear cell carcinoma has been a controversial entity since its recognition as distinct histological type in the World Health Organization's (WHO) classification of ovarian tumors in 1973 [1]. Clear cell carcinoma comprises 5–10% of surface epithelial ovarian cancers [2], and about 30–40% of the patients with clear cell carcinoma are diagnosed in the advanced stage [3]. Several authors have reported frequent admixtures of clear cell ovarian carcinoma with serous, mucinous, and endometrioid tumors [4], [5]. However, few papers addressed the difference in response to chemotherapy and survival between patients with pure and mixed-type advanced clear cell carcinoma.
Recent trends in the clinical management of advanced ovarian cancer include increased attention to maximal cytoreduction and general acceptance of paclitaxel-platinum-based adjuvant chemotherapy. The introduction of paclitaxel markedly changed the postoperative management of ovarian cancer patients [6], but the results and value of these newer efforts and therapies applied to clear cell carcinoma are as yet undetermined.
Today, paclitaxel-platinum-based chemotherapy is becoming the standard regimen for ovarian cancer worldwide. Previous research suggests a potential benefit of paclitaxel plus carboplatin regimens for stage I clear cell carcinoma [7]. However, few papers specifically addressed the efficacy of paclitaxel-platinum-based chemotherapy for advanced clear cell carcinoma because clear cell carcinoma occurs only rarely in Western countries. We studied the response to chemotherapy and survival for either paclitaxel-platinum-based chemotherapy or conventional platinum-based chemotherapy among 31 patients with stage III and IV clear cell ovarian carcinoma. Comparison was made to nine patients with stage III and IV mixed-type clear cell ovarian carcinoma. All patients were treated at six institutions during the same period. Prognostic factors for survival among the patients with pure, advanced, clear cell ovarian carcinoma were also evaluated.
Section snippets
Materials and methods
Between 1994 and 2001, a total of 41 patients with stage III and IV pure clear cell ovarian carcinoma were treated at six institutions; a total of 14 patients with stage III and IV mixed-type clear cell carcinoma treated in the same period were recruited as a comparison group. Both groups of patients were identified from the tumor registry, and clinical data were collected from the medical records and clinic visits. The three patients who refused adjuvant chemotherapy were excluded. An
Results
The median age of the 31 patients with advanced, pure, clear cell carcinoma was 51 years (range: 34–73 years). For the nine patients with mixed-type clear cell carcinoma, the median age was 54 years (range: 36–67 years). Patients with clear cell carcinoma had FIGO stage III and IV ovarian cancer: 6 had IIIb, 20 had IIIc, and 5 had stage IV disease. Seven patients with mixed-type clear cell carcinoma had stage IIIc and two had stage IV disease. Of the patients with mixed-type clear cell
Discussion
Clear cell carcinoma constitutes 5–10% of surface epithelial ovarian cancer [2], and about 30–40% of patients with clear cell carcinoma have advanced-stage disease at diagnosis [3]. Patients with advanced-stage clear cell carcinoma represent only 3–4% of patients with stage III and IV ovarian malignancies. Patients with stage I ovarian cancer might have favorable prognoses. Nonetheless, patients with clear cell carcinoma have poorer prognoses than do those with other pathological types of
References (24)
- et al.
Evaluation of complete surgical staging with pelvic and para-aortic lymphadenectomy and paclitaxel plus carboplatin chemotherapy for improvement of survival in stage I ovarian clear cell carcinoma
Gynecol. Oncol.
(2003) - et al.
Clear cell epithelial ovarian cancer (mesonephroid): bad prognosis only in early stages
Gynecol. Oncol.
(1993) - et al.
Uterine papillary serous carcinoma: a study of 108 cases with emphasis on the prognostic significance of associated endometrioid carcinoma, absence of invasion and concomitant ovarian carcinoma
Gynecol. Oncol.
(1992) - 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) - et al.
Survival probability in ovarian clear cell adenocarcinoma
Gynecol. Oncol.
(1999) - et al.
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) - et al.
Establishment and characterization of two human ovarian clear cell adenocarcinoma lines from metastatic lesions with different properties
Gynecol. Oncol.
(1995) - et al.
Cyclophosphamide and 5-fluorouracil act synergistically in ovarian clear cell adenocarcinoma cells
Cancer Lett.
(2001) - et al.
Low proliferation activity may be associated with chemoresistance in clear cell carcinoma of the ovary
Obstet. Gynecol.
(2002) - et al.(1973)
Surgical pathology of the ovaries
Surface epithelial–stromal tumor of the ovary
Cited by (95)
Therapeutic preferability of gemcitabine for ARID1A-deficient ovarian clear cell carcinoma
2019, Gynecologic OncologyCitation Excerpt :Ovarian clear cell carcinoma (OCCC) is a subtype of ovarian cancer with distinct characteristics from those of high-grade serous carcinoma (HGSC), including etiologies and molecular, genetic, and clinical characteristics [1–3]. The incidence of OCCC among ovarian cancer patients is higher in East Asia (approximately 30%) than in Europe and the United States (approximately 10%) [4–7]. OCCC has a response rate of approximately 30% to conventional, standard platinum-based chemotherapy established for ovarian cancers, which is significantly lower than that of HGSC, which has a response rate higher than 70% [6,8–10].
Is adjuvant chemotherapy beneficial for surgical stage I ovarian clear cell carcinoma?
2017, Gynecologic OncologyThe effect of adjuvant radiation on survival in early stage clear cell ovarian carcinoma
2016, Gynecologic OncologyCitation Excerpt :Traditionally, CT has been recommended for all patients with OCCC, despite the relatively favorable outcome and the relative chemoresistance to standard carboplatin based regimens. Reported response rates to chemotherapy for women with OCCC range between 11% and 56%, compared to response rates of over 70% for patients with serous ovarian cancer. [4,11,22–24] Combining the relative good prognosis of stage I OCCC with its relative lack of sensitivity to platinum-based CT, Takano et al. suggested that there is only a “mild beneficial effect” of adjuvant CT for stage I patients, with similar PFS and OS rates in the CT versus no-adjuvant CT groups [11].