Elsevier

Gynecologic Oncology

Volume 94, Issue 1, July 2004, Pages 197-203
Gynecologic Oncology

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

https://doi.org/10.1016/j.ygyno.2004.04.004Get rights and content

Abstract

Objective. The aim was to compare survival in pure and mixed-type advanced clear cell ovarian carcinoma and to determine the benefits among patients with pure advanced clear cell ovarian carcinoma treated in paclitaxel-platinum-based chemotherapy in comparison with those treated in conventional platinum-based chemotherapy after primary surgery.

Methods. Between 1994 and 2001, 31 women with stage III and IV pure clear cell ovarian carcinoma and nine patients with stage III and IV mixed-type clear cell carcinoma were identified from the tumor registry of six institutions. All patients underwent cytoreductive surgery followed by conventional platinum-based chemotherapy or paclitaxel and platinum-based chemotherapy.

Results. The median survival of women with pure clear cell carcinoma was 11 months, compared to 48+ months for those with mixed-type clear cell carcinoma (P = 0.003). Overall, for women with pure clear cell carcinoma, 35% had clinically complete responses to chemotherapy. For women with pure clear cell carcinoma treated with paclitaxel-platinum-based chemotherapy, the median survival was significantly longer than for those treated with conventional platinum-based chemotherapy (16.26 vs. 10.75 months, P = 0.045; with optimal cytoreduction, 40.95 vs. 9.02 months, P = 0.028). Univariate analysis showed paclitaxel-platinum-based treatment was the only favorable prognostic factor for women with advanced pure clear cell ovarian carcinoma (P = 0.05).

Conclusions. Patients with advanced pure clear cell ovarian carcinoma have poorer prognoses than those with the mixed type. Paclitaxel-platinum-based chemotherapy improved survival among our patients with advanced pure clear cell carcinoma, especially for those with optimal cytoreduction.

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

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