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

• Published in: Journal of gynecologic oncology Vol. 28; no. 4; pp. 1 - 13
• Main Authors: Mustafa Erkan Sarı, Mehmet Mutlu Meydanlı, Osman Türkmen, Günsü Kimyon Cömert, Ahmet Taner Turan, Alper Karalö, Hanifi Şahin, Ali Haberal, Eda Kocaman, Özgür Akbayır, Baki Erdem, Ceyhun Numanoğlu, Kemal Güngördük, Muzaffer Sancı, Mehmet Gökçü, Nejat Özgül, Mehmet Coşkun Salman, Gökhan Boyraz, Kunter Yüce, Tayfun Güngör, Salih Taşkın, Duygun Altın, Uğur Fırat Ortaç, Hülya Aydın Ayık, Tayup Şimşek, Macit Arvas, Ali Ayhan
• Format: Journal Article
• Language: Korean
• Published: 대한부인종양학회 10-07-2017
• Subjects: Adenocarcinoma; Adjuvant; Chemotherapy; Clear Cell; Endometrium; Neoplasm Invasiveness; Radiotherapy; Uterine Diseases
• ISSN: 2005-0380

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.