1. Clear Cell Carcinoma of the Endometrium
- Author
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David G. Mutch, Mohamed A. Elshaikh, Sudeshna Bandyopadhyay, Robert T. Morris, Sean C. Dowdy, Adnan Munkarah, Sumi Thomas, Eman Abdulfatah, Rouba Ali-Fehmi, Sharif Sakr, and Z. Al-Wahab
- Subjects
Adult ,0301 basic medicine ,Oncology ,medicine.medical_specialty ,Lymphovascular invasion ,Article ,Endometrium ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Internal medicine ,Adjuvant therapy ,Humans ,Medicine ,Stage (cooking) ,Lymph node ,Fisher's exact test ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Proportional hazards model ,Carcinoma ,Obstetrics and Gynecology ,Retrospective cohort study ,Middle Aged ,Prognosis ,United States ,Endometrial Neoplasms ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Clear cell carcinoma ,symbols ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Objectives Clear cell carcinoma (CCC) comprises a rare yet an aggressive subtype, accounting for less than 5% of all uterine carcinomas. Several clinicopathologic features have been predictive of poor prognosis; however, data remain controversial. The aim of this study was to evaluate the clinicopathologic features of a multi-institutional cohort of endometrial CCC in order to identify which, if any, have prognostic significance. Methods Retrospective review of endometrial CCC diagnosed between 1995 and 2012 at 3 institutions was conducted to evaluate clinicopathologic parameters: age, race, tumor size, stage, myometrial invasion (MI), lymphovascular invasion, lymph node and adnexal involvement, adjuvant therapy, and outcomes. Data were analyzed using Fisher exact, Cox regression, and Kaplan-Meier analyses. Results Patients’ ages ranged from 36 to 90 years (median, 67 years). The median tumor size was 3.6 cm. Inner-half MI was present in 44%, lymphovascular invasion in 34%, adnexal involvement in 16%, and lymph node metastasis in 30% of cases. Fifty-eight percent of the patients presented with early-stage disease. The 5-year overall survival (OS) was 58%. Shorter disease-free interval (DFI) was significantly associated with older age at diagnosis (>70 years), advanced-stage disease, adnexal involvement, and deep MI (P = 0.005, P = 0.001, P = 0.001, and P = 0.003, respectively). Patients who received adjuvant chemotherapy had a significantly worse DFI and 5-year OS (P = 0.001 and P = 0.001, respectively). A significantly shorter 5-year OS was noted with advanced stage (III–IV) and presence of adnexal involvement (P = 0.001 and P = 0.021, respectively). On Cox regression analysis, advanced-stage disease, older age, and adnexal involvement were significant independent predictors of worse DFI (P = 0.001, P = 0.005, and P = 0.019, respectively), whereas inner-half MI was a significant independent predictor of longer DFI (P = 0.004). Adjuvant radiotherapy alone was a significant independent predictor of better 5-year OS (P = 0.012). Conclusions In our series of endometrial CCC, older age at diagnosis, advanced stage, deep MI, and adnexal involvement were independent poor prognostic factors. Adjuvant radiotherapy had a significant positive impact on 5-year OS.
- Published
- 2017