Management of patients with early-stage ovarian clear cell carcinoma: Risk stratification and fertility conservation Journal Article


Authors: Manning-Geist, B.; Gordhandas, S.; Hodgson, A.; Zhou, Q. C.; Iasonos, A.; Chi, D. S.; Ellenson, L.; Aghajanian, C. A.; Abu-Rustum, N. R.; Leitao, M.; Long, K.; Rubinstein, M. M.; Sonoda, Y.; Alektiar, K.; Weigelt, B.; Zivanovic, O.; Grisham, R. N.
Article Title: Management of patients with early-stage ovarian clear cell carcinoma: Risk stratification and fertility conservation
Abstract: Objective We sought to describe clinicopathologic and treatment factors associated with oncologic outcomes in patients with early-stage ovarian clear cell carcinoma undergoing complete staging and in a sub-set of these patients undergoing fertility-conserving surgery. Methods We retrospectively identified patients with ovarian clear cell carcinoma initially treated at our institution from January 1, 1996 to March 31, 2020. Survival was estimated using Kaplan-Meier curves and compared by log-rank test. Survival-associated variables were identified by Cox proportional hazards regression. Results Of 182 patients, mismatch repair and p53 protein expression were assessed by immunohistochemistry on 82 and 66 samples, respectively. There were no significant differences in progression-free survival or overall survival between mismatch repair-deficient (n=6, including 4 patients with Lynch syndrome; 7.3%) and mismatch repair-proficient patients, whereas aberrant p53 expression (n=3; 4.5%) was associated with worse progression-free (p<0.001) and overall survival (p=0.01). Patients with stage IA/IC1 disease had a 95% 5-year overall survival rate (95% CI 88% to 98%); patients with stage IC2/IC3 disease had a similar 5-year overall survival rate (76%; 95% CI 54% to 88%) to that of patients with stage IIA/IIB disease (82%; 95% CI 54% to 94%). There was no difference in 5-year overall survival in patients with stage IA/IC1 undergoing chemotherapy versus observation (94% vs 100%). Nine patients underwent fertility-sparing surgery and none experienced recurrence. Of five patients who pursued fertility, all had successful pregnancies. Conclusions In patients with completely staged ovarian clear cell carcinoma, those with stage IA/IC1 disease have an excellent prognosis, regardless of chemotherapy. Aberrant p53 expression may portend worse outcomes. Additional investigation is warranted on the safety of fertility conservation in patients with stage IA/IC1 disease. © IGCS and ESGO 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: immunohistochemistry; adult; cancer chemotherapy; cancer survival; controlled study; human tissue; protein expression; cancer surgery; major clinical study; overall survival; histopathology; cancer recurrence; drug safety; cancer staging; outcome assessment; ovarian cancer; progression free survival; gene expression; retrospective study; protein p53; mismatch repair; medical record; pregnancy; kaplan meier method; fertility; lynch syndrome; international federation of gynecology and obstetrics; cancer prognosis; prognosis; human; female; article; ovarian clear cell adenocarcinoma
Journal Title: International Journal of Gynecological Cancer
Volume: 32
Issue: 12
ISSN: 1048-891X
Publisher: Lippincott Williams & Wilkins  
Date Published: 2022-12-01
Start Page: 1576
End Page: 1582
Language: English
DOI: 10.1136/ijgc-2022-003935
PUBMED: 36368707
PROVIDER: scopus
PMCID: PMC9822864
DOI/URL:
Notes: Article -- The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding author is MSK author Rachel N. Grisham. -- Export Date: 3 January 2023 -- Source: Scopus
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MSK Authors
  1. Dennis S Chi
    710 Chi
  2. Kaled M Alektiar
    333 Alektiar
  3. Yukio Sonoda
    473 Sonoda
  4. Mario Leitao
    576 Leitao
  5. Oliver Zivanovic
    291 Zivanovic
  6. Qin Zhou
    255 Zhou
  7. Alexia Elia Iasonos
    364 Iasonos
  8. Rachel Nicole Grisham
    172 Grisham
  9. Britta Weigelt
    641 Weigelt
  10. Lora Hedrick Ellenson
    109 Ellenson
  11. Anjelica Jane Hodgson
    18 Hodgson