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

Abstract

ObjectiveTo assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy.MethodsA 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.ResultsA 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).ConclusionExtra-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.

Is Omentectomy Necessary for Non-Endometrioid Endometrial Cancer

“…The rate of lymphatic dissemination in that study was 5.6%. Lymphadenectomy is generally recommended for these patients and it is reasonable to recommend omentectomy as a part of surgery because omentum is more at risk [20]. In this study, it was determined that the rate of omental metastases in clear cell histology was lower than in other histological types, but this rate is not low enough to ignore the omentectomy (Table 2).…”

NPNT promotes early-stage bone metastases in breast cancer by regulation of the osteogenic niche

“…Normally, bone metastases can cause several symptoms such as fractures, spinal cord compression, severe pain, hypercalcemia, and bone marrow aplasia. Current therapies, including tumor targeted chemo-/radio-/endocrine therapies, and bone remodeling therapies with denosumab and bisphosphonates have showed some effects in alleviating bone metastases associated symptoms [3], [4]. Unfortunately, these treatments are insufficient to relieve metastases burden and the median survival after diagnosis of overt skeletal metastases is as low as 2 years [5], [6].…”

The significance of L1CAM expression in clear cell carcinoma of the endometrium

“…Sir : Clear cell carcinoma is an uncommon histotype of endometrial carcinoma, representing less than 1% of cases . Although clear cell carcinoma is generally considered to be a clinically aggressive, ‘high risk’ cancer, reported patient outcomes have been markedly variable at every stage of disease, possibly reflecting an underlying biologic heterogeneity that is inherent to the histotype . Indeed, somatic mutation profiling of cases classified as clear cell carcinoma have shown them to be markedly heterogeneous at the molecular level, with subsets resembling serous carcinomas, endometrioid carcinoma, neither, or both .…”

“…This is confirmed by later published results on scoring the stromal percentage in colon cancer, and also in other epithelial cancer types. [6][7][8] It would be of interest to determine if the results published by Hynes and colleagues would change if our suggestions were taken into consideration. Sir: Clear cell carcinoma is an uncommon histotype of endometrial carcinoma, representing less than 1% of cases.…”