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

Abstract

ObjectiveWe 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.MethodsWe 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.ResultsOf 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.ConclusionsIn 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.

Proteomic profiling of ovarian clear cell carcinomas identifies prognostic biomarkers for chemotherapy

“…In the H1 cohort, late stage at diagnosis was associated with worse survival ( p ‐value = 0.0076, Figure S1A). The stage of the disease has been previously reported as prognostic factors [34]. In both cohorts, late stage at diagnosis was not significantly associated with worse RFS (Figure S1B, C).…”

Immuno-Oncology In Cancer Cervix Treatments: Literature Review

“…Conization and LEEP are associated with hazard of recurrence, cervical incompetance and premature delivery of future pregnancies and related risks to the child , so an immunotherapeutic treatment modality could be a complementary method or certainly an alternative. Remedy methods and outcomes for cervical cancer cases are largely depending on disease stage at diagnosis (35,36), with 5 year survival starting from over 90% if recognized in an early, localized stage to less than 20% if identified as distant or metastatic (36). Remedy options for early-stage and locally invasive cervical cancer encompass radical hysterectomy or radical trachelectomy with pelvic lymphadenectomy and concurrent chemotherapy and radiation treatment.…”