Chang-Halpenny Christine N, Natarajan Sathima, Hwang-Graziano Julie M
Departments of Radiation Oncology.
Pathology, Kaiser Permanente Southern California, Los Angeles, CA.
Am J Clin Oncol. 2018 Apr;41(4):371-378. doi: 10.1097/COC.0000000000000277.
Clear cell carcinoma (CCC) of the uterus is a rare but aggressive histology for which the role of adjuvant therapy for stage I-II disease is unclear. Our study investigated outcomes and patterns of failure in these patients.
We found 64 cases of CCC, including 26 of pure CCC, 22 mixed with endometrioid adenocarcinoma, and 16 mixed with uterine papillary serous carcinoma. Adjuvant treatment was given to 55%.
Median follow-up was 51.9 months. By Kaplan-Meier estimate, 5-year vaginal recurrence-free survival (RFS) was 91.3%, pelvic RFS was 92.6%, distant metastasis RFS was 81.6%, disease-free survival was 79.6%, and overall survival was 79.7%. Median time to recurrence was 20.7 months (range, 2 to 40.5 mo). Patients treated adjuvantly had higher proportion of stage II disease (40% vs. 6.9% observed, P=0.0031) and 20% (7/35) recurred. There were no significant differences in outcomes by histologic subtypes but numerically more recurrences with uterine papillary serous involvement. By univariate analysis, higher stage, presence of lymphovascular invasion, and lack of lymph node dissection were predictive of worse overall survival. Age 65 years and above was predictive of worse cancer-specific survival. Of 12 who progressed, only 1 was salvaged and 11 died of disease. Of progressors, 10 had documented distant metastasis. Median time from recurrence to death was 4.5 months (range, 0.2 to 21.2 mo).
Given aggressive and often unsalvageable nature of recurrence, consideration of adjuvant treatment (including chemotherapy and radiation) is warranted for early-stage CCC, particularly for stage II or those with poor prognostic factors.
子宫透明细胞癌（CCC）是一种罕见但侵袭性强的组织学类型，对于Ⅰ - Ⅱ期疾病辅助治疗的作用尚不清楚。我们的研究调查了这些患者的预后及失败模式。
我们发现了64例CCC病例，其中包括26例纯CCC、22例与子宫内膜样腺癌混合以及16例与子宫乳头状浆液性癌混合。55%的患者接受了辅助治疗。
中位随访时间为51.9个月。根据Kaplan - Meier估计，5年无阴道复发生存率（RFS）为91.3%，盆腔RFS为92.6%，远处转移RFS为81.6%，无病生存率为79.6%，总生存率为79.7%。复发的中位时间为20.7个月（范围为2至40.5个月）。接受辅助治疗的患者Ⅱ期疾病比例更高（40%对比观察到的6.9%，P = 0.0031），且20%（7/35）复发。组织学亚型之间的预后无显著差异，但在数值上子宫乳头状浆液性癌累及的复发更多。单因素分析显示，更高分期、存在淋巴管浸润以及未进行淋巴结清扫预示着总体生存率更差。65岁及以上年龄预示着癌症特异性生存率更差。在12例病情进展的患者中，仅1例得到挽救，11例死于疾病。在进展患者中，10例有远处转移记录。从复发到死亡的中位时间为4.5个月（范围为0.2至21.2个月）。
鉴于复发具有侵袭性且往往无法挽救的性质，对于早期CCC，特别是Ⅱ期或具有不良预后因素的患者，有必要考虑辅助治疗（包括化疗和放疗）。
