Cetinkaya Nilufer, Selcuk İlker, Ozdal Bulent, Meydanli Mehmet Mutlu, Gungor Tayfun
Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Hamamonu, 06230, Ankara, Turkey.
Department of Obstetrics and Gynecology, Hitit University Medical Faculty, Çorum, Turkey.
Arch Gynecol Obstet. 2017 Jan;295(1):189-195. doi: 10.1007/s00404-016-4183-x. Epub 2016 Aug 22.
To document the experience regarding patients treated for endometrial clear cell carcinoma (ECCC), with reference to clinical, biochemical, histopathologic, and prognostic features.
Twenty-six ECCC patients, diagnosed and treated between 2008 and 2014, were reviewed retrospectively. From the hospital records, all data related to patients' demographic, clinical, biochemical, and histopathologic assessments and adjuvant therapy adjustments were evaluated. Disease-free survival (DFS), overall survival (OS), and 5-year cumulative survival rates (CSR) were estimated as well as prognostic factors associated with OS.
The median follow-up time was 22.7 months, and the mean age at diagnosis was 64.0 years. Fourteen (53.8 %) women had early stage and 12 (46.2 %) women had advanced-stage disease. There were 17 (65.3 %) patients with pure clear cell carcinoma and 8 (30.7 %) patients with mixed histology on the hysterectomy specimen. Extra-uterine disease occurred more frequently in patients with pure ECCC and elevated CA-125 concentrations. Seventeen (65.3 %) patients received adjuvant platinum and taxane chemotherapy with (n: 13/17, 76.4 %) or without radiotherapy in the form of external beam radiotherapy (ERT) and/or vaginal brachytherapy (BRT). The rest of the patients (n: 9/26, 34.6 %), who had tumor with no or limited myometrial invasion without LVSI, impaired general health status, and non-compliance-to-post-operative treatment proposal received no adjuvant therapy. The mean DFS and OS were 49.54 and 50.01 months, respectively, with the 5-year CSR of 46.4 %. The mean OS was significantly shorter in patients with higher pre-operative CA-125 values, >2 cm tumor diameter, myometrial invasion ≥1/2, cervical involvement, uterine serosal and/or adnexal invasion, lymph node metastasis, and, thus, with advanced-stage disease. Uterine serosal invasion was the only significant prognostic factor associated with OS in the multivariate analysis.
Increased pre-operative serum CA-125 levels are associated with advanced-stage disease, and uterine serosal involvement is a significant prognostic factor associated with OS in women with ECCC.
记录子宫内膜透明细胞癌（ECCC）患者的治疗经验，参考临床、生化、组织病理学和预后特征。
回顾性分析2008年至2014年间诊断并治疗的26例ECCC患者。从医院记录中，评估所有与患者人口统计学、临床、生化和组织病理学评估以及辅助治疗调整相关的数据。估计无病生存期（DFS）、总生存期（OS）和5年累积生存率（CSR），以及与OS相关的预后因素。
中位随访时间为22.7个月，诊断时的平均年龄为64.0岁。14例（53.8%）女性为早期疾病，12例（46.2%）女性为晚期疾病。子宫切除标本中，17例（65.3%）患者为纯透明细胞癌，8例（30.7%）患者为混合组织学类型。宫外疾病在纯ECCC患者和CA-125浓度升高的患者中更常见。17例（65.3%）患者接受了铂类和紫杉烷辅助化疗，其中13例（76.4%）联合或不联合体外照射放疗（ERT）和/或阴道近距离放疗（BRT）形式的放疗。其余患者（9例/26例，34.6%），其肿瘤无肌层浸润或肌层浸润有限且无淋巴血管间隙浸润（LVSI）、一般健康状况受损且不遵守术后治疗建议，未接受辅助治疗。平均DFS和OS分别为49.54个月和50.01个月，5年CSR为46.4%。术前CA-125值较高、肿瘤直径>2 cm、肌层浸润≥1/2、宫颈受累、子宫浆膜和/或附件浸润、淋巴结转移以及因此处于晚期疾病的患者，其平均OS明显较短。在多变量分析中，子宫浆膜浸润是与OS相关的唯一显著预后因素。
术前血清CA-125水平升高与晚期疾病相关，子宫浆膜受累是ECCC女性患者中与OS相关的显著预后因素。
