Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan.
Department of Obstetrics and Gynecology, Toyohashi Municipal Hospital, Aichi, Japan.
Arch Gynecol Obstet. 2019 Sep;300(3):717-724. doi: 10.1007/s00404-019-05203-y. Epub 2019 Jun 4.
Clear-cell carcinoma (CCC) in reproductive-age women is likely to become an increasingly critical issue regarding possibilities of infertility, hormonal dysfunction, and mortality. The aim of this study was to examine the long-term oncologic outcome and its prognostic indicators based on a multicentric cohort of young patients with CCC.
During the period of 1990-2015, a total of 164 patients aged 45-year-old or younger were enrolled in the study. Clinicopathologic data of these young patients with CCC collected under a centralized pathological review system were subjected to uni- and multivariable analyses to evaluate overall survival (OS).
The median follow-up was 73.8 months (range 5.2-244.2) in the surviving patients. Among these patients, 104 (63.4%) had FIGO I disease, and 22 (13.4%), 31 (18.9%), and 7 (4.3%) had II, III, and IV disease, respectively. The 5-year OS rate was 74.5%. On stratification by the FIGO stage, the 5-year OS rates were as follows: stage I (90.2%), stage II (57.9%), and stage III/IV (39.3%), respectively (P < 0.0001). Confining analysis to stage I patients, there was no difference in OS between those who underwent fertility-sparing surgery and those who received radical surgery (P = 0.1593). In relapsed patients, the median survival after recurrence was 11.6 months. In multivariable analysis of stage I patients, the capsule status was an independent prognostic indicator of OS {IC2/IC3 vs. IA/IC1: HR 4.293 (95% CI 1.140-16.422), P = 0.0318}.
CCC patients staged greater than IC2/IC3 show a markedly increased risk of mortality. Thus, it is important to diagnose patients staged under IC2/IC3.
年轻女性的透明细胞癌（CCC）可能会成为一个日益严重的问题，涉及到不孕、激素功能障碍和死亡率的可能性。本研究的目的是基于年轻 CCC 患者的多中心队列，检查长期肿瘤学结果及其预后指标。
在 1990 年至 2015 年期间，共有 164 名年龄在 45 岁或以下的患者入组本研究。对这些年轻 CCC 患者的临床病理数据进行集中病理审查系统收集，并进行单变量和多变量分析，以评估总生存率（OS）。
在存活患者中，中位随访时间为 73.8 个月（范围为 5.2-244.2）。其中 104 例（63.4%）为 FIGO I 期疾病，22 例（13.4%）、31 例（18.9%）和 7 例（4.3%）分别为 II、III 和 IV 期疾病。5 年 OS 率为 74.5%。按 FIGO 分期分层，5 年 OS 率分别为：I 期（90.2%）、II 期（57.9%）和 III/IV 期（39.3%）（P<0.0001）。在局限于 I 期患者的分析中，接受保留生育能力手术和接受根治性手术的患者的 OS 无差异（P=0.1593）。在复发患者中，复发后中位生存时间为 11.6 个月。在 I 期患者的多变量分析中，囊壁状态是 OS 的独立预后指标{IC2/IC3 与 IA/IC1：HR 4.293（95%CI 1.140-16.422），P=0.0318}。
分期大于 IC2/IC3 的 CCC 患者死亡风险显著增加。因此，诊断分期为 IC2/IC3 以下的患者非常重要。
