Washington University School of Medicine, St. Louis, MO, United States of America.
NRG Oncology, Clinical Trial Development Division; Biostatistics & Bioinformatics: Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
Gynecol Oncol. 2023 Oct;177:38-45. doi: 10.1016/j.ygyno.2023.08.005. Epub 2023 Aug 25.
Clear cell carcinoma is a high-risk subtype of endometrial cancer. Some patients have a mixture of clear cell carcinoma with other histologic types (endometrioid or serous) or cannot be neatly assigned to one of these types. Protocol GOG-8032 within GOG-210 was designed to determine whether these tumors differ from pure clear cell carcinoma in stage at diagnosis, initial pattern of spread, or patient survival.
The term "mixed" was applied to tumors with multiple identifiable components, and "indeterminate" was applied to tumors with features intermediate between different histologic types. Three hundred eleven women with pure, mixed, or indeterminate clear cell carcinoma were identified in a larger cohort of patients undergoing hysterectomy for endometrial cancer in GOG-210. Histologic slides were centrally reviewed by expert pathologists. Baseline and follow-up data were analyzed.
One hundred thirty-six patients had pure clear cell carcinoma and 175 had a mixed or indeterminate clear cell pattern. Baseline clinicopathologic characteristics were similar except for a small difference in age at presentation. Univariate survival analysis confirmed the significance of typical endometrial cancer prognostic factors. Patients in the mixed categories had disease-free and overall survival similar to pure clear cell carcinoma, but the indeterminate clear cell/endometrioid group had longer survival.
In clear cell endometrial cancer, the presence of a definite admixed endometrioid or serous component did not correlate with a significant difference in prognosis. Patients whose tumors had indeterminate clear cell features had better prognosis. Some of these tumors may be endometrioid tumors mimicking clear cell carcinoma.
透明细胞癌是子宫内膜癌的一种高危亚型。有些患者的肿瘤由透明细胞癌与其他组织学类型（子宫内膜样或浆液性）混合而成，或者不能明确归入其中任何一种类型。GOG-210 中的 GOG-8032 方案旨在确定这些肿瘤在诊断时的分期、初始扩散模式或患者生存方面是否与单纯透明细胞癌存在差异。
术语“混合”用于存在多个可识别成分的肿瘤，“不确定”用于具有不同组织学类型之间特征的肿瘤。在 GOG-210 中接受子宫切除术治疗子宫内膜癌的更大患者队列中，鉴定出 311 例单纯、混合或不确定的透明细胞癌患者。组织学切片由专家病理学家进行中心审查。对基线和随访数据进行分析。
136 例患者为单纯透明细胞癌，175 例患者为混合或不确定的透明细胞模式。基线临床病理特征相似，但表现年龄略有差异。单变量生存分析证实了典型子宫内膜癌预后因素的重要性。混合组的无病生存和总生存与单纯透明细胞癌相似，但不确定的透明细胞/子宫内膜组的生存时间更长。
在透明细胞子宫内膜癌中，明确的混合子宫内膜样或浆液性成分的存在与预后无显著差异相关。肿瘤具有不确定的透明细胞特征的患者预后更好。其中一些肿瘤可能是模仿透明细胞癌的子宫内膜样肿瘤。
