Recurrent ovarian clear cell carcinoma: a retrospective evaluation of the efficacy and prognostic factors

Purpose: The aim of this study was to investigate the effectiveness of treatment and prognostic factors in patients with recurrent ovarian clear cell carcinoma. Materials and Methods: The 78 patients with ovarian clear cell carcinoma (CCC) in Peking University Cancer Hospital from 1996 to 2015 received laparotomy and initial chemotherapy. The efficacy of surgery, chemotherapy, and prognosis of patients with recurrent CCC were evaluated. Results: The overall response rate (RR) to platinum based chemotherapy of PTX + platinum regimen showed no significant correlation with PFI in this study (p = 0.683). According to non-platinum regimen, irinotecan + mitomycin C regimen had a higher activity (RR = 41.7%) compared with topotecan regimen (RR = 20%). The overall survival (OS) had a marked correlation with tumor staging (p = 0.027), residuals (p = 0.019), second-line chemotherapy response (p = 0.003), and progression free survival (PFS, p = 0.014). Conclusions: No residual tumor in initial surgery is critical for the prognosis of patients with CCC, even in optimal cytoreductive surgery. Irinotecan, as one kind of effective chemotherapy regimen, is preferred to be conducted in patients with recurrent CCC.

Clear cell carcinoma; Recurrence; Second-line chemotherapy; Irinotecan.

[1] Siegel R., Naishadham D., Jemal A.: “Cancer statistics, 2012”. CA Cancer J. Clin., 2012, 62, 10.

[2] Siegel R.L., Miller K.D., Jemal A.: “Cancer statistics, 2015”. CA Cancer J. Clin., 2015, 65, 5.

[3] Anglesio M.S., Carey M.S., Kobel M., Mackay H., Huntsman D.G.: “Clear cell carcinoma of the ovary: a report from the first Ovarian Clear Cell Symposium, June 24th, 2010”. Gynecol. Oncol., 2011, 121, 407.

[4] Mackay H.J., Brady M.F., Oza A.M., Reuss A., Pujade-Lauraine E., Swart A.M., et al.: “Prognostic relevance of uncommon ovarian histology in women with stage III/IV epithelial ovarian cancer”. Int. J. Gynecol. Cancer, 2010, 20, 945.

[5] Piccart M.J., Bertelsen K., James K., Cassidy J., Mangioni C., Simonsen E., et al.: “Randomized intergroup trial of cisplatin-paclitaxel versus cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer: three-year results”. J. Natl. Cancer Inst., 2000, 92, 699.

[6] Vasey P.A., Jayson G.C., Gordon A., Gabra H., Coleman R., Atkinson R., et al.: “Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma”. J. Natl. Cancer Inst., 2004, 96, 1682.

[7] Itamochi H., Kigawa J., Terakawa N.: “Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma”. Cancer Sci., 2008, 99, 653.

[8] Mizuno M., Kikkawa F., Shibata K., Kajiyama H., Ino K., Kawai M., et al.: “Long-term follow-up and prognostic factor analysis in clear cell adenocarcinoma of the ovary”. J. Surg. Oncol., 2006, 94, 138.

[9] Takano M., Kikuchi Y., Yaegashi N., Kuzuya K., Ueki M., Tsuda H., et al.: “Clear cell carcinoma of the ovary: a retrospective multicentre experience of 254 patients with complete surgical staging”. Br. J. Cancer, 2006, 94, 1369.

[10] del Carmen M.G., Birrer M., Schorge J.O.: “Clear cell carcinoma of the ovary: a review of the literature”. Gynecol. Oncol., 2012, 126, 481.

[11] Oncology FCoG: “FIGO staging for carcinoma of the vulva, cervix, and corpus uteri”. Int. J. Gynaecol. Obstet., 2014, 125, 97.

[12] Eisenhauer E.A., Therasse P., Bogaerts J., Schwartz L.H., Sargent D., Ford R., et al.: “New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)”. Eur. J. Cancer, 2009, 45, 228.

[13] Rustin G.J., Nelstrop A.E., McClean P., Brady M.F., McGuire W.P., Hoskins W.J., et al.: “Defining response of ovarian carcinoma to initial chemotherapy according to serum CA 125”. J. Clin. Oncol., 1996, 14, 1545.

[14] Esposito F., Cecere S.C., Magazzino F., Katsaros D., Ottaiano A., Gadducci A., et al.: “Second-line chemotherapy in recurrent clear cell ovarian cancer: results from the multicenter italian trials in ovarian cancer (MITO-9)”. Oncology, 2014, 86, 351.

[15] Koh W.J., Greer B.E., Abu-Rustum N.R., Apte S.M., Campos S.M., Cho K.R., et al.: “Cervical Cancer, Version 2.2015”. J. Natl. Compr. Canc. Netw., 2015, 13, 395.

[16] Sugiyama T., Kamura T., Kigawa J., Terakawa N., Kikuchi Y., Kita T., et al.: “Clinical characteristics of clear cell carcinoma of the ovary: a distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy”. Cancer, 2000, 88, 2584.

[17] Okamoto A., Glasspool R.M., Mabuchi S., Matsumura N., Nomura H., Itamochi H., et al.: “Gynecologic Cancer InterGroup (GCIG) consensus review for clear cell carcinoma of the ovary”. Int. J. Gynecol. Cancer, 2014, 24, S20.

[18] Takano M., Sugiyama T., Yaegashi N., Sakuma M., Suzuki M., Saga Y., et al.: “Low response rate of second-line chemotherapy for recurrent or refractory clear cell carcinoma of the ovary: a retrospective Japan Clear Cell Carcinoma Study”. Int. J. Gynecol. Cancer, 2008, 18, 937.

[19] Kunito S., Takakura S., Nagata C., Saito M., Yanaihara N., Yamada K., et al.: “Long-term survival in patients with clear cell adenocarcinoma of ovary treated with irinotecan hydrochloride plus cisplatin therapy as first-line chemotherapy”. J. Obstet. Gynaecol. Res., 2012, 38, 1367.

[20] Shimizu Y., Umezawa S., Hasumi K.: “A phase II study of combined CPT-11 and mitomycin-C in platinum refractory clear cell and mucinous ovarian carcinoma”. Ann. Acad. Med. Singapore, 1998, 27, 650.

[21] Shimizu Y., Umezawa S., Hasumi K.: “Successful treatment of clear cell adenocarcinoma of the ovary (OCCA) with a combination of CPT-11 and mitomycin C”. Gan To Kagaku Ryoho, 1996, 23, 587.

[22] Takano M., Kikuchi Y., Yaegashi N., Kuzuya K., Ueki M., Tsuda H., et al.: “Clear cell carcinoma of the ovary: a retrospective multicentre experience of 254 patients with complete surgical staging”. Br. J. Cancer, 2006, 94, 1369.