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Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era

Identifieur interne : 003A07 ( Pmc/Checkpoint ); précédent : 003A06; suivant : 003A08

Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era

Auteurs : M. Bijoy Thomas [États-Unis] ; Jason D. Wright [États-Unis] ; Aliza L. Leiser [États-Unis] ; Dennis S. Chi [États-Unis] ; David G. Mutch [États-Unis] ; Karl C. Podratz [États-Unis] ; Sean C. Dowdy [États-Unis]

Source :

Gynecologic oncology [ 0090-8258 ] ; 2008.

RBID : PMC:3667392

Abstract

Objective

To conduct an outcome analysis of patients with cervical clear cell carcinoma (CCCC) in the post-DES era.

Methods

A retrospective review was conducted at 3 major gynecologic cancer centers of all primary CCCC between 1982 and 2004.

Results

CCCC was confirmed in 34 patients. Median age was 53 years. DES exposure was confirmed in 2 (6%) patients. A history of smoking was elicited in 22%, and of abnormal Pap smear 18% patients. Primary surgical resection was performed in all stage I or IIA patients (n=26); they displayed superior 3-year overall survival (OS) compared to advanced stage (n=8) patients (91% vs. 22%, p<0.001). Pelvic lymph node involvement was noted in 25%; all patients with positive para-aortic nodes (20% of patients sampled) had positive pelvic nodes. All node positive patients were treated with adjuvant radiation, but nevertheless displayed reduced progression free (31% vs 92%, p<0.001) and overall survival (80% vs. 100%, p=0.02). Adjuvant radiotherapy did not appear to impact OS in patients with negative lymph nodes.

Discussion

This series provides insight into the management of early stage CCCC in the post-DES era. Although these patients may be at slightly higher risk of nodal spread, clear cell histology by itself does not appear to portend a worse prognosis than squamous cell carcinoma of the cervix in the absence of traditional risk factors. Our data suggest that patients with low risk early stage CCCC may be managed with radical surgery alone, without the need for adjuvant chemotherapy or radiation.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667392

DOI: 10.1016/j.ygyno.2008.02.007
PubMed: 18394687
PubMed Central: 3667392

Affiliations:

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PMC:3667392

Le document en format XML

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<author><name sortKey="Podratz, Karl C" sort="Podratz, Karl C" uniqKey="Podratz K" first="Karl C." last="Podratz">Karl C. Podratz</name>
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<series><title level="j">Gynecologic oncology</title>
<idno type="ISSN">0090-8258</idno>
<idno type="eISSN">1095-6859</idno>
<imprint><date when="2008">2008</date>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title>
<p id="P1">To conduct an outcome analysis of patients with cervical clear cell carcinoma (CCCC) in the post-DES era.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">A retrospective review was conducted at 3 major gynecologic cancer centers of all primary CCCC between 1982 and 2004.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">CCCC was confirmed in 34 patients. Median age was 53 years. DES exposure was confirmed in 2 (6%) patients. A history of smoking was elicited in 22%, and of abnormal Pap smear 18% patients. Primary surgical resection was performed in all stage I or IIA patients (<italic>n</italic>
=26); they displayed superior 3-year overall survival (OS) compared to advanced stage (<italic>n</italic>
=8) patients (91% vs. 22%, <italic>p</italic>
<0.001). Pelvic lymph node involvement was noted in 25%; all patients with positive <italic>para</italic>
-aortic nodes (20% of patients sampled) had positive pelvic nodes. All node positive patients were treated with adjuvant radiation, but nevertheless displayed reduced progression free (31% vs 92%, <italic>p</italic>
<0.001) and overall survival (80% vs. 100%, <italic>p</italic>
=0.02). Adjuvant radiotherapy did not appear to impact OS in patients with negative lymph nodes.</p>
</sec>
<sec id="S4"><title>Discussion</title>
<p id="P4">This series provides insight into the management of early stage CCCC in the post-DES era. Although these patients may be at slightly higher risk of nodal spread, clear cell histology by itself does not appear to portend a worse prognosis than squamous cell carcinoma of the cervix in the absence of traditional risk factors. Our data suggest that patients with low risk early stage CCCC may be managed with radical surgery alone, without the need for adjuvant chemotherapy or radiation.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <pmc-dir>properties manuscript</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-journal-id">0365304</journal-id>
<journal-id journal-id-type="pubmed-jr-id">3932</journal-id>
<journal-id journal-id-type="nlm-ta">Gynecol Oncol</journal-id>
<journal-id journal-id-type="iso-abbrev">Gynecol. Oncol.</journal-id>
<journal-title-group><journal-title>Gynecologic oncology</journal-title>
</journal-title-group>
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<issn pub-type="epub">1095-6859</issn>
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<article-id pub-id-type="manuscript">NIHMS121837</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Thomas</surname>
<given-names>M. Bijoy</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wright</surname>
<given-names>Jason D.</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Leiser</surname>
<given-names>Aliza L.</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chi</surname>
<given-names>Dennis S.</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mutch</surname>
<given-names>David G.</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Podratz</surname>
<given-names>Karl C.</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dowdy</surname>
<given-names>Sean C.</given-names>
</name>
<email>dowdy.sean@mayo.edu</email>
<xref ref-type="aff" rid="A1">a</xref>
<xref rid="FN1" ref-type="author-notes">*</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>a</label>
 Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, 55905, USA</aff>
<aff id="A2"><label>b</label>
 Division of Gynecologic Oncology, Washington University School of Medicine, MO, USA</aff>
<aff id="A3"><label>c</label>
 Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, NY, USA</aff>
<author-notes><corresp id="FN1"><label>*</label>
 Corresponding author. 200 1st Street SW, Rochester, MN 55905, USA. Fax: +1 507 266 9300</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>24</day>
<month>6</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="epub"><day>03</day>
<month>4</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="ppub"><month>6</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>30</day>
<month>5</month>
<year>2013</year>
</pub-date>
<volume>109</volume>
<issue>3</issue>
<fpage>335</fpage>
<lpage>339</lpage>
<abstract><sec id="S1"><title>Objective</title>
<p id="P1">To conduct an outcome analysis of patients with cervical clear cell carcinoma (CCCC) in the post-DES era.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">A retrospective review was conducted at 3 major gynecologic cancer centers of all primary CCCC between 1982 and 2004.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">CCCC was confirmed in 34 patients. Median age was 53 years. DES exposure was confirmed in 2 (6%) patients. A history of smoking was elicited in 22%, and of abnormal Pap smear 18% patients. Primary surgical resection was performed in all stage I or IIA patients (<italic>n</italic>
=26); they displayed superior 3-year overall survival (OS) compared to advanced stage (<italic>n</italic>
=8) patients (91% vs. 22%, <italic>p</italic>
<0.001). Pelvic lymph node involvement was noted in 25%; all patients with positive <italic>para</italic>
-aortic nodes (20% of patients sampled) had positive pelvic nodes. All node positive patients were treated with adjuvant radiation, but nevertheless displayed reduced progression free (31% vs 92%, <italic>p</italic>
<0.001) and overall survival (80% vs. 100%, <italic>p</italic>
=0.02). Adjuvant radiotherapy did not appear to impact OS in patients with negative lymph nodes.</p>
</sec>
<sec id="S4"><title>Discussion</title>
<p id="P4">This series provides insight into the management of early stage CCCC in the post-DES era. Although these patients may be at slightly higher risk of nodal spread, clear cell histology by itself does not appear to portend a worse prognosis than squamous cell carcinoma of the cervix in the absence of traditional risk factors. Our data suggest that patients with low risk early stage CCCC may be managed with radical surgery alone, without the need for adjuvant chemotherapy or radiation.</p>
</sec>
</abstract>
<kwd-group><kwd>Cervical clear cell carcinoma</kwd>
<kwd>Radical hysterectomy</kwd>
<kwd>Systematic lymphadenectomy</kwd>
<kwd>Radiation therapy</kwd>
</kwd-group>
<funding-group><award-group><funding-source country="United States">National Cancer Institute : NCI</funding-source>
<award-id>K12 CA090628-08 || CA</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Missouri (État)</li>
</region>
<settlement><li>Saint-Louis (Missouri)</li>
</settlement>
<orgName><li>École de médecine (Université Washington de Saint-Louis)</li>
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<tree><country name="États-Unis"><noRegion><name sortKey="Thomas, M Bijoy" sort="Thomas, M Bijoy" uniqKey="Thomas M" first="M. Bijoy" last="Thomas">M. Bijoy Thomas</name>
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<name sortKey="Chi, Dennis S" sort="Chi, Dennis S" uniqKey="Chi D" first="Dennis S." last="Chi">Dennis S. Chi</name>
<name sortKey="Dowdy, Sean C" sort="Dowdy, Sean C" uniqKey="Dowdy S" first="Sean C." last="Dowdy">Sean C. Dowdy</name>
<name sortKey="Leiser, Aliza L" sort="Leiser, Aliza L" uniqKey="Leiser A" first="Aliza L." last="Leiser">Aliza L. Leiser</name>
<name sortKey="Mutch, David G" sort="Mutch, David G" uniqKey="Mutch D" first="David G." last="Mutch">David G. Mutch</name>
<name sortKey="Podratz, Karl C" sort="Podratz, Karl C" uniqKey="Podratz K" first="Karl C." last="Podratz">Karl C. Podratz</name>
<name sortKey="Wright, Jason D" sort="Wright, Jason D" uniqKey="Wright J" first="Jason D." last="Wright">Jason D. Wright</name>
</country>
</tree>
</affiliations>
</record>

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Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era

Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era

Source :

Abstract

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