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

M. Bijoy Thomas, Jason D. Wright, Aliza L. Leiser, Dennis S. Chi, David G. Mutch, Karl C. Podratz, Sean Christopher Dowdy

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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.

Original languageEnglish (US)
Pages (from-to)335-339
Number of pages5
JournalGynecologic Oncology
Volume109
Issue number3
DOIs
StatePublished - Jun 2008

Fingerprint

Cervix Uteri
Carcinoma
Survival
Lymph Nodes
Radiation
Papanicolaou Test
Adjuvant Radiotherapy
Adjuvant Chemotherapy
Squamous Cell Carcinoma
Histology
Smoking

Keywords

  • Cervical clear cell carcinoma
  • Radiation therapy
  • Radical hysterectomy
  • Systematic lymphadenectomy

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Thomas, M. B., Wright, J. D., Leiser, A. L., Chi, D. S., Mutch, D. G., Podratz, K. C., & Dowdy, S. C. (2008). Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era. Gynecologic Oncology, 109(3), 335-339. https://doi.org/10.1016/j.ygyno.2008.02.007

Clear cell carcinoma of the cervix : A multi-institutional review in the post-DES era. / Thomas, M. Bijoy; Wright, Jason D.; Leiser, Aliza L.; Chi, Dennis S.; Mutch, David G.; Podratz, Karl C.; Dowdy, Sean Christopher.

In: Gynecologic Oncology, Vol. 109, No. 3, 06.2008, p. 335-339.

Research output: Contribution to journalArticle

Thomas, MB, Wright, JD, Leiser, AL, Chi, DS, Mutch, DG, Podratz, KC & Dowdy, SC 2008, 'Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era', Gynecologic Oncology, vol. 109, no. 3, pp. 335-339. https://doi.org/10.1016/j.ygyno.2008.02.007
Thomas MB, Wright JD, Leiser AL, Chi DS, Mutch DG, Podratz KC et al. Clear cell carcinoma of the cervix: A multi-institutional review in the post-DES era. Gynecologic Oncology. 2008 Jun;109(3):335-339. https://doi.org/10.1016/j.ygyno.2008.02.007
Thomas, M. Bijoy ; Wright, Jason D. ; Leiser, Aliza L. ; Chi, Dennis S. ; Mutch, David G. ; Podratz, Karl C. ; Dowdy, Sean Christopher. / Clear cell carcinoma of the cervix : A multi-institutional review in the post-DES era. In: Gynecologic Oncology. 2008 ; Vol. 109, No. 3. pp. 335-339.
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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.",
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