Is the presence of endometriosis associated with a survival benefit in pure ovarian clear cell carcinoma?

The authors found that endometriosis does not seem to affect the prognosis of pure ovarian clear cell carcinoma.

Key Points

Importance:

• This study aims to understand the impact of the presence of endometriosis on the prognoses of women with OCCC.

Highlight:

• In women with OCCC, although the presence of endometriosis seemed to be a poor prognostic factor for overall survival;  in the multivariate analysis, the extent of cytoreductive surgery appeared the only independent prognostic factor.

Key points: 

• This retrospective dual-institutional study designed using a well-defined homogeneous study population.
• A total of 93 women met the inclusion criteria; 48 were diagnosed with OCCC arising in endometriosis, while 45 had no concomitant endometriosis.
• Compared to women who had OCCC without endometriosis, the women with OCCC arising in endometriosis tended to be younger (48 vs 57; p = 0.007), premenopausal  (p < 0.001) and presented early stage disease (p < 0.001)
• The women who had OCCC without endometriosis were more likely to have ascitis (p = 0.014), positive peritoneal cytology (p = 0.002), and lymphovascular space involvement (p = 0.005).
• The absence of endometriosis is a prognostic factor for decreased overall survival on univariate analysis.
• On multivariate analysis, only the extent of cytoreductive surgery appeared to be an independent prognostic factor for survival.

Limitations:

• The number of patients with OCCC arising in endometriosis is relatively small.
• The median follow-up is short.
• The lack of central pathology review system may allow some variations.

Lay Summary

Ovarian clear cell carcinoma (OCCC) has been known to be associated with endometriosis for a long time. However, the impact of the presence of endometriosis around the tumor on the prognoses of women with OCCC is still controversial.

To shed more light on this issue, this group designed a retrospective and dual-institutional study with a well-defined, and homogeneous study population.

A total of 93 women met the inclusion criteria. Of these patients, 48 were diagnosed with OCCC arising in endometriosis, while 45 had no concomitant endometriosis.

The women with OCCC arising in endometriosis tended to be significantly younger (median age 48 vs. 57), premenopausal and presented with early stage disease compared to those who had OCCC without endometriosis. The women who had OCCC without endometriosis were more likely to have ascites, positive peritoneal cytology, and lymphovascular space invasion.

Although univariate analysis revealed the absence of endometriosis as a prognostic factor for decreased overall survival, the extent of cytoreductive surgery was identified as the only independent prognostic factor for both recurrence-free survival and overall survival in multivariate analysis.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29383437