The clinical value of surgeons' efforts of preventing intraoperative tumor rupture in stage I clear cell carcinoma of the ovary: A Korean multicenter study

• Published in: Gynecologic oncology 2015-06, Vol.137 (3), p.412-417
• Main Authors: Suh, Dong Hoon, Park, Jeong-Yeol, Lee, Jung-Yun, Kim, Byoung-Gie, Lim, Myong Cheol, Kim, Jae-Weon, Bae, Duk-Soo, Park, Sang-Yoon, Nam, Joo-Hyun, Kim, Kidong, No, Jae Hong, Kim, Yong-Beom
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma, Clear Cell - pathology; Adenocarcinoma, Clear Cell - surgery; Adult; Aged; Carcinoma, Ovarian Epithelial; Clear cell; Female; Gynecologic Surgical Procedures - methods; Hematology, Oncology and Palliative Medicine; Humans; Intraoperative Complications - prevention & control; Intraoperative tumor rupture; Middle Aged; Neoplasm Staging; Neoplasms, Glandular and Epithelial - pathology; Neoplasms, Glandular and Epithelial - surgery; Obstetrics and Gynecology; Ovarian neoplasms; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Prognosis; Republic of Korea; Retrospective Studies; Rupture, Spontaneous - prevention & control; Survival Analysis; Survival rate
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2015.03.058

Abstract Objective To demonstrate the survival impact of intraoperative tumor rupture in women with stage I clear cell carcinoma (CCC) of the ovary. Methods A total of 193 patients with stage I CCC of the ovary who had undergone a complete staging operation followed by ≥ three cycles of adjuvant platinum-based chemotherapy, were retrospectively reviewed. Survival analysis was performed and compared between three stage groups: IA/IB, IC1, and IC2/IC3. Results There were 70, 51, and 72 women with ovarian CCC in stages IA/IB, IC1, and IC2/IC3, respectively. Intraoperative tumor rupture occurred in 69 (35.8%) patients. Gross endometriosis (p = 0.020) and significant peritumoral adhesion (p < 0.001) were associated with intraoperative tumor rupture. However, neither laparoscopic approach nor large tumor size > 10 cm were associated with intraoperative tumor rupture. Patients with stage IC2/IC3 compared to those with stage IC1, had poorer progression-free survival (PFS) (5-year PFS, 68.5% versus 91.7%; p = 0.010) and overall survival (OS) (5-year OS, 81.1% versus 95.4%; p = 0.027). However, there was no significant difference between patients with stages IA/IB and IC1 CCC in PFS (5-year PFS 88.8% versus 91.7%; p = 0.291) and OS (5-year OS 94.6% versus 95.4%; p = 0.444). Stage IC2/IC3 was the only independent poor prognostic factor for OS (hazard ratio, 3.50; 95% confidence interval, 1.31 to 9.36). Conclusion Surgical spillage of tumor cells does not appear to have a negative impact on survival outcomes of women with stage I ovarian CCC who received ≥ three cycles of adjuvant platinum-based chemotherapy.