Ovarian clear cell carcinoma: Poor prognosis in stage Ic or IIc patients with positive peritoneal cytology

Background: Ovarian clear cell carcinoma (OCCA) is thought to have a poor prognosis due to low sensitivity to platinum-based chemotherapy. It is not known whether a conventional cisplatin-containing regimen should be used for OCCA patients, nor is it known whether there are other prognostic factors. Methods: The clinical and pathologic features of 15 patients with OCCA were studied to evaluate the treatment outcome and potential predictors of survival. Results: The median age was 54 years (range, 37 to 77 years). The disease extent at diagnosis was International Federation of Gynecology and Obstetrics (FIGO) stage I in 8 patients (53%), stage II in 4 patients (27%), and stage III in 3 patients (20%). Patients with advanced disease (stage III) had a poorer outcome than those with limited disease (stage I or II). In addition, patients with stage Ic or IIc disease and positive peritoneal cytology had a significantly lower survival rate (P<0.01 ) than those with negative peritoneal cytology. Three patients at stage Ic with positive peritoneal cytology, and 3 at stage III with residual tumors less than 2 cm in diameter, showed disease progression during cisplatin-based chemotherapy. Conclusion: The postoperative progress of OCCA depends on the presence not only of macroscopic residual disease due to incomplete tumor resection, but also of microscopic residual disease, as reflected by positive peritoneal cytology. Because OCCA shows a poor response to platinum-containing chemotherapy, prospective trials of alternative regimens for OCCA patients with poor prognosis are warranted. © JSCO/CLJ 1997.