Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the BC Cancer experience
Background: Since 2012, the BC Cancer provincial treatment guideline for surgically staged stage IA/B and IC1 (defined by intraoperative rupture only) clear cell ovarian cancer (CCOC) has been to offer observation only. We reviewed the clinical outcomes of all stage I CCOC patients since policy impl...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-02-01
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| Series: | Gynecologic Oncology Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352578919301225 |
| _version_ | 1818193315521101824 |
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| author | Shiru L. Liu Anna V. Tinker |
| author_facet | Shiru L. Liu Anna V. Tinker |
| author_sort | Shiru L. Liu |
| collection | DOAJ |
| description | Background: Since 2012, the BC Cancer provincial treatment guideline for surgically staged stage IA/B and IC1 (defined by intraoperative rupture only) clear cell ovarian cancer (CCOC) has been to offer observation only. We reviewed the clinical outcomes of all stage I CCOC patients since policy implementation. Methods: A retrospective, population-based cohort study of all stage I CCOC patients operated on between April 2012 and December 2017 was conducted. Patient, tumor, surgical and clinical outcome data were collected. Survival analysis was conducted using Kaplan-Meier methods. Results: 78 patients with stage I disease were identified. 40 patients with stages IA/B and IC1, who underwent post-operative observation, were included in the analysis. Lymph node dissection was omitted in 20 patients (50%). Median duration of follow-up was 36 months. There were 4 recurrences (10%), 3 metastatic. The 5-year disease-free survival is 90%, and the 5-year overall survival is 95% for stage IA/B and 90% for stage IC1 (p = 0.645). In comparison, 5-year overall survival for stage IC2 (surface involvement) and IC1 with sharp dissection (all received adjuvant chemotherapy) is 82% (p < 0.001) and for stage IC3 (positive washings) was 23% (p < 0.001). Conclusion: Adjuvant therapy can be safely omitted in patients with stage I A/B and IC1 CCOC. Recurrence rates are low and survival is >90% at 5 years. Stage IC2 /IC3 had worse outcomes, thus stage I substage is instrumental in predicting clinical outcomes for CCOC. Lymph node metastases are rare in stage IA/B/C1 CCOC as absence of lymphadenectomy did not increase the risk of disease recurrence. Keywords: Clear cell carcinoma, Ovarian cancer, Adjuvant therapy |
| first_indexed | 2024-12-12T00:44:27Z |
| format | Article |
| id | doaj.art-203a2fb359cc41868112d6eace5e2d19 |
| institution | Directory Open Access Journal |
| issn | 2352-5789 |
| language | English |
| last_indexed | 2024-12-12T00:44:27Z |
| publishDate | 2020-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj.art-203a2fb359cc41868112d6eace5e2d192022-12-22T00:44:09ZengElsevierGynecologic Oncology Reports2352-57892020-02-0131Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the BC Cancer experienceShiru L. Liu0Anna V. Tinker1Department of Medical Oncology, BC Cancer, Vancouver, BC, CanadaCorresponding author at: BC Cancer, 600 West 10th Ave, Vancouver, BC V5Z 4E6, Canada.; Department of Medical Oncology, BC Cancer, Vancouver, BC, CanadaBackground: Since 2012, the BC Cancer provincial treatment guideline for surgically staged stage IA/B and IC1 (defined by intraoperative rupture only) clear cell ovarian cancer (CCOC) has been to offer observation only. We reviewed the clinical outcomes of all stage I CCOC patients since policy implementation. Methods: A retrospective, population-based cohort study of all stage I CCOC patients operated on between April 2012 and December 2017 was conducted. Patient, tumor, surgical and clinical outcome data were collected. Survival analysis was conducted using Kaplan-Meier methods. Results: 78 patients with stage I disease were identified. 40 patients with stages IA/B and IC1, who underwent post-operative observation, were included in the analysis. Lymph node dissection was omitted in 20 patients (50%). Median duration of follow-up was 36 months. There were 4 recurrences (10%), 3 metastatic. The 5-year disease-free survival is 90%, and the 5-year overall survival is 95% for stage IA/B and 90% for stage IC1 (p = 0.645). In comparison, 5-year overall survival for stage IC2 (surface involvement) and IC1 with sharp dissection (all received adjuvant chemotherapy) is 82% (p < 0.001) and for stage IC3 (positive washings) was 23% (p < 0.001). Conclusion: Adjuvant therapy can be safely omitted in patients with stage I A/B and IC1 CCOC. Recurrence rates are low and survival is >90% at 5 years. Stage IC2 /IC3 had worse outcomes, thus stage I substage is instrumental in predicting clinical outcomes for CCOC. Lymph node metastases are rare in stage IA/B/C1 CCOC as absence of lymphadenectomy did not increase the risk of disease recurrence. Keywords: Clear cell carcinoma, Ovarian cancer, Adjuvant therapyhttp://www.sciencedirect.com/science/article/pii/S2352578919301225 |
| spellingShingle | Shiru L. Liu Anna V. Tinker Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the BC Cancer experience Gynecologic Oncology Reports |
| title | Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the BC Cancer experience |
| title_full | Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the BC Cancer experience |
| title_fullStr | Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the BC Cancer experience |
| title_full_unstemmed | Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the BC Cancer experience |
| title_short | Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the BC Cancer experience |
| title_sort | omission of adjuvant therapy in stage i clear cell ovarian cancer review of the bc cancer experience |
| url | http://www.sciencedirect.com/science/article/pii/S2352578919301225 |
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