Clinical analysis of 91 cases of stage Ⅰ ovarian clear cell carcinoma

LIU Qian; ZHOU Hui-mei; YANG Jia-xin; CAO Dong-yan; XIANG Yang; SHEN Keng

doi:10.19538/j.fk2025060116

Abstract：Objective To explore the occurrence and high-risk factors affecting prognosis of micro-metastasis(occult metastatic lesions)in stage Ⅰ ovarian clear cell carcinoma patients during comprehensive staging surgery or restaging surgery.Methods A retrospective analysis was performed on 160 patients with ovarian clear cell carcinoma admitted to Peking Union Medical College Hospital from February 2015 to December 2019,including 91 patients with lesions confined to the ovary at the time of surgery.Patients' age,surgical procedure,intraoperative findings,restaging surgery procedure,FIGO stage,pathological results and follow-up information were recorded in detail.Patients were divided into two groups based on the initial treatment approach:the comprehensive staging surgery group,who underwent comprehensive staging surgery at the initial treatment,and the restaging surgery group,who either did not undergo staging surgery or underwent incomplete staging at the initial treatment and subsequently underwent restaging surgery.Kaplan-Meier was used to plot survival curve and calculate and compare patients' overall survival and progression-free survival.COX risk regression model was used for prognostic analysis.Results The 91 patients was considered as clinical stage Ⅰ with a median age of 49 years(22-71 years)and a mean tumor size of(10.6±4.6)cm at the time of initial surgical exploration.The level of preoperative CA125 increased in 35 patients(38.5％).Totally 51 cases(56.0％)underwent comprehensive staging in the primary surgery,and 40 cases(44.0％)underwent restaging surgery.The confirmed metastasis rate after comprehensive staging surgery and restaging surgery was 15.4％(14/91).FIGO stage was upgraded in 14 patients(15.4％),including 6 patients(6.6％)was upgraded to stage Ⅱ and 8 patients(8.8％)to stage Ⅲ.After operation,85 patients(93.4％)received platinum-based chemotherapy,and 6 patients(6.6％)did not receive chemotherapy.The mean follow-up time was(49.5±19.5)months,the recurrence rate was 19.8％,and the mortality rate was 8.8％.FIGO stage was upgraded to Ⅱ-Ⅲ in 17.6％(9/51)of the patients in the comprehensive staging group and 12.5％(5/40)in restaging group.The lymph node metastasis rate of the two groups was 7.8％(4/51)and 7.5％(3/40),respectively,the difference being with no statistical significance(P＞0.05).The 5-year progression-free survival rate of patients in the comprehensive staging group and the restaging group was 74.2％ and 92.0％,respectively(P=0.063).The 5-year overall survival rate of the two groups was 86.0％ and 90.7％,respectively(P=0.676).Univariate analysis showed that FIGO stage(Ⅲ compared to Ⅰ,Ⅱ)had a statistically significant effect on progression-free survival(HR=4.158,95％ CI 1.334-12.963,P=0.014),while restaging surgery,compared to comprehensive staging surgery,had no statistical effect on progression-free survival(HR=0.361,95％ CI 0.117-1.109,P=0.075)and overall survival(HR=1.349,95％ CI 0.337-5.401,P=0.672).Multivariate analysis showed that FIGO stage Ⅲ had a statistically significant effect on PFS compared with stage Ⅰ and Ⅱ(HR=5.570,95％ CI 1.196-25.940,P=0.029).Conclusions The rates of upgrading of stage and lymph node metastasis of stage Ⅰ ovarian clear cell carcinoma are not low,and the upgrading of tumor stage is still an independent risk factor affecting prognosis.Therefore,the diagnosis rate of suspected early clear cell carcinoma of ovary should be increased in the initial operation,and the rate of incomplete surgical staging and restaging should be reduced.