Endometriosis Not a Prognostic Factor for Ovarian Clear Cell Carcinoma

Pavankumar Kamat

September 07, 2021

Endometriosis had no independent association with the prognosis of ovarian clear cell carcinoma (OCCC), irrespective of stage and residual disease (RD). These are findings from a recent study published in the journal  Gynecologic Oncology.

Endometriosis has been previously linked to earlier stage and younger age at diagnosis in patients with OCCC; however, several studies investigating the role of endometriosis as an independent prognostic factor in OCCC have presented contrasting results.

Researchers retrospectively reviewed medical records of 94 women with OCCC from a tertiary gynaecological cancer centre in the UK (2010-2019).  

Forty-six cases of endometriosis-free OCCC (Ef-OCCC) and 48 cases of endometriosis-related OCCC (Er-OCCC) were identified. The two groups did not differ significantly in terms of age (P=.2), International Federation of Gynecology and Obstetrics (FIGO) stage (P=.8), RD (P=.07), adjuvant chemotherapy (P=.4) or chemoresistance (P=.9).

Endometriosis had no significant effect on either OS or PFS. Median OS was 55.00 (95% CI, 32.00-189.00) months in the Ef-OCCC group vs 71.00 (95% CI, 47.00-97.00) months in the Er-OCCC group (log rank, 1.35; P=.2). Median PFS was 39.00 (95% CI, 19.00-143.00) months in the Ef-OCCC vs 39.00 (95% CI, 19.00-62.00) months in the Er-OCCC group (log rank, 0.7; P=.4). 

There was no significant difference between the two groups either in PFS after stratification for RD or in OS after stratification for FIGO stage or RD.

The study had several limitations. The small sample size and the retrospective design of the study may have introduced selection bias. There were no data available on the preventive factors of ovarian cancer, such as length of hormonal treatment, infertility and history of surgical interventions for endometriosis. Additionally, there were no adequate data available on second-line chemotherapy for recurrent or refractory disease. The authors, therefore, warn that the findings should be interpreted with caution. 

They stated: "Owing to the lack of clinical equipoise, there is a clear need for ongoing collaborative efforts towards larger, well-designed prospective studies to draw firmer conclusions on the intrinsic link between endometriosis and OCCC."

Tranoulis A, Buruiana FH, Gupta B, Kwong A, Lakhiani A, Yap J, Balega J, Singh K. Friend or foe? The prognostic role of endometriosis in women with clear cell ovarian carcinoma. A UK population-based cohort study. Arch Gynecol Obstet. 2021 Sep 1 [Epub ahead of print]. doi: 10.1007/s00404-021-06191-8. PMID: 34468823

This article originally appeared on Univadis, part of the Medscape Professional Network.

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