title: Clear cell carcinoma of the cervix: a multi-institutional review in the post-DES era.
abstract: OBJECTIVE
  To conduct an outcome analysis of patients with cervical clear cell carcinoma (CCCC) in the post-DES era.
  
  
  METHODS
  A retrospective review was conducted at 3 major gynecologic cancer centers of all primary CCCC between 1982 and 2004.
  
  
  RESULTS
  CCCC was confirmed in 34 patients. Median age was 53 years. DES exposure was confirmed in 2 (6%) patients. A history of smoking was elicited in 22%, and of abnormal Pap smear 18% patients. Primary surgical resection was performed in all stage I or IIA patients (n=26); they displayed superior 3-year overall survival (OS) compared to advanced stage (n=8) patients (91% vs. 22%, p<0.001). Pelvic lymph node involvement was noted in 25%; all patients with positive para-aortic nodes (20% of patients sampled) had positive pelvic nodes. All node positive patients were treated with adjuvant radiation, but nevertheless displayed reduced progression free (31% vs 92%, p<0.001) and overall survival (80% vs. 100%, p=0.02). Adjuvant radiotherapy did not appear to impact OS in patients with negative lymph nodes.
  
  
  CONCLUSIONS
  This series provides insight into the management of early stage CCCC in the post-DES era. Although these patients may be at slightly higher risk of nodal spread, clear cell histology by itself does not appear to portend a worse prognosis than squamous cell carcinoma of the cervix in the absence of traditional risk factors. Our data suggest that patients with low risk early stage CCCC may be managed with radical surgery alone, without the need for adjuvant chemotherapy or radiation.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: M Bijoy
authors.initials: MB
authors.lastname: Thomas
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Aliza L
authors.initials: AL
authors.lastname: Leiser
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000139:chemically induced / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D017024:Chemotherapy, Adjuvant; D004054:Diethylstilbestrol / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000139:chemically induced / Q000473:pathology / Q000601:surgery* / Q000628:therapy
chemical_list: D004054:Diethylstilbestrol