title: Survival impact of capsule rupture in stage I clear cell carcinoma of the ovary in comparison with other histological types.
abstract: OBJECTIVE
  We analyzed a large number of stage I clear cell carcinoma of the ovary (CCC) patients to estimate the survival impact of the capsule status in stage I CCC patients, particularly in comparison with non-CCC patients.
  
  
  METHODS
  Clinicopathologic data on 564 patients with stage I epithelial ovarian cancer (EOC) collected under the central pathological review system were subjected to uni- and multivariable analyses to evaluate the disease-free survival (DFS) and overall survival (OS).
  
  
  RESULTS
  There was no significant difference in both the OS and DFS of CCC patients between IA and IC(ir) (intraoperative capsule rupture) {IA vs. IC(ir); OS: P=0.1402, DFS: P=0.2701}. In contrast, CCC patients at IC(non-ir) {IC excluding for IC(ir), such as preoperative capsule rupture, positive ascites/washing, and surface involvement} showed a poorer OS and DFS than those at IC(ir), or those at the corresponding stage in non-CCC. In multivariable analysis, the capsule status was an independent prognostic factor of a poor OS and DFS {OS: HR, 2.832; 95% CI 1.156-6.938; P=0.023; DFS: HR, 4.327; 95% CI, 1.937-9.667; P=0.0004)} {In contrast, non-CCC: N.S. (OS/DFS)}. Furthermore, in CCC patients, intraperitoneal recurrences were more frequently observed in IC(non-ir) CCC than IA or IC(ir) CCC (P=0.0083) {In contrast, non-CCC: N.S.}.
  
  
  CONCLUSIONS
  This study suggests that CCC patients other than those with intraoperative capsule rupture show a considerable risk for mortality despite adjuvant chemotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Higashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kajiyama
authors.forename: Kiyosumi
authors.initials: K
authors.lastname: Shibata
authors.forename: Mika
authors.initials: M
authors.lastname: Mizuno
authors.forename: Kimio
authors.initials: K
authors.lastname: Mizuno
authors.forename: Satoyo
authors.initials: S
authors.lastname: Hosono
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Kawai
authors.forename: Toru
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nagasaka
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Kikkawa
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality / Q000473:pathology; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015996:Survival Rate; D055815:Young Adult