title: A recurrence-predicting prognostic factor for patients with ovarian clear-cell adenocarcinoma at reproductive age.
abstract: OBJECTIVE
  We retrospectively analyzed the clinicopathological features and evaluated the prognostic indicators of recurrence in 132 patients with clear cell adenocarcinoma (CCC) of the ovary at reproductive age.
  
  
  METHODS
  Between 1986 and 2011, as a regional population-based study, clinicopathological data on 132 young patients with CCC, collected under the central pathological review system, were subjected to uni- and multivariable analyses to evaluate recurrence-free survival (RFS).
  
  
  RESULTS
  The median age was 40 (27-45) years. The median follow-up period for surviving patients was 46.4 months. During the observation period, there were 16 recurrences in 87 patients with stage I tumors (18.4 %), 8 in 17 with stage II (47.1 %), and 16 in 28 with III-IV (57.1 %). Subsequently, 35 patients died of the disease. Those with stage I or II did not reach the median RFS. The median RFS of stage III-IV was 21.6 months. When analysis was confined to stage I patients, there was no significant difference in the RFS of CCC patients between IA and IC(r) (intraoperative capsule rupture) (P = 0.7957). In contrast, CCC patients with IC excluding IC(r) [IC(non-r)] showed a poorer RFS than those with IC(r) (P < 0.0001). In multivariable analysis confined to stage I patients, the substage group was only an independent prognostic factor for RFS [IA vs. IC(non-r)] [hazard ratio (HR) = 9.394; 95 % CI, 1.445-61.070; P = 0.0190].
  
  
  CONCLUSIONS
  We should keep in mind the greater risk of recurrence in patients with stage IC disease or higher, other than those stage IC patients with intraoperative rupture.
authors.affiliation: Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan, kajiyama@med.nagoya-u.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kajiyama
authors.forename: Mika
authors.initials: M
authors.lastname: Mizuno
authors.forename: Kiyosumi
authors.initials: K
authors.lastname: Shibata
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Umezu
authors.forename: Shiro
authors.initials: S
authors.lastname: Suzuki
authors.forename: Eiko
authors.initials: E
authors.lastname: Yamamoto
authors.forename: Hiroko
authors.initials: H
authors.lastname: Mitsui
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Sekiya
authors.forename: Kaoru
authors.initials: K
authors.lastname: Niimi
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Kawai
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 / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000077216:Carcinoma, Ovarian Epithelial; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D011379:Prognosis