title: The clinical value of surgeons' efforts of preventing intraoperative tumor rupture in stage I clear cell carcinoma of the ovary: A Korean multicenter study.
abstract: OBJECTIVE
  To demonstrate the survival impact of intraoperative tumor rupture in women with stage I clear cell carcinoma (CCC) of the ovary.
  
  
  METHODS
  A total of 193 patients with stage I CCC of the ovary who had undergone a complete staging operation followed by ≥three cycles of adjuvant platinum-based chemotherapy, were retrospectively reviewed. Survival analysis was performed and compared between three stage groups: IA/IB, IC1, and IC2/IC3.
  
  
  RESULTS
  There were 70, 51, and 72 women with ovarian CCC in stages IA/IB, IC1, and IC2/IC3, respectively. Intraoperative tumor rupture occurred in 69 (35.8%) patients. Gross endometriosis (p=0.020) and significant peritumoral adhesion (p<0.001) were associated with intraoperative tumor rupture. However, neither laparoscopic approach nor large tumor size >10cm were associated with intraoperative tumor rupture. Patients with stage IC2/IC3 compared to those with stage IC1, had poorer progression-free survival (PFS) (5-year PFS, 68.5% versus 91.7%; p=0.010) and overall survival (OS) (5-year OS, 81.1% versus 95.4%; p=0.027). However, there was no significant difference between patients with stages IA/IB and IC1 CCC in PFS (5-year PFS 88.8% versus 91.7%; p=0.291) and OS (5-year OS 94.6% versus 95.4%; p=0.444). Stage IC2/IC3 was the only independent poor prognostic factor for OS (hazard ratio, 3.50; 95% confidence interval, 1.31 to 9.36).
  
  
  CONCLUSIONS
  Surgical spillage of tumor cells does not appear to have a negative impact on survival outcomes of women with stage I ovarian CCC who received ≥three cycles of adjuvant platinum-based chemotherapy.
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors: Dong Hoon
authors: DH
authors: Suh
authors: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors: Jeong-Yeol
authors: JY
authors: Park
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Jung-Yun
authors: JY
authors: Lee
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Byoung-Gie
authors: BG
authors: Kim
authors: Center for Uterine Cancer and Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors: Myong Cheol
authors: MC
authors: Lim
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Jae-Weon
authors: JW
authors: Kim
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Duk-Soo
authors: DS
authors: Bae
authors: Center for Uterine Cancer and Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors: Sang-Yoon
authors: SY
authors: Park
authors: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors: Joo-Hyun
authors: JH
authors: Nam
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors: Kidong
authors: K
authors: Kim
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors: Jae Hong
authors: JH
authors: No
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: ybkimlh@snubh.org.
authors: Yong-Beom
authors: YB
authors: Kim
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D056910:Republic of Korea; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000517:prevention & control; D016019:Survival Analysis
keywords: Adenocarcinoma; Clear cell; Intraoperative tumor rupture; Ovarian neoplasms; Retrospective studies; Survival rate