Chang-Halpenny CN, et al. - Outcomes and patterns of failure with and without adjuvant therapy in patients with stage I-II clear cell carcinoma (CCC) of the uterus were determined. Aggressive and often unsalvageable nature of recurrence was noted and therefore, consideration of adjuvant treatment (including chemotherapy and radiation) is justified for early-stage CCC, particularly for stage II or those with poor prognostic factors.

• Researchers examined 64 cases of CCC, including 26 of pure CCC, 22 mixed with endometrioid adenocarcinoma, and 16 mixed with uterine papillary serous carcinoma.
• Adjuvant treatment was given to 55%.

• A median follow-up of 51.9 months was carried out.
• Kaplan-Meier estimate demonstrated 5-year vaginal recurrence-free survival (RFS) of 91.3%, pelvic RFS of 92.6%, distant metastasis RFS of 81.6%, disease-free survival of 79.6%, and overall survival of 79.7%.
• Median time to recurrence was 20.7 months (range, 2 to 40.5 mo).
• Higher proportion of stage II disease (40% vs 6.9% observed, P=0.0031) was noted in patients who were treated adjuvantly and 20% (7/35) of these recurred.
• By histologic subtypes, no significant differences in outcomes were noted but numerically more recurrences occurred with uterine papillary serous involvement.
• By univariate analysis, worse overall survival was predicted by higher stage, presence of lymphovascular invasion, and lack of lymph node dissection.
• Worse cancer-specific survival was predicted by age 65 years and above.
• Progression was evident in 12, of those, only 1 was salvaged and 11 died of disease.
• Of progressors, 10 had documented distant metastasis.
• The reported median time from recurrence to death was 4.5 months (range, 0.2 to 21.2 mo).