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Surgical and Medical Treatment of Clear Cell Ovarian Cancer: Results From the Multicenter Italian Trials in Ovarian Cancer (MITO) 9 Retrospective Study
  1. Francescapaola Magazzino, MD*,
  2. Dionyssios Katsaros, MD, PhD,
  3. Alessandro Ottaiano, MD,
  4. Angiolo Gadducci, MD§,
  5. Carmela Pisano, MD,
  6. Roberto Sorio, MD,
  7. Emanuela Rabaiotti, MD,
  8. Giovanni Scambia, MD, PhD#,
  9. Gennaro Cormio, MD, PhD*,
  10. Luca Scarampi, MD,
  11. Stefano Greggi, MD, PhD,
  12. Antonella Savarese, MD**,
  13. Marco Marinaccio, MD, PhD††,
  14. Paolo Scollo, MD‡‡ and
  15. Sandro Pignata, MD, PhD
  1. *II Ginecologia e Ostetricia, Azienda Ospedaliera Policlinico, Bari, Italy;
  2. Ginecologica, Azienda Ospedaliera O.I.R.M. - S. Anna, Università di Torino, Turin, Italy;
  3. Istituto Nazionale Tumori, Naples, Italy;
  4. §Ginecologia, Università di Pisa, Pisa, Italy;
  5. Oncologia Medica, CRO Aviano, Aviano, Italy;
  6. Ginecologia, Ospedale San Raffaele, Milan, Italy;
  7. #Ginecologia Oncologica, Policlinico Agostino Gemelli, Rome, Italy;
  8. **U. O. Oncologia, Regina Elena National Cancer Institute, Rome, Italy;
  9. ††I Ginecologia e Ostetricia, Azienda Ospedaliera Policlinico, Bari, Italy; and
  10. ‡‡Ginecologia ed Ostetricia, A.O. Cannizzaro, Catania, Italy.
  1. Address correspondence and reprint requests to Sandro Pignata, MD, PhD, Divisione di Oncologia Medica, Dipartimento Uro-Ginecologico, Istituto Nazionale Tumori, via M. Semmola, 80131 - Naples, Italy. E-mail: sandro.pignata{at}


Objective: Clear cell ovarian carcinoma has a poorer prognosis compared with other histological subtypes.

Materials and Methods: The Multicenter Italian Trials in Ovarian Cancer (MITO) 9 study retrospectively assessed an Italian cohort of patients with clear cell ovarian cancer observed in the years 1991-2007 in 20 Italian centers.

Results: A total of 240 patients with ovarian cancer were analyzed. Forty-five percent of the patients had stage I disease. In 62.9%, clear cell histology was pure, whereas in the other cases, a mixed population was evident. Most of the cases underwent standard surgery, whereas in 7.1% of the patients, a fertility-sparing surgery was given. Lymphadenectomy was performed in 47.9% (115/240) of the patients (54.3% in stages I and II; 39.2% in advanced stage). Most of the patients were treated with platinum-based chemotherapy including paclitaxel in 52.9%. Disease-free survival was longer in patients undergoing lymphadenectomy at surgery (P = 0.0001), both in early stages (P = 0.0258) and in stage III and IV diseases (P = 0.0037). The impact of lymphadenectomy was also evident on overall survival in patients with advanced-stage disease. At multivariate analysis, lymphadenectomy (done vs not done) and stage (I and II vs III and IV) were independently associated with longer disease-free and overall survival, whereas front-line chemotherapy (with vs without taxanes) was not significant.

Conclusion: This analysis suggests that lymphadenectomy has a strong prognostic role for clear cell ovarian cancer influencing disease-free survival and overall survival. The addition of paclitaxel to platinum-based chemotherapy does not affect the outcome.

  • Clear cell
  • Ovarian carcinoma
  • Lymphadenectomy
  • Chemotherapy

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  • The MITO group is supported by a project grant from Associazione Italiana per la Ricerca sul Cancro.