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Adjuvant Chemotherapy for Stage I Ovarian Clear Cell Carcinoma: Is it Necessary for Stage IA?
  1. Mika Mizuno, MD, PhD*,
  2. Hiroaki Kajiyama, MD, PhD*,
  3. Kiyosumi Shibata, MD, PhD*,
  4. Kimio Mizuno, MD, PhD,
  5. Osamu Yamamuro, MD, PhD,
  6. Michiyasu Kawai, MD, PhD§,
  7. Toru Nakanishi, MD, PhD,
  8. Tetsuro Nagasaka, MD, PhD and
  9. Fumitaka Kikkawa, MD, PhD*
  1. *Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine;
  2. Department of Obstetrics and Gynecology,Nagoya First Red Cross Hospital;
  3. Department of Obstetrics and Gynecology, Nagoya Second Red Cross Hospital;
  4. §Department of Obstetrics and Gynecology, Toyohashi MunicipalHospital;
  5. Department of Gynecology, Aichi Cancer Center; and
  6. Nagoya University School of Health Science, Nagoya, Japan.
  1. Address correspondence and reprint requests to Mika Mizuno, MD, PhD, Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. E-mail: mizunomizuno{at}


Background It is controversial whether patients with stage I ovarian clear cell carcinoma (CCC) benefit from postoperative chemotherapy. This study was designed to evaluate the postoperative outcomes associated with the inclusion or exclusion of adjuvant therapy in these patients.

Methods A total of 185 patients who were treated for stage I CCC between 1991 and 2007 were retrospectively evaluated. All of the patients had received comprehensive surgical staging, and their condition had been diagnosed by a central pathological review system. Only one patient with stage IB was excluded from this study.

Results Median follow-up time was 62 months (range 7–191 months). Median age was 52 years (30–75 years). There were 41, 93, and 50 patients in stage IA, intraoperative capsule ruptured IC (rupture-IC), and all other-IC groups, respectively. The 5-year recurrence-free survival rates for the substage were 97.6%, 87.8%, and 70.4% (P < 0.001), respectively. Among 134 patients consisting of those in the stage IA and rupture-IC groups, 91 patients received adjuvant chemotherapy (AC) and 43 patients did not (non-AC). There was no significant survival difference in each substage group between the non-AC and AC groups in 5-year recurrence-free survival rate (stage IA, 100% vs 93.8%; rupture-IC, 94.1% vs 86.6%). Multivariate analysis demonstrated that there was no significant prognostic factor for both recurrence and survival among the IA and rupture-IC groups. Postoperative therapy, regimen, and chemotherapy cycles were not significantly affected.

Conclusions This study indicates that adjuvant chemotherapy does not contribute to the improving prognosis of stage IA ovarian CCC. Whereas the histological type is CCC, the routine adjuvant chemotherapy after comprehensive surgical staging may be unnecessary for patients with at least stage IA.

  • Clear cell adenocarcinoma of ovary
  • Epithelial ovarian carcinoma
  • Adjuvant chemotherapy
  • Stage I
  • Intraoperative capsule rupture
  • Prognostic factors

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  • The authors declare no conflicts of interest.

  • Authors’ contributions: MM: clinical data collection, manuscript writing, manuscript revision and corrections; HK: clinical data collection and paper supervision; KS, KM, OY, MK, and TN: clinical data collection; TN: a pathologist and the person responsible for a central pathological review system; FK: intellectual mentorship, clinical data collection, and paper supervision. All authors have read and approved the final manuscript.

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