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Clear Cell Carcinoma of the Endometrium: Evaluation of Prognostic Parameters in a Multi-institutional Cohort of 165 Cases
  1. Eman Abdulfatah, MD*,
  2. Sharif Sakr, MD*,
  3. Sumi Thomas, MD,
  4. Zaid Al-Wahab, MD*,
  5. David G. Mutch, MD,
  6. Sean Dowdy, MD,
  7. Sudeshna Bandyopadhyay, MD*,
  8. Adnan Munkarah, MD§,
  9. Mohamed Elshaikh, MD,
  10. Robert Morris, MD and
  11. Rouba Ali-Fehmi, MD*
  1. *Department of Pathology, Wayne State University, Detroit, MI;
  2. Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN;
  3. Department of Obstetrics and Gynecology, Washington University, St Louis, MO; and Departments of
  4. §Obstetrics and Gynecology and
  5. Radiation Oncology, Henry Ford Hospital/Wayne State University; and
  6. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI.
  1. Address correspondence and reprint requests to Eman Abdulfatah, MD, Department of Pathology, Wayne State University, 540 E Canfield Ave, Detroit, MI 48201. E-mail:;


Objectives Clear cell carcinoma (CCC) comprises a rare yet an aggressive subtype, accounting for less than 5% of all uterine carcinomas. Several clinicopathologic features have been predictive of poor prognosis; however, data remain controversial. The aim of this study was to evaluate the clinicopathologic features of a multi-institutional cohort of endometrial CCC in order to identify which, if any, have prognostic significance.

Methods Retrospective review of endometrial CCC diagnosed between 1995 and 2012 at 3 institutions was conducted to evaluate clinicopathologic parameters: age, race, tumor size, stage, myometrial invasion (MI), lymphovascular invasion, lymph node and adnexal involvement, adjuvant therapy, and outcomes. Data were analyzed using Fisher exact, Cox regression, and Kaplan-Meier analyses.

Results Patients’ ages ranged from 36 to 90 years (median, 67 years). The median tumor size was 3.6 cm. Inner-half MI was present in 44%, lymphovascular invasion in 34%, adnexal involvement in 16%, and lymph node metastasis in 30% of cases. Fifty-eight percent of the patients presented with early-stage disease. The 5-year overall survival (OS) was 58%. Shorter disease-free interval (DFI) was significantly associated with older age at diagnosis (>70 years), advanced-stage disease, adnexal involvement, and deep MI (P = 0.005, P = 0.001, P = 0.001, and P = 0.003, respectively). Patients who received adjuvant chemotherapy had a significantly worse DFI and 5-year OS (P = 0.001 and P = 0.001, respectively). A significantly shorter 5-year OS was noted with advanced stage (III–IV) and presence of adnexal involvement (P = 0.001 and P = 0.021, respectively). On Cox regression analysis, advanced-stage disease, older age, and adnexal involvement were significant independent predictors of worse DFI (P = 0.001, P = 0.005, and P = 0.019, respectively), whereas inner-half MI was a significant independent predictor of longer DFI (P = 0.004). Adjuvant radiotherapy alone was a significant independent predictor of better 5-year OS (P = 0.012).

Conclusions In our series of endometrial CCC, older age at diagnosis, advanced stage, deep MI, and adnexal involvement were independent poor prognostic factors. Adjuvant radiotherapy had a significant positive impact on 5-year OS.

  • Clear cell carcinoma
  • Clinicopathologic
  • Prognostic
  • Radiotherapy

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  • The authors declare no conflicts of interest.