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Demographic, Clinical, and Prognostic Factors of Ovarian Clear Cell Adenocarcinomas According to Endometriosis Status
  1. Tine H. Schnack, PhD, MD*,
  2. Estrid Høgdall, Cand Pharm, DrMed, Professor,
  3. Lotte Nedergaard Thomsen, MD, PhD and
  4. Claus Høgdall, DrMed, MD*
  1. * Juliane Marie Centret, Gynaecological Clinic, University Hospital of Copenhagen, København Ø;
  2. Department of Pathology, Molecular Unit, Herlev Hospital, Herlev; and
  3. Department of Pathology, University Hospital of Copenhagen, København Ø, Denmark.
  1. Address correspondence and reprint requests to Tine H. Schnack, PhD, MD, Department of Gynecology and Obstetrics, Gynecologic Clinic, afsn 4232, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark. E-mail: Tine{at}


Objectives Women with endometriosis carry an increased risk for ovarian clear cell adenocarcinomas (CCCs). Clear cell adenocarcinoma may develop from endometriosis lesions. Few studies have compared clinical and prognostic factors and overall survival in patients diagnosed as having CCC according to endometriosis status.

Methods Population-based prospectively collected data on CCC with coexisting pelvic (including ovarian; n = 80) and ovarian (n = 46) endometriosis or without endometriosis (n = 95) were obtained through the Danish Gynecological Cancer Database. χ2 Test, independent-samples t test, logistic regression, Kaplan-Meier test, and Cox regression were used. Statistical tests were 2 sided. P values less than 0.05 were considered statistically significant.

Results Patients with CCC and pelvic or ovarian endometriosis were significantly younger than CCC patients without endometriosis, and a higher proportion of them were nulliparous (28% and 31% vs 17% (P = 0.07 and P = 0.09). Accordingly, a significantly higher proportion of women without endometriosis had given birth to more than 1 child. Interestingly, a significantly higher proportion of patients with ovarian endometriosis had pure CCCs (97.8% vs 82.1%; P = 0.001) as compared with patients without endometriosis. Overall survival was poorer among CCC patients with concomitant ovarian endometriosis (hazard ratio, 2.56 [95% confidence interval, 1.29–5.02], in the multivariate analysis.

Conclusions Age at CCC diagnosis and parity as well as histology differ between CCC patients with and without concomitant endometriosis. Furthermore, CCC patients with concomitant ovarian endometriosis have a poorer prognosis compared with endometriosis-negative CCC patients. These differences warrant further research to determine whether CCCs with and without concomitant endometriosis develop through distinct pathogenic pathways.

  • Endometriosis
  • Clear cell carcinomas
  • Ovarian cancer

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  • The authors declare no conflicts of interest.