Introduction/Background Ovarian clear cell carcinoma (OCCC) with recurrence/progression after treatment has dismal prognosis. We aimed to investigate the management and outcomes of such patients.

Methodology OCCC patients who received primary surgery between 2000 and 2013 with cancer recurrence or progression after primary treatment were analyzed. Univariate and multivariate analyses were used to identify the independent predictors of survival after recurrence (SAR), progression-free interval (PFI) and cancer-specific survival (CSS).

Results A total of 64 patients experienced treatment failure (49 with cancer recurrence and 15 with progression without upfront remission). The 5-year CSS rates of recurrent/progressive OCCC patients were 22.9% (progression group: median CSS 5.9 months [range, 0.8–25.2] versus recurrence group 43.6 months [range, 7.1–217.8] ; p<0.001). Patients with solitary recurrence had significantly better SAR than those with disseminated relapse (median: not reached vs 8.9 months, p<0.001). On multivariate analysis, three models each for SAR and CSS were formulated alternatively including highly correlated variables. Of these, solitary relapse pattern (HR 0.07, p<0.001), PFI-1 >12 months (HR 0.22–0.40, p=0.023 to <0.001), CA125 <35U/mL at initial recurrence (HR 0.32, p=0.007), and overall salvage treatment included radiotherapy (HR, 0.19, p=0.001) were significant predictors of longer SAR, and better CSS (p=0.034 to <0.001).

Conclusion Recurrent OCCC can be treated with curative intent if the relapse is solitary and can be completely resected or encompassed with radiotherapy. Meanwhile, novel therapies are needed for disseminated relapse or progression during primary treatment.

Disclosure Conflict of interest statement: C.-H. Lai, TTY Biopharm (Research fund to Institution), Roche (fund to Inst), MSD (fund to Inst), AstraZeneca (Advisory board); A. Chao, AstraZeneca (fund to Inst). The other authors have no conflicts of interest to disclose.