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Oncologic outcomes after secondary surgery in recurrent clear-cell carcinoma of the ovary
  1. Hiroaki Kajiyama1,
  2. Shiro Suzuki,
  3. Nobuhisa Yoshikawa,
  4. Michiyasu Kawai2,
  5. Kiyosumi Shibata3,
  6. Tetsuro Nagasaka4 and
  7. Fumitaka Kikkawa
  1. 1 Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicime, Nagoya, Japan
  2. 2 Obstetrics and Gynecology, Toyohashi Municipal Hospital, Toyohashi, Japan
  3. 3 Department of Obstetrics and Gynecology, Bantane Hospital, Fujita Health University, Nagoya, Japan
  4. 4 Deaprtment of Medical Technology, School of Health, Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
  1. Correspondence to Dr Hiroaki Kajiyama, Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya 466-8550, Japan; kajiyama{at}


Objective Complete tumor resection is considered essential in the management of patients with ovarian clear-cell carcinoma. There is a debate regarding whether patients with recurrent ovarian clear-cell carcinoma benefit from secondary cytoreductive surgery.

Methods Details of patients with clear-cell carcinoma were collected by the Tokai Ovarian Tumor Study Group (Nagoya University Hospital and 13 affiliated institutions) and evaluated between January 1990 and December 2015. Histology was confirmed after central pathological review. The primary endpoint of the study was disease-free survival after secondary cytoreductive surgery. Distributions of events were evaluated using the χ2 test. Survival analysis was based on the Kaplan-Meier method. Survival curves were compared using the log-rank test. A value of p<0.05 was considered significant.

Results A total of 169 patients who underwent secondary cytoreductive surgery (N=25) or medical management (N=144) for recurrent clear-cell carcinoma were collected. The median age for patients undergoing secondary cytoreductive surgery was 50 years (range 35–66). Overall, 18 patients had complete resection. In patients who underwent secondary cytoreductive surgery, the median disease-free and post-recurrence survival periods were 10.9 months and 21.2 months, respectively. Moreover, among 18 patients who underwent complete resection, seven showed no evidence of disease during the observation periods. The median post-recurrence survival periods of patients with complete or incomplete resection were 30.1 months and 10.4 months, respectively (p=0.002). On stratification by the recurrence site, patients with intraperitoneal recurrence showed poorer post-recurrence survival than those with recurrence at other sites (p=0.016). However, comparison between the secondary cytoreductive surgery group versus the medical management group showed there was no difference in post-recurrence survival, even when considering complete tumor resection (p=0.114).

Conclusion Patients with intraperitoneal recurrence or incomplete tumor resection had the worst survival after secondary cytoreductive surgery.

  • ovarian clear-cell carcinoma
  • secondary cytoreductive surgery
  • recurrence
  • post-recurrence survival
  • recurrence site

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  • Contributors HK: data analysis and interpretation, and writing the manuscript. SS, MK and NY: data collection. KS: supervisor of this work. FK: supervising and funding.

  • Funding This study was supported by a JSPS (Japan Society for the Promotion of Science) KAKENHI Grant-in-Aid for Scientific Research: grant number 17H04338 and 16K15704.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.