Archives of Gynecology and Obstetrics

, Volume 300, Issue 3, pp 717–724 | Cite as

Long-term oncologic outcome and its prognostic indicators in reproductive-age women with ovarian clear-cell carcinoma

  • Hiroaki KajiyamaEmail author
  • Shiro Suzuki
  • Nobuhisa Yoshikawa
  • Kaoru Niimi
  • Michiyasu Kawai
  • Kiyosumi Shibata
  • Fumitaka Kikkawa
Gynecologic Oncology



Clear-cell carcinoma (CCC) in reproductive-age women is likely to become an increasingly critical issue regarding possibilities of infertility, hormonal dysfunction, and mortality. The aim of this study was to examine the long-term oncologic outcome and its prognostic indicators based on a multicentric cohort of young patients with CCC.

Patients and methods

During the period of 1990–2015, a total of 164 patients aged 45-year-old or younger were enrolled in the study. Clinicopathologic data of these young patients with CCC collected under a centralized pathological review system were subjected to uni- and multivariable analyses to evaluate overall survival (OS).


The median follow-up was 73.8 months (range 5.2–244.2) in the surviving patients. Among these patients, 104 (63.4%) had FIGO I disease, and 22 (13.4%), 31 (18.9%), and 7 (4.3%) had II, III, and IV disease, respectively. The 5-year OS rate was 74.5%. On stratification by the FIGO stage, the 5-year OS rates were as follows: stage I (90.2%), stage II (57.9%), and stage III/IV (39.3%), respectively (P < 0.0001). Confining analysis to stage I patients, there was no difference in OS between those who underwent fertility-sparing surgery and those who received radical surgery (P = 0.1593). In relapsed patients, the median survival after recurrence was 11.6 months. In multivariable analysis of stage I patients, the capsule status was an independent prognostic indicator of OS {IC2/IC3 vs. IA/IC1: HR 4.293 (95% CI 1.140–16.422), P = 0.0318}.


CCC patients staged greater than IC2/IC3 show a markedly increased risk of mortality. Thus, it is important to diagnose patients staged under IC2/IC3.


Epithelial ovarian carcinoma Clear-cell carcinoma Reproductive-age Fertility-sparing surgery Overall survival Post-recurrence survival 



Clear-cell carcinoma


Fertility-sparing surgery


Overall survival


Post-recurrence survival



We sincerely thank TOTSG members for collaborating in data collection.

Author contributions

HK: data analysis and interpretation, drafting paper; SS, NY, KN, MK: data collection; KS: revising manuscript; FK: supervising and funding.

Compliance with ethical standards

Conflict of interest

All authors declare that there are no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Obstetrics and GynecologyToyohashi Municipal HospitalAichiJapan
  3. 3.Department of Obstetrics and GynecologyBantane Hospital, Fujita Health UniversityAichiJapan

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