Clinical Outcomes of Clear Cell Carcinoma of the Uterus: A Single-Centre Experience

Purpose This analysis was conducted to report the clinical profile, treatment and disease outcomes in patients with clear cell carcinoma (CCC) of the uterus treated at a tertiary cancer centre. Methods Patients with histologically proven CCC of the uterus treated from January 2019 to December 2023 were included in the study. The demographic profile, clinicopathological characteristics, treatment details and clinical outcome data were obtained from a prospectively maintained institutional database. Potential prognostic factors including age, stage, myometrial invasion, adnexal or nodal involvement, lymphovascular space invasion, p53 status, extent of surgical staging and adjuvant treatment were analysed for impact on progression-free survival (PFS) and overall survival (OS). Results Twenty-eight patients with uterine CCC were treated during the study period. Median age was 62 years (IQR 57–70), and 64.3% patients presented in advanced (III/IV) stage of the disease. Eleven (39.2%) patients had pelvic nodal metastases, of which 6 (21.4%) also had involvement of para-aortic nodes. Six patients (21.4%) had distant metastases at presentation. The remaining 22 patients with no distant metastases underwent surgical staging; lymphadenectomy was performed in 21 patients (95.5%). Twenty patients (91%) received adjuvant external beam radiotherapy; 6 (21.4%) also received vaginal brachytherapy. Adjuvant chemotherapy was given to 11 (50%) patients. Median follow-up was 34.8 months (IQR 20–52). The 3-year PFS and the 3-year OS were 59.7% and 68.2% for the entire cohort, 75% and 83.3% for patients with stage I/II disease and 53.9% and 62.5% for those with stage III/IV disease, respectively. The addition of adjuvant chemotherapy was not associated with an improvement in survival. None of the clinicopathological factors were found to have a significant correlation with survival outcomes. Conclusion Uterine CCC is a rare clinically aggressive subtype of uterine cancers with poor survival outcomes, especially in advanced stages. Adjuvant radiotherapy was used in majority of the patients and may play a role in improving outcomes. Optimal systemic therapies need to be evaluated in future studies.