Comparison of the Clinical Characteristics and Prognosis Between Clear Cell Carcinomas and High-grade Serous Ovarian Carcinomas

Comparison of the Clinical Characteristics and Prognosis Between Clear Cell Carcinomas and High-grade Serous Ovarian Carcinomas | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of the Clinical Characteristics and Prognosis Between Clear Cell Carcinomas and High-grade Serous Ovarian Carcinomas Shixiang Dong, Fengsheng Yu, Yutong Liu, Xiao Yu, Xin Sun, Wenjie Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1114209/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: To compare the clinical characteristics and prognosis of women with clear cell versus high-grade serous ovarian carcinoma. Methods: Retrospective analysis of the clinical data of 50 cases patients with ovarian clear cell carcinoma (OCCC) and 103 cases with high-grade serous ovarian carcinoma (HGSOC), who were initially treated and completed standardized therapy in Affiliated Hospital of Qingdao University from January 2013 to December 2017. Results: There were significant differences in age, gravidity (G > 1), chief complaint, with ovarian endometriosis, tumor diameter, unilateral or bilateral, cystic and solid tumor, CA125, HE4, CA199, lactate dehydrogenase (LDH), and FIGO stage between the two groups. The differences in the prognosis between OCCC patients and HGSOC patients with early stage (FIGO I-II) were not statistically significant. The 5-year overall survival and progression-free survival of OCCC patients were significantly worse than those of HGSOC patients with advanced stage (FIGO III-IV) (P < 0.05). FIGO stage and non-R0 resection were independent risk factors affecting the prognosis of patients with ovarian clear cell carcinoma, screening by Cox regression analysis. FIGO stage, the lowest value of CA125, and non-R0 resection were independent risk factors affecting the prognosis of patients with high-grade serous ovarian cancer. Conclusions: The clinical characteristics and prognosis of OCCC are different from those of HGSOC. OCCC patients have a significantly worse prognosis than those with HGSOC in the advanced stage (FIGO Ⅲ-Ⅳ). Satisfactory tumor resection is an essential factor related to the prognosis of patients with OCCC and HGSOC. Sexual & Reproductive Medicine Cancer Biology Ovarian clear cell carcinoma High-grade serous ovarian carcinoma Prognosis Risk factors Clinical characteristics Figures Figure 1 Figure 2 Introduction Epithelial ovarian cancer (EOC) is one of the most lethal malignancies in gynecological tumors. According to 2014 WHO diagnostic criteria 1 , the primary tissue types of EOC include seven types (serous carcinoma, endometrioid carcinoma, clear cell carcinoma, mucinous carcinoma, serous mucinous carcinoma, malignant Brenner tumor, and undifferentiated carcinoma), each of which has its unique clinical characteristics and biological behavior. Ovarian clear cell carcinoma (OCCC) is a kind of EOC with unusual biological behavior. Although most OCCC can be detected in the early stage, it still has a high tendency of recurrence after chemotherapy. 2 Compared with high-grade serous ovarian carcinoma (HGSOC), OCCC has different clinical characteristics and prognoses. A series of large clinical studies on patients with EOC have also excluded patients with clear cells in recent years. As a result, there has been little progress in the treatment of OCCC in the last 30 years. This paper retrospectively analyzed the clinical and follow-up data of 50 patients with OCCC and 103 cases with HGSOC. They were initially treated and completed standardized therapy in the Affiliated Hospital of Qingdao University from January 2013 to December 2017. We compared the differences in clinical characteristics and prognosis between the two groups. And we evaluated the risk factors affecting the prognosis. We wish we could provide some specific clinical basis for the further study of patients with OCCC. Materials And Methods Patients From January 2013 to December 2017, 99 patients with OCCC and 194 patients with HGSOC were registered and treated by the Affiliated Hospital of Qingdao University. The detailed clinical data were collected by reviewing medical charts and clinical follow-up visits. Patients were eligible if they fulfilled the following: (1) had histologically confirmed pure-type OCCC or HGSOC, (2) operations were performed at the Affiliated Hospital of Qingdao University, (3) standard treatment was completed, (4) did not complicate with other primary malignancies or serious complications that affect survival, (5) postoperative follow-up was standardized and complete. Finally, 50 patients with OCCC and 103 patients with HGSOC were enrolled in the current study. Figure 1 shows the data acquisition process. All the patients included had provided written informed consent for the use of their clinical data. The study was approved by the ethics committee at the Affiliated Hospital of Qingdao University in Shandong, China. (Ethical approval number: QYFY WZLL 26500) All the operation was performed by the gynecologic oncologist of Affiliated Hospital of Qingdao University to achieve optimal cytoreduction as far as possible, which was defined as no residual macroscopical lesion after primary debulking surgery. Staging was performed according to the FIGO staging system (FIGO,2014). Most of the patients received platinum-based chemotherapy regimens as the postoperative first-line treatment. Follow-up All patients were routinely followed up for disease progression by telephone or outpatient examinations until December 2020 or mortality. The Overall Survival (OS) was defined as the time from the diagnosis to death or the last follow-up time. Progression-Free Survival (PFS) was defined as the time from therapy initiation to the time of disease progression, relapse, or the last follow-up time. Disease progression or relapse was defined according to the Gynecologic Cancer Intergroup, GCIG. 3 Patients with ovarian cancer after the treatment initiation appeared the following conditions: (1) elevated CA125; (2) a clinically palpable mass; (3) a mass found based on computed tomography, magnetic resonance imaging, or ultrasound; (4) hydrothorax or ascites; (5) Ileus with unknown causes; if 2 out of 5 items are satisfied, it is considered as clinical recurrence; If the patient has only elevated CA125 without clinical manifestations and radiographic evidence, it is a biochemical recurrence. Elevated CA125 was defined as two consecutive occasions when CA125 was greater than the normal upper limit (35U/mL) in patients with normal CA125 or in patients whose values were normalized during treatment. For patients who never normalized CA125, it was greater than twice the nadir on two consecutive measurements. Statistical Analysis Statistical Package for Social Science (SPSS) statistical software (Version 20.0, SPSS Inc, Chicago, Ill) was used for all analyses. T-test was used for the measurement data following a normal distribution. A nonparametric test was used for data that did not conform to normal distribution. The Pearson's chi-squared test, Yate's correction for continuity, or Fisher exact test was used to analyze the enumeration data. Kaplan-Meier curves were used to analyze the distribution of OS and PFS by groups. The log-rank test examined the comparison of patient survival among subgroups. Multivariate survival analysis was performed using the Cox regression model, including prognostic factors that were significant in univariate analysis by Logistic regression. All of the P values reported were 2-sided, and a value of P< 0.05 was considered statistically significant. Results Patients’ Characteristics The patients’ characteristics between the two groups are summarized in Table 1. Among the patients with malignant ovarian cancer who visited our hospital (n=697) from January 2013 to December 2017, 99 patients (14.2%) were diagnosed with OCCC, and 194 patients (27.8%) were diagnosed with HGSOC. There were 50 patients in the group of OCCC with the average age of 51.3 years old and 103 patients in the HGSOC group with the average age of 56.1 years old included in the present analysis. Patients with confirmed OCCC were younger than HGSOC (P<0.05). Most of the OCCC showed a large unilateral cystic solid tumor. The proportion of asymptomatic patients was higher in the OCCC group than in the HGSOC group. Compared with HGSOC, OCCC patients had fewer pregnancies and more patients with ovarian endometriosis. There is a great difference between OCCC and HGSOC in terms of tumor markers. The values of CA125, HE4, and LDH in the OCCC group were lower than that in the HGSOC group, while the CA199 values were higher than that in the HGSOC group. Among the patients with CA125 27, while only 18.6% in the HGSOC group (P < 0.003). At the same time, the proportion of patients in stages Ⅰ-Ⅱ was 74% in the OCCC group and only 22.3% in the HGSOC group (P < 0.0001). Prognosis of Patients in the 2 Groups with Different stages. During the median follow-up time of 44 months (range, 6-93 months), 15 patients (30.0%) in the OCCC group and 52 patients (50.5%) in the HGSOC group were dead (P=0.017). Figure 2 depicts the OS and PFS of each group. In patients with FIGO stages Ⅰ-Ⅱ, the 5-year OS and PFS rates of patients with OCCC (83.8% and 89.2%, respectively) were higher than those of patients with HGSOC (67.2% and 87.0%, respectively). However, this was not statistically significant (P = 0.786 and P =0.194, respectively). In patients with FIGO stages Ⅲ-Ⅳ, the 5-year OS and PFS rates of patients with OCCC (15.4% and 0.0%, respectively) were significantly lower than those of patients with HGSOC (34.1% and 11.4%, respectively; P <0.001 and P<0.001, respectively). The median OS and PFS for the two groups with FIGO stages Ⅲ-Ⅳ were: OCCC (OS/PFS), 20/7 months; HGSOC (OS/PFS), 53/16 months. In the univariate survival analysis by Logistic regression, significant prognostic factors for OCCC were the lowest value of CA125, lactate dehydrogenase, bilateral tumors, R0 resection, and FIGO stage. Significant prognostic factors for HGSOC were age, menopausal status, intrauterine device use, the lowest value of CA125, R0 resection, and FIGO stage (Table 2). Multivariate Cox regression analyses revealed that R0 resection and FIGO stage were independent risk factors for the prognosis of patients with OCCC. And the lowest value of CA125, R0 resection, and FIGO stage were independent risk factors for the prognosis of patients with HGSOC (Table 3). Discussion Ovarian clear cell carcinoma accounts for 5% to 25% of EOC with obvious regionality. OCCC incidence was markedly higher in Asia than in other regions. 4 The rate of early detection of OCCC is also higher than that of HGSOC. However, although a high proportion of patients with OCCC are detected early, much literature has reported that the prognosis of patients with OCCC is similar to or worse than that of patients with HGSOC. 5-9 Compared with other histologic types of EOC, OCCC is more aggressive and less sensitive to platinum-based chemotherapy. 10 Oliver et al. enrolled 544 patients with OCCC and 7054 patients with serous carcinoma. They found that patients with OCCC were younger and had a higher proportion of early stage. 4 FIGO stages Ⅰ-Ⅱ accounted for more than 50% (57-81%) of patients with OCCC. OCCC also has some special clinical features, such as frequent presentation as a large pelvic mass, association with endometriosis, vascular thrombotic events, and hypercalcemia. 2 Although no patients with OCCC were found to have hypercalcemia in our study, this may be related to our relatively small sample size. The lower incidence of bilaterality of OCCC compared to HGSOC observed in this study has been confirmed by other authors. 11 Strong evidence for an association between ovarian endometriosis and OCCC has been established in many studies. 11-14 Patients with ovarian endometriosis have a higher risk of developing ovarian cancer, and the risk was particularly elevated in subjects with a long-standing history of ovarian endometriosis. 12 Park et al. 14 even proposed that ovarian endometriosis may be a precancerous lesion of OCCC. In the present study, 36% of OCCC patients were complicated with ovarian endometriosis, compared with 1.0% of HGSOC patients (P<0.01), which fully demonstrated the association between ovarian endometriosis and OCCC. Compared with other types of EOC, OCCC lacks effective tumor biomarkers. CA125, which plays a vital role in other types of ovarian cancer, has less clinical significance in OCCC. 15 In recent years, some scholars have studied the clinical significance of CA199 in OCCC. Nakagawa et al. 16 reported that 54% of OCCC patients were associated with elevated CA199. Zhu et al. 17 suggested that CA199 may help to distinguish the prognosis of patients. The clinical value of CA199 in patients with OCCC is worthy of further investigation. Hypercalcemia is one of the most common paraneoplastic syndromes in malignant tumors. However, ovarian cancer with hypercalcemia is rarely reported. Japanese scholars Fujino et al. 18 proposed that OCCC is most closely related to hypercalcemia in patients with ovarian cancer. For patients with OCCC complicated with hypercalcemia, recurrence is often accompanied by an increase in serum calcium. However, none of the 50 OCCC patients included in this study were complicated with hypercalcemia, which is inconsistent with the above reports and may be related to the insufficient sample size. OCCC has been generally accepted as unfavorable when compared with other types of EOC, which has been supported by several retrospective studies. 19-21 However, Oliver et al. 4 found that patients with OCCC had a better overall prognosis compared with serous carcinoma. Oliver et al. believed that this difference was related to younger age, earlier stage, and better performance status of patients with OCCC. The study also found that, after adjusting the age, stage, and performance status, the prognosis of OCCC was significantly better than serous carcinoma in stages I–II. At the same time, it was significantly worse in stages Ⅲ-Ⅳ. In our study, we used HGSOC as the control group. We found no statistically significant difference in OS and PFS between the two groups in stages I–II. However, in stages Ⅲ-Ⅳ patients, OCCC patients displayed worse OS and PFS. The factors affecting the prognosis of patients with OCCC continue to be a topic of hot debate in medicine. The sample size of the clinical studies on OCCC by Nasioudis et al. was relatively large. Nasioudis et al. 22 evaluated the effect of chemotherapy on prognosis in 2325 OCCC patients with stage I. They found that the survival benefit of chemotherapy on patients with OCCC in the early stage might only be apparent when the lesion was confined to the ovary. Jenison et al. 11 found that incomplete capsules had a significant adverse effect on the prognosis of patients with OCCC in stage I. Therefore, to improve the prognosis of patients with OCCC, we should try our best to avoid iatrogenic upgrading. In conclusion, there are many differences in clinical features and prognosis between OCCC and HGSOC. Most of the OCCC showed a large unilateral cystic solid tumor. The detection of CA199 is more critical in patients with OCCC than in patients with HGSOC. OCCC has a high incidence of early stage. OCCC patients have a significantly worse prognosis than those with HGSOC in the advanced stage (FIGO Ⅲ-Ⅳ). Clinically, we should try to maintain the integrity of the tumor envelope during surgery. R0 resection is an essential factor that can improve the prognosis of patients with both OCCC and HGSOC. Our study was a retrospective single-center study; a larger prospective multi-center study is needed for further prospective external validation. Declarations Ethics approval and consent to participate The study was approved by the ethics committee at the Affiliated Hospital of Qingdao University in Shandong, China. (Ethical approval number: QYFY WZLL 26500). Consent for publication Not applicable. Availability of data and materials The data during the current study are available from the corresponding author on reasonable request. An additional movie file shows the data in more detail [see Additional file 1] Competing interests The authors declare that there are no competing interests in this study. Funding No funding was received to assist with the preparation of this manuscript. Authors’ Contributions S.D. clinical data collection, manuscript writing, manuscript revision, and corrections; F.Y. manuscript revision and paper supervision; Y.L., X.S., W.W. and X.Y. clinical data collection and follow-up; Y.W. intellectual mentorship and paper supervision. All authors have read and approved the final manuscript. Acknowledgements Not applicable. References Lu Z, Chen J. Introduction of WHO classification of tumors of female reproductive organs, fourth edition. Zhonghua Bing Li Xue Za Zhi. 2014;43:649-50. Behbakht K, Randall TC, Benjamin I, Morgan MA, King S, Rubin SC. Clinical characteristics of clear cell carcinoma of the ovary. Gynecol Oncol. 1998;70:255-8. Vergote I, Rustin GJS, Eisenhauer EA, Kristensen GB, Pujade-Lauraine E, Parmar M, et al. Re: new guidelines to evaluate the response to treatment in solid tumors [ovarian cancer]. J Natl Cancer Inst. 2000;92:1534-5. Oliver KE, Brady WE, Birrer M, Gershenson DM, Fleming G, Farley JH, et al. An evaluation of progression-free survival and overall survival of ovarian cancer patients with clear cell carcinoma versus serous carcinoma treated with platinum therapy: An NRG Oncology/Gynecologic Oncology Group experience. Gynecol Oncol. 2017;147:243-9. Chan JK, Teoh D, Hu JM, Shin JY, Osann K, Kapp DS. Do clear cell ovarian carcinomas have poorer prognosis compared to other epithelial cell types? A study of 1411 clear cell ovarian cancers. Gynecol Oncol. 2008;109:370-6. Crozier MA, Copeland LJ, Silva EG, Gershenson DM, Stringer CA. Clear cell carcinoma of the ovary: A study of 59 cases. Gynecol Oncol. 1989;35:199-203. Dembo AJ, Davy M, Stenwig AE, Berle EJ, Bush RS, Kjorstad K. Prognostic factors in patients with stage Ⅰ epithelial ovarian cancer. Obstetrics & Gynecology. 1990;75:263-73. Kennedy AW, Markman M, Biscotti CV, Emery JD, Rybicki LA. Survival probability in ovarian clear cell adenocarcinoma. Gynecol Oncol. 1999;74:108-14. Leitao MM, Boyd J, Hummer A, Olvera N, Arroyo CD, Venkatraman E, et al. Clinicopathologic analysis of early-stage sporadic ovarian carcinoma. Am J Surg Pathol. 2004;28:147-59. Pectasides D, Fountzilas G, Aravantinos G, Kalofonos C, Efstathiou H, Farmakis D, et al. Advanced stage clear-cell epithelial ovarian cancer: the Hellenic Cooperative Oncology Group experience. Gynecol Oncol. 2006;102: 285-91. Jenison EL, Montag AG, Griffiths CT, Welch WR, Lavin PT, Greer J, et al. Clear cell adenocarcinoma of the ovary: A clinical analysis and comparison with serous carcinoma. Gynecol Oncol. 1989;32:65-71. Brinton LA, Gridley G, Persson I, Baron J, Bergqvist A. Cancer risk after hospital discharge diagnosis of endometriosis. Am J Obstet Gynecol. 1997;176:572-9. King CM, Barbara C, Prentice A, Brenton JD, Charnock-Jones DS. Models of endometriosis and their utility in studying progression to ovarian clear cell carcinoma. J Pathol. 2016;238:185-96. Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, et al. Significance of ovarian endometriosis on the prognosis of ovarian clear cell carcinoma. Int J Gynecol Cancer. 2018;28:11-8. Kim HS, Choi HY, Lee M, Suh DH, Kim K, No JH, et al. Systemic inflammatory response markers and CA-125 levels in ovarian clear cell carcinoma: A two center cohort study. Cancer Res Treat. 2016;48:250-8. Nakagawa N, Koda H, Nitta N, Nakahara Y, Uno J, Hashimoto T, et al. Reactivity of CA19-9 and CA125 in histological subtypes of epithelial ovarian tumors and ovarian endometriosis. Acta Med Okayama. 2015;69:227-35. Zhu J, Jiang L, Wen H, Bi R, Wu X, Ju X. Prognostic value of serum CA19-9 and perioperative CA-125 levels in ovarian clear cell carcinoma. Int J Gynecol Cancer. 2018;28:1108-16. Fujino T, Watanabe T, Yamaguchi K, Nagasaki K, Onishi E, Iwamoto I, et al. The development of hypercalcemia in a patient with an ovarian tumor producing parathyroid hormone-related protein. Cancer. 2015;70: 2845-50. Goff BA, Cuesta R, Muntz HG, Fleischhacker D, Ek M, Rice LW, et al. Clear cell carcinoma of the ovary: A distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy in stage Ⅲ disease. Gynecol Oncol. 1996;60:412. Winter WE 3rd, Maxwell GL, Tian C, Carlson JW, Ozols RF, Rose PG, et al. Prognostic factors for stage Ⅲ epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:3621-27. Duska LR, Garrett L, Henretta M, Ferriss JS, Lee L, Horowitz N. When 'never-events' occur despite adherence to clinical guidelines: the case of venous thromboembolism in clear cell cancer of the ovary compared with other epithelial histologic subtypes. Gynecol Oncol. 2010;116:374-7. Nasioudis D, Mastroyannis SA, Albright BB, Haggerty AF, Ko EM, Latif NA. Adjuvant chemotherapy for stage Ⅰ ovarian clear cell carcinoma: Patterns of use and outcomes. Gynecol Oncol. 2018;150:14-8. Tables TABLE 1. Patients’ characteristics between the 2 groups. OCCC HGSOC Characteristics （N=50） （N=103） P Age, mean (SD), yrs 51.3 (7.8) 56.1 (8.9) 0.001 † ≤50 yrs, n (%) 24 (48.0) 31 (30.1) 0.030 ‡ >50 yrs, n (%) 26 (52.0) 72 (69.9) Menopausal status, n (%) No 21 (42.0) 35 (34.0) 0.334 ‡ Yes 29 (58.0) 68 (66.0) Gravidity, times ≤ 1 time, n (%) 19 (38.0) 19 (18.4) 0.009 ‡ >1 time, n (%) 31 (62.0) 84 (81.6) Intrauterine device use, n (%) No 39 (78.0) 83 (80.6) 0.709 ‡ Yes 11 (22.0) 20 (19.4) Chief complaint, n (%) 0.001 § Abdominal distension 12 (24.0) 63 (61.2) Abdominal pain 16 (32.0) 40 (38.8) Menstrual alterations or post-menopausal vaginal bleeding 10 (20.0) 10 (9.7) Asymptomatic 16 (32.0) 13 (12.6) With ovarian endometriosis, n (%) No 32 (64.0) 102 (99.0) <0.001 ‡ Yes 18 (36.0) 1 (1.0) Tumor diameter, mean (SD), cm 11.6 (4.3) 8.4 (4.2) 10 cm, n (%) 31 (62.0) 34 (33.0) Bilateral tumors, n (%) No 41 (82.0) 36 (35.0) <0.001 ‡ Yes 9 (18.0) 67 (65.0) Cystic solid tumor, n (%) No 12 (24.0) 46 (44.7) 0.013 ‡ Yes 38 (76.0) 57 (55.3) CA125, mean (SD), U/ml 288.5 (435.2) 1570.4 (2068.1) <0.001 † ≤1000 U/ml, n (%) 46 (92.0) 59 (57.3) 1000 U/ml, n (%) 4 (8.0) 44 (42.7) The nadir of CA125 after treatment, mean (SD), U/ml 37.1 (127.5) 30.5 (113.9) 0.748 † ≤10 U/ml, n (%) 29 (58.0) 50 (48.5) 0.272 ‡ >10 U/ml, n (%) 21 (42.0) 53 (51.5) He4, mean (SD), pmol/L 153.0 (205.1) 689.9 (778.6) <0.001 † ≤140 pmol/L, n (%) 37 (74.0) 20 (19.4) 140 pmol/L, n (%) 13 (26.0) 83 (80.6) CA199, mean (SD), U/ml 51.6 (80.8) 23.3 (47.9) 0.025 † ≤27 U/ml, n (%) 29 (58.0) 84 (81.6) 0.002 ‡ >27 U/ml, n (%) 21 (42.0) 19 (18.4) Blood calcium, mean (SD), mmol/L 2.2 (0.2) 2.2 (0.2) 0.824 † ≤2.52mmol/L, n (%) 50 (100.0) 100 (97.1) 0.551 § >2.52mmol/L, n (%) 0 (0.0) 3 (2.9) Lactate dehydrogenase, mean (SD), U/L 191.3 (61.4) 253.4 (166.4) 0.001 † ≤250 U/L, n (%) 43 (86.0) 67 (65.0) 0.007 ‡ >250 U/L, n (%) 7 (14.0) 36 (35.0) Platelet to lymphocyte ratio, mean (SD) 216.5 (104.5) 242.3 (132.2) 0.229 † ≤200, n (%) 24 (48.0) 46 (44.7) 0.697 ‡ >200, n (%) 26 (52.0) 57 (55.3) R0 resection, n (%) No 7 (14.0) 28 (27.2) 0.069 ‡ Yes 43 (86.0) 75 (72.8) FIGO stage, n (%) <0.001 ‡ Ⅰ-Ⅱ 37 (74.0) 23 (22.3) Ⅲ-Ⅳ 13 (26.0) 80 (77.7) † t Test. ‡Pearson’s chi-squared test. §Fisher exact test. R0 resection, complete resection; SD, standard deviation. TABLE 2. Univariate analyses of prognosis by Logistic regression OCCC HGSOC Variable OR 95%CI P OR 95%CI P Age 0.500 0.146-1.712 0.270 2.940 1.211-7.137 0.017 >50 (vs ≤50) Menopausal status 0.348 0.100-1.210 0.097 4.038 1.673-9.751 0.002 Yes (vs No) Intrauterine device use 2.417 0.603-9.678 0.213 0.255 0.085-0.768 0.015 Yes (vs No) The lowest value of CA125 6.875 1.766-26.765 0.005 3.775 1.669-8.534 0.001 >10 (vs ≤10) Lactate dehydrogenase 22.667 2.411-213.102 0.006 0.971 0.432-2.182 0.942 >250 (vs ≤250) Bilateral tumors 14.437 2.506-83.168 0.003 2.059 0.901-4.704 0.087 Yes (vs No) R0 resection 22.667 2.411-213.102 0.006 14.815 4.090-53.660 <0.001 No (vs Yes) FIGO stage 45.375 7.283-282.695 <0.001 10.538 2.889-38.441 <0.001 Ⅲ-Ⅳ (vs Ⅰ-Ⅱ) CI, confidence interval; OR, odds ratio. TABLE 3. Multivariate analyses of prognosis by multivariate Cox regression. OCCC HGSOC Variable HR 95%CI P HR 95%CI P The lowest value of CA125 2.995 0.727-12.337 0.129 2.087 1.123-3.880 0.020 >10 (vs ≤10) R0 resection 7.884 1.689-36.811 0.009 3.693 1.940-7.030 <0.001 No (vs Yes) FIGO stage 4.555 1.088-19.071 0.038 3.910 1.186-12.889 0.025 Ⅲ-Ⅳ (vs Ⅰ-Ⅱ) CI, confidence interval; HR, hazard ratio. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.sav Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1114209","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":66062369,"identity":"7611606b-9024-4ea2-b244-413f509fc4ae","order_by":0,"name":"Shixiang Dong","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shixiang","middleName":"","lastName":"Dong","suffix":""},{"id":66062370,"identity":"b9952e44-d266-45d8-a840-c925c2ad22ee","order_by":1,"name":"Fengsheng Yu","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fengsheng","middleName":"","lastName":"Yu","suffix":""},{"id":66062371,"identity":"9b7ae208-c39e-4abe-8e33-50b671b8c499","order_by":2,"name":"Yutong Liu","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yutong","middleName":"","lastName":"Liu","suffix":""},{"id":66062372,"identity":"c11b83b7-2f93-40fa-b928-c68565218d10","order_by":3,"name":"Xiao Yu","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Yu","suffix":""},{"id":66062373,"identity":"e8f7c2e9-e1eb-45fd-8366-8250e6864b00","order_by":4,"name":"Xin Sun","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Sun","suffix":""},{"id":66062374,"identity":"6b159888-aa1c-4a07-8e19-7b216d2f9680","order_by":5,"name":"Wenjie Wang","email":"","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenjie","middleName":"","lastName":"Wang","suffix":""},{"id":66062375,"identity":"ec68a542-cce4-4fa7-bc8c-a6ca10df13d0","order_by":6,"name":"Yankui Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYFCCBDBpwM/MfPgBaVok29nSDEjTYnCeR0GCKA18x3MMPxf8OmxsfJiHwYChxiaaoBbJM2+MpWf2HTYzO8x74AHDsbTcBkJaDG7kbpDm7TlsY3aYL8GAseEwUVo2/wZpMW7mMZAgVss2aZ4fh80MmInVInnm/Tdr3oZ0Y4nDwEBOIMYvfMfTkm/z/LE27O8/fPjBhxobwloYDgAxY1szhJNAUDlMC8OfOqLUjoJRMApGwQgFAArHQwfr/dsGAAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Hospital of Qingdao University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yankui","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2021-11-25 12:44:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1114209/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1114209/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":16037469,"identity":"5e3ceba7-8a04-4438-9d68-532d3fb87438","added_by":"auto","created_at":"2021-11-30 19:24:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43825,"visible":true,"origin":"","legend":"Flow chart of data selection.","description":"","filename":"Fig01.png","url":"https://assets-eu.researchsquare.com/files/rs-1114209/v1/2a41f8469d1a84eb910057c7.png"},{"id":16037470,"identity":"d67c9a74-2513-41ee-919a-8bafe1597ecc","added_by":"auto","created_at":"2021-11-30 19:24:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":264162,"visible":true,"origin":"","legend":"Left, overall survival in the two groups, in FIGO stages Ⅰ-Ⅱ (A), and in FIGO stages Ⅲ-Ⅳ (C). Right, progression-free survival in the two groups in FIGO stages Ⅰ-Ⅱ (B), and in FIGO stages Ⅲ-Ⅳ (D).","description":"","filename":"Fig02.png","url":"https://assets-eu.researchsquare.com/files/rs-1114209/v1/2c8635fd250e0422e82e0ffc.png"},{"id":17444466,"identity":"7f37c0aa-1dd6-4d80-a7cf-3a9ed5701f35","added_by":"auto","created_at":"2022-01-18 22:44:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":565330,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1114209/v1/2e11a61d-abfc-44f1-9638-ed4884243dc9.pdf"},{"id":16037471,"identity":"3c0e00b2-fa58-4cce-b35d-e83ac27032b9","added_by":"auto","created_at":"2021-11-30 19:24:14","extension":"sav","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":54805,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.sav","url":"https://assets-eu.researchsquare.com/files/rs-1114209/v1/75f8d4380809aeaae1f93fe9.sav"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparison of the Clinical Characteristics and Prognosis Between Clear Cell Carcinomas and High-grade Serous Ovarian Carcinomas\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEpithelial ovarian cancer (EOC) is one of the most lethal malignancies in gynecological tumors. According to 2014 WHO diagnostic criteria\u003csup\u003e1\u003c/sup\u003e, the primary tissue types of EOC include seven types (serous carcinoma, endometrioid carcinoma, clear cell carcinoma, mucinous carcinoma, serous mucinous carcinoma, malignant Brenner tumor, and undifferentiated carcinoma), each of which has its unique clinical characteristics and biological behavior. Ovarian clear cell carcinoma (OCCC) is a kind of EOC with unusual biological behavior. Although most OCCC can be detected in the early stage, it still has a high tendency of recurrence after chemotherapy.\u003csup\u003e2\u003c/sup\u003e Compared with high-grade serous ovarian carcinoma (HGSOC), OCCC has different clinical characteristics and prognoses. A series of large clinical studies on patients with EOC have also excluded patients with clear cells in recent years. As a result, there has been little progress in the treatment of OCCC in the last 30 years. This paper retrospectively analyzed the clinical and follow-up data of 50 patients with OCCC and 103 cases with HGSOC. They were initially treated and completed standardized therapy in the Affiliated Hospital of Qingdao University from January 2013 to December 2017. We compared the differences in clinical characteristics and prognosis between the two groups. And we evaluated the risk factors affecting the prognosis. We wish we could provide some specific clinical basis for the further study of patients with OCCC.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom January 2013 to December 2017, 99 patients with OCCC and 194 patients with HGSOC were registered and treated by the Affiliated Hospital of Qingdao University. The detailed clinical data were collected by reviewing medical charts and clinical follow-up visits. Patients were eligible if they fulfilled the following: (1) had histologically confirmed pure-type OCCC or HGSOC, (2) operations were performed at the Affiliated Hospital of Qingdao University, (3) standard treatment was completed, (4) did not complicate with other primary malignancies or serious complications that affect survival, (5) postoperative follow-up was standardized and complete. Finally, 50 patients with OCCC and 103 patients with HGSOC were enrolled in the current study. Figure 1 shows the data acquisition process. All the patients included had provided written informed consent for the use of their clinical data. The study was approved by the ethics committee at the Affiliated Hospital of Qingdao University in Shandong, China. (Ethical approval number: QYFY WZLL 26500)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll the operation was performed by the gynecologic oncologist of Affiliated Hospital of Qingdao University to achieve optimal cytoreduction as far as possible, which was defined as no residual macroscopical lesion after primary debulking surgery. Staging was performed according to the FIGO staging system (FIGO,2014). Most of the patients received platinum-based chemotherapy regimens as the postoperative first-line treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were routinely followed up for disease progression by telephone or outpatient examinations until December 2020 or mortality. The Overall Survival (OS) was defined as the time from the diagnosis to death or the last follow-up time. Progression-Free\u0026nbsp;Survival\u0026nbsp;(PFS) was\u0026nbsp;defined\u0026nbsp;as\u0026nbsp;the\u0026nbsp;time\u0026nbsp;from therapy initiation to the\u0026nbsp;time\u0026nbsp;of disease progression, relapse, or the last follow-up\u0026nbsp;time. Disease progression or relapse was defined according to the Gynecologic Cancer Intergroup, GCIG.\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003ePatients with ovarian cancer after the treatment initiation appeared the following conditions: (1) elevated CA125; (2) a clinically palpable mass; (3) a mass found based on computed tomography, magnetic resonance imaging, or ultrasound; (4) hydrothorax or ascites; (5) Ileus with unknown causes; if 2 out of 5 items are satisfied, it is considered as clinical recurrence; If the patient has only elevated CA125 without clinical manifestations and radiographic evidence, it is a biochemical recurrence. Elevated CA125 was defined as two consecutive occasions when CA125 was greater than the normal upper limit (35U/mL) in patients with normal CA125 or in patients whose values were normalized during treatment. For patients who never normalized CA125, it was greater than twice the nadir on two\u0026nbsp;consecutive\u0026nbsp;measurements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical Package for Social Science (SPSS) statistical software (Version 20.0, SPSS Inc, Chicago, Ill) was used for all analyses. T-test was used for the measurement data following a normal distribution. A nonparametric test was used for data that did not conform to normal distribution. The Pearson\u0026apos;s chi-squared test, Yate\u0026apos;s correction for continuity, or Fisher exact test was used to analyze the enumeration data. Kaplan-Meier curves were used to analyze the distribution of OS and PFS by groups. The log-rank test examined the comparison of patient survival among subgroups. Multivariate survival analysis was performed using the Cox regression model, including prognostic factors that were significant in univariate analysis by Logistic regression. All of the P values reported were 2-sided, and a value of P\u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatients\u0026rsquo; Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients\u0026rsquo; characteristics between the two groups are summarized in Table 1. Among the patients with malignant ovarian cancer who visited our hospital (n=697) from January 2013 to December 2017, 99 patients (14.2%) were diagnosed with OCCC, and 194 patients (27.8%) were diagnosed with HGSOC. There were 50 patients in the group of OCCC with the average age of 51.3\u0026thinsp;years old and 103 patients in the HGSOC group with the average age of 56.1\u0026thinsp;years old included in the present analysis. Patients with confirmed OCCC were younger than HGSOC (P\u0026lt;0.05). Most of the OCCC showed a large unilateral cystic solid tumor. The proportion of asymptomatic patients was higher in the OCCC group than in the HGSOC group. Compared with HGSOC, OCCC patients had fewer pregnancies and more patients with ovarian endometriosis. There is a great difference between OCCC and HGSOC in terms of tumor markers. The values of CA125, HE4, and LDH in the OCCC group were lower than that in the HGSOC group, while the CA199 values were higher than that in the HGSOC group. Among the patients with CA125 \u0026lt; 1000, 45.7% of the patients in the OCCC group had CA199 \u0026gt; 27, while only 18.6% in the HGSOC group (P \u0026lt; 0.003). At the same time, the proportion of patients in stages Ⅰ-Ⅱ was 74% in the OCCC group and only 22.3% in the HGSOC group (P \u0026lt; 0.0001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrognosis of Patients in the 2 Groups with Different stages.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the median follow-up time of 44 months (range, 6-93 months), 15 patients (30.0%) in the OCCC group and 52 patients (50.5%) in the HGSOC group were dead (P=0.017). Figure 2 depicts the OS and PFS of each group. In patients with FIGO stages Ⅰ-Ⅱ, the 5-year OS and PFS rates of patients with OCCC (83.8% and 89.2%, respectively) were higher than those of patients with HGSOC (67.2% and 87.0%, respectively). However, this was not statistically significant (P = 0.786 and P =0.194, respectively). In patients with FIGO stages Ⅲ-Ⅳ, the 5-year OS and PFS rates of patients with OCCC (15.4% and 0.0%, respectively) were significantly lower than those of patients with HGSOC (34.1% and 11.4%, respectively; P \u0026lt;0.001 and P\u0026lt;0.001, respectively). The median OS and PFS for the two groups with FIGO stages Ⅲ-Ⅳ were: OCCC (OS/PFS), 20/7 months; HGSOC (OS/PFS), 53/16 months.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the univariate survival analysis by Logistic regression, significant prognostic factors for OCCC were the lowest value of CA125, lactate dehydrogenase, bilateral tumors, R0 resection, and FIGO stage. Significant prognostic factors for HGSOC were age, menopausal status, intrauterine device use, the lowest value of CA125, R0 resection, and FIGO stage (Table 2). Multivariate Cox regression analyses revealed that R0 resection and FIGO stage were independent risk factors for the prognosis of patients with OCCC. And the lowest value of CA125, R0 resection, and FIGO stage were independent risk factors for the prognosis of patients with HGSOC (Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOvarian\u0026nbsp;clear\u0026nbsp;cell\u0026nbsp;carcinoma accounts for 5% to 25% of EOC with obvious regionality. OCCC incidence was markedly higher in Asia than in other regions.\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThe rate of early detection of OCCC is also higher than that of HGSOC. However, although a high proportion of patients with OCCC are detected early, much literature has reported that the prognosis of patients with OCCC is similar to or worse than that of patients with HGSOC.\u003csup\u003e5-9\u003c/sup\u003e Compared with other histologic types of EOC, OCCC is more aggressive and less sensitive to platinum-based chemotherapy.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eOliver et al. enrolled 544 patients with OCCC and 7054 patients with serous carcinoma. They found that patients with OCCC were younger and\u0026nbsp;had a higher proportion of early stage.\u003csup\u003e4\u003c/sup\u003e FIGO stages Ⅰ-Ⅱ accounted for more than 50% (57-81%) of patients with OCCC. OCCC also has some special clinical features, such as frequent presentation as a large pelvic mass, association with endometriosis, vascular thrombotic events, and hypercalcemia.\u003csup\u003e2\u003c/sup\u003e Although no patients with OCCC were found to have hypercalcemia in our study, this may be related to our relatively small sample size. The lower incidence of bilaterality of OCCC compared to HGSOC observed in this study has been confirmed by other authors.\u003csup\u003e11\u003c/sup\u003e Strong evidence for an association between ovarian endometriosis and OCCC has been established in many studies.\u003csup\u003e11-14\u003c/sup\u003e Patients with ovarian endometriosis have a higher risk of developing ovarian cancer, and the risk was particularly elevated in subjects with a long-standing history of ovarian endometriosis.\u003csup\u003e12\u003c/sup\u003e Park et al.\u003csup\u003e14\u003c/sup\u003e even proposed that ovarian endometriosis may be a precancerous lesion of OCCC. In the present study, 36% of OCCC patients were complicated with ovarian endometriosis, compared with 1.0% of HGSOC patients (P\u0026lt;0.01), which fully demonstrated the association between ovarian endometriosis and OCCC.\u003c/p\u003e\n\u003cp\u003eCompared with other types of EOC, OCCC lacks effective tumor biomarkers. CA125, which plays a vital role in other types of ovarian cancer, has less clinical significance in OCCC.\u003csup\u003e15\u003c/sup\u003e In recent years, some scholars have studied the clinical significance of CA199 in OCCC. Nakagawa et al.\u003csup\u003e16\u003c/sup\u003e reported that 54% of OCCC patients were associated with elevated CA199. Zhu et al.\u003csup\u003e17\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003esuggested that CA199 may help to distinguish the prognosis of patients. The clinical value of CA199 in patients with OCCC is worthy of further investigation. Hypercalcemia\u0026nbsp;is one of the most common paraneoplastic syndromes in malignant tumors. However, ovarian cancer with hypercalcemia is rarely reported. Japanese scholars Fujino et al.\u003csup\u003e18\u003c/sup\u003e proposed that OCCC is most closely related to hypercalcemia in patients with ovarian cancer. For patients with OCCC complicated with hypercalcemia, recurrence is often accompanied by an increase in serum calcium. However, none of the 50 OCCC patients included in this study were complicated with hypercalcemia, which is inconsistent with the above reports and may be related to the insufficient sample size.\u003c/p\u003e\n\u003cp\u003eOCCC has been generally accepted as unfavorable when compared with other types of EOC, which has been supported by several retrospective studies.\u003csup\u003e19-21\u003c/sup\u003e However, Oliver et al.\u003csup\u003e4\u003c/sup\u003e found that patients with OCCC had a better overall prognosis compared with serous carcinoma. Oliver et al. believed that this difference was related to younger age, earlier stage, and better performance status of patients with OCCC. The study also found that, after adjusting the age, stage, and performance status, the prognosis of OCCC was significantly better than serous carcinoma in stages I\u0026ndash;II. At the same time, it was significantly worse in stages Ⅲ-Ⅳ. In our study, we used HGSOC as the control group. We found no statistically significant difference in OS and PFS between the two groups in stages I\u0026ndash;II. However, in stages Ⅲ-Ⅳ patients, OCCC patients displayed worse OS and PFS.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The factors affecting the prognosis of patients with OCCC continue to be a topic of hot debate in medicine. The sample size of the clinical studies on OCCC by Nasioudis et al. was relatively large. Nasioudis et al.\u003csup\u003e22\u003c/sup\u003e evaluated the effect of chemotherapy on prognosis in 2325 OCCC patients with stage I. They found that the survival benefit of chemotherapy on patients with OCCC in the early stage might only be apparent when the lesion was confined to the ovary. Jenison et al.\u003csup\u003e11\u003c/sup\u003e found that incomplete capsules had a significant adverse effect on the prognosis of patients with OCCC in stage I. Therefore, to improve the prognosis of patients with OCCC, we should try our best to avoid iatrogenic upgrading.\u003c/p\u003e\n\u003cp\u003eIn conclusion, there are many differences in clinical features and prognosis between OCCC and HGSOC. Most of the OCCC showed a large unilateral cystic solid tumor. The detection of CA199 is more critical in patients with OCCC than in patients with HGSOC. OCCC has a high incidence of early stage. OCCC patients have a significantly worse prognosis than those with HGSOC in the advanced stage (FIGO Ⅲ-Ⅳ). Clinically, we should try to maintain the integrity of the tumor envelope during surgery. R0 resection is an essential factor that can improve the prognosis of patients with both OCCC and HGSOC.\u003c/p\u003e\n\u003cp\u003eOur study was a retrospective single-center study; a larger prospective multi-center study is needed for further prospective external validation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee at the Affiliated Hospital of Qingdao University in Shandong, China. (Ethical approval number: QYFY WZLL 26500).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data during the current study are available from the corresponding author on reasonable request. An additional movie file shows the data in more detail [see Additional file 1]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no competing interests in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.D. clinical data collection, manuscript writing, manuscript revision, and corrections; F.Y. manuscript revision and paper supervision; Y.L., X.S., W.W. and X.Y. clinical data collection and follow-up; Y.W. intellectual mentorship and paper supervision. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLu Z, Chen J. Introduction of WHO classification of tumors of female reproductive organs, fourth edition. Zhonghua Bing Li Xue Za Zhi. 2014;43:649-50.\u003c/li\u003e\n\u003cli\u003eBehbakht K, Randall TC, Benjamin I, Morgan MA, King S, Rubin SC. Clinical characteristics of clear cell carcinoma of the ovary. Gynecol Oncol. 1998;70:255-8.\u003c/li\u003e\n\u003cli\u003eVergote I, Rustin GJS, Eisenhauer EA, Kristensen GB, Pujade-Lauraine E, Parmar M, et al. Re: new guidelines to evaluate the response to treatment in solid tumors [ovarian cancer]. J Natl Cancer Inst. 2000;92:1534-5.\u003c/li\u003e\n\u003cli\u003eOliver KE, Brady WE, Birrer M, Gershenson DM, Fleming G, Farley JH, et al. An evaluation of progression-free survival and overall survival of ovarian cancer patients with clear cell carcinoma versus serous carcinoma treated with platinum therapy: An NRG Oncology/Gynecologic Oncology Group experience. Gynecol Oncol. 2017;147:243-9.\u003c/li\u003e\n\u003cli\u003eChan JK, Teoh D, Hu JM, Shin JY, Osann K, Kapp DS. Do clear cell ovarian carcinomas have poorer prognosis compared to other epithelial cell types? A study of 1411 clear cell ovarian cancers. Gynecol Oncol. 2008;109:370-6.\u003c/li\u003e\n\u003cli\u003eCrozier MA, Copeland LJ, Silva EG, Gershenson DM, Stringer CA. Clear cell carcinoma of the ovary: A study of 59 cases. Gynecol Oncol. 1989;35:199-203.\u003c/li\u003e\n\u003cli\u003eDembo AJ, Davy M, Stenwig AE, Berle EJ, Bush RS, Kjorstad K. Prognostic factors in patients with stage Ⅰ epithelial ovarian cancer. Obstetrics \u0026amp; Gynecology. 1990;75:263-73.\u003c/li\u003e\n\u003cli\u003eKennedy AW, Markman M, Biscotti CV, Emery JD, Rybicki LA. Survival probability in ovarian clear cell adenocarcinoma. Gynecol Oncol. 1999;74:108-14.\u003c/li\u003e\n\u003cli\u003eLeitao MM, Boyd J, Hummer A, Olvera N, Arroyo CD, Venkatraman E, et al. Clinicopathologic analysis of early-stage sporadic ovarian carcinoma. Am J Surg Pathol. 2004;28:147-59.\u003c/li\u003e\n\u003cli\u003ePectasides D, Fountzilas G, Aravantinos G, Kalofonos C, Efstathiou H, Farmakis D, et al. Advanced stage clear-cell epithelial ovarian cancer: the Hellenic Cooperative Oncology Group experience. Gynecol Oncol. 2006;102: 285-91.\u003c/li\u003e\n\u003cli\u003eJenison EL, Montag AG, Griffiths CT, Welch WR, Lavin PT, Greer J, et al. Clear cell adenocarcinoma of the ovary: A clinical analysis and comparison with serous carcinoma. Gynecol Oncol. 1989;32:65-71.\u003c/li\u003e\n\u003cli\u003eBrinton LA, Gridley G, Persson I, Baron J, Bergqvist A. Cancer risk after hospital discharge diagnosis of endometriosis. Am J Obstet Gynecol. 1997;176:572-9.\u003c/li\u003e\n\u003cli\u003eKing CM, Barbara C, Prentice A, Brenton JD, Charnock-Jones DS. Models of endometriosis and their utility in studying progression to ovarian clear cell carcinoma. J Pathol. 2016;238:185-96.\u003c/li\u003e\n\u003cli\u003ePark JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, et al. Significance of ovarian endometriosis on the prognosis of ovarian clear cell carcinoma. Int J Gynecol Cancer. 2018;28:11-8.\u003c/li\u003e\n\u003cli\u003eKim HS, Choi HY, Lee M, Suh DH, Kim K, No JH, et al. Systemic inflammatory response markers and CA-125 levels in ovarian clear cell carcinoma: A two center cohort study. Cancer Res Treat. 2016;48:250-8.\u003c/li\u003e\n\u003cli\u003eNakagawa N, Koda H, Nitta N, Nakahara Y, Uno J, Hashimoto T, et al. Reactivity of CA19-9 and CA125 in histological subtypes of epithelial ovarian tumors and ovarian endometriosis. Acta Med Okayama. 2015;69:227-35.\u003c/li\u003e\n\u003cli\u003eZhu J, Jiang L, Wen H, Bi R, Wu X, Ju X. Prognostic value of serum CA19-9 and perioperative CA-125 levels in ovarian clear cell carcinoma. Int J Gynecol Cancer. 2018;28:1108-16.\u003c/li\u003e\n\u003cli\u003eFujino T, Watanabe T, Yamaguchi K, Nagasaki K, Onishi E, Iwamoto I, et al. The development of hypercalcemia in a patient with an ovarian tumor producing parathyroid hormone-related protein. Cancer. 2015;70: 2845-50.\u003c/li\u003e\n\u003cli\u003eGoff BA, Cuesta R, Muntz HG, Fleischhacker D, Ek M, Rice LW, et al. Clear cell carcinoma of the ovary: A distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy in stage Ⅲ disease. Gynecol Oncol. 1996;60:412.\u003c/li\u003e\n\u003cli\u003eWinter WE 3rd, Maxwell GL, Tian C, Carlson JW, Ozols RF, Rose PG, et al. Prognostic factors for stage Ⅲ epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:3621-27.\u003c/li\u003e\n\u003cli\u003eDuska LR, Garrett L, Henretta M, Ferriss JS, Lee L, Horowitz N. When 'never-events' occur despite adherence to clinical guidelines: the case of venous thromboembolism in clear cell cancer of the ovary compared with other epithelial histologic subtypes. Gynecol Oncol. 2010;116:374-7.\u003c/li\u003e\n\u003cli\u003eNasioudis D, Mastroyannis SA, Albright BB, Haggerty AF, Ko EM, Latif NA. Adjuvant chemotherapy for stage Ⅰ ovarian clear cell carcinoma: Patterns of use and outcomes. Gynecol Oncol. 2018;150:14-8.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eTABLE 1. Patients\u0026rsquo;\u0026nbsp;characteristics between the 2 groups.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003eOCCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003eHGSOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e（N=50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e（N=103）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eAge, mean (SD), yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e51.3 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e56.1 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.001\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;50 yrs, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e24 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e31 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.030\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;50 yrs, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e26 (52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e72 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eMenopausal status, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e21 (42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e35 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.334\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e29 (58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e68 (66.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eGravidity, times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;\u0026nbsp;1 time, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e19 (38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e19 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.009\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;1 time, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e31 (62.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e84 (81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eIntrauterine device use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e39 (78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e83 (80.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.709\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e11 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e20 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eChief complaint, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.001\u003cem\u003e\u0026sect;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e12 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e63 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eAbdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e16 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e40 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eMenstrual\u0026nbsp;alterations\u0026nbsp;or\u0026nbsp;post-menopausal vaginal\u0026nbsp;bleeding\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e10 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e10 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eAsymptomatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e16 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e13 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eWith\u0026nbsp;ovarian\u0026nbsp;endometriosis, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e32 (64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e102 (99.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e18 (36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eTumor diameter, mean (SD), cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e11.6 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e8.4 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;10\u0026nbsp;cm, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e19 (38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e69 (67.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.001\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;10 cm, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e31 (62.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e34 (33.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eBilateral tumors, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e41 (82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e36 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e9 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e67 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eCystic solid tumor, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e12 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e46 (44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.013\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e38 (76.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e57 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eCA125, mean (SD), U/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e288.5 (435.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e1570.4 (2068.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;1000 U/ml, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e46 (92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e59 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;1000 U/ml, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e4 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e44 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eThe\u0026nbsp;nadir\u0026nbsp;of CA125 after treatment,\u0026nbsp;mean (SD),\u0026nbsp;U/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e37.1 (127.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e30.5 (113.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.748\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;10 U/ml, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e29 (58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e50 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.272\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;10 U/ml, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e21 (42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e53 (51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eHe4, mean (SD),\u0026nbsp;pmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e153.0 (205.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e689.9 (778.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;140\u0026nbsp;pmol/L, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e37 (74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e20 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;140\u0026nbsp;pmol/L, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e13 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e83 (80.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eCA199, mean (SD), U/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e51.6 (80.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e23.3 (47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.025\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;27 U/ml, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e29 (58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e84 (81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.002\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;27 U/ml, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e21 (42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e19 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eBlood calcium, mean (SD), mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e2.2 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e2.2 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.824\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;2.52mmol/L, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e50 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e100 (97.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.551\u003cem\u003e\u0026sect;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;2.52mmol/L, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e3 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eLactate dehydrogenase, mean (SD), U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e191.3 (61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e253.4 (166.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.001\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;250 U/L, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e43 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e67 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.007\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;250 U/L, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e7 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e36 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003ePlatelet to lymphocyte ratio, mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e216.5 (104.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e242.3 (132.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.229\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003e\u0026le;200, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e24 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e46 (44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.697\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003e\u0026gt;200, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e26 (52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e57 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eR0 resection, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e7 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e28 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e0.069\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e43 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e75 (72.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eFIGO stage, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"52.285714285714285%\"\u003e\n \u003cp\u003eⅠ-Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e37 (74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.142857142857142%\"\u003e\n \u003cp\u003e23 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.428571428571429%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"57.72870662460568%\"\u003e\n \u003cp\u003eⅢ-Ⅳ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e13 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.13564668769716%\"\u003e\n \u003cp\u003e80 (77.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u0026dagger; t Test.\u003c/p\u003e\n \u003cp\u003e\u0026Dagger;Pearson\u0026rsquo;s chi-squared test.\u003c/p\u003e\n \u003cp\u003e\u0026sect;Fisher exact test.\u003c/p\u003e\n \u003cp\u003eR0 resection, complete resection; SD, standard deviation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eTABLE 2.\u0026nbsp;Univariate analyses\u0026nbsp;of prognosis by Logistic regression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.036390101892284%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"37.409024745269285%\"\u003e\n \u003cp\u003eOCCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"37.55458515283843%\"\u003e\n \u003cp\u003eHGSOC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.146-1.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.211-7.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u0026gt;50 (vs\u0026nbsp;\u0026le;50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eMenopausal status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.100-1.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e4.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.673-9.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eYes (vs No)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eIntrauterine device use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.603-9.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.085-0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eYes (vs No)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eThe lowest value of CA125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e6.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.766-26.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e3.775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.669-8.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u0026gt;10 (vs\u0026nbsp;\u0026le;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eLactate dehydrogenase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e22.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.411-213.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.432-2.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u0026gt;250 (vs\u0026nbsp;\u0026le;250)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eBilateral tumors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e14.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.506-83.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.901-4.704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eYes (vs No)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eR0 resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e22.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.411-213.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e14.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e4.090-53.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eNo (vs Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eFIGO stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e45.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e7.283-282.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e10.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.889-38.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eⅢ-Ⅳ (vs Ⅰ-Ⅱ)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eCI, confidence interval; OR, odds ratio.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eTABLE 3. Multivariate\u0026nbsp;analyses\u0026nbsp;of prognosis by\u0026nbsp;multivariate Cox\u0026nbsp;regression.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"37.354651162790695%\"\u003e\n \u003cp\u003eOCCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"37.645348837209305%\"\u003e\n \u003cp\u003eHGSOC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eThe lowest value of CA125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0.727-12.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.123-3.880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003e\u0026gt;10 (vs\u0026nbsp;\u0026le;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eR0 resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e7.884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.689-36.811\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e3.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.940-7.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eNo (vs Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25.072886297376094%\"\u003e\n \u003cp\u003eFIGO stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e4.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.088-19.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"8.746355685131196%\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e3.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1.186-12.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.037900874635568%\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eⅢ-Ⅳ (vs Ⅰ-Ⅱ)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" width=\"100%\"\u003e\n \u003cp\u003eCI, confidence interval; HR, hazard ratio.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ovarian clear cell carcinoma, High-grade serous ovarian carcinoma, Prognosis, Risk factors, Clinical characteristics","lastPublishedDoi":"10.21203/rs.3.rs-1114209/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1114209/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e To compare the clinical\u0026nbsp;characteristics\u0026nbsp;and\u0026nbsp;prognosis of women with clear cell versus high-grade serous ovarian carcinoma.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eRetrospective\u0026nbsp;analysis of the clinical data of 50 cases patients with ovarian\u0026nbsp;clear\u0026nbsp;cell\u0026nbsp;carcinoma (OCCC) and 103 cases with high-grade serous ovarian carcinoma (HGSOC), who were initially treated and completed standardized therapy in Affiliated Hospital of Qingdao University from January 2013 to December 2017.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere were significant differences in age, gravidity (G \u0026gt; 1), chief complaint, with ovarian\u0026nbsp;endometriosis, tumor\u0026nbsp;diameter, unilateral or bilateral, cystic and solid tumor, CA125, HE4, CA199, lactate dehydrogenase (LDH), and FIGO stage between the two groups. The differences in the prognosis between OCCC patients and HGSOC patients with early stage (FIGO I-II) were not statistically significant. The 5-year overall survival and progression-free\u0026nbsp;survival of OCCC patients were significantly worse than those of HGSOC patients with advanced stage (FIGO III-IV) (P \u0026lt; 0.05). FIGO stage and non-R0 resection were independent risk factors affecting the prognosis of patients with ovarian clear cell carcinoma, screening by Cox regression analysis. FIGO stage, the lowest value of CA125, and non-R0 resection were independent risk factors affecting the prognosis of patients with high-grade serous ovarian cancer.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe clinical characteristics and prognosis of OCCC are different from those of HGSOC. OCCC patients have a significantly worse prognosis than those with HGSOC in the advanced stage (FIGO Ⅲ-Ⅳ). Satisfactory tumor resection is an essential factor related to the prognosis of patients with OCCC and HGSOC.\u003c/p\u003e","manuscriptTitle":"Comparison of the Clinical Characteristics and Prognosis Between Clear Cell Carcinomas and High-grade Serous Ovarian Carcinomas","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-11-30 19:24:12","doi":"10.21203/rs.3.rs-1114209/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"122b6aad-8346-4afc-8837-fc80be346807","owner":[],"postedDate":"November 30th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":8803870,"name":"Sexual \u0026 Reproductive Medicine"},{"id":8803871,"name":"Cancer Biology"}],"tags":[],"updatedAt":"2022-01-18T22:44:08+00:00","versionOfRecord":[],"versionCreatedAt":"2021-11-30 19:24:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1114209","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1114209","identity":"rs-1114209","version":["v1"]},"buildId":"uwybb5PU2iWlRI8EIam5Y","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}