Publications by authors named "İbrahim Yalçın"

36 Publications

Multidimensional Scaling of the Mineral Nutrient Status and Health Risk Assessment of Commonly Consumed Fruity Vegetables Marketed in Kyrgyzstan.

Biol Trace Elem Res 2021 May 28. Epub 2021 May 28.

Department of Civil Engineering, Faculty of Engineering and Natural Sciences, Bahcesehir University, 34353, Besiktas, Istanbul, Turkey.

Intensive production of fruits and vegetables causes heavy metal accumulation. Consumption of this kind of foodstuff is a growing concern of the modern world with the additional distress of the supply of enough foodstuffs. To contribute to this global purpose, this research aimed to find out the mineral nutrient and heavy metal concentrations of commonly consumed fruity vegetables in Kyrgyzstan. Totally, ten different fruity type vegetables were collected from five different large bazaars of Kyrgyzstan. From these, 20 samples, including washed/unwashed rinds of vegetables, were quantified in terms of their B, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, and Zn contents by using inductively coupled plasma-optical emission spectrometry (ICP-OES). The concentrations of the fruity vegetables were found in the following range: B (1.392-25.816), Ca (92.814-4095.466), Cd (0.007-0.086), Cr (0.009-0.919), Cu (0.351-8.351), Fe (4.429-126.873), K (920.124-10,135.995), Mg (61.973-879.085), Mn (1.113-78.938), Na (36.132-266.475), Ni (0.039-1.215), Pb (0.081-2.906), and Zn (1.653-87.107) (mg kg). It was determined that red capia pepper was the vegetable having the highest daily nutritional value according to evaluation done in our study. Taking into account of the HI values, all of the vegetables analyzed were determined to be lower than the limit value of 1 that falls into acceptable limits in terms of being safe. Peppers demonstrated the highest variation in terms of the elemental content. The high Cr content rendered hot pepper risky for consumption by both genders regarding with CR, and in terms of CR, it has been observed that nickel contents being found in vegetables including tomatoes pose a moderate risk for consumption. Quite lower risk was detected in red/Brandy-wine tomatoes, eggplants, and cucumber for both genders. As most striking result in our study, the Brandy-wine type tomato was found to be healthiest (as well as safest) and nutritious vegetable looking from the viewpoint of consumption in Kyrgyzstan.
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http://dx.doi.org/10.1007/s12011-021-02759-2DOI Listing
May 2021

, a hyperaccumulator shows elevated levels of Cd accumulation and genomic template stability in binary application of Cd and Ni: a physiological and genetic approach.

Int J Phytoremediation 2021 Mar 4:1-15. Epub 2021 Mar 4.

Department of Biology, Faculty of Arts & Sciences, Marmara University, Istanbul, Turkey.

In this study, to determine whether having potential to be used as hyperaccumulator for Cd and Ni, numerous experiments were designed for conducting assessments for physiological and genotoxic changes along with defining possible alterations on mineral nutrient status of L. by applying Cd-Ni binary treatments (0, 100, 200 and 400 µM). Our study revealed that there were increases in the concentrations of B, Cr, Fe, K, Mg, and Mn whereas decreases were noticed in the concentrations of Na and Zn and the levels of Ca were inversely proportional to Cd-Ni applications showing tendency to increase at the low concentration and to decrease at the high concentration. Randomly Amplified Polymorphic DNA (RAPD) and Inter Simple Sequence Repeat (ISSR) analyses revealed that rather than band losses and new band formations, mostly intensity changes in the band profiles, and low polymorphism and high genomic template stability (GTS) were observed. Although, to date, was defined as an efficient hyperaccumulator/potential accumulator or competent phytoremedial agent by researchers. Our research revealed that showing high accumulation capability for Cd and having low polymorphism rate and high genomic template stability is a versatile hyperaccumulator, especially for Cd; therefore, highly recommended by us for decontamination of water polluted with Cd. Many studies have been focused on the effects of individual metal ions. However, heavy metal contaminants usually exist as their mixtures in natural aquatic environments. Especially, Cd and Ni coexist in industrial wastes.In this study, the accumulation properties of for both Cd and Ni were investigated and the effects of Cd and Ni on the bioaccumulation of B, Ca, Cu, Fe, Mg, K, Mn, Na, Pb and Zn in were also determined. This study furthermore aimed to assess the genotoxic effects of Cd and Ni found in being extended concentrations on DNA using the Randomly Amplified Polymorphic DNA-Polymerase Chain Reaction (RAPD-PCR) method.
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http://dx.doi.org/10.1080/15226514.2021.1892586DOI Listing
March 2021

Impact of cytoreductive surgery on survival of patients with low-grade serous ovarian carcinoma: A multicentric study of Turkish Society of Gynecologic Oncology (TRSGO-OvCa-001).

J Surg Oncol 2021 May 3;123(8):1801-1810. Epub 2021 Mar 3.

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Ankara Baskent University, Ankara, Turkey.

Background And Objectives: The aim of this study was to analyze the factors affecting recurrence-free (RFS) and overall survival (OS) rates of women diagnosed with low-grade serous ovarian cancer (LGSOC).

Methods: Databases from 13 participating centers in Turkey were searched retrospectively for women who had been treated for stage I-IV LGSOC between 1997 and 2018.

Results: Overall 191 eligible women were included. The median age at diagnosis was 49 years (range, 21-84 years). One hundred seventy-five (92%) patients underwent primary cytoreductive surgery. Complete and optimal cytoreduction was achieved in 148 (77.5%) and 33 (17.3%) patients, respectively. The median follow-up period was 44 months (range, 2-208 months). Multivariate analysis showed the presence of endometriosis (p = .012), lymphovascular space invasion (LVSI) (p = .022), any residual disease (p = .023), and the International Federation of Gynecology and Obstetrics (FIGO) stage II-IV disease (p = .045) were negatively correlated with RFS while the only presence of residual disease (p = .002) and FIGO stage II-IV disease (p = .003) significantly decreased OS.

Conclusions: The maximal surgical effort is warranted for complete cytoreduction as achieving no residual disease is the single most important variable affecting the survival of patients with LGSOC. The prognostic role of LVSI and endometriosis should be evaluated by further studies as both of these parameters significantly affected RFS.
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http://dx.doi.org/10.1002/jso.26450DOI Listing
May 2021

Effect of Mg doping on morphology, photocatalytic activity and related biological properties of ZnMgO nanoparticles.

Turk J Chem 2020 18;44(4):1177-1199. Epub 2020 Aug 18.

Department of Mechatronics Engineering, Faculty of Engineering and Natural Sciences, Bahçeşehir University, İstanbul Turkey.

The objective of this study is to synthesize ZnO and Mg doped ZnO (ZnMgO) nanoparticles via the sol-gel method, and characterize their structures and to investigate their biological properties such as antibacterial activity and hemolytic potential.Nanoparticles (NPs) were synthesized by the sol-gel method using zinc acetate dihydrate (Zn(CHCOO).2HO) and magnesium acetate tetrahydrate (Mg(CHCOO).4HO) as precursors. Methanol and monoethanolamine were used as solvent and sol stabilizer, respectively. Structural and morphological characterizations of ZnMgO nanoparticles were studied by using XRD and SEM-EDX, respectively. Photocatalytic activities of ZnO and selected Mg-doped ZnO (ZnMgO) nanoparticles were investigated by degradation of methylene blue (MeB). Results indicated that Mg doping (both 10% and 30%) to the ZnO nanoparticles enhanced the photocatalytic activity and a little amount of Zn0.90 Mg0.10 O photocatalyst (1.0 mg/mL) degraded MeB with 99% efficiency after 24 h of irradiation under ambient visible light. Antibacterial activity of nanoparticles versus ( ) was determined by the standard plate count method. Hemolytic activities of the NPs were studied by hemolysis tests using human erythrocytes. XRD data proved that the average particle size of nanoparticles was around 30 nm. Moreover, the XRD results indicatedthat the patterns of Mg doped ZnO nanoparticles related to ZnO hexagonal wurtzite structure had no secondary phase for x ≤ 0.2 concentration. For 0 ≤ x ≤ 0.02, NPs showed a concentration dependent antibacterial activity against . While ZnMg O totally inhibited the growth of , upper and lower dopant concentrations did not show antibacterial activity.
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http://dx.doi.org/10.3906/kim-2004-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751926PMC
August 2020

High-grade endometrial stromal sarcoma versus undifferentiated uterine sarcoma: a Turkish uterine sarcoma group study-001.

Arch Gynecol Obstet 2021 Jan 3. Epub 2021 Jan 3.

Department of Gynecologic Oncology, Saglik Bilimleri University Ankara City Hospital, Ankara, Turkey.

Objective: Prognostic factors associated with high-grade endometrial stromal sarcoma (HGESS) and undifferentiated uterine sarcoma (UUS) have not been distinctly determined due to the repetitive changes in the World Health Organization (WHO) classification. We aimed to compare clinicopathologic features and outcomes of patients with HGESS with those of patients with UUS.

Methods: A multi-institutional, retrospective, cohort study was conducted including 71 patients, who underwent surgery at 13 centers from 2008 to 2017. An experienced gynecopathologist from each institution re-evaluated the slides of their own cases according to the WHO classification. Factors associated with refractory/progressive disease, recurrence or death were examined using logistic regression analyses. Kaplan-Meier method and log-rank test were used for survival comparisons.

Results: The median disease-free survival (DFS) for HGESS and UUS was 12 months and 6 months, respectively. While the median overall survival was not reached in HGESS group, it was 22 months in the UUS group. Kaplan-Meier analyses revealed that patients with UUS had a significantly poorer DFS than those with HGESS (p = 0.016), although OS did not differ between the groups (p = 0.135). Lymphovascular-space involvement (LVSI) was the sole significant factor associated with progression, recurrence or death for HGESS (Hazard ratio: 9.353, 95% confidence interval: 2.539-34.457, p = 0.001), whereas no significant independent factor was found for UUS.

Conclusions: UUS has a more aggressive behavior than HGESS. While no significant predictor of prognosis was found for UUS, LVSI is the sole independent prognostic factor for HGESS, with patients 9.3 times more likely to experience refractory/progressive disease, recurrence or death.
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http://dx.doi.org/10.1007/s00404-020-05915-6DOI Listing
January 2021

Morcellation in gynecology: short review and suggestions from Turkish Society of Minimally Invasive Gynecologic Oncology

J Turk Ger Gynecol Assoc 2021 02 4;22(1):53-57. Epub 2021 Jan 4.

Department of Gynecologic Oncology, Acıbadem University Faculty of Medicine, İstanbul, Turkey

Morcellation allows the removal of a large uterus and fibroids through small incisions with minimally invasive surgery. It helps to prevent the complications associated with large incisions in both hysterectomy and myomectomy operations. Currently, there is much debate regarding the use of power morcellation in laparoscopic hysterectomy and myomectomy, mainly due to the risk of peritoneal dissemination of undiagnosed uterine sarcomas. Unfortunately, there is no valid pre-operative diagnostic method that can differentiate sarcomas from myomas, and the currently available scientific literature regarding morcellation is insufficient. As the Turkish Society of Minimally Invasive Gynecological Oncology, we present our consensus opinion and suggestions for the preoperative evaluation and morcellation of fibroids, in line with the recent literature.
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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944225PMC
February 2021

Management of gynecological cancers in the COVID-19 era: a survey from Turkey

J Turk Ger Gynecol Assoc 2020 12;21(4):265-271

Department of Obstetrics and Gynecology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey

Objective: This study aimed to investigate how gynecologic oncologists modified their patient management during Coronavirus disease-2019 (COVID-19) in Turkey.

Material And Methods: An online survey was sent to gynecologic oncology specialists and fellows in Turkey. It included management questions about strategies for newly diagnosed or recurrent endometrial, cervical, ovarian and vulvar cancer during the pandemic. Participants were asked if treatment of these cancers can be delayed or not and, if yes, the duration of delay.

Results: 32.9% of surgeons prescribed oral or intrauterine progesterone for early stage, low-grade endometrial cancer. Conversely, 65.7% and 45.7% of the most surgeons did not change their management for early stage high-grade and advanced stage endometrial cancers respectively, as they perform surgery. 58% and 67.1% of the surgeons continued to prefer standard surgical treatment for microinvasive and early stage cervical cancers, respectively. Radiotherapy was preferred administered with hypofractionated doses for locally advanced cervical cancer (57.1%). While 67.1% of surgeons operated early stage ovarian cancer patients, 50% administered neoadjuvant chemotherapy (NACT) to all advanced stage ovarian cancers and 50% administered more cycles of NACT in preference to interval debulking surgery. 93.7% of the surgeons responded that treatment should not be delayed beyond eight weeks.

Conclusion: Most Turkish gynecologic oncologists modified their management of gynecologic cancers due to the COVID-19 pandemic. While chemotherapy was preferred for ovarian cancer, postponement of the surgery, with or without non-surgical options, was considered for early stage, low-grade endometrial cancer. Treatment of gynecologic cancers should be decided on a case by case basis, taking into account local COVID-19 infection rates and availability of health facilities. Prognosis is also an important consideration if delay is contemplated. Standard treatment and normal time-frames should be used if possible. If not, a postponement for a maximum of eight weeks or referral to another center were acceptable alternatives.
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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726458PMC
December 2020

Can risk groups accurately predict non-sentinel lymph node metastasis in sentinel lymph node-positive endometrial cancer patients? A Turkish Gynecologic Oncology Group Study (TRSGO-SLN-004).

J Surg Oncol 2021 Feb 1;123(2):638-645. Epub 2020 Dec 1.

Department of Gynecology and Obstetrics, Koç University School of Medicine, İstanbul, Turkey.

Background And Objectives: The purpose of this study was to find out the risk factors associated with non-sentinel lymph node metastasis and determine the incidence of non-sentinel lymph node metastasis according to risk groups in sentinel lymph node (SLN)-positive endometrial cancer patients.

Methods: Patients who underwent at least bilateral pelvic lymphadenectomy after SLN mapping were retrospectively analyzed. Patients were categorized into low, intermediate, high-intermediate, and high-risk groups defined by ESMO-ESGO-ESTRO.

Results: Out of 395 eligible patients, 42 patients had SLN metastasis and 16 (38.1%) of them also had non-SLN metastasis. Size of SLN metastasis was the only factor associated with non-SLN metastasis (p = .012) as 13/22 patients with macrometastasis, 2/10 with micrometastasis and 1/10 with isolated tumor cells (ITCs) had non-SLN metastasis. Although all 4 metastases (1.8%) among the low-risk group were limited to SLNs, the non-SLN involvement rate in the high-risk group was 42.9% and all of these were seen in patients with macrometastatic SLNs.

Conclusions: Non-SLN metastasis was more frequent in higher-risk groups and the risk of non-SLN metastasis increased with the size of SLN metastasis. Proceeding to complete lymphadenectomy when SLN is metastatic should further be studied as the effect of leaving metastatic non-SLNs in-situ is not known.
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http://dx.doi.org/10.1002/jso.26310DOI Listing
February 2021

Environment-Based Impairment in Mineral Nutrient Status and Heavy Metal Contents of Commonly Consumed Leafy Vegetables Marketed in Kyrgyzstan: a Case Study for Health Risk Assessment.

Biol Trace Elem Res 2021 Mar 17;199(3):1123-1144. Epub 2020 Jun 17.

Faculty of Engineering and Natural Sciences, Department of Civil Engineering, Bahcesehir University, Besiktas, 34353, Istanbul, Turkey.

Leafy vegetables are important components of the human diet for providing mineral nutrients. However, due to the tendency of metal accumulation, metal contents of leafy vegetables need not only to be determined but also estimated health risk for revealing possible health effects on humans. The aims of this study are (I) to examine comprehensive concentrations of trace/heavy metals along with some macroelements including Ca, Cd, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, and Zn in selected leafy vegetables from Kyrgyzstan; (II) to assess recommended dietary allowances (RDA); and (III) to evaluate hazard quotient (HQ) and carcinogenic risk estimation with associated vegetable consumption. For this purpose, B, Ca, Cd, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, and Zn elements were quantified, utilizing an ICP-OES instrument, in 18 samples belonging to 12 different groups of leafy vegetables including celery, Chinese parsley, dill, garden sorrel, lettuce, parsley, purple basil, spinach, and white-red-napa cabbage collected from different bazaars of Kyrgyzstan. Average elemental contents of the analyzed vegetables were determined (in mg kg) as follows: B (3.21-64.79), Ca (852.51-17,183.20), Cd (0.015-0.09), Cu (6.08-63.47), Fe (116.52-768.66), K (2347.04-17,305.42), Mg (136.34-1261.11), Na (54.75-526.42), Ni (0.09-1.3), Pb (1.91-9.54), and Zn (29.49-314.93). Estimated daily intake, recommended daily allowance, hazard quotients, and carcinogenic risk values of the vegetables were calculated with the help of these results. In considering HQ values, Chinese cabbage was determined to be safe for the consumption of both genders whereas parsley to be safe for only males. Based on the carcinogenic risk calculation, most of the vegetables examined in this study were categorized as moderately risky. It was inferred from the given results that airborne pollution has impaired/increased the mineral contents of vegetables for both genders. The findings obtained from this study were compared with international standards and will contribute to the data available on a global scale.
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http://dx.doi.org/10.1007/s12011-020-02208-6DOI Listing
March 2021

Coexistence of uterine adenomyosis is not associated with a better prognosis in endometrioid-type endometrial cancer.

Ir J Med Sci 2020 Aug 23;189(3):835-842. Epub 2020 Jan 23.

Zekai Tahir Burak Women's Health Training and Research Hospital, Department of Gynecologic Oncology, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

Background: Prognostic value of accompanying adenomyosis in endometrial cancer is the subject of interest due to their common etiology and co-occurrence frequency. However, it is still unclear whether adenomyosis has a role in the prognosis of endometrial cancer.

Aims: The aim of this study was to determine the effects of adenomyosis on the prognosis of patients with endometrial cancer.

Methods: In this study, medical records of 552 patients with endometrioid endometrial cancer who underwent surgery between 2007 and 2017 were retrospectively reviewed. The patients were divided into two groups based on the presence or absence of adenomyosis, and these two groups were compared in terms of the clinicopathological factors and survival outcomes of patients.

Results: Of these patients, 103 (18.7%) had adenomyosis, and the remaining 449 (81.3%) did not. The endometrial cancer patients with adenomyosis exhibited earlier stages (p < 0.001), lower tumor grades (p < 0.001), tumor sizes ≤ 2 cm (p = 0.002), myometrial invasion < 50% (p < 0.001), and negative lymphovascular space invasion (p < 0.001). The 5-year overall survival rate was comparable between the adenomyosis and non-adenomyosis groups (95 vs. 89.1%, respectively; p = 0.085). The presence of adenomyosis was significantly associated with a higher 5-year disease-free survival rate (95.1 vs. 87.9%; p = 0.047), but adenomyosis did not remain as a prognostic factor in multivariate analysis.

Conclusion: The results of our study showed that the endometrioid endometrial cancer patients with adenomyosis are significantly associated with smaller tumor sizes, less myometrial invasion, lower tumor grades, less lymphovascular space invasion, and earlier FIGO stages. Nevertheless, adenomyosis was not found to be an independent prognostic factor for endometrioid endometrial cancer.
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http://dx.doi.org/10.1007/s11845-020-02172-zDOI Listing
August 2020

Heavy Metal Levels and Mineral Nutrient Status in Different Parts of Various Medicinal Plants Collected from Eastern Mediterranean Region of Turkey.

Biol Trace Elem Res 2020 Sep 22;197(1):316-329. Epub 2019 Nov 22.

Department of Biology, Faculty of Science and Arts, Hatay Mustafa Kemal University, 31040, Hatay, Turkey.

Medicinal plants have been used for treatment of many diseases since the ancient times with traditional knowledge being transferred from generation to generation. However, in recent years, many natural habitats have been contaminated due to increased anthropogenic activities. Plants which are exposed to heavy metal toxicity may experience several serious problems. Furthermore, the inclusion of these plants into the food chain poses a threat to human health as well. Additionally, presence of heavy metals directly effect mineral nutrition and consequently the food quality. The aim of this study herewith is to determine the heavy metal content and mineral nutrient status of some medicinal plants to have insight on their health repercussions on plants and humans. The concentrations of Al, B, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb and Zn in commonly used parts (root, rhizome, seed, resin, gall, fruit) especially for remedial purposes of 17 medicinal plants collected from Turkey were analyzed by ICP-OES. The measured values for concentrations from lowest to highest were (in mg kg) 30.983-368.877 for Al, 13.845-186.015 for B, 1335.699-11213.951 for Ca, 0.016-0.653 for Cd, 0.379-30.708 for Cr, 23.838-90.444 for Cu, 78.960-1228.845 for Fe, 1035.948-6393.491 for K, 83.193-2252.031 for Mg, 12.111-362.570 for Mn, 278.464-1968.775 for Na, 1.945-35.732 for Ni, 0.796-17.162 for Pb and 166.910-395.252 for Zn. Overall, heavy metal concentrations in medicinal plants collected nearby industrial regions, mining and farming sites, were found to be in slightly higher levels. This shows us that it is of crucial importance that the areas where medicinal plants are collected are clean especially by means of heavy metals for the reason that these plants can cause more harm than the benefits they may provide if they are contaminated.
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http://dx.doi.org/10.1007/s12011-019-01974-2DOI Listing
September 2020

SATEN III-Splitting Adjuvant Treatment of stage III ENdometrial cancers: an international, multicenter study.

Int J Gynecol Cancer 2019 10 2;29(8):1271-1279. Epub 2019 Sep 2.

Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Introduction: The purposes of this study were to compare adjuvant treatment modalities and to determine prognostic factors in stage III endometrioid endometrial cancer (EC).

Methods: SATEN III was a retrospective study involving 13 centers from 10 countries. Patients who had been operated on between 1998 and 2018 and diagnosed with stage III endometrioid EC were analyzed.

Results: A total of 990 women were identified; 317 with stage IIIA, 18 with stage IIIB, and 655 with stage IIIC diseases. The median follow-up was 42 months. The 5-year disease-free survival (DFS) of patients with stage III EC by adjuvant treatment modality was 68.5% for radiotherapy (RT), 54.6% for chemotherapy (CT), and 69.4% for chemoradiation (CRT) (p=0.11). The 5-year overall survival (OS) for those patients was 75.6% for RT, 75% for CT, and 80.7% for CRT (p=0.48). For patients with stage IIIA disease treated by RT versus CT versus CRT, the 5-year OS rates were 75.6%, 75.0%, and 80.7%, respectively (p=0.48). Negative peritoneal cytology (HR: 0.45, 95% CI: 0.23 to 0.86; p=0.02) and performance of lymphadenectomy (HR: 0.33, 95% CI: 0.16 to 0.77, p=0.001) were independent predictors for improved OS for stage IIIA EC. For women with stage IIIC EC treated by RT, CT, and CRT, the 5-year OS rates were 78.9%, 67.0%, and 69.8%, respectively (p=0.08). Independent prognostic factors for better OS for stage IIIC disease were age <60 (HR: 0.50, 95%CI: 0.36 to 0.69, p<0.001), grade 1 or 2 disease (HR: 0.59, 95% CI: 0.37 to 0.94, p=0.014; and HR: 0.65, 95%CI: 0.46 to 0.91, p=0.014, respectively), absence of cervical stromal involvement (HR: 063, 95% CI: 0.46 to 0.86, p=0.004) and performance of para-aortic lymphadenectomy (HR: 0.52, 95% CI: 0.35 to 0.72, p<0.001).

Discussion: Although not statistically significant, CRT seemed to be a better adjuvant treatment option for stage IIIA endometrioid EC. Systematic lymphadenectomy seemed to improve survival outcomes in stage III endometrioid EC.
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http://dx.doi.org/10.1136/ijgc-2019-000643DOI Listing
October 2019

A novel multivariable prediction model for lymphatic dissemination in endometrioid endometrial cancer: The lymph node Metastasis Risk Index.

Eur J Obstet Gynecol Reprod Biol 2019 Sep 25;240:310-315. Epub 2019 Jul 25.

Zekai Tahir Burak Women's Health Hospital, Talatpasa Blv, Ankara, Turkey.

Objective: The purpose of this study was to develop a risk assessment index that could determine which endometrioid endometrial cancer (EC) patients would benefit from a lymphadenectomy.

Methods: The final pathology reports of 353 women who underwent complete surgical staging, including pelvic and para-aortic lymphadenectomy, for endometrioid EC between January 2008 and June 2018 were retrospectively reviewed. A logistic regression was used to investigate the clinicopathological factors associated with a positive nodal status. The independent risk factors for lymphatic dissemination were used to build a risk model and a "Lymph Node (LN) Metastasis Risk Index" was defined as follows: (tumor grade) × (primary tumor diameter) × (percentage of myometrial invasion) × (preoperative serum CA 125 level). The scores used in the LN Metastasis Risk Index were weighted according to the odds ratios assigned for each variable. The diagnostic performance of the model was expressed as the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio.

Results: The LN Metastasis Risk Index correctly identified 35 of 40 LN-positive women at a cutoff point of 981.0 (sensitivity: 87.5%, specificity: 86.3%, negative predictive value: 98.2%, positive predictive value: 44.9%, positive likelihood ratio: 6.37, and negative likelihood ratio: 0.14). The area under the receiver operating characteristic curve was 0.90 (95% confidence interval = 0.858-0.947) at this cutoff. The clinical accuracy of the model was 86.4%. When a cutoff point of <981.0 was selected in order to define those women at low-risk for lymphatic dissemination, our prediction model classified 275 women (77.9%) as being at low-risk for nodal involvement. Among these 275 women, 5 actually had positive LNs, which indicated a 1.8% false-negative rate.

Conclusion: After external validation, the LN Metastasis Risk Index may be a valuable tool for the surgical management of endometrioid EC.
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http://dx.doi.org/10.1016/j.ejogrb.2019.07.015DOI Listing
September 2019

Comparison of survival outcomes in optimally and maximally cytoreduced stage IIIC ovarian high-grade serous carcinoma: Women with only peritoneal tumor burden versus women with both peritoneal and lymphogenous dissemination.

J Obstet Gynaecol Res 2019 Oct 1;45(10):2074-2081. Epub 2019 Aug 1.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey.

Aim: The aim of this study was to analyze the survival outcomes of stage IIIC ovarian high-grade serous carcinoma (HGSC) patients with both peritoneal and lymphatic dissemination (IP+/RP+) who had undergone maximal or optimal cytoreduction followed by intravenous carboplatin/paclitaxel chemotherapy compared to those women with stage IIIC ovarian HGSC with only peritoneal involvement (IP+/RP-) who were treated similarly.

Methods: We performed a retrospective, multicenter study with the participation of five gynecological cancer centers. First, the stage IIIC ovarian HGSC patients were classified into optimally or maximally debulked cohorts. Then, in each cohort, the patients were divided into two groups; the IP+/RP- group included those women with transcoelomic spreading outside the pelvis with no nodal disease, and the IP+/RP+ group included those patients with transcoelomic dissemination outside the pelvis in addition to a positive nodal status. The survival outcomes were compared between the two groups in each cohort.

Results: A total of 405 ovarian HGSC patients were analyzed. In the optimally debulked cohort (n = 257), the progression-free survival (PFS) and overall survival (OS) medians for the IP+/RP- group (n = 69) were 24 and 57 months, respectively, compared to 21 and 58 months, respectively, for the IP+/RP+ group (n = 188) (P = 0.78 and P = 0.40, respectively). In the maximally debulked cohort (n = 148), the PFS and OS medians for the IP+/RP- group (n = 55) were 35 and 63 months, respectively, compared to 25 and 51 months, respectively, for the IP+/RP+ group (n = 93) (P = 0.49 and P = 0.31, respectively).

Conclusion: Our findings indicated no survival differences between the IP+/RP- and the IP+/RP+ groups.
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http://dx.doi.org/10.1111/jog.14075DOI Listing
October 2019

Is It Possible to Develop a Prediction Model for Lymphovascular Space Invasion in Endometrioid Endometrial Cancer?

Int J Gynecol Pathol 2020 May;39(3):213-220

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences.

Objective: The purpose of this retrospective study was to define a risk index that would serve as a surrogate marker of lymphovascular space invasion (LVSI) in women with endometrioid endometrial cancer (EC).

Materials And Methods: Final pathology reports of 498 women who underwent surgery with curative intent for endometrioid EC between January 2008 and June 2018 were retrospectively reviewed. Logistic regression was used to investigate clinicopathologic factors associated with positive LVSI status. Independent risk factors for LVSI were used to build a risk model and "risk of LVSI index" was defined as "tumor grade×primary tumor diameter×percentage of myometrium involved." The scores used in the "risk of LVSI index" were weighted according to the odds ratios assigned for each variable. The risk of LVSI index was noted for each patient. The diagnostic performance of the model was expressed as sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio.

Results: According to the "risk of LVSI index," presence of LVSI was correctly estimated in 89 of 104 LVSI-positive women at a cutoff of 161.0 (sensitivity 85.5%, specificity 79.4%, negative predictive value 95.4%, positive predictive value 52.3%, positive likelihood ratio 4.15, negative likelihood ratio 0.18). The area under curve of the receiver-operating characteristics was 0.90 (95% confidence interval, 0.87-0.93) at this cutoff.

Conclusions: It seems possible to predict the presence of LVSI in women with endometrioid EC when the "risk of LVSI index" is calculated. However, external validation of this model is warranted.
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http://dx.doi.org/10.1097/PGP.0000000000000596DOI Listing
May 2020

Effect of Adjuvant Therapy on Oncologic Outcomes of Surgically Confirmed Stage I Uterine Carcinosarcoma: a Turkish Gynecologic Oncology Study

Balkan Med J 2019 07 15;36(4):229-234. Epub 2019 Mar 15.

Department of Gynecologic Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Background: Uterine carcinosarcoma is rare neoplasm that mostly presents as metastatic disease. Stage is one of the most important prognostic factor, however, the management of the early stage uterine carcinosarcoma is still controversial.

Aims: To evaluate prognostic factors, treatment options, and survival outcomes in patients with surgically approved stage I uterine carcinosarcoma.

Study Design: Cross-sectional study.

Methods: Data of 278 patients with uterine carcinosarcoma obtained from four gynecologic oncology centers were reviewed, and 70 patients with approved stage I uterine carcinosarcoma after comprehensive staging surgery were studied.

Results: The median age of the entire cohort was 65 years (range; 39-82). All patients underwent both pelvic and paraaortic lymphadenectomy. Forty-one patients received adjuvant therapy. The median follow-up time was 24 months (range; 1-129). Nineteen (27.1%) patients had disease failure. The 3-year disease-free survival and cancer-specific survival of the entire cohort was 67% and 86%, respectively. In the univariate analysis, only age was significantly associated with disease-free survival (p=0.022). There was no statistical significance for disease-free survival between observation and receiving any type of adjuvant therapy following staging surgery. Advanced age (<75 vs ≥75 years) was the only independent prognostic factor for recurrence (hazard ratio: 3.8, 95% CI=1.10-13.14, p=0.035) in multivariate analysis. None of the factors were significantly associated with cancer-specific survival.

Conclusion: Advanced age was the only independent factor for disease-free survival in stage I uterine carcinosarcoma. Performing any adjuvant therapy following comprehensive lymphadenectomy was not related to the improved survival of the stage I disease.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2019.2018.12.75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636652PMC
July 2019

Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer.

Int J Gynecol Cancer 2019 03 21;29(3):505-512. Epub 2019 Jan 21.

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Ankara, Turkey.

Objective: The purpose of this study was to assess the prognostic significance of lymphovascular space invasion in women with low-risk endometrial cancer.

Methods: A dual-institutional, retrospective department database review was performed to identify patients with 'low-risk endometrial cancer' (patients having <50% myometrial invasion with grade 1 or 2 endometrioid endometrial cancer according to their final pathology reports) at two gynecologic oncology centers in Ankara, Turkey. Demographic, clinicopathological and survival data were collected.

Results: We identified 912 women with low-risk endometrial cancer; 53 patients (5.8%) had lymphovascular space invasion. When compared with lymphovascular space invasion-negative patients, lymphovascular space invasion-positive patients were more likely to have post-operative grade 2 disease (p<0.001), deeper myometrial invasion (p=0.003), and larger tumor size (p=0.005). Patients with lymphovascular space invasion were more likely to receive adjuvant therapy when compared with lymphovascular space invasion-negative women (11/53 vs 12/859, respectively; p<0.001). The 5-year recurrence-free survival rate for lymphovascular space invasion-positive women was 85.5% compared with 97.0% for lymphovascular space invasion-negative women (p<0.001). The 5-year overall survival rate for lymphovascular space invasion-positive women was significantly lower than that of lymphovascular space invasion-negative women (88.2% vs 98.5%, respectively; p<0.001). Age ≥60 years (HR 3.13, 95% CI 1.13 to 8.63; p=0.02) and positive lymphovascular space invasion status (HR 6.68, 95% CI 1.60 to 27.88; p=0.009) were identified as independent prognostic factors for decreased overall survival.

Conclusions: Age ≥60 years and positive lymphovascular space invasion status appear to be important prognostic parameters in patients with low-risk endometrial cancer who have undergone complete surgical staging procedures including pelvic and para-aortic lymphadenectomy. Lymphovascular space invasion seems to be associated with an adverse prognosis in women with low-risk endometrial cancer; this merits further assessment on a larger scale with standardization of the lymphovascular space invasion in terms of presence/absence and quantity.
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http://dx.doi.org/10.1136/ijgc-2018-000069DOI Listing
March 2019

Recurrence patterns and prognostic factors in lymphovascular space invasion-positive endometrioid endometrial cancer surgically confined to the uterus.

Taiwan J Obstet Gynecol 2019 Jan;58(1):82-89

Department of Gynecologic Oncology, School of Medicine, Baskent University, Y. Bahcelievler Mah., Mareşal Fevzi Çakmak Cad., No: 45, Çankaya, Ankara, Turkey. Electronic address:

Objective: The purpose of this study was to determine the patterns of failure and prognostic factors for lymphovascular space invasion (LVSI)-positive endometrioid endometrial cancer (EC) patients in the setting of negative lymph nodes (LNs).

Materials And Methods: A multicenter, retrospective department database review was performed to identify LVSI-positive patients with disease surgically confined to the uterus at two gynecologic oncology centers in Turkey. Demographic, clinicopathological and survival data were collected.

Results: We identified 185 LVSI-positivewomen with negative LNs during the study period. Fifty-five (29.7%) were classified as Stage IA, 94 (50.8%) as Stage IB, and 36 (19.5%) as Stage II. The median age at diagnosis was 59 years and the median duration of follow-up was 44 months. The total number of the recurrences was 12 (6.5%). We observed 5 (2.9%) loco-regional recurrences, 3 (1.5%) retroperitoneal failures, and 4 (2.0%) distant relapses. The 5-year progression-free survival (PFS) was 86.1% while the 5-year overall survival (OS) rate was 87.7%. Grade 3 histology (Hazard Ratio [HR] 2.9, 95% Confidence Interval [CI] 1.02-8.50; p = 0.04), cervical stromal invasion (HR 4.5, 95% CI 1.61-12.79; p = 0.004) and age ≥ 60 years (HR 5.8, 95% CI 1.62-21.32; p = 0.007) were found to be independent prognostic factors for decreased OS. Adjuvant treatment did not appear as a prognostic factor for OS even in univariate analysis.

Conclusion: The recurrence rate among LVSI-positive endometrioid EC patients is low in the setting of negative LNs. However, one out of three patients with a recurrence experiences distant relapses which usually portend worse outcomes.
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http://dx.doi.org/10.1016/j.tjog.2018.11.016DOI Listing
January 2019

Risk Factors for Lymph Node Metastasis among Lymphovascular Space Invasion-Positive Women with Endometrioid Endometrial Cancer Clinically Confined to the Uterus.

Oncol Res Treat 2018 13;41(12):750-754. Epub 2018 Nov 13.

Introduction: We aimed to assess risk factors for lymph node (LN) metastasis among lymphovascular space invasion(LVSI)-positive women with pure endometrioid endometrial cancer (EC) clinically confined to the uterus.

Methods: Medical records of women who underwent primary surgery for EC between 2007 and 2016 at either of 2 gynecological oncology centers were retrospectively reviewed. Patient data were analyzed with respect to LN involvement, and predictive factors for LN metastasis were investigated.

Results: 280 patients with surgically staged endometrioid-type EC with LVSI were identified. LN involvement was detected in 88 patients (31.4%) with a systematic LN dissection. In multivariate analysis, elevated baseline serum CA 125 levels, deep myometrial invasion (MMI), adnexal involvement and positive peritoneal cytology were found to be independent risk factors for LN metastasis. In women without deep MMI and elevated baseline serum CA 125 levels, the rate of LN metastasis was 19%. The presence of solely deep MMI increased this probability up to 29.1%. The rate of LN metastasis was found to be 46.8% for women with both deep MMI and elevated baseline serum CA 125 levels.

Conclusion: These findings may be useful in the decision-making process for LVSI-positive women who are unstaged.
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http://dx.doi.org/10.1159/000492585DOI Listing
August 2019

Clinicopathological analysis of borderline ovarian tumours and risk factors related to recurrence: experience of single institution.

J Obstet Gynaecol 2019 Feb 29;39(2):253-258. Epub 2018 Oct 29.

a The Faculty of Medicine , Istanbul University , İstanbul , Turkey.

This study was conducted to determine the demographic and clinicopathologic characteristics and evaluate the prognostic value of various factors, such as the extensiveness of surgery, related to the tumour itself and the clinical features in the recurrence of borderline ovarian tumours (BOT). We retrospectively evaluated the data of 103 patients with a borderline ovarian tumours treated at our institution between the years 2000 and 2012. The median age was 37 (16-79) years and the majority of the patients were premenopausal (76.7%). During the follow-up, 16 recurrences were observed (15.5%). The multivariate analysis showed that the micropapillary architecture and fertility sparing surgery were the only significant independent predictors for the development of a recurrence amongst all of the demographic and clinicopathological features. In our study group, we identified that the micropapillary architecture itself and the fertility sparing surgery had a significant impact on the development of a BOT recurrence. The patients who possess these features should be followed up more closely for a long time period. Impact statement What is already known on this subject? A borderline ovarian tumour is known as a recurrent disease. The recurrence rate varies between 5 and 20%. It is well known in the literature that patients treated by an oophorectomy have a relatively lower risk of development of a recurrence compared to the patients treated by cystectomy. What do the results of this study add? Although some of the clinicopathological features are shown to be risk factors for the development of a recurrence in many studies, some of the pathological-clinical and the demographic features have not been described as yet, or have been considered to be equivocal regarding the development of a recurrence. In this study, we investigate all possible demographic, pathological, and clinical factors associated with a recurrence. Not only the well-known pathological characteristics but also the new pathological parameters and clinical approaches have been investigated. For instance, microinvasion architecture and lymphadenectomy speculated in the literature as the risk factors for the development of a recurrence, have not been identified as risk factors in our study. On the other hand, our statistical analyses have revealed that micropapillary architecture should be described as a risk factor for the development of a recurrence. What are the implications of these findings for clinical practice and/or further research? We hope our study becomes influential in the literature on the field of a micropapillary architecture and the development of a recurrence. The patients carrying this feature have to be followed up very closely and carefully. Furthermore, our findings have indicated no significant relation between the performing of a lymphadenectomy and the rate of a recurrence. This result might be encouraging for the gynaecological surgeons to refrain from a lymphadenectomy for the borderline ovarian tumours.
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http://dx.doi.org/10.1080/01443615.2018.1499076DOI Listing
February 2019

Heavy Metal Levels and Mineral Nutrient Status of Natural Walnut (Juglans regia L.) Populations in Kyrgyzstan: Nutritional Values of Kernels.

Biol Trace Elem Res 2019 May 27;189(1):277-290. Epub 2018 Aug 27.

Department of Chemical Engineering, Faculty of Engineering, Kyrgyz-Turkish Manas University, Bishkek, Kyrgyzstan.

In this study, mineral nutrient and heavy metal (Al, Ca, Cd, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, and Zn) contents of the walnut kernels and their co-located soil samples collected from the four different zones of natural walnut forests (Sary-Chelek, Arslanbap, and Kara-Alma in Jalal-Abad Region and Kara-Shoro in Osh Region) in Kyrgyzstan were investigated. The highest concentrations for all elements determined in the soil samples were observed in the Sary-Chelek zone whereas the Arslanbap zone was found to be having the lowest concentrations except Fe and Zn. The highest concentrations in the kernels of walnut samples were found to be in the Sary-Chelek zone for Ca, Fe, K, Mg, and Zn; in the Kara-Shoro zone for Cu; in the Arslanbap zone for Mn; and in the Kara-Alma zone for Na whereas the lowest concentrations were found to be in the Arslanbap zone for Ca, Fe, K, Mg, Na, and Zn and in the Sary-Chelek zone for Cu and Mn, respectively. Also, the levels of Al, Cd, Ni, and Pb in kernel samples could not be detected by ICP-OES because their levels were lower than the threshold detection point (10 μg.kg). Additionally, our data indicated that the walnut kernels from Kyrgyzstan have higher values for RDA (recommended daily allowances) in comparison with the walnut kernels from other countries.
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http://dx.doi.org/10.1007/s12011-018-1461-4DOI Listing
May 2019

Colposcopic biopsy findings among women with either HPV-16 only or HPV-18 only who have normal cervical cytology.

Int J Gynaecol Obstet 2018 Dec 6;143(3):300-305. Epub 2018 Sep 6.

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Research and Training Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

Objective: To compare colposcopic biopsy results among women with normal cervical cytology who had positive test results for either HPV-16 only or HPV-18 only.

Methods: A cross-sectional study was conducted at Zekai Tahir Burak Women's Health Research and Training Hospital, Ankara, Turkey, between July 1, 2015, and October 31, 2017. Colposcopic biopsy results were compared among women in the HPV-16 only (n=185) and HPV-18 only (n=43) groups.

Results: Women who had HPV-16 only were more likely to be smokers than women with HPV-18 only (P=0.003). By contrast, women with HPV-18 only were more likely to be aged at least 45 years than women who had HPV-16 only (P=0.038). High-grade squamous intraepithelial lesions were detected more frequently in the HPV-16 only group (51 [27.6%]) than in the HPV-18 only group (4 [9.3%]; P=0.010). By contrast, no between-group difference was found for the rate of invasive cervical cancer, which was detected in 1 (0.5%) woman in the HPV-16 only group and 1 (2.3%) woman in HPV-18 only group (P=0.342).

Conclusion: Although the risk of high-grade squamous intraepithelial lesions was increased among women with HPV-16 only, this finding did not influence the rate of invasive cervical cancer when compared with women in the HPV-18 only group.
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http://dx.doi.org/10.1002/ijgo.12652DOI Listing
December 2018

Does the primary route of spread have a prognostic significance in stage III non-serous epithelial ovarian cancer?

J Ovarian Res 2018 Mar 5;11(1):21. Epub 2018 Mar 5.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Adana, Turkey.

Background: The purpose of this retrospective study was to determine the prognosis of non-serous epithelial ovarian cancer (EOC) patients with exclusively retroperitoneal lymph node (LN) metastases, and to compare the prognosis of these women to that of patients who had abdominal peritoneal involvement.

Methods: A multicenter, retrospective department database review was performed to identify patients with stage III non-serous EOC at 7 gynecologic oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. The patients were divided into three groups based on the initial sites of disease: 1) the retroperitoneal (RP) group included patients who had positive pelvic and /or para-aortic LNs only. 2) The intraperitoneal (IP) group included patients with > 2 cm IP dissemination outside of the pelvis. These patients all had a negative LN status, 3) The IP / RP group included patients with > 2 cm IP dissemination outside of the pelvis as well as positive LN status. Survival data were compared with regard to the groups.

Results: We identified 179 women with stage III non-serous EOC who were treated at 7 participating centers during the study period. The median age of the patients was 53 years, and the median duration of follow-up was 39 months. There were 35 (19.6%) patients in the RP group, 72 (40.2%) in the IP group and 72 (40.2%) in the IP/RP group. The 5-year disease-free survival (DFS) rates for the RP, the IP, and IP/RP groups were 66.4%, 37.6%, and 25.5%, respectively (p = 0.002). The 5-year overall survival (OS) rate for the RP group was significantly longer when compared to those of the IP, and the IP/RP groups (74.4% vs. 54%, and 36%, respectively; p = 0.011). However, we were not able to define "RP only disease" as an independent prognostic factor for increased DFS or OS.

Conclusions: Primary non-serous EOC patients with node-positive-only disease seem to have better survival when compared to those with extra-pelvic peritoneal involvement.
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http://dx.doi.org/10.1186/s13048-018-0393-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838854PMC
March 2018

Is the presence of endometriosis associated with a survival benefit in pure ovarian clear cell carcinoma?

Arch Gynecol Obstet 2018 Apr 30;297(4):1005-1013. Epub 2018 Jan 30.

Department of Gynecologic Oncology, School of Medicine, Baskent University, Y. Bahcelievler Mah Mareşal Fevzi Çakmak Cad., No: 45, Çankaya, Ankara, Turkey.

Background: The purpose of this study was to compare the prognoses of women with pure ovarian clear cell carcinoma (OCCC) arising from endometriosis to those of women with pure OCCC not arising from endometriosis treated in the same manner.

Methods: A dual-institutional, retrospective database review was performed to identify patients with pure OCCC who were treated with maximal or optimal cytoreductive surgery (CRS) followed by paclitaxel/carboplatin chemotherapy between January 2006 and December 2016. Patients were divided into two groups according to the detection of cancer arising in endometriosis or not, on the basis of pathological findings. Demographic, clinicopathological, and survival data were collected, and prognosis was compared between the two groups.

Results: Ninety-three women who met the inclusion criteria were included. Of these patients, 48 (51.6%) were diagnosed with OCCC arising in endometriosis, while 45 (48.4%) had no concomitant endometriosis. OCCC arising in endometriosis was found more frequently in younger women and had a higher incidence of early stage disease when compared to OCCC patients without endometriosis. The 5-year overall survival (OS) rate of the patients with OCCC arising in endometriosis was found to be significantly longer than that of women who had OCCC without endometriosis (74.1 vs. 46.4%; p = 0.003). Although univariate analysis revealed the absence of endometriosis (p = 0.003) as a prognostic factor for decreased OS, the extent of CRS was identified as an independent prognostic factor for both recurrence-free survival (hazard ratio (HR) 8.7, 95% confidence interval (CI) 3.15-24.38; p < 0.001) and OS (HR 11.7, 95% CI 3.68-33.71; p < 0.001) on multivariate analysis.

Conclusion: Our results suggest that endometriosis per se does not seem to affect the prognosis of pure OCCC.
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http://dx.doi.org/10.1007/s00404-018-4651-6DOI Listing
April 2018

Carcinosarcoma of the ovary compared to ovarian high-grade serous carcinoma: impact of optimal cytoreduction and standard adjuvant treatment.

Int J Clin Oncol 2018 Apr 16;23(2):329-337. Epub 2017 Nov 16.

Department of Gynecologic Oncology, Faculty of Medicine, Baskent University, Y. Bahcelievler Mah., Mareşal Fevzi Çakmak Cad., No: 45, Çankaya, Ankara, Turkey.

Objective: The purpose of this retrospective study was to compare the prognoses of women with ovarian carcinosarcoma (OCS) who had optimal cytoreductive surgery followed by platinum plus taxane combination chemotherapy to those of women with ovarian high-grade serous carcinoma (HGSC) treated in the same manner.

Methods: A multicenter, retrospective department database review was performed to identify patients with OCS at eight gynecologic oncology centers in Turkey. A total of 54 women with OCS who had undergone optimal cytoreductive surgery followed by platinum plus taxane combination chemotherapy between 1999 and 2017 were included in this case-control study. Each case was matched to two women with ovarian HGSC who had undergone optimal cytoreductive surgery followed by platinum plus taxane combination chemotherapy. The Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analysed using Cox proportional hazards models.

Results: Median disease-free survival (DFS) was 29 months [95% confidence interval (CI) 0-59, standard error (SE) 15.35] versus 27 months (95% CI 22.6-31.3, SE 2.22; p = 0.765) and median overall survival (OS) was 62 versus 82 months (p = 0.53) for cases and controls, respectively. For the entire cohort, the presence of ascites [hazard ratio (HR) 2.32; 95% CI 1.02-5.25, p = 0.04] and platinum resistance [HR 5.05; 95% CI 2.32-11, p < 0.001] were found to be independent risk factors for decreased OS.

Conclusion: DFS and OS rates of patients with OCS and HGSC seem to be similar whenever optimal cytoreduction is achieved and followed by platinum plus taxane combination chemotherapy.
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http://dx.doi.org/10.1007/s10147-017-1215-xDOI Listing
April 2018

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus.

J Gynecol Oncol 2017 Nov;28(6):e78

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objective: To compare the clinical validity of the Gynecologic Oncology Group-99 (GOG-99), the Mayo-modified and the European Society for Medical Oncology (ESMO)-modified criteria for predicting lymph node (LN) involvement in women with endometrioid endometrial cancer (EC) clinically confined to the uterus.

Methods: A total of 625 consecutive women who underwent comprehensive surgical staging for endometrioid EC clinically confined to the uterus were divided into low- and high-risk groups according to the GOG-99, the Mayo-modified, and the ESMO-modified criteria. Lymphovascular space invasion is the cornerstone of risk stratification according to the ESMO-modified criteria. These 3 risk stratification models were compared in terms of predicting LN positivity.

Results: Systematic LN dissection was achieved in all patients included in the study. LN involvement was detected in 70 (11.2%) patients. LN involvement was correctly estimated in 51 of 70 LN-positive patients according to the GOG-99 criteria (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR-], 0.4), 64 of 70 LN-positive patients according to the ESMO-modified criteria (LR+, 2.5; LR-, 0.13) and 69 of the 70 LN-positive patients according to the Mayo-modified criteria (LR+, 2.2; LR-, 0.03). The area under curve of the Mayo-modified, the GOG-99 and the ESMO-modified criteria was 0.763, 0.753, and 0.780, respectively.

Conclusion: The ESMO-modified classification seems to be the risk-stratification model that most accurately predicts LN involvement in endometrioid EC clinically confined to the uterus. However, the Mayo-modified classification may be an alternative model to achieve a precise balance between the desire to prevent over-treatment and the ability to diagnose LN involvement.
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http://dx.doi.org/10.3802/jgo.2017.28.e78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641528PMC
November 2017

Investigation of Heavy Metal Level and Mineral Nutrient Status in Widely Used Medicinal Plants' Leaves in Turkey: Insights into Health Implications.

Biol Trace Elem Res 2018 Apr 19;182(2):387-406. Epub 2017 Jul 19.

Department of Urban and Regional Planning, Faculty of Architecture, Kirklareli University, Kayali, 39020, Kirklareli, Turkey.

The use of plants in treatments has been as old as humanity and it has preserved its popularity for centuries til now because of their availability, affordability and safeness. However, despite their widespread use, safety and quality issues have been major concerns in the world due to industrial- and anthropogenic-based heavy metal contamination risks. Thus, this study was attempted to analyze the heavy metal levels and mineral nutrient status of widely used medicinal plants in Turkey to have insights about their health implications on humans. The plant concentrations of B, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb and Zn were analyzed by ICP-OES in the leaves of 44 medical plants purchased from herbal markets of three different districts of Istanbul/Turkey. The measured lowest to highest concentrations were 0.065-79.749 mg kg B, 921.802-12,854.410 mg kg Ca, 0.020-0.558 mg kg Cd, 0.015-4.978 mg kg Cr, 0.042-8.489 mg kg Cu, 34.356-858.446 mg kg Fe, 791.323-15,569.349 mg kg K, 102.236-2837.836 mg kg Mg, 4.915-91.519 mg kg Mn, 10.224-3213.703 mg kg Na, 0.001-5.589 mg kg Ni, 0.003-3.636 mg kg Pb and 2.601-36.102 mg kg Zn. Those levels in plants were in acceptable limits though some elements in some plants have high limits which were not harmful. Variations (above acceptable limits) in element concentrations also indicated that these plants could be contaminated with other metals and that genetic variations may influence accumulation of these elements at different contents. Overall, analyzed medicinal plants are expected not to pose any serious threat to human health.
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http://dx.doi.org/10.1007/s12011-017-1070-7DOI Listing
April 2018

Risk factors for paraaortic lymph node metastasis in endometrial cancer.

Int J Clin Oncol 2017 Oct 18;22(5):937-944. Epub 2017 May 18.

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

Objective: The purpose of this study was to determine the risk factors for paraaortic lymph node (LN) metastasis in endometrial cancer (EC) patients who underwent comprehensive surgical staging.

Methods: A total of 641 women with EC (endometrioid, non-endometrioid, or mixed histology) who underwent comprehensive surgical staging including pelvic and paraaortic LN dissection between 2008 and 2016 were included in this retrospective study. Patient data were analyzed with respect to paraaortic LN involvement, and predictive factors for paraaortic LN metastasis were investigated.

Results: Lymph node metastasis was detected in 90 (14%) patients, isolated pelvic LN metastasis in 28 (4.3%), isolated paraaortic LN metastasis in 15 (2.3%), and both pelvic and paraaortic LN metastasis in 47 (7.3%) women, respectively. Univariate analysis showed that the risk of paraaortic LN metastasis significantly increased in patients with non-endometrioid histology, age greater than 60 years, grade 3 tumor, deep myometrial invasion, lymphovascular space invasion (LVSI), primary tumor diameter (≥2 cm), cervical stromal invasion, adnexal involvement, serosal invasion, pelvic LN involvement, two or more positive pelvic LNs, and positive peritoneal cytology (p < 0.05). At the end of multivariate analysis, the presence of LVSI [odds ratio (OR), 4.8; 95% confidence interval (CI), 1.25-18.2; p = 0.022] and pelvic LN metastasis (OR, 18.8; 95% CI, 5.7-61.6; p < 0.001) remained as independent risk factors for paraaortic LN involvement in women with EC.

Conclusion: The presence of LVSI and pelvic LN involvement appear to be independent risk factors for paraaortic LN metastasis in patients with EC. LVSI may be considered as a routine pathological parameter during frozen section analysis in women with EC undergoing surgery.
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http://dx.doi.org/10.1007/s10147-017-1139-5DOI Listing
October 2017

Impact of office hysteroscopy in repeated implantation failure: Experience of a single center.

J Turk Ger Gynecol Assoc 2016 1;17(4):197-200. Epub 2016 Dec 1.

Department of Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey; Centrum Clinic Women's Health and ART Centre, Ankara, Turkey.

Objective: Repeated implantation failure (RIF) is a clinical entity affecting many couples undergoing assisted reproductive technology (ART). Various intrauterine pathologies contribute to RIF. Nevertheless, vaginal sonography and hysterosalpingography, which are the common diagnostic tools for the initial follow-up, have limited sensitivities. In this context, we aimed to evaluate the impact of office hysteroscopy (oHS) on live birth rates (LBRs) when performed prior to subsequent ART cycles in women with a history of RIF.

Material And Methods: The database of an assisted reproduction center was retrospectively reviewed to detect eligible cases. A total of 363 women out of 2875 admissions were consecutively included in the analysis, of which 119 formed the oHS group and 244 formed the non-oHS group prior to a new ART cycle. Women in the oHS arm were examined during their early follicular phase via a vaginoscopic approach 1-6 months before the beginning of a new cycle. The standard fertilization-intracytoplasmic sperm injection (IVF/ICSI) cycle was applied to all the women.

Results: In the oHS group (n=119), 61 patients had intrauterine abnormalities, with an overall abnormality rate of 51.2%. Implantation, pregnancy, and LBRs of the groups were statistically similar. LBRs of the women with abnormal oHS findings (15/61, 24.5%), with normal oHS findings (14/58, 24.1%), and without oHS (39/244, 16%) were statistically similar (p=0.41).

Conclusion: Unrecognized intrauterine pathologies can be easily detected and concurrently treated during oHS with high success rate. However, a beneficial impact depends on the extent of the pathology and thus, routine application to enhance reproductive outcomes is still not warranted.
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http://dx.doi.org/10.5152/jtgga.2016.16166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147758PMC
December 2016

Comparison of intracytoplasmic sperm injection with testicular spermatozoa success in infertile men with obstructive and non-obstructive azoospermia; a retrospective analysis.

Hum Fertil (Camb) 2017 Sep 8;20(3):186-191. Epub 2016 Dec 8.

b Department of Biostatistics , Ankara University School of Medicine , Ankara , Turkey.

The aim of this study was to compare the outcome of intracytoplasmic sperm injection (ICSI) and embryo transfer between couples with infertility due to male non-obstructive azoospermia (NOA) and obstructive azoospermia (OA). A retrospective analysis of 234 couples with azoospermia who were treated by ICSI and embryo transfer between January 2007 and October 2010 was performed. There were 61 couples in NOA group and 173 couples in OA group. Fertilization rates, pregnancy and clinical pregnancy rates were the main outcome measures. The number of retrieved mature oocytes, injected oocytes, metaphase II (MII) oocytes, two distinct pronuclei oocytes, cleavage embryos and embryos transferred was not significantly different between the groups. The fertilization rate was significantly lower in NOA group when compared to OA group (56.2 vs. 66.7%, respectively; p = 0.013) and the pregnancy rate was significantly lower in NOA group than OA group (36.1 vs. 50.9%, respectively; p = 0.046). The clinical pregnancy rates were not statistically different between the patients with NOA and OA azoospermia groups (24.6 vs. 36.4%, respectively; p = 0.09). This study suggests that ICSI and embryo transfer together with testicular sperm extraction results in statistically significant lower fertilization and pregnancy rates in men with NOA when compared to men with OA.
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http://dx.doi.org/10.1080/14647273.2016.1264632DOI Listing
September 2017