Publications by authors named "Derman Başaran"

58 Publications

UPDATE ON SENTINEL LYMPH NODE MAPPING IN ENDOMETRIAL CANCER PATIENTS WITH A HIGH RISK FOR NODAL METASTASIS.

Indian J Gynecol Oncol 2020 Jun 13;18(2). Epub 2020 Apr 13.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Surgery is the mainstay of treatment for the majority of patients diagnosed with endometrial carcinoma. Systematic lymphadenectomy has traditionally been considered a standard part of surgical therapy. More recently, however, the value of this has been a subject of much debate. The sentinel lymph node (SLN) mapping algorithm has emerged as an acceptable alternative to conventional pelvic and para-aortic lymph node dissection in endometrial cancer. Clinical trials have demonstrated the accuracy of SLN mapping in detecting nodal spread in patients with endometrial cancer. However, data regarding the oncological outcomes of this approach, particularly in the setting of endometrial cancer with a high risk of nodal spread, is still lacking. In this review, we provide an overview of SLN mapping in endometrial cancer. We will specifically discuss its use in patients with a high risk for nodal metastasis. Controversies and future directions for research will also be discussed.
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http://dx.doi.org/10.1007/s40944-020-00386-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899161PMC
June 2020

Acute pericarditis after transabdominal cardiophrenic lymph node dissection and pericardotomy during ovarian cancer debulking surgery: A case report.

Gynecol Oncol Rep 2021 Feb 11;35:100683. Epub 2020 Dec 11.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

•Complete gross resection as part of debulking surgery is crucial in advanced ovarian cancer.•Supradiaphragmatic lymph node resection may prolong survival in patients with ovarian cancer.•We report acute pericarditis after supradiaphragmatic lymph node resection and pericardotomy.
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http://dx.doi.org/10.1016/j.gore.2020.100683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750320PMC
February 2021

The Landmark Series: Minimally Invasive Surgery for Cervical Cancer.

Ann Surg Oncol 2021 Jan 30;28(1):204-211. Epub 2020 Oct 30.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Cervical cancer incidence and mortality have declined in developed countries during the past few decades as a result of screening programs and vaccination. However, it remains a significant cause of cancer-related mortality in young women. Early-stage cervical cancer, defined as disease limited to the cervix, has traditionally been treated with abdominal radical hysterectomy via laparotomy. Although most early-stage cervical cancers can be cured with open radical hysterectomy, the morbidity associated with open radical hysterectomy is significant compared with simple extrafascial hysterectomy. Since the early 1990s, minimally invasive surgery has been explored for the treatment of this disease, with the goal of minimizing the morbidity associated with open surgery, as reported for endometrial cancer surgery. This report reviews the landmark studies describing and evaluating minimally invasive surgery in the treatment of patients with early-stage cervical cancer.
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http://dx.doi.org/10.1245/s10434-020-09265-0DOI Listing
January 2021

Impact of provider volume on front-line chemotherapy guideline compliance and overall survival in elderly patients with advanced ovarian cancer.

Gynecol Oncol 2020 11 16;159(2):418-425. Epub 2020 Aug 16.

The Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America.

Purpose: We sought to evaluate whether provider volume or other factors are associated with chemotherapy guideline compliance in elderly patients with epithelial ovarian cancer (EOC).

Methods: We queried the SEER-Medicare database for patients ≥66 years, diagnosed with FIGO stage II-IV EOC from 2004 to 2013 who underwent surgery and received chemotherapy within 7 months of diagnosis. We compared NCCN guideline compliance (6 cycles of platinum-based doublet) and chemotherapy-related toxicities across provider volume tertiles. Factors associated with guideline compliance and chemotherapy-related toxicities were assessed using logistic regression. Overall survival (OS) was compared across volume tertiles and Cox proportional-hazards model was created to adjust for case-mix.

Results: 1924 patients met inclusion criteria. The overall rate of guideline compliance was 70.3% with a significant association between provider volume and compliance (64.5% for low-volume, 72.2% for medium-volume, 71.7% for high-volume, p = .02). In the multivariate model, treatment by low-volume providers and patient age ≥ 80 years were independently associated with worse chemotherapy-guideline compliance. In the survival analysis, there was a significant difference in median OS across provider volume tertiles with median survival of 32.8 months (95%CI 29.6, 36.4) low-volume, 41.9 months (95%CI 37.5, 46.7) medium-volume, 42.1 months (95%CI 38.8, 44.2) high-volume providers, respectively (p < .01). After adjusting for case-mix, low-volume providers were independently associated with higher rates of mortality (aHR 1.25, 95%CI: 1.08, 1.43).

Conclusions: In a modern cohort of elderly Medicare patients with advanced EOC, we found higher rates of non-compliant care and worse survival associated with treatment by low-volume Medicare providers. Urgent efforts are needed to address this volume-outcomes disparity.
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http://dx.doi.org/10.1016/j.ygyno.2020.07.104DOI Listing
November 2020

Unusual usage of the automated stapler in gynecologic oncology: method for diaphragmatic full thickness implant resection without entrance to pleural space

J Turk Ger Gynecol Assoc 2020 12 16;21(4):301-302. Epub 2020 Jun 16.

Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Ankara Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey

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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726463PMC
December 2020

Primary leiomyosarcoma of the uterine cervix: report of 4 cases, systematic review, and meta-analysis.

Tumori 2020 Oct 13;106(5):413-423. Epub 2020 May 13.

Gynecologic Oncology Surgery Department, Health Sciences University, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

Background: Primary cervical leiomyosarcomas (CLMS) constitute 21% of all cervical sarcomas. Because of their rarity, to our knowledge, fewer than 40 cases have been reported. The aim of this study is to evaluate the clinical and surgical-pathological features, prognosis, treatment options, and survival of primary CLMS.

Methods: A systematic review of the medical literature was conducted to evaluate articles about primary CLMS. The literature was searched between 1959 and May 2019. On final evaluation, there were 29 articles (one consisted of 8 cases; one consisted of 3 cases) and 42 cases with the addition of our 4 cases.

Results: Age (⩾48 versus ⩽47 years) (hazard ratio.HR], 4.528; 95% confidence interval.CI], 1.550-13.227; =0.006) and mitoses count (<10/10 high-power field [HPF] versus ⩾10/10 HPF) (HR, 3.865; 95% CI, 1.046-14.278; =0.043) are independent prognostic factors for recurrence and age (HR, 5.318; 95% CI, 1.671-16.920; =0.005) and hysterectomy (performed versus not performed) (HR, 4.377; 95% CI, 1.341-14.283; =0.014) are independent prognostic factors for death because of disease on multivariate analysis.

Conclusions: Information on primary CLMS is sparse and obtained from rare case reports and case series. Hysterectomy must be the first choice of treatment in these patients according to our results on multivariate analysis. The type of hysterectomy does not have an effect on oncologic outcome. Radical hysterectomy is not obligatory and more data are needed to make more accurate conclusions.
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http://dx.doi.org/10.1177/0300891620919161DOI Listing
October 2020

Mucinous endometrial cancer: Clinical study of the eleven cases.

North Clin Istanb 2020 3;7(1):60-64. Epub 2019 Jul 3.

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey.

Objective: In this study, we analyzed surgico-pathologic factors of mucinous type endometrial carcinoma and examined its frequency of recurrence.

Methods: In this study, eleven cases, definitely diagnosed as pure mucinous type endometrium carcinoma between January 1993 and May 2013, were reviewed.

Results: Of 1640 women with endometrium carcinoma, 11 (0.67%) of them had a mucinous cell type. Mean age of the study group was 55 years. According to the FIGO 2009, 10 (90.9%) cases were evaluated as stage I and 1 (9.1%) as stage IIIC1. The presence of lymph node metastasis was noticed in only one (12.5%) of eight patients who underwent lymphadenectomy. In this case, metastasis was detected in the pelvic lymph node. Four patients underwent adjuvant therapy as pelvic radiotherapy. Median follow-up time was 50 months (range, 5-84). Recurrence was observed in one (9.1%) patient with stage IIIC1 endometrial cancer in 30 months after primary surgery. The site of recurrence was only in the upper abdominal region.

Conclusion: Based on our study, mucinous endometrial carcinoma has good prognostic factors, and long term survival can be achieved surgically alone in patients with stage I.
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http://dx.doi.org/10.14744/nci.2019.17048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103747PMC
July 2019

Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes.

Gynecol Oncol 2020 03 7;156(3):591-597. Epub 2020 Jan 7.

Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA. Electronic address:

Objective: To compare oncologic and perioperative outcomes in patients who underwent minimally invasive surgery (MIS) compared to laparotomy for newly diagnosed early-stage cervical carcinoma.

Methods: We retrospectively identified patients who underwent radical hysterectomy for stage IA1 with lymphovascular invasion (LVI), IA2, or IB1 cervical carcinoma at our institution from 1/2007-12/2017. Clinicopathologic characteristics and surgical and oncologic survival outcomes were compared using appropriate statistical testing. Multivariable Cox regression analysis was used to control for potential confounders.

Results: We identified 196 evaluable cases-117 MIS (106 robotic [90.6%]) and 79 laparotomy cases. Cohorts had similar age, BMI, substage, histologic subtype, clinical and pathologic tumor size, positive margins, and presence of LVI. The MIS group had more cases with no residual tumor in the hysterectomy (24.8% vs. 10.1%, P = 0.01). The laparotomy group had more cases with positive nodes (29.1% vs. 17.1%, P = 0.046) and more patients who received adjuvant therapy (53.2% vs. 33.3%, P = 0.006). Median follow-up was ~4 years. Five-year disease-free survival (DFS) rates were 87.0% in the MIS group and 86.6% in the laparotomy group (P = 0.92); 5-year disease-specific survival (DSS) rates were 96.5% and 93.9%, respectively (P = 0.93); and 5-year overall survival (OS) rates were 96.5% and 87.4%, respectively (P = 0.15). MIS was not associated with DFS, DSS, or OS on multivariable regression analysis. The rate of postoperative complications was significantly lower in the MIS cohort (11.1% vs. 20.3%; P = 0.04).

Conclusions: MIS radical hysterectomy for cervical carcinoma did not confer worse oncologic outcomes in our single-center and concurrent series of patients with early-stage cervical carcinoma.
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http://dx.doi.org/10.1016/j.ygyno.2019.12.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056548PMC
March 2020

Sentinel lymph node mapping alone compared to more extensive lymphadenectomy in patients with uterine serous carcinoma.

Gynecol Oncol 2020 01 16;156(1):70-76. Epub 2019 Nov 16.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. Electronic address:

Objectives: The objective of our study was to assess survival among patients with uterine serous carcinoma (USC) undergoing sentinel lymph node (SLN) mapping alone versus patients undergoing systematic lymphadenectomy (LND).

Methods: We retrospectively reviewed patients undergoing primary surgical treatment for newly diagnosed USC at our institution from 1/1/1996-12/31/2017. Patients were assigned to either SLN mapping alone (SLN cohort) or systematic LND without SLN mapping (LND cohort). Progression-free (PFS) and overall survival (OS) were estimated using Kaplan-Meier method, compared using Logrank test.

Results: 245 patients were available for analysis: 79 (32.2%) underwent SLN, 166 (67.7%) LND. 132 (79.5%) in the LND cohort had paraaortic LND (PALND) versus none in the SLN cohort. Median age: 66 and 68 years in the SLN and LND cohorts, respectively (p>0.05). Proportion of stage I/II disease: 67.1% (n = 53) and 64.5% (n = 107) in the SLN and LND cohorts, respectively (p>0.05). Median follow-up: 23 (range, 1-96) and 66 months (range, 4-265) in the SLN and LND cohorts, respectively (p < 0.001). Two-year OS in stage I/II disease (n = 160, 60.1%): 96.6% (SE ± 3.4) and 89.6% (SE ± 2.2) in the SLN and LND cohorts, respectively (p = 0.8). Two-year OS in stage III disease (n = 77): 73.6% (SE ± 10.2) and 77.3% (SE ± 5.8) in the SLN and LND cohorts, respectively (p = 0.8).

Conclusions: SLN mapping alone and systematic LND yielded similar survival outcomes in stage I-III USC. In our practice, the SLN algorithm has replaced systematic LND as the primary staging modality in this setting.
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http://dx.doi.org/10.1016/j.ygyno.2019.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980657PMC
January 2020

Can we predict surgical margin positivity while performing cervical excisional procedures?

J Obstet Gynaecol 2020 Jul 4;40(5):666-672. Epub 2019 Sep 4.

Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

We designed this study to evaluate any factors associated with positive surgical margin in conisation specimens and to determine the optimal cone size. The medical records of patients who had undergone a loop electrosurgical excision procedure (LEEP), cold-knife conisation (CKC) and needle excision of the transformation zone (NETZ) procedure were reviewed retrospectively. Two hundred and sixty eight women fulfilled the inclusion criteria. Univariate analyses showed that 'postmenopause', 'HSIL on smear', 'previous colposcopic examination revealing HSIL in endocervical curettage (ECC) material and in two or more ectocervical quadrants' and 'managing with LEEP' were significant predictors of surgical margin positivity. Nulliparous patients showed significantly lower rate of surgical margin positivity. 'Postmenopause', 'previous colposcopic examination revealing HSIL in ECC material and in two or more ectocervical quadrants' and 'HSIL on smear' were identified as independent predictors of surgical margin positivity according to multivariate analyses.IMPACT STATEMENT Previous studies demonstrated 'menopause', 'Age ≥50', 'managing with LEEP', 'disease involving >2/3 of cervix at visual inspection', 'training level of the surgeon', 'cytology squamous cell carcinoma' and 'mean cone height' as factors associated with positive surgical margin in conisation specimens. In our study, univariate analyses showed that 'postmenopause', 'HSIL on smear', 'previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants' and 'managing with LEEP' were associated with surgical margin positivity. On the other hand, nulliparous women showed significantly lower rate of surgical margin positivity compared with parous women. Multivariate analyses showed that 'postmenopause', 'previous colposcopic examination revealing HSIL in endocervical curettage material and in two or more ectocervical quadrants' and 'HSIL on smear' were independent predictors of surgical margin positivity in conisation specimens. We can predict high-risk patients with regard to surgical margin positivity. Prediction of high-risk patients and management with a tailored approach may help minimise surgical margin positivity rates.
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http://dx.doi.org/10.1080/01443615.2019.1645101DOI Listing
July 2020

Cytoreductive surgery in advanced stage malignant ovarian germ cell tumors.

J Gynecol Obstet Hum Reprod 2019 Sep 19;48(7):461-466. Epub 2019 Jun 19.

Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Division, Ankara, Turkey. Electronic address:

Introduction: To evaluate the survival effect of cytoreductive surgery in advanced stage malignant ovarian germ cell tumors (MOGCT).

Material And Methods: Clinicopathological data of patients with MOGCT that were treated between 1991 and 2014. Maximal debulking was defined as no gross residual tumor after primary or recurrence surgery; optimal and suboptimal debulking were used for patients with residual tumors of ≤1cm and >1cm, respectively.

Results: In total, 31 patients with advanced stage MOGCT were analyzed. The median age at diagnosis was 21 (14-57) years. The median follow-up duration was 64.1 months. Of these 31 patients; 7 patients underwent sub-optimal debulking, 5 patients had optimal surgery and 18 had maximal debulking. Five-year DFS according to surgical resection rates were 29% in suboptimal debulking group, 75% in optimal debulking group and 93% in maximal cytoreduction group (p<0.001). Three of seven patients who underwent sub-optimal debulking were died of disease, however no deaths were seen in patients with optimal and maximal debulking. Five-year OS was 32% in suboptimal debulking group, and 100% in optimal and maximal debulking groups (p=0.001).

Discussion: The benefit of cytoreductive surgery is less well-established in MOGCT of ovary compared to ovarian tumors of epithelial origin due to rareness of this histological subtype. Patients with MOGCT are usually younger and preservation of fertility is an important issue which may lead to suboptimal procedures, sometimes in exchange for diminished survival. Our data demonstrated that maximal cytoreduction should be aimed in patients with advanced stage MOGCT, as it is significantly associated with improved overall survival.
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http://dx.doi.org/10.1016/j.jogoh.2019.06.006DOI Listing
September 2019

Hormone therapy following surgery in low-grade endometrial stromal sarcoma: Is it related to a decrease in recurrence rate?

J Chin Med Assoc 2019 May;82(5):385-389

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, University of Health Sciences, Ankara, Turkey.

Background: Low-grade endometrial stromal sarcoma (LGESS) is, in most cases, a slow-growing malignancy; however, it is related with high recurrence rates. The aim of this study is to determine which factors may be associated with the recurrence rate of LGESS.

Methods: The clinicopathological features and treatment options in 37 patients with LGESS were evaluated.

Results: All patients underwent the hysterectomy and bilateral salpingo-oophorectomy. Additionally, lymphadenectomy was performed in 56.8% (n = 21) of the patients. Among the patients who underwent lymphadenectomy, 14.3% (n = 3) had lymph node metastasis. The disease was limited to the uterus in 75.7% of patients. Treatment following surgery was radiotherapy in three patients, chemotherapy in seven patients, hormone therapy in 12 patients, and chemotherapy plus hormone therapy in one patient. Megestrol acetate was used in all patients who received hormone therapy. Median follow-up time was 96 months. The 5-year disease-free survival and disease-specific survival were 72% and 97%, respectively. The recurrence rate was 27%. Only hormone therapy following surgery was significantly associated with a lower recurrence rate, even in patients with stage 1 disease. None of the patients treated with hormone therapy following surgery had recurrence, whereas recurrence occurred in 38.5% of the patients who underwent surgery only (p = 0.039).

Conclusion: Hormone therapy after surgery should be considered a viable option for decreasing the LGESS recurrence rate, regardless of the disease stage.
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http://dx.doi.org/10.1097/JCMA.0000000000000039DOI Listing
May 2019

Maximal cytoreduction is related to improved disease-free survival in low-grade ovarian serous carcinoma.

Tumori 2019 Jun 27;105(3):259-264. Epub 2019 Mar 27.

1 Department of Gynecologic Oncology, Faculty of Medicine, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Objective: To evaluate the factors predicting oncologic outcomes in low-grade ovarian serous carcinoma (LGOSC).

Methods: Seventy patients with LGOSC were included in the study. According to the residual disease present at the end of the initial cytoreductive surgery (CRS), surgical outcomes are defined as follows: maximal CRS for absence of macroscopic residual tumors, optimal CRS for macroscopic residual tumors with diameters ranging from 0.1 to ⩽1 cm diameter, and suboptimal CRS for macroscopic residual tumors measuring >1 cm in diameter.

Results: Five-year disease-free survival (DFS) and cancer-specific survival (CSS) were 61% and 83%, respectively. Surgical outcomes were suboptimal in 3 (4.3%) patients, optimal in 8 (11.4%) patients, and maximal in 59 (84.3%) patients. Stage and surgical outcomes were related to DFS ( < 0.05). Compared with maximal CRS, the presence of residual tumors (suboptimal and optimal debulking) was related to threefold increased risk of disease failure (recurrence or progression) (hazard ratio [95% confidence interval] 3.00 [1.27-7.09]; =0.012). CSS was associated with disease stage alone (=0.03). Advanced stage was related with lower DFS and CSS.

Conclusions: Maximal CRS facilitates an improvement in DFS. Achieving no residual disease after the completion of surgery should be a cornerstone of LGOSC management.
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http://dx.doi.org/10.1177/0300891619839293DOI Listing
June 2019

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

The preoperative serum CA125 can predict the lymph node metastasis in endometrioid-type endometrial cancer.

Ginekol Pol 2018;89(11):599-606

Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Department of Gynecology, Ankara, Turkey.

Objectives: To evaluate the predictive value of preoperative CA125 in extra-uterine disease and its association with poor prognostic factors in endometrioid-type endometrial cancer (EC).

Material And Methods: A total of 423 patients with pathologically proven endometrioid-type EC were included in the study. The association between preoperative CA125 level and surgical-pathological factors was evaluated. The conventional cut-off value was defined as 35 IU/mL.

Results: A high CA125 level ( > 35 IU/mL) was significantly associated with all of the studied poor prognostic factors, except grade. The risk of lymph node metastasis (LNM) increased from 15.9% to 45.7% when CA125 level was > 35 IU/mL (p < 0.05). The optimal cut-off value for the prediction of LNM in patients aged > 50 years was determined to be 16 IU/mL (sensitivity, specificity, positive predictive value, and negative predictive value were 71%, 60%, 35%, and 87%, respectively.) Conclusions: Preoperative CA125 level was significantly related with the extent of the disease and LNM. The age-dependent cut-off level of CA125 can improve the prediction of LNM in endometrioid-type EC. For older patients, CA125 level of > 16 IU/ml could be used to predict LNM. However, further studies are needed to evaluate the appropriate cut-off level of CA125 for younger patients.
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http://dx.doi.org/10.5603/GP.a2018.0103DOI Listing
February 2019

Recurrence in Uterine Tumors with Ovarian Sex-Cord Tumor Resemblance: A Case Report and Systematic Review.

Turk Patoloji Derg 2018 ;34(3):225-233

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences , ANKARA, TURKEY Department of Pathology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences , ANKARA, TURKEY.

Objective: The aim of this study was to evaluate the prognostic factors of recurrence in uterine tumors resembling ovarian sex-cord tumors (UTROSCT) and to determine clinical-pathological characteristics, treatment options and outcome.

Material And Method: An electronic literature search was conducted from 1976 to 2018. After the comprehensive evaluation and conjunction with our case, the study included 79 cases.

Results: The median age at initial diagnosis was 49 years (range; 16-86 years). The age was under 40 years in 21 (26.6%) patients. Whereas 68 patients underwent at least hysterectomy, 9 patients had organ sparing surgery. There was necrosis in 4 (5.1%) patients, atypia in 16 (20.3%) patients, and infiltrative tumor border in 34 (43%) patients. At least one mitosis per 10 high power fields was determined in 36 (45.5%) patients. The tumor involved at least part of the myometrium in 54 (68.3%) patients. Median follow-up time was 30 months (range; 3-296 months). Recurrence was determined in 5 (6.3%) patients. The disease free survival (DFS) was significantly related only to surgery type. None of the pathologic features were associated with DFS. The 5-year DFS was 86% and 96% in patients who underwent organ sparing surgery or not, respectively (p=0.038).

Conclusion: The accurate pathologic diagnosis of UTROSCT has great value in shaping surgical management and management during the follow-up period. Organ sparing surgery was related to poor DFS. Although recurrence is rare, it should be kept in mind for patients with UTROSCT.
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http://dx.doi.org/10.5146/tjpath.2018.01429DOI Listing
December 2018

Blood Vessel Invasion in Endometrial Cancer Is One of the Mechanisms of Spread to the Cervix.

Pathol Oncol Res 2019 Oct 25;25(4):1431-1436. Epub 2018 Oct 25.

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

To evaluate the association between type of invaded vessels (blood or lymphatic) and cervical involvement in endometrial cancer (EC). Pathological slides of 93 patients with EC who had vascular space invasion in hematoxylin-eosin staining underwent immunohistochemical assay with CD31 and podoplanin. CD31 and podoplanin were used to identify blood and lymphatic invaded vessels, respectively. Cervical stromal invasion (CSI) was determined in 21 (30%) patients. The rate of CD31-positivity was significantly higher in patients with CSI than without (76.2 and 34.7%, p = 0.001; respectively). Podoplanin-positivity was determined in 47.6 and 81.6% of patients with and without CSI, respectively (p = 0.005). Age, myometrial invasion and the combination of CD31-positivity with podoplanin-negativity were found as independent predictors for CSI. Blood vessel invasion is an important factor for CSI in EC. Blood vessel invasion rather than lymphatic vessel invasion is one of the predominant ways by which EC spreads to the cervix.
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http://dx.doi.org/10.1007/s12253-018-0498-1DOI Listing
October 2019

Vaginal Closure with EndoGIA to Prevent Tumor Spillage in Laparoscopic Radical Hysterectomy for Cervical Cancer.

J Minim Invasive Gynecol 2019 May - Jun;26(4):602. Epub 2018 Jul 29.

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey (all authors).

Study Objective: To demonstrate a method of vaginal closure with the EndoGIA surgical stapler (Medtronic, Istanbul, Turkey) to prevent tumor spillage in laparoscopic radical hysterectomy.

Design: A step-by-step explanation of the procedure using a video.

Setting: Women's health teaching and research hospital.

Patient: A 40-year-old woman with clinical stage IBI cervical squamous cell carcinoma.

Interventions: Laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition. Institutional ethical committee approval was not sought. However, the patient signed an informed consent that allows us to use her clinical data.

Measurements And Main Results: Minimally invasive surgery is increasingly being used in cervical cancer surgery. However, there is a current and significant debate regarding the safety of these methods. Colpotomy, which is the last step of laparoscopic radical hysterectomy, could be related to an increased risk for tumor spillage. Vaginal closure before colpotomy may be an option to prevent this spillage. In this method, after completion of the radical hysterectomy steps, the initial 5-mm left lower quadrant trocar was changed to a 15-mm trocar to allow for the placement of an EndoGIA with a green cartridge. The uterine manipulator was removed, and the uterus was elevated with a myoma screw. Then, the stapler was placed, and we checked that no other unintended structure was included in the jaws of the stapler before the firing. The EndoGIA surgical stapler was fired 2times to close the vagina. The stapler places 2 triple-staggered rows of titanium staples and knife blade cuts simultaneously between them. Once the vagina was divided, the stapler was released. The upper part of the vaginal cuff was excised and sent to pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with intracorporeal suturing.

Conclusion: Vaginal closure with the EndoGIA surgical stapler before colpotomy provides a safe and easy method to prevent tumor spillage and could improve the unfavorable results related to minimally invasive surgery in patients with cervical cancer.
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http://dx.doi.org/10.1016/j.jmig.2018.07.015DOI Listing
August 2019

Independent predictors of survival in endometrium cancer: platelet-to-lymphocyte ratio and platelet/neutrophil/monocyte-to-lymphocyte ratio

J Turk Ger Gynecol Assoc 2018 Jun;19(2):78-86

Department of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Diseases Training and Research Hospital, Ankara, Turkey

Objective: To evaluate the association between ratios of inflammatory markers and survival in endometrium cancer (EC).

Material And Methods: Four hundred ninety-seven patients with epithelial EC were included. The evaluated ratios were neutrophil (N)/lymphocyte (L), neutrophil count divided by the lymphocyte count; platelet (P)/lymphocyte, platelets divided by the lymphocyte count; lymphocyte/monocyte (M), lymphocytes divided by the monocyte count; NM/L, neutrophil plus monocyte divided by the lymphocyte count; PNM/L, the sum total counts of platelets, neutrophils and monocytes divided by the lymphocyte count.

Results: The median follow-up time was 24 months (1-129). Recurrence and exitus occurred in 34 (7%) and 18 (3.7%) patients, respectively. Metastasis in pelvic or para-aortic lymph nodes were significantly related only with low L/M. None of the inflammatory ratios were associated with disease-free survival. In multi-variant analysis, only high P/L (>168) and high PNM/L (>171) were related with a statistically significant hazard ratio for death of 2.91 (p=0.024) and 2.93 (p=0.023), respectively.

Conclusion: The P/L and PNM/L were in relation with worse overall survival and also independent prognostic factors for OS.
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http://dx.doi.org/10.4274/jtgga.2017.0112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994810PMC
June 2018

Are patients and physicians willing to accept less-radical procedures for cervical cancer?

J Gynecol Oncol 2018 Jul 12;29(4):e50. Epub 2018 Mar 12.

Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University, Prague, Czech Republic.

Objective: To evaluate the opinions of women who underwent surgery for cervical cancer (CC) and physicians who treat CC about the acceptability of increased oncological risk after less-radical surgery.

Methods: One hundred eighty-two women who underwent surgery for CC and 101 physicians participated in a structured survey in 3 tertiary cancer centers in Czech Republic and Turkey. Patients and physicians were asked whether they would accept any additional oncological risks, which would be attributable to the omission of parametrectomy (radical hysterectomy/trachelectomy vs. simple hysterectomy/trachelectomy) or pelvic lymph node dissection (systematic resection vs. sentinel lymph node sampling).

Results: Although 52.2% of patients reported morbidity related to their previous treatment, the majority of patients would not accept less-radical surgical treatment if it was associated with any increased risk of recurrence (50%-55%, no risk; 17%-24%, risk <0.1%). Physicians tended to accept a significantly higher risk than patients in the Czech Republic, but not in Turkey. Patients with higher education levels, more advanced-stage of disease, or adverse events related to previous cancer treatment, and patients who received adjuvant therapy were significantly more likely to accept an increased oncological risk.

Conclusion: Patients, even if they suffered from morbidity related to previous CC treatment, do not want to choose between oncological safety and a better quality of life. Physicians tend to accept the higher oncological risk associated with less-radical surgical procedures, but attitudes differ regionally. Professionals should be aware of this tendency when counselling the patients before less-radical surgery.
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http://dx.doi.org/10.3802/jgo.2018.29.e50DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981102PMC
July 2018

Prognostic effect of isolated paraaortic nodal spread in endometrial cancer

J Turk Ger Gynecol Assoc 2018 11 28;19(4):201-205. Epub 2018 Mar 28.

Clinic of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey

Objective: To evaluate the prognostic effect of isolated paraaortic lymph node metastasis in endometrial cancer (EC).

Material And Methods: This retrospective study included patients with FIGO 2009 stage IIIC2 disease due to isolated paraaortic lymph node metastasis (LNM). Patients with sarcomatous histology, synchronous gynecologic cancers and patients with concurrent pelvic lymph node metastases or patients that have intraabdominal tumor spread were excluded. Kaplan-Meier method was used for calculation of progression free survival (PFS) and overall survival.

Results: One thousand six hundred and fourteen patients were operated for EC during study period. Nine hundred and sixty-one patients underwent lymph node dissection and 25 (2.6%) were found to have isolated LNM in paraaortic region and these constituted the study cohort. Twenty (80%) patients had endometrioid EC. Median number of retrieved lymph nodes from pelvic region and paraaortic region was 21.5 (range: 5-41) and 34.5 (range: 1-65), respectively. Median number of metastatic paraaortic nodes was 1 (range: 1-32). The median follow-up time was 15 months (range 5-94). Seven (28%) patients recurred after a median of 20 months (range, 3-99) from initial surgery. Three patients recurred only in pelvis, one patient had upper abdominal spread and 3 had isolated extraabdominal recurrence. Involvement of uterine serosa, positive peritoneal cytology and presence of adnexal metastasis were significantly associated with diminished PFS (p<0.05).

Conclusion: The presence of serosal involvement or adnexal involvement is as important as gross peritoneal spread and is related with poor survival in patients with isolated paraaortic nodal spread in EC. Chemotherapy should be the mainstay of treatment in this patient cohort which may eradicate systemic tumor spread.
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http://dx.doi.org/10.4274/jtgga.2017.0152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250084PMC
November 2018

The Clinicopathological Study of 21 Cases With Uterine Smooth Muscle Tumors of Uncertain Malignant Potential: Centralized Review Can Purify the Diagnosis.

Int J Gynecol Cancer 2018 02;28(2):233-240

Objective: The objective of this study was to investigate the clinicopathological features and factors associated with recurrence in patients with uterine smooth muscle tumor of uncertain malignant potential (STUMP).

Methods: Forty-six cases diagnosed between 2000 and 2014 from 2 tertiary centers underwent blind slide review. Initial diagnosis included smooth muscle tumors with equivocal diagnosis, STUMPs, and cases that were named as leiomyosarcomas (LMS) or low-grade LMS despite not fulfilling the Stanford criteria.

Results: In total, 21 patients with a final diagnosis of STUMP were available. Fifteen (68.1%) of 22 patients with an initial diagnosis of STUMP, 4 (22.2%) of 18 cases with an equivocal smooth muscle tumor diagnosis, and 2 (33.3%) of 6 cases with an initial diagnosis of LMS were interpreted as STUMP after slide review. The mean age at diagnosis was 43 years (range, 20-64 years). The mean follow-up time was 65.9 months (range, 10-154 months). Four patients (19.0%) developed recurrent disease. Recurrent tumors were LMS in 3 patients (75%). One patient (4.8%) with recurrence succumbed to disease. There was no difference in patients' age (P = 1.0) or type of initial surgery (uterus conserving versus hysterectomy) (P = 0.57) between patients who recurred and did not recur.

Conclusions: Uterine STUMPs can harbor significant uncertainty regarding the original diagnosis and clinical outcomes. Recurred cases may have an aggressive clinical course associated with multiple relapses and death. Uterine mesenchymal tumors other than ordinary myomas and overt sarcomas deserve a second opinion in centers with experience because the real diagnosis may vary significantly.
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http://dx.doi.org/10.1097/IGC.0000000000001178DOI Listing
February 2018

Therapeutic value of lymphadenectomy and adjuvant radiotherapy in uterine corpus confined endometrioid-type cancer.

J Chin Med Assoc 2018 Aug 26;81(8):714-723. Epub 2017 Dec 26.

Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Division, Ankara, Turkey.

Background: To determine the efficacy of lymphadenectomy and adjuvant radiotherapy in patients with endometrioid-type cancer confined to the uterine corpus.

Methods: A total of 323 patients were evaluated. Patients were stratified according to depth of myometrial invasion (DMI) and tumor grade.

Results: Lymphadenectomy was performed in 83% of the entire cohort. Age (<60 vs. ≥60) and DMI affected disease-free survival. Addition of lymphadenectomy improved the disease-specific survival. The improved effect of lymphadenectomy was only observed in DMI ≥½ and grade 2 tumor (78.5% vs. 95.4%). However, that effect in this group was determined in patients with more than 50 removed lymph nodes. Performing adjuvant radiotherapy and the type of the radiotherapy (vaginal brachytherapy vs. external beam radiotherapy) were not significant for disease-free and disease-specific survival. In the entire cohort, loco-regional recurrence occurred in 3.1% and 4.4% of patients with or without adjuvant radiotherapy, respectively. However, these rates were 2.6% and 13.6% for patients with DMI ≥½ and grade 2 who were older than 60 years, respectively.

Conclusion: Lymphadenectomy should be performed in patients with DMI ≥½ and grade 2 to improve survival. Adjuvant vaginal brachytherapy may only be given to patients who are older than 60 years old with moderate differentiation and deep myometrial invasion to reduce loco-regional recurrence.
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http://dx.doi.org/10.1016/j.jcma.2017.05.014DOI Listing
August 2018

Histological Follow-Up in Patients with Atypical Glandular Cells on Pap Smears.

J Cytol 2017 Oct-Dec;34(4):203-207

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

Context: Atypical glandular cells (AGCs) result in the Papanicolaou (Pap) smear may be associated with significant genital and nongenital neoplastic processes.

Aims: To evaluate the underlying histopathology in women who had AGCs on Pap smears.

Settings And Design: Retrospective cross-sectional study.

Patients And Methods: Clinicopathological data of patients who had AGC on Pap smears and underwent histological workup between January 2004 and December 2014 were retrieved from the computerized database of a tertiary care center. Patients with a prior history of cervical intraepithelial neoplasia or gynecological cancer were excluded.

Statistical Analysis Used: Chi-square test or Fisher's exact tests were used as appropriate.

Results: Cytological examination of the uterine cervix was carried out in 117,560 patients. We identified 107 patients (0.09%) with AGC and 80 of those with histological follow-up were included in the study. The median age at diagnosis was 47 years (range, 18-79), and 32 women (40%) were postmenopausal, while 56 (70%) had gynecological symptoms. Significant preinvasive or invasive lesions on pathological examination were detected in 27 (33.8%) patients, including 12 endometrial adenocarcinomas (15%), 8 cervical carcinomas (10%), 3 cervical intraepithelial neoplasia II/III (3.75%), 2 ovarian adenocarcinomas (2.5%), and 2 metastatic tumors (2.5%). Univariate analysis showed that postmenopausal status ( < 0.001), age >50 years old ( < 0.001), having symptoms at the time of admission ( = 0.041), and AGC "favor neoplasia" smear results ( = 0.041) were the clinical factors associated with significant pathological outcome.

Conclusions: Patients with AGC on Pap smears should be evaluated vigilantly with histological workup, especially if they are postmenopausal or symptomatic.
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http://dx.doi.org/10.4103/JOC.JOC_209_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655657PMC
November 2017

Vaginal Reconstruction for Vaginal Obliteration Secondary to Stevens Johnson Syndrome: A Case Report and Review of Literature.

Oman Med J 2017 Sep;32(5):436-439

Departments of Obstetrics and Gynecology, Gynecologic Oncology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Stevens-Johnson syndrome (SJS) is a rare and acute life-threatening condition, which is almost always precipitated by drugs. Genital mucositis in female patients may also be an important cause of long-term morbidity secondary to mucosal scarring. We present the case of a 33-year-old nulligravid woman with distal vaginal synechiae necessitating a surgical approach, which occurred after an episode of SJS. Also, we aimed to review the literature to reveal cases which required surgical management for long-term genital sequelae as well as discuss preventive measures.
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http://dx.doi.org/10.5001/omj.2017.82DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632693PMC
September 2017

Revaluating the survival effects of International Federation of Gynecology and Obstetrics 1988 stage IIIA criteria for endometrial cancer.

J Turk Ger Gynecol Assoc 2017 Sep;18(3):110-115

Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.

Objective: This study aimed to define factors that affected survival in the International Federation of Gynecology and Obstetrics (FIGO) 1988 stage IIIA endometrial cancer (EC).

Material And Methods: The study included patients with EC who underwent surgery between 1992 and 2013. Patients with adnexal metastases, uterine serosal involvement or positive peritoneal cytology (stage IIIA disease according to the former 1988 FIGO staging system) were selected for further analysis. Clinical and pathologic factors associated with progression-free survival (PFS) were evaluated using univariate and multivariate statistical tests.

Results: Seventy-seven patients with stage IIIA disease according to the 1988 FIGO staging system were included. The median follow-up was 37 months (range, 1-175 months) and recurrence was detected in 19 patients. Univariate analysis revealed that the presence of uterine serosal invasion and advanced histologic grade (grade 1-2 vs. grade 3) were associated with diminished PFS (p=0.001, p=0.047). The presence of adnexal involvement and positive peritoneal cytology had no statistically significant influence on PFS (p=0.643 and p=0.795, respectively).

Conclusion: In patients with stage IIIA EC according to the FIGO 1988 staging system, only uterine serosal involvement was related with adverse oncologic outcomes, not adnexal involvement or presence of positive cytology.
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http://dx.doi.org/10.4274/jtgga.2017.0033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590205PMC
September 2017

Therapy Modalities, Prognostic Factors, and Outcome of the Primary Cervical Carcinosarcoma: Meta-analysis of Extremely Rare Tumor of Cervix.

Int J Gynecol Cancer 2017 11;27(9):1957-1969

*Gynecologic Oncology Clinic and †Pathology Division, Etlik Zubeyde Hanim Women's Health Teaching and Researching Hospital, Ankara, Turkey.

Objective: The aim of this study was to evaluate the prognostic factors, treatment options, and survival outcomes of primary carcinosarcomas of the uterine cervix.

Methods: An electronic search of the literature was conducted from 1951 to February 2017 to identify articles on primary cervical carcinosarcoma. After comprehensive evaluation of case series and case reports, 81 cases were included in the study.

Results: The most common clinical FIGO (International Federation of Gynecology and Obstetrics) stage was IB at 53% of cases. Median follow-up time was 15 months (range, 1.75-156 months). Two-year disease-free survival (DFS) and overall survival (OS) of the entire cohort were 49% and 60%, respectively. Both 2-year DFS and OS were significantly higher in patients with stage I than in those with stage II disease or greater (73% vs 22%, P = 0.000 and 82% vs 33%, P = 0.000, respectively). Two-year OS was 17% for patients who received primary radiotherapy, whereas it was 68% for those who underwent only surgery (P = 0.003). Surgery followed by adjuvant radiotherapy with or without chemotherapy was significantly associated with improved DFS and OS compared with primary radiotherapy. Two-year DFS was 63% in patients who underwent primary surgery, whereas it was 100% in patients treated with primary surgery followed by adjuvant radiotherapy with chemotherapy (P = 0.030). Stage alone was an independent prognostic factor for risk of both recurrence and death (hazard ratios, 9.8 [P = 0.004] and 14 [P = 0.018], respectively).

Conclusions: In due course of presentation, the tumor stage has a great importance because it is the only independent factor for prognosis. Surgery followed by adjuvant radiotherapy with or without chemotherapy seems to be related with better OS and DFS.
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http://dx.doi.org/10.1097/IGC.0000000000001086DOI Listing
November 2017

Impact of adjuvant treatment on oncologic outcomes in patients with stage I leiomyosarcoma of the uterus.

Turk J Med Sci 2017 Jun 12;47(3):841-846. Epub 2017 Jun 12.

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

Background/aim: This study aimed to evaluate the role of adjuvant therapy for stage I uterine leiomyosarcoma (LMS).

Materials And Methods: Clinicopathological data of cases of stage I uterine LMS from 1998 to 2015 were retrieved from the computerized database of Hacettepe University Hospital. The Kaplan-Meier method was used to estimate survival and progression-free survival, and survival differences were analyzed by log-rank test. Cox regression analysis was performed to account for the potential influence of confounding factors.

Results: We evaluated the outcomes of 35 patients with histologically proven stage I LMS. The median age at diagnosis was 50 years. All patients underwent surgical treatment and 20 patients (57.1%) received adjuvant therapy. Twelve of these patients (34.3%) received adjuvant chemotherapy, 3 (8.6%) received adjuvant pelvic irradiation, and 5 (14.2%) received adjuvant chemotherapy with pelvic irradiation. The median follow-up duration was 34 months (range: 3-231 months). Twenty-three (65.7%) patients had a recurrence during follow-up. Adjuvant therapy did not significantly improve median progression-free survival or median overall survival. Cox regression analysis did not demonstrate any significant impact of the factors studied, including age, menopausal status, tumor size, mitotic count, staging surgery, or adjuvant therapy.

Conclusion: Adjuvant therapy for surgically treated stage I uterine LMS did not improve oncologic outcomes.
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http://dx.doi.org/10.3906/sag-1603-135DOI Listing
June 2017

Stage IIIC transitional cell carcinoma and serous carcinoma of the ovary have similar outcomes when treated with platinum-based chemotherapy.

J Turk Ger Gynecol Assoc 2017 Mar;18(1):33-37

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

Objective: Previous studies reported better outcomes for transitional cell carcinoma (TCC) of the ovary when compared with more common histologic types such as serous epithelial ovarian cancers (EOCs). The aim of this study was to compare the survival outcomes of platinum- based chemotherapy in patients with stage IIIC TCCs and serous EOCs.

Material And Methods: Clinicopathologic features and survival data of patients with FIGO stage IIIC TCC and serous EOC who had undergone primary surgery followed by six cycles of intravenous platinum/taxane between 2007 and 2015 were retrieved from the database of Hacettepe University Hospital.

Results: We identified 14 (10.9%) TCCs and 114 (89.1%) serous EOCs. The median follow-up duration was 28 months (range, 3-101 months). Univariate analysis revealed that the TCCs and serous EOCs had similar progression-free survival (PFS) and overall survival (OS). Patients with residual disease less than 1 cm had longer OS than patients with residual disease greater than 1 cm (75.0 vs. 45.0 months, p=0.012). Cox regression analysis of all potential prognostic factors showed that the only independent prognostic factor significantly associated with OS was residual disease less than 1 cm [hazard ratio=0.38; 95% confidence interval: (0.19-0.77); p=0.007].

Conclusion: Surgically treated advanced stage TCCs did not have a significantly better prognosis after platinum/taxane-based chemotherapy when compared with serous EOCs. Residual tumor volume after primary surgery was the only independent predictor of OS in patients with EOC. Our results demonstrate the significance of achieving optimal cytoreduction in all histologic subtypes of EOC.
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http://dx.doi.org/10.4274/jtgga.2016.0190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450208PMC
March 2017

Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue.

Int J Gynecol Cancer 2017 05;27(4):748-753

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

Objective: The aim of this study was to evaluate the effectiveness of histological grade, depth of myometrial invasion, and tumor size to identify lymph node metastasis (LNM) in patients with endometrioid endometrial cancer (EC).

Methods: A retrospective computerized database search was performed to identify patients who underwent comprehensive surgical staging for EC between January 1993 and December 2015. The inclusion criterion was endometrioid type EC limited to the uterine corpus. The associations between LNM and surgicopathological factors were evaluated by univariate and multivariate analyses.

Results: In total, 368 patients were included. Fifty-five patients (14.9%) had LNM. Median tumor sizes were 4.5 cm (range, 0.7-13 cm) and 3.5 cm (range, 0.4-33.5 cm) in patients with and without LNM, respectively (P = 0.005). No LMN was detected in patients without myometrial invasion, whereas nodal spread was observed in 7.7% of patients with superficial myometrial invasion and in 22.6% of patients with deep myometrial invasion (P < 0.0001). Lymph node metastasis tended to be more frequent in patients with grade 3 disease compared with those with grade 1 or 2 disease (P = 0.131).

Conclusions: The risk of lymph node involvement was 30%, even in patients with the highest-risk uterine factors, that is, those who had tumors of greater than 2 cm, deep myometrial invasion, and grade 3 disease, indicating that 70% of these patients underwent unnecessary lymphatic dissection. A precise balance must be achieved between the desire to prevent unnecessary lymphadenectomy and the ability to diagnose LNM.
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http://dx.doi.org/10.1097/IGC.0000000000000937DOI Listing
May 2017