Publications by authors named "Mehmet M Meydanli"

11 Publications

  • Page 1 of 1

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

Comparison of stage III mucinous and serous ovarian cancer: a case-control study.

J Ovarian Res 2018 Oct 30;11(1):91. Epub 2018 Oct 30.

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

Background: The purpose of this case-control study was to compare the prognoses of women with stage III mucinous ovarian carcinoma (MOC) who received maximal or optimal cytoreduction followed by paclitaxel plus carboplatin chemotherapy to those of women with stage III serous epithelial ovarian cancer (EOC) treated in the similar manner.

Methods: We performed a multicenter, retrospective review to identify patients with stage III MOC at seven gynecologic oncology departments in Turkey. Eighty-one women with MOC were included. Each case was matched to two women with stage III serous EOC in terms of age, tumor grade, substage of disease, and extent of residual disease. Survival estimates were measured using Kaplan-Meier plots. Variables predictive of outcome were analyzed using Cox regression models.

Results: With a median follow-up of 54 months, the median progression-free survival (PFS) for women with stage III MOC was 18.0 months (95% CI; 13.8-22.1, SE: 2.13) compared to 29.0 months (95% CI; 24.04-33.95, SE: 2.52) in the serous group (p = 0.19). The 5-year overall survival rate of the MOC group was significantly lower than that of the serous EOC group (44.9% vs. 66.3%, respectively; p < 0.001). For the entire cohort, presence of multiple peritoneal implants (Hazard ratio [HR] 2.39; 95% confidence interval [CI], 1.38-4.14, p = 0.002) and mucinous histology (HR 2.28; 95% CI, 1.53-3.40, p < 0.001) were identified as independent predictors of decreased OS.

Conclusion: Patients with MOC seem to be 2.3 times more likely to die of their tumors when compared to women with serous EOC.
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http://dx.doi.org/10.1186/s13048-018-0464-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208168PMC
October 2018

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

Risk Factors for Recurrence in Low-Risk Endometrial Cancer: A Case-Control Study.

Oncol Res Treat 2018 6;41(7-8):466-470. Epub 2018 Jul 6.

Aim: The aim of this study was to investigate the risk factors for recurrence in patients with low-risk endometrial cancer (EC).

Patients And Methods: This retrospective study was performed using 10 gynecological oncology department databases. Patients who met the following criteria were included in the study: (a) endometrioid-type histology, (b) histological grade 1 or 2, (c) no or < 50% myometrial invasion, (d) no intraoperative evidence of extrauterine spread, and (e) the patient underwent at least a pelvic lymphadenectomy. Recurrence was detected in 56 patients who were histologically diagnosed with low-risk EC, and these patients made up the case group. A total of 224 patients with low-risk EC without recurrence were selected (control group) using a dependent random sampling method. The case and control groups were match-paired in terms of grade, stage, and operative technique.

Results: Lymphovascular space invasion (LVSI) (odds ratio (OR) 5.8, 95% confidence interval (CI) 2.0-16.9; p = 0.001) and primary tumor diameter (PTD) ≥ 20 mm (OR 6.6, 95% CI 2.7-15.8; p < 0.001) were found to be independent risk factors for recurrence in women with low-risk EC.

Conclusion: The presence of LVSI and PTD ≥ 20 mm seem to be significant risk factors for recurrence in women with low-risk EC.
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http://dx.doi.org/10.1159/000488112DOI Listing
August 2019

Prognostic factors for maximally or optimally cytoreduced stage III nonserous epithelial ovarian carcinoma treated with carboplatin/paclitaxel chemotherapy.

J Obstet Gynaecol Res 2018 Jul 4;44(7):1284-1293. Epub 2018 May 4.

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

Objective: To identify factors predictive of poor prognosis in women with stage III nonserous epithelial ovarian cancer (EOC) who had undergone maximal or optimal primary cytoreductive surgery (CRS) followed by six cycles of intravenous carboplatin/paclitaxel chemotherapy.

Methods: A multicenter, retrospective department database review was performed to identify patients with stage III nonserous EOC who had undergone maximal or optimal primary CRS followed by six cycles of carboplatin/paclitaxel chemotherapy at seven gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected.

Results: A total of 218 women met the inclusion criteria. Of these, 64 (29.4%) patients had endometrioid, 61 (28%) had mucinous, 54 (24.8%) had clear-cell and 39 (17.9%) had mixed epithelial tumors. Fifty-five (25.2%) patients underwent maximal CRS, whereas 163 (74.8%) had optimal debulking. With a median follow-up of 31.5 months, the 5-year progression-free survival (PFS) and overall survival (OS) rates were 34.8% and 44.2%, respectively. Bilaterality (hazard ratio [HR] 1.44, 95% CI 1.01-2.056; P = 0.04), age (HR 2.25, 95% CI 1.176-4.323; P = 0.014) and maximal cytoreduction (HR 0.34, 95% CI 0.202-0.58; P < 0.001) were found to be independent prognostic factors for PFS. However, age (HR 2.6, 95% CI 1.215-5.591; P = 0.014) and maximal cytoreduction (HR 0.31, 95% CI 0.166-0.615; P < 0.001) were defined as independent prognostic factors for OS.

Conclusion: The extent of CRS seems to be the only modifiable prognostic factor associated with stage III nonserous EOC. Complete cytoreduction to no gross residual disease should be the main goal of management in these women.
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http://dx.doi.org/10.1111/jog.13663DOI Listing
July 2018

Prognostic factors and patterns of recurrence in lymphovascular space invasion positive women with stage IIIC endometriod endometrial cancer.

J Obstet Gynaecol Res 2018 Jun 8;44(6):1140-1149. Epub 2018 Mar 8.

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

Aim: The purpose of this study was to determine the prognostic factors and patterns of failure in lymphovascular space invasion (LVSI)-positive women with stage IIIC endometrioid endometrial cancer (EC).

Methods: A multicenter, retrospective, department database review was performed to identify LVSI-positive patients with stage IIIC endometrioid EC at five gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected.

Results: We identified 172 LVSI-positive women with stage IIIC endometrioid EC during the study period; 75 (43.6%) were classified as Stage IIIC and 97 (56.4%) as Stage IIIC . The median age at diagnosis was 59 years, and the median duration of follow up was 34.5 months. The total number of recurrences was 46 (26.7%). We observed 14 (8.1%) locoregional recurrences, 12 (7.0%) retroperitoneal failures and 20 (11.6%) distant relapses. For the entire study cohort, 5-year progression-free survival (PFS) was 67.4%, while the 5-year overall survival (OS) rate was 75.1%. Grade 3 histology (hazard ratio [HR] 2.62, 95% confidence interval [CI] 1.34-5.12; P = 0.005), cervical stromal invasion (HR 2.33, 95% CI 1.09-4.99; P = 0.028) and myometrial invasion (MMI) ≥50% (HR 4.0, 95% CI 1.16-13.69; P = 0.028) were found to be independent prognostic factors for decreased OS.

Conclusion: Uterine factors such as grade 3 disease, cervical stromal invasion and deep MMI seem to be independently associated with decreased OS in LVSI-positive women with stage IIIC endometrioid EC. The high distant recurrence rate in this subgroup of patients warrants further studies in order to identify the most effective treatment strategy for those patients.
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http://dx.doi.org/10.1111/jog.13615DOI Listing
June 2018

Comparison Of Early-Stage High-Grade Serous Primary Fallopian Tube Cancers and Epithelial Ovarian Cancers: A Multicenter Study.

Oncol Res Treat 2017 21;40(4):203-206. Epub 2017 Mar 21.

Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.

Introduction: We compared the disease free-survival (DFS) and overall survival (OS) rates of patients with high-grade serous primary fallopian tube cancer (HG-sPFTC) and high-grade serous epithelial ovarian cancer (HG-sEOC).

Methods: 22 early-stage cancer patients (International Federation of Gynecology and Obstetrics (FIGO) stages I-II) with HG-sPFTC were retrospectively evaluated. In addition, 44 control patients diagnosed with HG-sEOC were matched to these patients with respect to tumor stage at diagnosis. All patients underwent complete surgical staging, followed by adjuvant chemotherapy. Kaplan-Meier curves were used to generate survival data.

Results: The mean age of HG-sPFTC patients was 59.4 ± 6.2 years, and that of HG-sEOC patients 55.2 ± 11.0 years (p = 0.002). All patients underwent 6 cycles of platinum-based adjuvant chemotherapy. All operations were optimal. The 5-year DFSs were 77.3% for HG-sPFTC patients and 75% for HG-sEOC patients (p = 1.00).The 5-year OS rates were 81.8% in women with HG-sPFTC and 77.3% in those with HG-sEOC (p = 0.75).

Conclusion: The DFS and OS rates of patients with early-stage (FIGO stages I and II) HG-sPFTC and HG-sEOC were similar. The surgical and adjuvant therapy management of these malignancies should be similar.
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http://dx.doi.org/10.1159/000458440DOI Listing
November 2017

Diagnostic Impacts of Serum CA-125 Levels, Pap Smear Evaluation, and Endometrial Sampling in Women with Endometrial Clear Cell Carcinoma.

Oncol Res Treat 2016 25;39(5):283-8. Epub 2016 Apr 25.

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

Background: Endometrial clear cell carcinoma (ECCC) is a rare variant of endometrial cancer with an unfavorable prognosis. The aim of this study was to determine the relationships, if any, between preoperative serum cancer antigen 125 (CA-125) levels, the last Papanicolaou (Pap) smear, the results of endometrial biopsy and tumor histology, and disease-stage according to permanent histopathology.

Materials And Methods: The data of 26 women with ECCC were collected from their medical records to compare demographics, preoperative serum CA-125 levels, Pap test results, histological diagnosis of the endometrial biopsy, and tumor histology, as well as the disease stage according to permanent histopathology.

Results: The mean age at diagnosis was 64.0 years. There were 17 (65.3%) women with pure ECCC and 8 (30.7%) women with a mixed histology. Stage III-IV disease was diagnosed in 12 (46.2%) women and occurred more frequently in pure ECCC (n = 11, 91.7%). CA-125 values were significantly higher in advanced stage disease. Cytological evaluation indicated the presence of 71.4% (10/14) cytological abnormalities in pure ECCC. The overall sensitivity of endometrial sampling for the detection of malignancy was 92.3% (24/26), whereas the accurate diagnosis of ECCC was only 34.7% (8/23) with the Pipelle sampler.

Conclusion: Pap test abnormalities are frequent in ECCC. Although it is less accurate in the diagnosis of ECCC than in the detection of malignancy, endometrial sampling is still the main procedure for the diagnosis of ECCC. Higher preoperative CA-125 concentrations imply the presence of advanced stage ECCC.
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http://dx.doi.org/10.1159/000445860DOI Listing
April 2017

Abscess in adenomyosis mimicking a malignancy in a 54-year-old woman.

Infect Dis Obstet Gynecol 2003 ;11(1):59-64

Department of Pathology, School of Medicine, Inonu University, Malatya, Turkey.

Background: Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems.

Case: A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95 x 85 mm leiomyoma-like lesion including a 53 x 43 mm cystic space and 9 x 6 mm papillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful.

Conclusion: The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.
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http://dx.doi.org/10.1155/S1064744903000085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1852262PMC
August 2003