Publications by authors named "Nurettin Boran"

68 Publications

Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!

Turk J Med Sci 2021 May 20. Epub 2021 May 20.

Background/aim: The objective of the study was to evaluate the response, relapse, reproductive results and demographic features of the patients with endometrioid adenocancer (EAC) and endometrial intraepithelial neoplasia (EIN) who were treated with conservative treatment. This is the largest study when we consider the single center studies in this field.

Materials And Methods: In the current retrospective study, 38 patients (6 EAC, 31 EIN, 1 synchron tumors of ovary and endometrium) were recruited. They were treated with progesterone products for their fertility desire and comorbidity. Reproductive results, response rates, recurerence rates and survival analyses had calculated.

Results: Mean duration of the medical treatment was 10 months (range 2-60). Among the 32 patients with EIN, 28 (87.5%) had a response, 8 (25%) had a relapse and 4 (12.5%) had a persistance. Among the 32 patients who expecting fertility, seven patients got pregnant (21.8%) with a total of five live births. The median follow-up was 40.5 months (range 3-180), and recurrence-free interval was 28.7 (range 2-180).

Conclusion: Fertility-sparing treatment of EAC and EIN is feasible approach and a chance should be given to spontaneous pregnancies nearby artificial reproductive techniques.
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http://dx.doi.org/10.3906/sag-2012-207DOI Listing
May 2021

Analysis of the prognostic factors determining the oncological outcomes in patients with high-risk early-stage cervical cancer.

J Obstet Gynaecol 2021 May 2:1-8. Epub 2021 May 2.

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

We aimed to evaluate clinicopathological data in high-risk early-stage cervical cancer and to define the prognostic factors determining the oncological outcomes. This retrospective study included 158 patients with stage IB-IIA cervical cancer who underwent radical hysterectomy plus lymph node dissection. Each patient had at least one high-risk factor. The median tumour diameter of the study group was 30 mm (range, 6-80). Seventy-five (47.5%) patients had parametrial invasion, 32 (20.3%) had positive surgical margins, and 108 (68.4%) had lymph node metastasis. The median duration of follow-up was 42 months (range, 1-228). During this period, 28 patients developed recurrence, and the recurrent disease occurred in a distant area in 18 patients. Five-year disease-free survival was 77.5%, and five-year disease-specific survival was 85%. In multivariate analysis, adjuvant radiotherapy was identified as an independent prognostic factor for recurrence and death. The recurrence (Odds ratio: 10.139, 95% CI: 1.477-69.590,  = .018) and mortality rates (Odds ratio: 16.485, 95% CI: 2.484-109.408,  =.004) were higher in patients who did not receive adjuvant therapy.IMPACT STATEMENT The decision to proceed with adjuvant therapy in the patients with early-stage disease treated with surgery depends on the presence of risk factors in pathological examination. Various prognostic factors have been identified in cervical cancer (CC). However, there is a limited number of studies describing the prognostic factors in early-stage CC with high-risk factors. In current study, the recurrence and mortality rates were higher in patients who did not receive adjuvant therapy. No relationship was found between the survival outcomes and the number of high-risk factors. Most of the patients who developed recurrence had the recurrence in the distant localisation. This result questioned the adequacy of adjuvant therapy. There is still a debate over the prognostic factors and the adjuvant treatment options in the patients with early-stage cervical cancer who possess high-risk factors. Adjuvant RT or adjuvant concomitant chemoradiotherapy must definitely be used in this patients. However, adjuvant therapy fails approximately 14-32%, thus multimodal treatment modalities must be developed to improve the recurrence rates and the survival.
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http://dx.doi.org/10.1080/01443615.2021.1882974DOI Listing
May 2021

Recurrence pattern and prognostic factors for survival in cervical cancer with lymph node metastasis.

J Obstet Gynaecol Res 2021 Jun 25;47(6):2175-2184. Epub 2021 Mar 25.

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

Aim: The aim of this study is to evaluate the recurrence pattern and oncological outcomes in cervical cancer (CC) patients with lymph node metastasis.

Methods: This study included 224 International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-IIIB CC patients with pathologically proven lymph node metastasis. Surgical intervention was grouped as hysterectomy performed/not performed. Adjuvant therapy decision was made by the tumor board. Radiotherapy was applied to all patients with lymph node metastasis.

Results: Only paraaortic lymph node metastasis was determined as an independent prognostic factor for recurrence. Presence of paraaortic lymph node metastasis increased the risk of recurrence more than two times (odds ratio: 2.129; 95% confidence interval: 1.011-4.485; p = 0.047). An independent prognostic factor for death because of disease was age only. Risk of death was nearly doubled with younger age (odds ratio: 2.693; 95% confidence interval: 1.064-6.184; p = 0.037).

Conclusion: The most of recurrences were located at distant sites and multiple regions. Paraaortic lymph node metastasis was the only independent prognostic factor for recurrence, in spite of that age was an independent predictor for risk of death in patients with early stage or locally advanced CC and also with surgically proven metastatic lymph nodes. Furthermore, the presence of the paraaortic lymph node metastasis was significantly associated with distant recurrence. Therefore, more appropriate and individualized therapy strategy focusing on intenser systemic chemotherapy options in addition to radiotherapy should be taken into consideration according to paraaortic lymph node metastasis and age.
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http://dx.doi.org/10.1111/jog.14762DOI Listing
June 2021

Prognostic factors and survival outcomes of women with uterine leiomyosarcoma: A Turkish Uterine Sarcoma Group Study-003.

Curr Probl Cancer 2021 Feb 9:100712. Epub 2021 Feb 9.

Department of Gynecologic Oncology, Ankara State Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

To assess the clinicopathological features, prognostic factors, and survival rates associated with uterine leiomyosarcoma (uLMS). Databases from 15 participating gynecological oncology centers in Turkey were searched retrospectively for women who had been treated for stage I-IV uLMS between 1996 and 2018. Of 302 consecutive women with uLMS, there were 234 patients with Federation of Gynecology and Obstetrics (FIGO) stage I disease and 68 with FIGO stage II-IV disease. All patients underwent total hysterectomy. Lymphadenectomy was performed in 161 (54.5%) cases. A total of 195 patients received adjuvant treatment. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 42% and 54%, respectively. Presence of lymphovascular space invasion (LVSI), higher degree of nuclear atypia, and absence of lymphadenectomy were negatively correlated with DFS, while LVSI, mitotic count, higher degree of nuclear atypia, FIGO stage II-IV disease, and suboptimal surgery significantly decreased OS. LVSI and higher degree of nuclear atypia appear to be prognostic indicators for uLMS. Lymphadenectomy seems to have a significant effect on DFS but not on OS.
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http://dx.doi.org/10.1016/j.currproblcancer.2021.100712DOI Listing
February 2021

The role of lymphadenectomy in patients with stage III&IV uterine serous carcinoma: Results of multicentric Turkish study.

J Gynecol Obstet Hum Reprod 2021 May 13;50(5):102063. Epub 2021 Jan 13.

Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey. Electronic address:

Objective: The aim of this study was to evaluate clinicopathological features, oncological outcome and prognostic factors for recurrence in advanced stage uterine serous carcinoma (USC) patients.

Methods: Patients with 2009 International Federation of Gynecology and Obstetrics stage III&IV uterine serous carcinoma were enrolled from 4 gynecologic oncology centers and a study group was created. Response to therapy was evaluated according to the WHO criteria. Progression-free survival (PFS) and overall survival (OS) estimates were determinated by using the Kaplan-Meier method. Survival curves were compared with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model.

Results: Entire cohort included 63 patients. Median age of cohort was 64 years. Thirty-five (55.6 %) patients were stage IV. Lymphadenectomy was performed in 57 (90.5 %) patients and lymph node metastasis was positive in 45 (71.4 %) patients. Maximal cytoreduction (no residue tumor) was achieved in 53 (84.1 %) patients. However, optimal cytoreduction (residue tumor ≤1 cm) was achieved in 6 (9.5 %) patients and suboptimal cytoreduction (residue tumor >1 cm) was achieved in 3 (4.8 %) patients. Median follow-up time was 19 (range;1-152) months. Complete clinical response was obtained in 58 (92.1 %) patients after standard adjuvant therapy. Disease failure was detected in 25 patients. Study group had a 2-year PFS of 51 % and 2-year OS of 80 %. On multivariate analysis, performing lymphadenectomy was an independent prognostic factor for PFS (Odds ratio: 24.794, 95 % Confidence Interval: 4.214-145.869; p < 0.001).

Conclusion: Lymphadenectomy should be a part of the standard surgical therapy in advanced stage USC.
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http://dx.doi.org/10.1016/j.jogoh.2021.102063DOI Listing
May 2021

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

Pulmonary morbidity related to diaphragm surgery performed for gynecological cancers.

Turk J Obstet Gynecol 2020 Dec 10;17(4):292-299. Epub 2020 Dec 10.

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

Objective: To evaluate pulmonary morbidity related to diaphragm surgery performed for gynecological cancers and to identify the impact of transdiaphragmatic thoracotomy.

Materials And Methods: We reviewed clinical and pathologic data of 232 women who had undergone diaphragm surgery as a part of cytoreductive surgery procedures performed for gynecological cancers.

Results: Transdiaphragmatic thoracotomy occurred in 52 patients (22.4%). Rate of pulmonary complications among patients who had a transdiaphragmatic thoracotomy was higher compared with patients who did not have a transdiaphragmatic thoracotomy (40.4% vs 20.6%, p=0.004). Transdiaphragmatic thoracotomy [odds ratio (OR), 2.66; 95% confidence interval (CI), 1.20-5.92; p=0.016], colon resection (OR, 5.21; 95% CI, 2.34-11.63; p<0.001), ileostomy (OR, 19.61; 95% CI, 1.64-250.0; p=0.019), and any extra-pulmonary complication occurrence (OR, 2.35; 95% CI, 1.13-4.88; p=0.023) were identified as independent predictors of pulmonary morbidity. Patients with transdiaphragmatic thoracotomy developed pleural effusion, pleural effusion necessitating drainage, pneumothorax, pneumonitis, and atelectasis more frequently compared with patients who did not have transdiaphragmatic thoracotomy. Rate of admission to postoperative intensive care of patients with transdiaphragmatic thoracotomy (30.8%) was significantly higher than that of patients without transdiaphragmatic thoracotomy (12.2%) (p=0.001).

Conclusion: Transdiaphragmatic thoracotomy is an independent predictor of pulmonary morbidity among patients who underwent diaphragm surgery. Avoiding accidental transdiaphragmatic thoracotomies with maximal attention and performing full-thickness resection procedures with alternative surgical techniques preventing a thoracotomy may help decrease pulmonary morbidity rates and postoperative care costs.
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http://dx.doi.org/10.4274/tjod.galenos.2020.54781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731606PMC
December 2020

Retrospective Analysis of Pure Ovarian Immature Teratoma in Patients Aged 15-39 Years: A Turkish Multicenter Study.

J Adolesc Young Adult Oncol 2020 Dec 9. Epub 2020 Dec 9.

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

To evaluate the clinicopathological characteristics and surgical outcomes in patients with pure ovarian immature teratomas (POITs). In this multicenter study, a retrospective review was made of the databases of six Gynecology Oncology Departments in Turkey to identify patients with POITs who had undergone surgery between 1993 and 2019. Evaluation was made of 48 patients with a median age at diagnosis of 22.5 years (range, 15-37 years). In 40 (83%) patients, stage I was determined and in eight patients, an advanced stage (IIIB, IIIC, and IVB) was determined. Tumors were found to be grade I in 17 (35.4%) cases, grade II in 12 (25%), and grade III in 19 (39.6%). Fertility-sparing surgery was applied to 42 (87.5%) patients and radical surgery to 6 (12.5%). The median follow-up was 60 months (range, 3-246 months). Recurrence was seen in seven patients, all with grade III tumors. In the final pathological examination of recurrent tumors, mature teratoma was reported in five patients, and immature teratoma in one patient. Salvage surgery was not performed in one patient as the tumor was unresectable and so a regimen of bleomycin, etoposide, and cisplatin (BEP) was administered. POITs are rare tumors seen at a young age, and benign or malignant relapse can be seen in these tumors. In this cohort, the malignant recurrence rate was 4.1%, and the benign recurrence rate was 10.4%. All the recurrences were in grade III tumors. Benign recurrences can be treated with surgery alone and the malignant group should be treated with surgery followed by chemotherapy.
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http://dx.doi.org/10.1089/jayao.2020.0155DOI Listing
December 2020

Patterns of diaphragm involvement in stage 3B/3C ovarian-tubal-peritoneal epithelial cancer patients and survival outcomes.

Arch Gynecol Obstet 2021 01 28;303(1):241-248. Epub 2020 Sep 28.

Gynecological Oncology Department, University of Health Sciences, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Etlik Street, Ankara, 06010, Turkey.

Purpose: Demonstrate survival outcomes of stage 3B/3C ovarian-tubal-peritoneal epithelial cancer patients who had metastases on diaphragm.

Methods: 141 patients who had undergone diaphragm surgery as a part of primary cytoreductive surgery procedures performed for stage 3B and 3C ovarian-tubal-peritoneal epithelial cancers were reviewed retrospectively. Patients who were administered neoadjuvant chemotherapy and patients who were suboptimally cytoreduced were not included to the study.

Results: Median follow-up time was 42 months. Median overall survival of the patients who underwent diaphragm full-thickness resection (n = 18) because of tumors infiltrating diaphragm muscle was 40 months. Median overall survival of the patients who did not have a transdiaphragmatic thoracotomy (n = 113) was 77 months. Patients who underwent a willful full-thickness diaphragm resection because of tumors invading diaphragm muscle had significantly shorter survival compared with patients who did not have a transdiaphragmatic thoracotomy (p = 0.033). Seven (38.9%) of the 18 patients who underwent diaphragm full-thickness resection developed a recurrence in thorax. Twelve (9.8%) of the remaining 123 patients developed a recurrence in thorax. Patients who underwent full-thickness diaphragm resection because of tumors infiltrating diaphragm muscle developed recurrence in the thorax more frequently (p = 0.001).

Conclusions: Diaphragm muscle involvement is a predictor of thorax recurrences and worse survival outcomes in stage 3B and 3C ovarian-tubal-peritoneal epithelial cancers. Thus, this should be considered when selecting appropriate adjuvant treatment and route of administration (intravenous/intraperitoneal) in patients who had diaphragm implants infiltrating diaphragm muscle.
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http://dx.doi.org/10.1007/s00404-020-05802-0DOI Listing
January 2021

Ovarian Dysgerminoma: A Tertiary Center Experience.

J Adolesc Young Adult Oncol 2021 Jun 5;10(3):303-308. Epub 2020 Aug 5.

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

The aim of this study is to evaluate the oncologic outcome in patients with pure ovarian dysgerminomas treated and followed-up in our hospital. This study included 18 ovarian dysgerminoma patients with unilateral and/or bilateral salpingo-oophorectomy (BSO) ± hysterectomy+omentectomy+bilateral pelvic ± para-aortic lymphadenectomy+peritoneal cytologic sampling. Four (22%) patients underwent definitive surgery, including type I hysterectomy and BSO. Only one of the remaining 14 patients underwent BSO because of bilateral streak gonad presence during intraoperative examination. Thirteen patients (72%) had conservative surgeries. In addition, staging surgeries were performed to all patients except for one patient with 16 weeks of pregnancy (patient #3) in the study group. Retroperitoneal lymphadenectomy was part of the staging procedure except for this pregnant patient. Lymph node metastasis was positive in four (22%) patients. Three (16%) patients recurred and none of them died because of disease during follow-up period. Two of the relapsed patients were treated with combination of surgery and chemotherapy, whereas the third patient received only chemotherapy for treatment. Fertility sparing surgery should be the choice of treatment in patients with pure ovarian dysgerminoma. In addition, staging surgery, including retroperitoneal lymph node dissection is obligatory for determining stage IA patients who are exempt from adjuvant chemotherapy. Close surveillance policy enables early detection of patients with recurrences in whom salvage therapy is highly curable.
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http://dx.doi.org/10.1089/jayao.2020.0087DOI Listing
June 2021

Complementary surgery for cervical cancer patients inadequately treated with extrafacial hysterectomy.

J Gynecol Obstet Hum Reprod 2020 Nov 13;49(9):101800. Epub 2020 May 13.

Acibadem University Hospital, İstanbul, Turkey.

Objective: To evaluate surgical outcomes and survival outcomes of cervical cancer patients who underwent complementary surgery after an extrafacial hysterectomy METHODS: Patients with cervical cancer, who underwent extrafacial hysterectomy initially and thereafter underwent complementary surgery were reviewed retrospectively. Complementary surgery consisted of radical parametrectomy, proximal vaginectomy and pelvic lymphadenectomy.

Results: Twenty patients were evaluated. Histopathologic subtype was squamous cell carcinoma in twelve patients, adenocarcinoma in six patients and adenosquamous carcinoma in two patients. Route of surgery was laparotomy in 19 patients and laparoscopy in one patient. Two patients were staged as stage 1A2, nine were staged as stage 1B1, four were staged as stage 1B2, one was staged as stage 2A1, one was staged as stage 2B and three were staged as stage 3C1. The median tumor size was 16.5 (Range, 4-40) mm. Grade ≥ 3 complications related to surgery occured in 8 (40%) patients. Four of them were managed intraoperatively and recovered problem free. Remaining four (20%) needed reoperation. Pathology reports revealed involvement of parametrium in one (5%) patient, involvement of the proximal vagina in one (5%) patient, matastasis to pelvic lymph nodes in 3 (15%) patients. Five (25%) patients received adjuvant radiotherapy. Consequently, 5-year and 10-year cumulative survival was calculated as 94%.

Conclusion: Complementary surgery and radiotherapy show similar oncologic outcomes in patients with early-stage cervical cancer who had undergone simple hysterectomy initially. Complementary surgery is associated with slightly higher rate of morbidity compared with radiotherapy, however significant proportion of complications can be noticed and repaired intraoperatively.
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http://dx.doi.org/10.1016/j.jogoh.2020.101800DOI Listing
November 2020

A RARE CASE OF A RETROPERITONEAL LEIOMYOMATOSIS.

J Gynecol Obstet Hum Reprod 2021 Jun 20;50(6):101760. Epub 2020 Apr 20.

Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Clinic, Health Sciences University, TURKEY. Electronic address:

Leiomyomas are mostly located in the uterus.Retroperitoneal presentation of leiomyomas are rare and have a greater diagnostic challenge.Because retroperinoteal tumours are quite rare and mostly malignant. Therefore, differantial diagnosis is difficult.We report a rare case of retroperitoneal leiomyomatosis, in which there were concurrent leiomyomas in uterus, pelvic and paraaortic regions that are adjacent to pelvic and paraaortic vascular structures.The patient underwent type 1 hysterectomy and bilateral salpingo-oophorectomy and had a total excision of the myomas from adjacent structures. Histological examination of the surgical specimen revealed that leiomyoma. She has been disease -free for 24 months now.
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http://dx.doi.org/10.1016/j.jogoh.2020.101760DOI Listing
June 2021

High-grade uterine corpus-confined endometrial cancer with lymphadenectomy: does adjuvant therapy improve survival?

Turk J Obstet Gynecol 2019 Sep 10;16(3):180-186. Epub 2019 Oct 10.

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

Objective: To evaluate the necessity of adjuvant therapy and other prognostic factors in high-grade uterine corpus-confined endometrial cancer (EC) with lymphadenectomy performed.

Materials And Methods: This study included 120 patients who had endometrioid-type grade 3, serous-type, clear cell-type, and undifferentiated-type EC and underwent lymphadenectomy.

Results: Patients with high-grade uterine corpus-confined EC who underwent lymphadenectomy were evaluated. The modality of adjuvant therapy performed was not a predictor for the site of recurrence. The loco-regional recurrence rate decreased from 9.5% to 3.8% in patients who received radiotherapy. However, this difference was not statistically significant (p=0.206). In addition, performing adjuvant chemotherapy did not alter the risk of extrapelvic recurrence. Only International Federation of Gynecology and Obstetrics 2009 stage was significant in the univariate analysis. On the other hand, age, tumor type, number of removed lymph nodes, presence of myometrial and lymphovascular space invasion, tumor size and adjuvant therapy modality were not related with disease-free survival.

Conclusion: Performing adjuvant therapy and therapy modality does not improve oncologic outcomes in intermediate and high-risk patients. However, radiotherapy reduced the risk of local recurrence by more than 50%. Vaginal brachytherapy was efficient as external beam radiotherapy. Therefore, vaginal brachytherapy should be used for these patients in order to reduce loco-regional recurrence even if it is not reported to be effective on disease-free survival.
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http://dx.doi.org/10.4274/tjod.galenos.2019.04578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792051PMC
September 2019

Metastasis patterns of the spleen and association with survival outcomes in advanced ovarian-tubal-peritoneal epithelial cancer.

Arch Gynecol Obstet 2019 11 23;300(5):1367-1375. Epub 2019 Sep 23.

Gynecological Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, University of Health Sciences, Etlik Street, 06010, Ankara, Turkey.

Purpose: To evaluate the significance of parenchymal, hilar and capsular involvement of the spleen with regard to survival.

Methods: All patients who underwent primary cytoreductive surgery for advanced ovarian-tubal-peritoneal (OTP) epithelial cancer were reviewed retrospectively. Stage 3C patients who had an upper abdomen involvement and who were optimally debulked were included. Patients who had abdomen-confined disease, but were upstaged to stage 4B due to splenic parenchymal metastases were also included.

Results: Seventy four patients eligible with the inclusion criteria who underwent splenectomy and 69 patients who did not undergo splenectomy were included. The median follow-up time was 39.1 months. The median overall survival of the study group was 61.4 months. Patients who underwent splenectomy were grouped according to the involved site of the spleen: parenchyma subgroup, hilus subgroup, capsule subgroup and benign subgroup. The median overall survival of patients in the hilus subgroup was 41.1 months. The median overall survival of patients who were not in the hilus subgroup was 65.5 months. Patients in the hilus subgroup showed significantly shorter survival (p = 0.035). Hilus subgroup was associated with a statistically significant increase in mortality risk (hazard ratio 1.971; 95% confidence interval 1.1-3.531).

Conclusions: Splenic hilus involvement predicts poorer survival outcomes among stage 3C epithelial OTP cancer patients with disease expansion to upper abdomen. According to current study and many published studies, hilar involvement had a higher incidence rate compared to parenchymal involvement. Thus, hilar involvement would be a beneficial clinical predictor of survival for larger number of patients.
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http://dx.doi.org/10.1007/s00404-019-05300-yDOI Listing
November 2019

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

Sertoli-Leydig cell tumor of the ovary: Analysis of a single institution database and review of the literature.

J Obstet Gynaecol Res 2019 Jul 20;45(7):1311-1318. Epub 2019 May 20.

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

Aim: To evaluate the clinical characteristics and outcome of ovarian Sertoli-Leydig cell tumors (SLCTs) managed at a single institution.

Methods: The hospital records of 17 patients with the diagnosis of ovarian SLCT between 1994 and 2018 were reviewed retrospectively.

Results: The median age of the patients was 30 years (range, 18-67 years). All the patients had unilateral tumors. All of the 17 were stage 1 tumors. Two (11.8%) patients were stage 1C1 and two (11.8%) patients were stage 1C2. Thirteen (76.5%) patients were stage 1A. Three (17.6%) of the tumors were well differentiated, 11 (64.7%) were intermediately differentiated, 1 (5.9%) was poorly differentiated, and the degree of the differentiation was not identified for 2 (11.8%) patients. One showed retiform pattern and one had heterologous elements at the histopathologic evaluation. Among the 17 patients, we identified structural/vascular renal and ureteral anomalies in 3 (17.6%) patients. Eight patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, seven underwent unilateral salpingo-oophorectomy or oophorectomy and two underwent cystectomy with or without additional surgical staging procedures. Four patients received adjuvant chemotherapy. All the 17 patients were alive and free of disease for 1-287 months after the diagnosis. Median follow-up time was 78 months. None of the patients recurred.

Conclusion: Sertoli-Leydig cell tumors are rare ovarian malignancies with low recurrence rates and have a favorable outcome compared to malignant epithelial tumors of the ovary. Main treatment is surgical resection and it is appropriate to prefer fertility sparing conservative surgeries for young patients.
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http://dx.doi.org/10.1111/jog.13977DOI Listing
July 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

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

Uncommon borderline ovarian tumours: A clinicopathologic study of seventeen patients

J Turk Ger Gynecol Assoc 2019 11 4;20(4):224-230. Epub 2018 Sep 4.

Department of Gynecologic Oncology Surgery, University of Health Sciences, Etlik Zübeyde Hanım Women Disease Training and Research Hospital, Ankara, Turkey

Objective: To evaluate uncommon types of borderline ovarian tumors (BOT) and define the clinical, surgical, and pathologic features.

Material And Methods: Seventeen patients who were treated in our hospital between 1990 and 2017 were identified. Patients’ data were collected from the gynecologic oncology clinic electronic database, patients’ files, and pathology reports. Conservative surgery was defined as preservation of the uterus and at least part of one ovary.

Results: The mean age was 47 (range, 22-70) years. Based on histopathologic tumor type, there was mixed tumor in five (29.4%) patients, endometrioid-type in nine (52.9%), seromusinous-type in two (11.8%), and Brenner-type in one (5.9%). Conservative surgery was performed in 4 patients. Two patients with endometrioid BOT had synchronous endometrial pathology, including one (11%) patient with endometrial cancer, one (11%) with endometrial hyperplasia without atypia, and 3 (33%) patients had endometriosis. The median follow-up was 19 (range, 1-137) months. No recurrence was observed during the follow-up period.

Conclusion: In our small volume case series, it could be said that non-serous/non-mucinous BOT has excellent prognosis. However, endometrial pathology should be checked in endometrioid type.
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http://dx.doi.org/10.4274/jtgga.galenos.2018.2018.0098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883761PMC
November 2019

Pro-Gastrin Releasing Peptide: A New Serum Marker for Endometrioid Adenocarcinoma.

Gynecol Obstet Invest 2018 13;83(6):540-545. Epub 2018 Jun 13.

Department of Pathology, Ufuk University Faculty of Medicine, Ankara, Turkey.

Background: Gastrin-releasing peptide (GRP) is thought to play a role in the metastatic process of various malignancies. The more stable precursor of GRP, pro-GRP (ProGRP), has been shown to be secreted by neuroendocrine tumors. This study was designed to assess the validity of ProGRP as a diagnostic marker in endometrioid adenocarcinomas (EAs) of the endometrium.

Methods: Thirty-seven patients with a diagnosis of EA, 23 patients with endometrial hyperplasia, and 32 age-matched controls with normal endometrial histology were recruited for this study. Serum ProGRP and cancer antigen 125 (CA125) values were compared between groups.

Results: Median serum ProGRP levels were significantly higher in the cancer group compared to corresponding levels in both the hyperplasia and control groups (p = 0.008 and p < 0.001 respectively; endometrial cancer: 27.5 pg/mL; hyperplasia: 16.1 pg/mL; controls: 12.9 pg/mL). Age and endometrial thickness were positively correlated with ProGRP levels (r = 0.322, p = 0.006 and r = 0.269, p = 0.023, respectively). Receiver Operating Characteristic curve analyses for EA revealed a threshold of 20.81 pg/mL, with a sensitivity of 60.7% and specificity of 81.4%, positive predictive value of 68% and negative predictive value of 76.1%.

Conclusion: Significantly higher ProGRP levels were observed in patients with EA than in controls. Serum ProGRP has good diagnostic sensitivity and specificity for EA.
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http://dx.doi.org/10.1159/000488854DOI Listing
January 2019

A comparison of clinico-pathologic characteristics of patients with serous and clear cell carcinoma of the uterus.

Turk J Obstet Gynecol 2016 Sep 15;13(3):137-143. Epub 2016 Sep 15.

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

Objective: Serous carcinoma and clear cell carcinomas account for 10% and 3% of endometrial cancers but are responsible for 39% and 8% of cancer deaths, respectively. In this study, we aimed to compare serous carcinoma and clear cell carcinoma regarding the surgico-pathologic and clinical characteristics, and survival, and to detect factors that affected recurrence and survival.

Materials And Methods: We retrospectively analyzed patients with clear cell and serous endometrial cancer who underwent surgery between January 1993 and December 2013 in our clinic. We used Kaplan-Meier estimator to analyze survival.

Results: The tumor type in 49 patients was clear cell carcinomas and was serous uterine carcinoma in 51 patients. Advanced stage (stage III and IV) disease was present in 42% of the patients in the clear cell group, whereas this rate was 62% in the serous group (p=0.044). Lymph node metastasis was detected in 37% of the patients with clear cell carcinomas and 51% of the patients with serous carcinoma (p=0.17). The adjuvant therapies used did not differ significantly between the groups (p=0.192). The groups had similar recurrence patterns. Five-year progression-free survival and the 5-year overall survival were 60.6% and 85.8%, 45.5% and 67.8% in the patients with clear cell carcinomas and serous tumor, respectively.

Conclusion: With the exception that more advanced stages were observed in patients with serous carcinoma endometrial cancers at presentation, the surgico-pathologic features, recurrence rates and patterns, and survival rates did not differ significantly between the groups with clear cell carcinoma and serous carcinoma endometrial cancers.
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http://dx.doi.org/10.4274/tjod.14478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558304PMC
September 2016

Extraperitoneal lymph node dissection in locally advanced cervical cancer; the prognostic factors associated with survival.

J Turk Ger Gynecol Assoc 2017 06 7;18(2):77-84. Epub 2017 Feb 7.

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

Objective: Surgical staging was recently recommended for the decision of treatment in locally advanced cervical cancer. We aimed to investigate clinical outcomes as well as factors associated with overall survival (OS) in patients with locally advanced cervical cancer who had undergone extraperitoneal lymph node dissection and were managed according to their lymph node status.

Material And Methods: The medical records of 233 women with stage IIb-IVa cervical cancer who were clinically staged and underwent extraperitoneal lymph node dissection were retrospectively reviewed. Paraaortic lymph node status determined the appropriate radiotherapeutic treatment field. Surgery-related complications and clinical outcomes were evaluated.

Results: The median age of the patients was 52 years (range, 26-88 years) and the median follow-up time was 28.4 months (range, 3-141 months). Thirty-one patients had laparoscopic extraperitoneal lymph node dissection and 202 patients underwent laparotomy. The number of paraaortic lymph nodes extracted was similar for both techniques. Sixty-two (27%) of the 233 patients had paraaortic lymph node metastases. The 3-year and 5-year OS rates were 55.1% and 46.5%, respectively. The stage of disease, number of metastatic paraaortic lymph nodes, tumor type, and paraaortic lymph node status were associated with OS. In multivariate Cox regression analyses, tumor type, stage, and presence of paraaortic lymph node metastases were the independent prognostic factors of OS.

Conclusion: Paraaortic lymph node metastasis is the most important prognostic factor affecting survival. Surgery would give hints about the prognosis and treatment planning of the patient.
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http://dx.doi.org/10.4274/jtgga.2016.0202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5458440PMC
June 2017

Amphricrine carcinoma of the cervix-adeno neuroendocrine tumor: A case report.

Turk J Obstet Gynecol 2016 Jun 15;13(2):99-102. Epub 2016 Jun 15.

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

Adenoneuroendocrine carcinoma is a very rare form of cervical carcinoma that includes both endocrine and exocrine components. In general terms, these carcinomas progress aggressively and show early metastases due to the neuroendocrine component. The most important criteria related to prognosis is the stage of the disease. Without clearly determined therapeutic protocols this carcinoma is generally seen at earlier ages and causes high mortality. Many radiotherapy and multidrug chemotherapy protocols are used after surgical intervention. Detection of the neuroendocrine component of cervical tumors is achieved through immunohistochemical staining. Herein, we present a woman aged 50 years who was admitted to the hospital with abdominal pain and postmenopausal vaginal bleeding whose examination revealed a cervical tumor. A pathologic examination after surgery resulted as "adenocarcinoma and large cell neuroendocrine carcinoma." Afterwards, a combined chemotherapy regimen (cisplatin + etoposid) was administered to the patient and 6 months of progress is evaluated in this report.
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http://dx.doi.org/10.4274/tjod.72325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558347PMC
June 2016

Maximum surgical effort is warranted for recurrent adult granulosa cell tumors of ovary.

Tumori 2016 Aug 9;102(4):404-8. Epub 2016 May 9.

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

Purpose: Adult granulosa cell tumor (AGCT) of ovary is a rare tumor and usually has a benign course. Due to its indolent nature, recurrences are observed in a wide period and data on management of recurrences in AGCT are relatively sparse. We aimed to evaluate the clinical features, management, and survival of patients with recurrent AGCT.

Methods: The data of 144 patients with AGCT treated in Etlik Zubeyde Hanim Teaching and Research Hospital between 1990 and 2013 were retrospectively evaluated. Patients with radiologic or pathologic recurrences were included in the analysis.

Results: A total of 18 patients (12.5%) with recurrent AGCT were included. Median follow-up was 97.5 months (range 6-255 months). A total of 16 patients underwent salvage surgery and maximal debulking was achieved in 13 patients. Ten patients had unifocal and 8 had multifocal tumors. Maximal debulking could be achieved in all patients with unifocal recurrence. On the other hand, maximal debulking could only be obtained in 3 patients (37%) with multifocal recurrence (p = 0.031). Multifocality of recurrent disease and the presence of residual tumor after surgery were associated with diminished progression-free survival and overall survival (31 vs 207 months, p = 0.031; and 22 vs 220 months, p = 0.005, respectively).

Conclusions: Multifocal recurrence and suboptimal surgery were related with poor survival outcomes in patients with AGCT recurrence. Surgical treatment of recurrent AGCT should aim to achieve no visible disease.
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http://dx.doi.org/10.5301/tj.5000510DOI Listing
August 2016

Prognostic Factors in Adult Granulosa Cell Tumor: A Long Follow-Up at a Single Center.

Int J Gynecol Cancer 2016 May;26(4):619-25

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

Objective: In this study, we aimed to demonstrate characteristics, recurrence rates, survival numbers, and factors associated with survival of patients with adult granulosa cell tumor (AGCT) from a single institution. Our secondary goal was to evaluate the necessity of staging surgery and the importance of a comprehensive lymphadenectomy in these patients.

Methods: The data of 158 patients in our institution who were diagnosed with AGCT between 1988 and 2013 were evaluated. The data were obtained from the files of the patients, electronic database of the gynecologic oncology clinic, operation notes, and pathology records.

Results: The median (range) age of the patients was 50.3 (22-82) years. The main symptom was postmenopausal bleeding (25.9%). Seventy-six percent of the patients underwent staging surgery including lymphadenectomy. Among these patients, 3 (2.5%) had lymph node metastasis. The median (range) follow-up time was 97 (1-296) months. In the follow-up period, 18 patients (12.5%) had recurrence. Menopausal status (P = 0.016), advanced age (P = 0.024), cyst rupture (P = 0.001), poorly differentiated tumor (P = 0.002), and advanced stage (P < 0.001) were associated with recurrence. Stage was the only independent prognostic factor for the development of recurrence. None of the patients had lymph node failure.

Conclusions: In the present study with a long follow-up period and in which most of the patients had staging surgery including lymphadenectomy (76.6%), lymph node recurrence was not observed and the total recurrence rate (12.5%) was lower than that reported in the literature. The study showed the importance of surgical staging in patients with AGCT.
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http://dx.doi.org/10.1097/IGC.0000000000000659DOI Listing
May 2016

Reimplantation of an autoamputated ovary in the omentum: A case report.

Turk J Obstet Gynecol 2015 Dec 15;12(4):248-250. Epub 2015 Dec 15.

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

Autoamputation is one of the complications of ovarian torsion. In many cases, ovarian torsion develops as a result of mature cystic teratoma. Herein, we present a woman aged 27 years whose right ovary was autoamputated and reimplanted in the omentum. It should be noted that autoamputated ovaries can reimplant in surrounding tissues by revascularization and present as mobile abdominal masses with atypical localization.
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http://dx.doi.org/10.4274/tjod.24022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563534PMC
December 2015

The Factors Predicting Recurrence in Patients With Serous Borderline Ovarian Tumor.

Int J Gynecol Cancer 2016 Jan;26(1):66-72

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

Objective: In this study, we aimed to demonstrate the characteristics, recurrence rates, survival, and factors associated with survival of patients with serous borderline ovarian tumor (BOT) who were operated on in a single institution. Our secondary goal was to evaluate the necessity of staging surgery and the importance of a comprehensive lymphadenectomy in these patients.

Materials And Methods: The patients who were diagnosed in our institution between January 1990 and April 2014 with a final diagnosis of serous BOT were evaluated retrospectively. Kaplan-Meier method was used for analysis of progression-free survival (PFS). Univariate Cox proportional hazards model and log rank test were used for analysis of continuous and categorical variables affecting survival, respectively.

Results: One hundred twenty-one (75%) patients underwent staging surgery. Stage I disease was observed in 63%, stage III was observed in 11% of the patients, and only 0.6% of patients had stage II disease. Among 162 patients, 72 patients (44%) had conservative surgery. Eight (4.9%) patients had recurrence, one of which was invasive. All recurrences were in the patients who had conservative surgery. Median follow-up of the patients was 57 months (range, 37-270 years). Five- and 10-year PFS rates were 94.9% and 92.8%, respectively. In the univariate analysis of patients with serous BOT, PFS was worse in the presence of positive para-aortic lymph nodes, positive abdominal cytology, and conservative surgery (P = 0.008, P < 0.001, P = 0.007, respectively). The patients having noninvasive implant and advanced-stage disease had a tendency to have worse PFS (P = 0.067, P = 0.069, respectively).

Conclusions: Staging surgery generally gives us an idea of the probability of recurrence but not an idea of overall survival. Therefore, staging surgery including lymphadenectomy could be suggested to have information about the probability of recurrence and to be able to detect patients with an invasive implant that is the only probable factor affecting overall survival.
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http://dx.doi.org/10.1097/IGC.0000000000000568DOI Listing
January 2016

Malignant transformation of mature cystic teratoma of the ovary: a case series.

J Exp Ther Oncol 2015 ;11(1):11-6

The aim of this study was to analyze the patients with malignant transformation (MT) arising in mature cystic teratoma of the ovary (MCTO) and evaluate the clinicopathologic features, managements, and prognosis of these cases. The records of the patients with MT arising in MCTO who were treated at our hospital were reviewed retrospectively. The demographic features, presenting symptoms, preoperative ultrasonographic evaluations, surgical treatments, pathological findings, adjuvant therapies, follow-up outcomes, and survival time were examined. Eighteen patients with MT arising in MCTO were detected during the study period. The incidence rate of MT was 0.404% of all MCTO and squamous cell carcinoma was the most common histologic type (66.7%). The median age of the patients was 48 (range, 28-79) and the mean tumor size was 12 cm. Eleven patients (61.1%) were classified as stage IA, 1 (5.6%) as stage IC, 1 (5.6%) as stage IIC, 4 (22.2%) as stage IIIC, and the remaining 1 (5.6%) as stage IV. The overall 5-year survival rate was 66.7%. MT of MCTO is a rare occurrence entity and early detection and complete surgical staging are cardinal for survival. Additionally, this malignancy usually occurs in postmenopausal women and the high tumor diameter may be associated with MT.
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September 2015