Publications by authors named "Osman Türkmen"

47 Publications

Evaluation of peripheral nodal recurrence in patients with endometrial cancer.

J Turk Ger Gynecol Assoc 2021 Jun 10. Epub 2021 Jun 10.

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

Objective: We aimed to evaluate the clinico-pathological patient features, prognostic factors, treatment options and outcomes of peripheral nodal recurrence (PNR) of endometrial cancer (EC).

Material And Methods: The data of 9 patients with PNR of EC from two institutions were reviewed. The electronic literature was reviewed from 1972 to May 2018 to identify articles about PNR in EC. Finally, 42 cases were evaluated.

Results: 19 (45.2%) patients were initially diagnosed with either stage I or II disease, whereas 20 (47.7%) patients had stage III or IV disease. The stages were not reported in 3 patients. PNR developed as the first recurrence in 40 (95.2%) patients and as the second recurrence in 2 (4.8%) patients. Isolated PNR appeared in 35 (83.3%) patients. Seven (16.7%) patients had PNR coexisting with multiple other sites of tumoral involvement. In the entire cohort, the 5-year and 10-year post-recurrence survival (PRS) were both 78%. Only the presence of distant hematogenous metastasis concurrent with PNR was significantly related to poor PRS (p=0.005). Among patients with isolated PNR, those who had surgery had 30% higher 5-year PRS than those treated without surgery, however, this difference was not found as statistically significant (80% vs. 50%; p>0.05).

Conclusion: A concurrent distant hematogenous metastasis was the only factor related to poor survival. A wide range of therapies exist for PNR but none of the therapies appear to be more advantageous over others. However, surgery as a component of treatment can render a survival advantage for patients who have isolated PNR.
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http://dx.doi.org/10.4274/jtgga.galenos.2021.2021.0072DOI Listing
June 2021

Defining prognostic factors in older patients with endometrial cancer.

Ir J Med Sci 2021 Jun 8. Epub 2021 Jun 8.

Department of Gynecologic Oncology, Faculty of Medicine, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Etlik Street, 06010, Yenimahalle, Ankara, Turkey.

Background: Endometrial cancer (EC) is most frequently seen in older and postmenopausal women.

Aim: The aim of this study was to evaluate the rate of recurrence and survival and clinical, pathological, surgical, and treatment factors affecting recurrence and survival in older patients with EC.

Methods: Three hundred and six (21.7%) patients aged ≥ 65 out of a total of 1413 patients diagnosed with and treated for epithelial EC at the Division of Gynecologic Oncology between January 1993 and May 2013 were evaluated retrospectively. All patients were staged according to FIGO 2009 staging system. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were determined. Independent prognostic factors affecting recurrence and survival were evaluated by multivariate logistic regression analysis.

Results: The median age of the patients was 68 (65-92) years. Eighty-nine patients (29.1%) were diagnosed with stage III-IV disease. Tumor type was endometrioid in 226 (73.9%) patients, and 101 (33%) patients were diagnosed with FIGO grade 1 endometrioid endometrial cancer. One hundred fifty-three patients received adjuvant therapy after surgery. Five-year PFS, 5-year CSS, and 5-year OS were 73%, 85%, and 83%, respectively. Only the 2009 FIGO stage was independently associated with PFS (OR = 3.495, 95% CI 1.592-7.675; p = 0.002) and CSS (OR = 6.135, 95%CI 1.269-31.417; p = 0.024).

Conclusion: In conclusion, 2009 FIGO stage was found to be the only independent prognostic factor associated with recurrence and death in older patients with endometrial cancer.
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http://dx.doi.org/10.1007/s11845-021-02663-7DOI Listing
June 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

Spotlight on oncologic outcomes and prognostic factors of pure endometrioid ovarian carcinoma.

J Gynecol Obstet Hum Reprod 2021 Jun 8;50(6):102105. Epub 2021 Mar 8.

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

Aim: To determine the prognostic factors related to recurrence and survival, and to evaluate the need for adjuvant chemotherapy in patients with endometrioid type epithelial ovarian cancer (EEOC).

Methods: This study included 63 EEOC patients who were surgically staged.

Results: The FIGO 2014 stage was stage I in 41 (65 %) patients, stage II in 8 (12.5 %) patients, stage III in 14 (22.5 %) patients. 5-year failure-free survival (FFS) was 78 % in the entire cohort. 15 (23.8 %) patients had disease failure. In univariate analysis, advanced stage (II&III), high grade tumor, presence of ascites, bilateral tumor, presence of omental metastasis, positive peritoneal cytology were prognostic factors for poor FFS. Only the stage was determined to be an independent prognostic factor for disease-failure. According to multivariate analysis, stage II&III was related to a statistically significant hazard ratio for a disease failure of 3.49 (95 % confidence interval: 1.029-11.841; p = 0.045). The effectiveness of adjuvant chemotherapy was assessed for 41 patients with stage I. Eleven (26.8 %) patients with stage I did not receive adjuvant chemotherapy. Whereas 5-year FFS was 88 % in patients receiving adjuvant chemotherapy, that was 91 % in patients without adjuvant chemotherapy (p = 0.923).

Conclusion: The independent prognostic factor for recurrence in EEOC was stage only. Adjuvant chemotherapy was not related to improvement in FFS in the early stage EEOC that were completely staged.
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http://dx.doi.org/10.1016/j.jogoh.2021.102105DOI Listing
June 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

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

Risk factors for evisceration in gynecological oncology surgeries

Turk J Med Sci 2021 04 30;51(2):508-517. Epub 2021 Apr 30.

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

Background/aim: To investigate the risk factors for evisceration in a gynecological oncology population. The secondary aim was to evaluate the impact of evisceration on survival.

Materials And Methods: Inclusion criteria consisted of having had an elective surgery performed through a xiphoidopubic incision in our institution and having a gynecological malignancy based on pathology. A total of 198 patients were evaluated, 54 with evisceration and 144 without evisceration. Due to the widely varied prognosis of female genital cancers, the survival was analyzed on a homogenized group, including only 62 patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer.

Results: The preoperative factors associated with evisceration in the univariate analysis were old age, high body mass index (BMI), hypertension, smoking, comorbidities, high American Society of Anesthesiologist (ASA) score (3 and 4), and low preoperative albumin level. The associated intraoperative factors were bleeding volume, receiving more than two units of erythrocyte suspension or fresh frozen plasma, and having had a major operation. The associated postoperative factors were the albumin transfusion and the antibiotic use in the early postoperative period. In the multivariate analysis, smoking, low levels of preoperative albumin, high BMIs, and high ASA scores (3 and 4) were independent prognostic factors for evisceration. Evisceration was not associated with recurrence and survival in the patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer.

Conclusion: Smoking, preoperative hypoalbuminemia, obesity, and high ASA scores (3and 4) were the prognostic factors for evisceration. Short-term modifiable factors such as smoking cessation and improved nutritional status should be considered in elective gynecological oncology surgeries. Evisceration had no impact on survival and recurrence in the patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer.
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http://dx.doi.org/10.3906/sag-2004-333DOI Listing
April 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

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

Can preoperative inflammatory markers differentiate endometrial cancer from complex atypical hyperplasia/endometrial intraepithelial neoplasia?

J Obstet Gynaecol Res 2020 Jul 28;46(7):1148-1156. Epub 2020 May 28.

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

Aim: The aim of this study was to identify the differences between complex atypical hyperplasia/endometrial intraepithelial neoplasia (CAH/EIN) and endometrioid-type grade 1 endometrial cancer in terms of preoperative systemic inflammatory markers and to evaluate the effectiveness of such markers in predicting cancer.

Methods: Between January 2005 and September 2018, a total of 372 patients with final histopathologic diagnoses of CAH/EIN (n = 143) and endometrioid-type grade 1 endometrial cancer (n = 229) were included in the study. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and platelet distribution width (PDW) were used as preoperative inflammatory markers. Receiver operating characteristics (ROC) analysis was used to assess the diagnostic prediction of NLR, PLR and PDW values to distinguish the two groups. Univariate and multivariate logistic regression analysis was performed by regrouping the patients according to the cut-off values found in the ROC analysis.

Results: The univariate analysis revealed that advanced age, decreases in PDW and also PLR could be predictors of cancer. The cut-off values were as ≤48.9% for PDW and ≤133.3 for PLR. The values defined using ROC analysis were found to be statistically significant for PDW and PLR in identifying endometrioid grade 1 endometrial cancer. For PDW, sensitivity, specificity, positive predictive value and negative predictive value were 52.8%, 62.2%, 68.9% and 45.5%, respectively (P = 0.001); for PLR, those were 55.9%, 59.4%, 68.8% and 45.7%, respectively (P = 0.005). In multivariate analysis, advanced age (>53 years), low PDW (≤48.9%) and low PLR (≤133.3) were related to statistically significant odds ratio for diagnostic prediction to differentiate endometrioid grade 1 cases from CAH/EIN of 8.01 (P < 0.001), 1.79 (P = 0.019) and 1.73 (P = 0.025), respectively.

Conclusions: The PLR and PDW values in the preoperative blood parameters could be used to differentiate endometrial cancer from precancerous lesions.
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http://dx.doi.org/10.1111/jog.14314DOI Listing
July 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

Factors predicting recurrence in patients with stage IA endometrioid endometrial cancer: what is the importance of LVSI?

Arch Gynecol Obstet 2020 03 27;301(3):737-744. Epub 2019 Dec 27.

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

Purpose: The aim of this study is to define the clinical and pathological prognostic factors for recurrence and to evaluate the recurrence patterns and adjuvant therapies used in this group of patients with stage IA endometrioid type endometrial cancer (FIGO 2009-International Federation of Gynecology and Obstetrics).

Methods: Among the patients with epithelial endometrial cancer operated between January 1993 and May 2013 in a single institution, 720 patients with stage IA endometrioid endometrial cancer were included. Patients with a tumor type of serous, clear cell, mucinous, undifferentiated, and mixed type and with a tumor containing sarcomatous component and the patients with a secondary primer cancer were excluded from the study.

Results: Lympho-vascular space invasion (LVSI) was present in 60 (8.3%) patients. Pelvic and para-aortic lymphadenectomy was performed in 266 (36.9%) patients. Median follow-up time was 48 months (range 3-240). Recurrence occurred in 23 (3.4%) patients and 6 (0.9%) died of disease. The median time-to recurrence (TTR) was 24 months (range 4-52 months) in the patients with recurrence. LVSI was associated with recurrence in the univariate analysis. Five-year disease-free survival (DFS) decreased from 96.8 to 80.1% in the presence of LVSI (p < 0.001). This association could not be shown in patients who had had lymphadenectomy (p = 0.136). Extra-pelvic recurrence occurred in 6.7% and 1% of the patients with and without LVSI, respectively, (p = 0.001). Any independent prognostic factor could not be detected in the multivariate analysis.

Conclusions: Only LVSI and tumor grade were associated with DFS and disease-specific survival (DSS), respectively, in the 686 patients with stage IA endometrial cancer in the univariate analysis, since these associations could not be shown in multivariate analysis.
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http://dx.doi.org/10.1007/s00404-019-05418-zDOI Listing
March 2020

Which factors predict parametrial involvement in early stage cervical cancer? A Turkish multicenter study.

Eur J Obstet Gynecol Reprod Biol 2019 Dec 22;243:63-66. Epub 2019 Oct 22.

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

Objective: To evaluate the clinical and pathological factors for predicting the parametrial involvement (PI) in early stage cervical cancer.

Study Design: This study included 406 patients with type III radical hysterectomy + pelvic ± para-aortic lymphadenectomy and FIGO stage I and II cervical adenocarcinoma, squamous type, and adenosquamous type cervical cancer.

Results: The entire cohort of patients had lymphadenectomy performed. Early stage cervical cancer patients were evaluated. FIGO 2014 stage, uterine invasion, LVSI, surgical border involvement, vaginal metastasis, stromal invasion and lymph node metastasis were found to be effective for PI on univariate analyses. However; age, tumor type and tumor size did not determine the parametrial invasion. LVSI (HR: 4.438, 95%CI: 1.771-11.121; p = 0.001), lymph node metastases (HR: 2.418, 95%CI: 1.207-4.847; p = 0.013) and vaginal involvement (HR: 4.109, 95%CI: 1.674-10.087; p = 0.02) are independent prognostic factors on multivariate analysis.

Conclusion: Lymph node metastases, LVSI and surgical border involvement are independent prognostic factors for PI in early stage cervical cancer patients. Therefore, less radical surgical approaches for early stage tumors with no nodal spread, negative LVSI and no surgical border involvement are applicable.
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http://dx.doi.org/10.1016/j.ejogrb.2019.10.033DOI Listing
December 2019

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

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

Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study.

J Gynecol Oncol 2018 Jul 13;29(4):e48. Epub 2018 Mar 13.

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

Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC).

Methods: A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 (≤0.15), and LNR2 (>0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models.

Results: One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30-82) and the median duration of follow-up was 40 months (range, 1-228 months). There were 167 (80.7%) women with LNR ≤0.15, and 40 (19.3%) women with LNR >0.15. The 5-year progression-free survival (PFS) rates for LNR ≤0.15 and LNR >0.15 were 76.1%, and 58.5%, respectively (p=0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR ≤0.15 to 62.3% for LNR >0.15 (p=0.005). LNR >0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]=2.05; 95% confidence interval [CI]=1.07-3.93; p=0.03) and OS (HR=3.35; 95% CI=1.57-7.19; p=0.002).

Conclusion: LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC.
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http://dx.doi.org/10.3802/jgo.2018.29.e48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981100PMC
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

Oncological Outcomes of Stage II Endometrial Cancer: A Retrospective Analysis of 250 Cases.

Int J Gynecol Cancer 2018 01;28(1):161-167

Objective: The aim of this study was to investigate the effect of different surgical approaches, adjuvant therapy, and pathological characteristics on oncological outcomes in patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage II endometrial cancer (EC).

Methods: A multicenter, retrospective department database review was performed to identify patients with FIGO 2009 stage II EC who underwent surgical staging between 2002 and 2015 at 5 gynecologic oncology centers in Turkey.

Results: Original pathology reports of 4867 patients who underwent surgical treatment for EC were analyzed. The study group consisted of 250 FIGO stage II patients. Of these patients, 203 (81.2%) had endometrioid and 47 (18.8%) had nonendometrioid histologic subtype of EC. Whereas 199 patients (79.6%) underwent type I hysterectomy, the remaining 51 patients (20.4%) underwent radical hysterectomy. Of the 250 patients, 208 patients (83.2%) had adjuvant therapy including radiotherapy (pelvic external beam radiotherapy and/or vaginal brachytherapy [VBT]) and/or platinum-based chemotherapy. Disease recurred in 29 patients (11.6%). The 5-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 82% and 85%, respectively. Multivariate analysis showed that only adjuvant treatment (P = 0.001; hazard ratio, 4.02; 95% confidence interval, 1.72-9.36) was significantly associated with DFS. According to multivariate analysis, only age older than 60 years (P = 0.01; hazard ratio, 3.03; 95% confidence interval, 1.3-7.04) was identified as an independent risk factor for OS. However, there were no differences in OS when evaluated by grade, histology, tumor size, type of hysterectomy, or adjuvant treatment.

Conclusions: In stage II EC, adjuvant external beam radiotherapy ± VBT were associated with increased DFS but not OS. However, the benefit of VBT alone on DFS could not be demonstrated. Only age was an independent risk factor for OS. Type of hysterectomy and histologic subtype of the tumor for patients with uterus-confined disease improved neither DFS nor OS in our study group.
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http://dx.doi.org/10.1097/IGC.0000000000001133DOI Listing
January 2018

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

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