Publications by authors named "Tolga Tasci"

45 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

Current and future immunotherapy approaches in ovarian cancer.

Ann Transl Med 2020 Dec;8(24):1714

Division of Medical Oncology, Department of Internal Medicine, Bahcesehir University Faculty of Medicine, Istanbul, Turkey.

Ovarian cancer (OC) is the major cause of gynecologic cancer deaths and relapse is common despite advances in surgery and systemic chemotherapy. Therefore, novel treatments are required to improve long-term outcomes of the disease. Efficacy of immunotherapy was demonstrated in many tumors and it has been since incorporated into clinical practice for them. Although early data form preclinical studies imply that OC has an immunogenic microenvironment, immune checkpoint inhibitors (ICIs) did not produce favorable results in clinical trials to date. This review will highlight data from clinical studies regarding immunotherapy in OC and its combination with other agents as well as immunologic prospects which could strengthen the therapeutic armament against the disease in the future.
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http://dx.doi.org/10.21037/atm-20-4499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812210PMC
December 2020

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

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

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

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

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

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

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

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

Performing gynecologic cancer surgery during the COVID-19 pandemic in Turkey: A multicenter retrospective observational study.

Int J Gynaecol Obstet 2020 Oct 11;151(1):33-38. Epub 2020 Aug 11.

Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Medeniyet University, Istanbul, Turkey.

Objective: To report the perioperative outcomes of 200 patients with gynecologic cancer who underwent surgery during the Novel Coronavirus Disease (COVID-19) pandemic and the safety of surgical approach.

Methods: Data of patients operated between March 10 and May 20, 2020, were collected retrospectively. Data were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows v. SP21.0.

Results: Data of 200 patients were included. Their mean age was 56 years. Of the patients, 54% (n=108), 27.5% (n=55), 12.5% (n=25), and 2% (n=4) were diagnosed as having endometrial, ovarian, cervical, and vulvar cancer, respectively. Of them, 98% underwent non-emergent surgery. A minimally invasive surgical approach was used in 18%. Stage 1 cancer was found in 68% of patients. Surgeons reported COVID-related changes in 10% of the cases. The rate of postoperative complications was 12%. Only two patients had cough and suspected pneumonic lesions on thoracic computed tomography postoperatively, but neither was positive for COVID-19 on polymerase chain reaction testing.

Conclusion: Based on the present findings, it is thought that gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to the measures. Postponement or non-surgical management should only be considered in patients with documented infection. Gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to measures. Only 1% of patients developed COVID-19-related symptoms during the postoperative follow-up period.
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http://dx.doi.org/10.1002/ijgo.13296DOI 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

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

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

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

Vanishing endometrial carcinoma in hysterectomy specimens: probable implications for fertility sparing management

Turk J Med Sci 2017 Dec 19;47(6):1744-1750. Epub 2017 Dec 19.

Background/aim: The vanishing cancer phenomenon was first reported in radical prostatectomy specimens in the absence of neo-adjuvant treatment. Reported cases are mostly well-differentiated and low-volume tumors. A similar entity was described for hysterectomy specimens of patients with biopsy proven endometrial cancer (EC). In this study, we discuss the probable reasons for vanishing EC and long-term follow-up results of EC patients without residual tumors in hysterectomy specimens. Materials and methods: This study was carried at two institutions in Ankara, Turkey, in a retrospective design. The computerized databases of both institutions were searched for endometrioid type EC patients whose final pathological specimens failed to show any residual tumor. Results: We evaluated 38 endometrial biopsy confirmed EC patients with no residual tumor detected in the hysterectomy specimens among a total of 224 women (17%) with the disease confined to the endometrium. During the follow-up period, no recurrences were noted among the patients. Conclusion: It can be suggested that premenopausal women with FIGO grade 1 endometrioid type EC with MRI proven "absent myometrial invasion" would have a significant probability of having no residual tumor after endometrial biopsy without any further medical treatment.
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http://dx.doi.org/10.3906/sag-1607-93DOI Listing
December 2017

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

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

Uterine and Ovarian Carcinosarcomas: Do They Behave Similarly?

J Obstet Gynaecol Can 2017 Jul;39(7):559-563

Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Ankara, Turkey.

Objective: We aimed to compare the clinicopathologic characteristics, recurrence patterns, and survival of patients with ovarian carcinosarcomas (OCs) and uterine carcinosarcomas (UCs).

Methods: Patients who were diagnosed with UCs or OCs on the basis of final pathology reports and who underwent surgery between January 1993 and January 2015 were included in the study. Data of patients were obtained from Gynecological Oncology Clinic electronic database and patient files.

Results: The study included 101 and 21 patients who underwent surgery for UCs and OCs, respectively. Forty percent and 67% of patients who had UCs and OCs, respectively, experienced lymph node metastasis (P = 0.051). Median follow-up time was 12 months (range, 1-158 months) for patients with UCs and 24 months (range 1-154 months) for patients with OCs. Recurrence developed outside the abdomen in 58% of patients with UCs and in 10% of patients with OCs (P = 0.005). Median time to recurrence was 9 months (range 3-58 months) in patients with UCs, whereas it was 18 months (range 11-72 months) in patients with OCs (P = 0.002). Five-year disease-free survival was 34% and 19% for patients with UCs and OCs, respectively (P = 0.90). Five-year overall survival was 56% for patients with UCs and 54% for patients with OCs (P = 0.51).

Conclusion: We found that UCs recurred earlier and extra-abdominally. Recurrence pattern should be kept in mind during the planning of adjuvant therapies for these patients.
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http://dx.doi.org/10.1016/j.jogc.2017.03.098DOI Listing
July 2017

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

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

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

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

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

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

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

Fertility-Sparing Surgery Should Be the Standard Treatment in Patients with Malignant Ovarian Germ Cell Tumors.

J Adolesc Young Adult Oncol 2017 Jun 13;6(2):270-276. Epub 2017 Jan 13.

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

Purpose: To validate the oncological safety of fertility preservation in malignant ovarian germ cell tumors (MOGCTs) and to define the significance of maximal cytoreduction in early stage MOGCTs.

Materials And Methods: Sixty-nine patients with stage I and II MOGCTs who underwent surgical treatment were included in the study. Fertility-sparing surgery is defined as conservative surgery and hysterectomy and contralateral salpingo-oophorectomy were defined as definitive surgery. Both surgical approaches involved lymphadenectomy and omentectomy. Most patients received platinum-based combinations for adjuvant therapy. Survival outcomes of the conservative surgery group were compared with the definitive surgery group.

Results: Median age of the study group was 21 years (range: 12-40 years). Median tumor size measured 150 mm (range, 20-300 mm). Surgery type (conservative surgery vs. definitive surgery) and lymphadenectomy (performed vs. not performed) were insignificant for the recurrence (p = 0.758, p = 0.271). However, surgical outcome (maximal vs. optimal and suboptimal) and type of tumor (dysgerminoma vs. nondysgerminoma) determined the recurrence (p = 0.001, p = 0.021).

Conclusion: Fertility-conserving approach is safe in early stage MOGCTs. However, maximal cytoreduction should be achieved in this group of patients, without conceding fertility-conserving approach. On the other hand, development of chemotherapy options with less gonadotoxic effects, but equal or stronger efficiency in comparison with platinum-based chemotherapy, will certainly facilitate management of this patient group.
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http://dx.doi.org/10.1089/jayao.2016.0086DOI Listing
June 2017

Is Neurosurgery With Adjuvant Radiotherapy an Effective Treatment Modality in Isolated Brain Involvement From Endometrial Cancer?: From Case Report to Analysis.

Int J Gynecol Cancer 2017 02;27(2):315-325

*Gynecologic Oncology Division, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara; and †Gynecologic Oncology Division, Medipol University School of Medicine, Istanbul, Turkey.

Aim: The aim of this study was to evaluate the treatment options and post-brain involvement survival (PBIS) of patients with isolated brain involvement from endometrial cancer (EC).

Materials And Methods: The literature electronic search was conducted from 1972 to May 2016 to identify articles about isolated (without extracranial metastases) brain involvement from EC at recurrence and the initial diagnosis. Forty-eight articles were found. After comprehensive evaluation of case series and case reports, the study included 49 cases.

Results: The median age of the patients at initial diagnosis was 57 years (range, 40-77 years). Poor differentiation was determined in 36 (73.5%) patients. Thirty-five (71.4%) patients had a single brain lesion. Lesion was found in the supratentorial part of the brain in 33 (67.3%) patients. Median PBIS for all cohorts was 13 months (range, 0.25-118 months) with 2-year PBIS of 52% and 5-year PBIS of 37%. Age, tumor type, grade, disease-free interval, diagnosis time of brain lesion, localization, and number of brain lesion were not predictive of PBIS. Two-year PBIS was 77% in patients who underwent surgical resection and radiotherapy, whereas it was 19% in the surgical resection-only group, and 20% in the primary radiotherapy-only group (Ps = 0.003 and 0.001, respectively). Chemotherapy was not associated with improved PBIS.

Conclusions: Although neuroinvasion from EC appears mostly with a disseminated disease, there is a considerable amount of patients with isolated brain involvement who would have a higher chance of curability. Surgery with radiotherapy is the rational current management option, and this improves the survival for isolated brain involvement from EC.
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http://dx.doi.org/10.1097/IGC.0000000000000886DOI Listing
February 2017

Uterine adenosarcomas: A dual-institution experience.

J Obstet Gynaecol 2017 Jan 6;37(1):93-96. Epub 2016 Dec 6.

b Department of Gynaecologic Oncology , Etlik Zübeyde Hanım Women Health Education and Research Hospital , Ankara , Turkey.

There has been limited literature about treatment and follow-up strategies of uterine adenosarcomas because of their rare nature. For this study we retrospectively investigated the medical database of the two major womens' health hospitals in Turkey. A total of 15 patients were identified from the hospital's database. Median follow-up was 86.43 months for all patients. Seven out of 15 patients had recurrences during their follow-up. Among these 7 patients, 4 of them had stage IA disease. Median Disease Free Survival (DFS) and Overall Survival (OS) were calculated as 41.47 and 57.21 months, respectively. According to our study, polypoid tumours confined to the uterus with superficial myometrial invasion can be treated without comprehensive surgical staging. We believe that, publishing all the data in an organised manner even though they are small in size, gives us an opportunity to design meta-analysis for the development of more appropriate treatment strategies.
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http://dx.doi.org/10.1080/01443615.2016.1228619DOI Listing
January 2017

Factors related to treatment outcomes in low-risk gestational neoplasia.

Tumori 2017 Mar 4;103(2):177-181. Epub 2016 Aug 4.

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

Objective: To define the factors associated with methotrexate (MTX) resistance in patients with low-risk gestational trophoblastic neoplasia (GTN).

Methods: A total of 63 patients with low-risk GTN according to International Federation of Gynecology and Obstetrics (FIGO) criteria were included. A total of 37 (58.7%) patients were treated with successive doses of 1 mg/kg intramuscular (IM) MTX on days 1, 3, 5, and 7, and 0.1 mg/kg IM folinic acid (FA) on days 2, 4, 6, and 8, until β-human chorionic gonadotropin (hCG) levels were normalized. After the β-hCG value dropped to the normal level, an additional cycle of MTX/FA was administered. This protocol is defined as the standard protocol. In a watchful waiting protocol, the same 8-day IM MTX/FA regimen was given only once (n = 8) or twice (n = 18) to 26 (41.3%) patients and patients in whom β-hCG values declined were subjected to follow-up and no additional cycles were administered as long as there was a decrease in β-hCG value. Clinical response and factors affecting therapeutic outcomes were analyzed retrospectively.

Results: Of 63 patients, 47 (74.3%) were cured with primary MTX/FA treatment irrespective of any protocol. Of the 16 patients who were not able to be treated with primary MTX/FA, 3 were treated with single-agent actinomycin-D and 11 were treated with multi-agent chemotherapy. Univariate analysis showed that a pretreatment β-hCG level of ≥5000 IU/L was related to reduced therapeutic response (p = 0.001). The FIGO score, antecedent gestational pathology, and treatment with standard or watchful waiting protocol were not related to treatment response.

Conclusions: The level of β-hCG prior to therapy is an important factor for predicting therapeutic outcomes. It should be noted that the success of the therapy decreases notably in case of high β-hCG level.
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http://dx.doi.org/10.5301/tj.5000550DOI Listing
March 2017

Mucinous borderline ovarian tumors: Analysis of 75 patients from a single center.

J Turk Ger Gynecol Assoc 2016 12;17(2):96-100. Epub 2016 Jan 12.

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

Objective: To analyze the clinicopathologic features, recurrence and survival rates, reproductive history, and treatment of patients with mucinous borderline ovarian tumors (mBOTs).

Material And Methods: Patients with a diagnosis of mBOT were evaluated retrospectively. Patients with borderline ovarian tumors other than mucinous type and concomitant invasive cancer were excluded.

Results: A total of 75 patients were identified. Median age was 38 years. The most common symptom was pain (42.7%). Median CA-125 level was 23.5 IU/mL (range, 1-809 IU/mL). Median tumor size was 200 mm (range, 40-400 mm), and 6.7% of mBOTs were bilateral. Thirty-six (48%) patients underwent staging surgery. Two patients (5.9%) had nodal involvement. One patient received platinum-based adjuvant chemotherapy. One (1.3%) patient had recurrence. None of the patients died because of the ovarian tumor. A total of 43 patients had conservative surgery.

Conclusion: Prognosis of mBOTs is excellent, and fertility-sparing surgery should be considered in the reproductive age group. Furthermore, the necessity of staging surgery is controversial.
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http://dx.doi.org/10.5152/jtgga.2016.15208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922732PMC
July 2016

Liver recurrence in endometrial cancer: a multi-institutional analysis of factors predictive of postrecurrence survival.

Clin Exp Metastasis 2016 10 23;33(7):707-15. Epub 2016 Jun 23.

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

Predictive factors for survival following liver metastasis in endometrial cancer (EC) have not been studied to date. It is expected that patients who initially presented with liver metastasis or developed liver metastasis as the subsequent metastatic site of progressive disease are likely to have poor outcomes. However, patients developing liver metastasis as the first site of recurrence may have a chance of benefiting from the salvage therapies. Therefore, we aimed to determine factors influencing postrecurrence survival in EC patients who developed liver metastasis as the first site of recurrence. Patients with EC who underwent primary surgery at three centers between 1993 and 2013 were reviewed. Liver recurrence was defined as documentation of parenchymal liver metastasis either by radiologically or biopsy, after a disease-free interval of ≥3 months. Patients with liver metastasis at presentation, or liver metastasis as the subsequent metastatic site of progressive disease were excluded. Forty-six patients were identified. Median time to liver recurrence was 12 months, with 91.3 % of recurrences detected within 3 years. Most patients (73.9 %) had liver recurrence concomitant with extra-hepatic disease. Median survival after the diagnosis of liver recurrence was 9 months. While in univariate analysis, time to liver recurrence (p < 0.001) and presence of concomitant extra-hepatic metastasis (p = 0.048) were potential predictors of survival, multivariate analysis revealed that time to liver recurrence (p < 0.001) was the only independent predictor. This criterion may be used as a marker for stratifying patients into different prognostic risk groups and for selection of patients for salvage therapies.
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http://dx.doi.org/10.1007/s10585-016-9806-xDOI Listing
October 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

Bone recurrence rarely seen in endometrial cancer and review of the literature.

J Obstet Gynaecol Res 2016 Jun 13;42(6):602-11. Epub 2016 Apr 13.

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

Aim: To evaluate the clinical findings and treatment results of patients with endometrial cancer (EC) who experienced initial recurrence or progression in bones.

Methods: Ten EC patients experiencing initial recurrence or disease progression in bones were included in the study. Disease recurrences located in a single bone and in more than one bone were defined as single localization bone recurrence (BR) and multiple localization BR, respectively. Time from initial surgery to BR was determined as disease-free interval (DFI) and time from BR to death or last contact with a patient was described as post-recurrence survival (PRS).

Results: Seven of 10 patients were asymptomatic. The median DFI was 13 months (range: 2-68). While eight patients had isolated BR, two patients also had concurrent extraosseous recurrences. Five patients had single and four patients had multiple localization BR. The most common sites for BR were the femur (55.5%) and vertebra (44.4%). Two-year PRS was 37.5% in all patients and 50% in patients with endometrioid EC. None of the patients with non-endometrioid type EC survived. In patients with multiple localization BR and with recurrence only occurred in the bones, two-year PRS was 75% and 50%, respectively. None of the patients with BR with extraosseous involvement survived beyond two years. Two-year PRS was 50% in patients without extraosseous dissemination, independent from localization.

Conclusion: The BR rate was remarkable in asymptomatic EC survivors. A single bone was frequently involved. Little is known of the optimal treatment for metastatic bone disease in EC, thus, management should be individualized and patients should be encouraged to participate in clinical trials.
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http://dx.doi.org/10.1111/jog.12960DOI Listing
June 2016

Pulmonary recurrence in patients with endometrial cancer.

J Chin Med Assoc 2016 Apr 10;79(4):212-20. Epub 2016 Feb 10.

EtlikZubeydeHanim Women's Health Teaching and Research Hospital, Department of Gynecology and Obstetrics, Gynecologic Oncology Division, Ankara, Turkey.

Background: In this article, we aimed to define the clinical, pathological, and surgical factors predicting pulmonary recurrence (PR) and determining survival after PR in patients with endometrial cancer.

Methods: Thirty-six (2.7%) patients were analyzed who suffered pulmonary failure in the first recurrence out of 1345 patients who had at least extrafascial hysterectomy plus bilateral salpingo-oophorectomy for endometrial cancer between January 1993 and May 2013. The recurrence was designated as an isolated PR in cases of the presence of recurrence only in the lung, while it was called a synchronized PR if the patient had extrapulmonary recurrence in addition to PR.

Results: In the multivariate analysis in the entire cohort, only International Federation of Gynecology and Obstetrics stage was an independent prognostic factor for PR. Two-year overall survival (OS) was 52% in patients with PR. In the univariate analysis, early International Federation of Gynecology and Obstetrics stage, absence of lymphatic metastasis, negative lymphovascular space invasion, absence of cervical invasion, negative adnexal spread, negative peritoneal cytology, negative omental metastasis, adjuvant radiotherapy after initial surgery, isolated PR, and chemotherapy upon recurrence were associated with improved OS after PR. The OS was 54 months for patients with isolated PR, while it was 10 months for patients who had synchronized PR. Furthermore, OS was 43 months and 13 months for the patients who took chemotherapy and radiotherapy, respectively.

Conclusion: Advanced stage is associated with PR. If recurrence is only in the lung, survival is better. Systemic treatment after PR is associated with improved survival. However, multi-center studies are required to standardize the treatment for PR.
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http://dx.doi.org/10.1016/j.jcma.2015.10.010DOI Listing
April 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

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

Step by step right upper quadrant cytoreduction guided by computed tomography in advanced ovarian cancer.

Gynecol Oncol 2015 Dec 8;139(3):582-3. Epub 2015 Oct 8.

Department of Gynecologic Oncology, Etlik Zubeyde Hanim Teaching and Research Hospital, Ankara, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.ygyno.2015.10.006DOI Listing
December 2015

Salvage Cytoreductive Surgery for Recurrent Endometrial Cancer.

Int J Gynecol Cancer 2015 Nov;25(9):1623-32

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

Objective: The aim of this study was to determine the effect of salvage cytoreductive surgery (SCS) on overall survival (OS) among patients with recurrent endometrial cancer and if there is any predictor for residual tumor status.

Methods: Between January 1993 and May 2013, data of 34 patients who had SCS for recurrent endometrial cancer were retrospectively analyzed. Overall survival was determined from SCS to last follow-up.

Results: The surgical procedure was local excision without laparotomy in 12 patients, and optimal cytoreduction (no visible disease) was achieved in 24 of 34 patients. There were no perioperative deaths. None of the factors was associated with achievement of optimal cytoreduction. Five-year OS rates were 37% and 27% for the entire cohort and for the laparotomy group, respectively. For the entire cohort, disease-free interval (from initial surgery to recurrence), adjuvant therapy after initial surgery, CA-125 level at recurrence, multiplicity of recurrence, surgical procedure, and optimal cytoreduction and for the laparotomy group adjuvant treatment and optimal cytoreduction were associated with OS. In the laparotomy group, OS rates were 53 and 9 months in the patients who did and did not have optimal SCS, respectively.

Conclusions: Significant survival benefit can be achieved with optimal resection. Prospective studies should be designed to define optimal cytoreduction and to determine the predictors of optimal cytoreduction achievement.
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http://dx.doi.org/10.1097/IGC.0000000000000543DOI Listing
November 2015