Browsing by Author "Altundag, Ozden"

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Combined Versus Sequential Antracycline and Taxane Adjuvant Regimens in Triple Negative Breast Cancer Patients.
(2016) Oguz, Arzu; Keskin, Gul Sema Yildiran; Akcali, Zafer; Colak, Dilsen; Altundag, Ozden; Altundag, Mustafa Kadri; https://orcid.org/0000-0001-6512-6534; https://orcid.org/0000-0003-2473-4431; https://orcid.org/0000-0003-0197-6622; https://orcid.org/0000-0003-0197-6622; W-8004-2019; U-7339-2017; GRY-5456-2022; W-9219-2019; W-9219-2019
Complications of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: An evaluation of 100 cases
(2021) Akilli, Huseyin; Gunakan, Emre; Haberal, Ali; Altundag, Ozden; Kuscu, Ulku Esra; Taskiran, Cagatay; Ayhan, Ali; 0000-0002-5240-8441; 0000-0001-8854-8190; 0000-0003-0197-6622; 34038007; AAX-3230-2020; ABI-1707-2020; W-9219-2019
Objective To evaluate the perioperative outcomes and complications of patients with peritoneal carcinomatosis who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). Methods This retrospective study included 100 patients operated on between 2016 and 2020. Patients' characteristics, including age, comorbidities, chemotherapy history, treatment failures, cancer type, histology, platinum sensitivity, and perioperative complications, were documented. Perioperative complications were classified according to the Clavien-Dindo classification. Results Median age was 58 years and median follow-up time was 16 months. Eighty-six (86%) patients had ovarian cancer; 11 (11%) experienced grade III-IV complications, and the only relevant factor was the presence of multiple metastasis (P = 0.031). Seven patients (7%) had surgical-site infection; in multivariant analyses, only ostomy formation was found as an independent risk factor for surgical-site infection (odds ratio [OR] 14.01; 95% confidence interval [CI] 1.36-143.52; P = 0.024). Fifteen (15%) patients experienced elevated serum creatinine after surgery and the median time to creatinine elevation was 5 days postoperatively (range 3-15 days). In multivariant analyses, only age of of 58 years or more was found as a significant factor for the elevation of serum creatinine (OR 6.96; 95% CI 1.42-32.81; P = 0.014). Conclusion Our results showed that the presence of multiple metastases increased the risk of grade III-IV complications and age of 58 years or more was the leading risk factor for renal complications. However, we could not find a relation between postoperative complications and oncologic outcomes. HIPEC seems to be a safe approach in experienced hands.
Correlation of Histopahologic Response and Prognostic Markers with Survival in Locally Advanced Non-Small Cell Lung Cancer Patients Who Have Treated with Neoadjuvant Chemotherapy
(2015) Kucukoztas, Nadire; Oguz, Arzu; Rahatli, Samed; Dizdar, Omer; Keskin, Gul Sema Yildiran; Ozyilkan, Ozgur; Altundag, Ozden; 0000-0001-8825-4918; 0000-0003-0197-6622; 0000-0001-5588-0306; 0000-0001-6512-6534; 0000-0003-3163-7429; AAD-2817-2021; W-9219-2019; AAM-3226-2021; W-8004-2019; AAJ-3047-2021
Correlation of Response and Prognostic Markers with Survival in Locally Advanced NSCLC Patients Who Have Treated with Neoadjuvant Chemotherapy
(2015) Altundag, Ozden; Kucukortas, Nadire; Rahatli, Samed; Keskin, Gul Sema Yildiran; Oguz, Arzu; 0000-0001-6512-6534; 0000-0003-3163-7429; 0000-0003-0197-6622; W-8004-2019; AAJ-3047-2021; W-9219-2019
Effect of Increased Number of Neoadjuvant Chemotherapy Cycles on Tumor Resectability and Pathologic Response in Advanced Stage Epithelial Ovarian Cancer
(2018) Akilli, Huseyin; Rahatli, Samed; Tohma, Yusuf Aytac; Karakas, Latife Atasoy; Altundag, Ozden; Ayhan, Ali; 0000-0002-5240-8441; 0000-0003-3163-7429; 0000-0001-9418-4733; 0000-0003-0197-6622; AAX-3230-2020; AAJ-3047-2021; AAE-6482-2021; AEY-5060-2022; W-9219-2019; AAJ-5802-2021
Purpose: To identify the significance of the number of neoadjuvant chemotherapy (NACT) cycles on pathologic response and to define relationship between multiple cycles of NACT and the timing of interval debulking surgery (IDS) in epithelial ovarian cancer (EOC) patients. Methods: This retrospective case-control study was carried out at the Baskent University in Ankara between 2007 and 2017. We reviewed 62 patients with advanced stage (IIIC-IV) EOC who received NACT in other institutes and operated in our clinic. On the basis of the number of NACT cycles, patients were divided into 2 groups: group 1 received 3 cycles and group 2 received 4 to 6 cycles.The influence of the number of NACT cycles on complete pathologic response, lymph node involvement, overall survival (OS), progression free survival (PFS), platinum resistance and residual tumor were evaluated. Results: The median OS was 44.4 +/- 4.8 months and 48.8 +/- 4.49 months for group 1 and group 2 respectively (p=0.122). PFS was 19.3 +/- 3.75 months in group 1 and 24.3 +/- 4.67 months in group 2 (p=0.84). Tumor morphology according to lymph node involvement, no visible tumor and complete pathologic response were similar for both groups (p=0.49, p=0.79 and p=0.6 respectively). Pathological absence of residual disease were 13.6% vs 7.5% for group 1 and group 2 respectively (p=0.6) and complete pathologic response rate was 6/62 (9.67%). Platinum resistance developed in 4(18.2%) patients and 18(45%) patients in group 1 and 2 respectively (p=0.031). Complete resection rates were similar for both groups (p=0.9). After multivariate survival analyses, complete resection remained significant (p=0.000, odds ratio/ OR 2.28 [1.41-3.701]), and was independent of age, platinum resistance and number of NACT cycles. Complete resection rates were almost equal in each groups, (68.2% [15/22] and 67.5% [27/40] for group 1 and group 2 respectively (p=0.9)). Conclusions: Our data suggests that giving more than 3 cycles of NACT is unnecessary because increased number of cycles did not change the resectability and complete pathologic response, while it increased platinum resistance. Moreover OS and PFS remained similar.
Fertility Sparing in Uterine Sarcomas: Single Center Experience of 13 Patients
(2019) Tunc, Mehmet; Tohma, Yusuf Aytac; Sahin, Han Ifi; Akilli, Huseyin; Karakas, Latife Atasoy; Altundag, Ozden; Haberal, Ali; Ayhan, Ali; https://orcid.org/0000-0001-9418-4733; https://orcid.org/0000-0002-5240-8441; https://orcid.org/0000-0001-7369-5470; https://orcid.org/0000-0003-0197-6622; https://orcid.org/0000-0002-1486-7209; AAE-6482-2021; AAX-3230-2020; AEY-5060-2022; W-9219-2019; AAI-9331-2021; AAJ-5802-2021
Purpose of Investigation: The feasibility and safety of conservative surgery is not well defined for fertility sparing approach for uterine sarcoma due to very low incidence and poor prognosis. The authors present their experience regarding fertility preservation for uterine sarcoma. Materials and Methods: A total of 13 patients with uterine sarcoma were included in this retrospective case study; endometrial stromal sarcoma (ESS) (n=6) and leiomyosarcoma (LMS) (n=7). Patients data, including clinicopathological characteristics and prognostic information were extracted from medical records. Excision of mass and reconstruction of uterus was performed for fertility sparing in all patients and staging surgery (bilateral pelvic and para-aortic lymphadenectomy +/- omentectomy) as performed for five cases (one ESS case and four LMS cases). Results: The median size of the mass was 8.5 (range: 1-22) cm. Median follow-up time was 54 (range 13-142) months. Recurrence rate was 69.2% (9/13). The mean relapse interval was 30.69 months. Four patients died and all of them was diagnosed with LMS. Four pregnancies (37%) were recorded. Two of them occurred with assisted reproductive technologies (intracytoplasmic sperm injection), the other two pregnancies were spontaneous, and all of them had a cesarean delivery. Conclusion: Patients should be informed about prognosis of uterine sarcomas and risk of fertility preserving approach. Close follow-up is obligatory and complementary surgery should be performed after completion of fertility due to high recurrence rate and poor prognosis especially with LMS.
Good Outcomes of Patients with Stage IB Endometrial Cancer with Surgery Alone
(2014) Rahatli, Samed; Dizdar, Omer; Kucukoztas, Nadire; Oguz, Arzu; Yalcin, Selim; Ozen, Ozlem; Reyhan, Nihan Haberal; Tarhan, Cagla; Yildiz, Ferah; Dursun, Polat; Altundag, Ozden; Ayhan, Ali
Background: Most patients with endometrial cancer have stage I disease. Adjuvant therapy in stage IB (formerly IC) endometrial cancer is controversial, treatment options including observation or brachytherapy/radiotherapy in grade 1-3 patients with or without chemotherapy. The purpose of this study was to assess the outcomes of our patients with stage IB endometrioid endometrial cancer. Materials and Methods: Sixty two patients with stage IB endometrial cancer and endometrioid histology were retrospectively evaluated. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Adjuvant radiotherapy was discussed with patients and utilized by those who accepted. Adjuvant chemotherapy was not given to any of the patients. Results: Median age was 62 (range, 42-95). Ninety percent of the patients had grade 1-2 disease. Thirteen patients (21%) received intra vaginal brachytherapy (IVBT) and one received whole pelvic radiotherapy (WPRT). Median follow-up time was 46 months (range, 9-77 months). Three patients experienced recurrence (4.8%), two of them died on follow-up and one was still alive at last visit. Two patients with recurrence had FIGO grade 2 tumors and one had a grade 3 tumor. Two patients (3.2%) died without evidence of recurrent disease. Relapse free survival at 5 years was 94.4% and overall survival was 93.1%. Conclusions: Patients with stage IB disease in our study demonstrated relatively low recurrence rates with this stage of endometrial cancer.
Is There Any Correlation Between Molecular Subtypes and Blood Groups in Breast Cancer?
(2014) Kucukoztas, Nadire; Oguz, Arzu; Babacan, Taner; Dizdar, Omer; Rahatli, Samed; Sarici, Saim Furkan; Keskin, Gul Sema Yildiran; Diker, Omer; Akin, Serkan; Altundag, Ozden; Altundag, Kadri; https://orcid.org/0000-0001-5588-0306; https://orcid.org/0000-0001-6512-6534; https://orcid.org/0000-0003-3163-7429; https://orcid.org/0000-0001-7162-4812; https://orcid.org/0000-0002-7542-9229; https://orcid.org/0000-0003-0197-6622; AAM-3226-2021; W-8004-2019; AAJ-3047-2021; GWZ-4666-2022; B-8984-2017; W-9219-2019
Multi-institutional validation of the ESMO-ESGO-ESTRO consensus conference risk grouping in Turkish endometrial cancer patients treated with comprehensive surgical staging
(2020) Gultekin, Melis; Guler, Ozan Cem; Sari, Sezin Yuce; Yildirim, Berna Akkus; Onal, Cem; Celik, Husnu; Yuce, Kunter; Ayhan, Ali; Arik, Zafer; Kose, Fatih; Altundag, Ozden; Mustafayev, Teuta Zoto; Atalar, Banu; Bolukbasi, Yasemin; Yildiz, Ferah; 0000-0001-6908-3412; 0000-0002-2742-9021; 0000-0002-0156-5973; 0000-0003-0197-6622; 0000-0001-6661-4185; 32347768; AAC-5654-2020; D-5195-2014; G-4827-2016; W-9219-2019; AAJ-5802-2021
In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, >= 50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)+/- VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statement What is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous. What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups. What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging.
Paraaortic Lymph Node Dissection in Endometrial Cancer; Is It Necessary?
(2014) Dizdar, Omer; Oguz, Arzu; Kucukoztas, Nadire; Dursun, Polat; Altundag, Ozden; Ayhan, Ali
Posttransplant Malignancies in Adult Renal and Hepatic Transplant Patients
(2020) Rahatli, Samed; Altundag, Ozden; Soy, Ebru Ayvazoglu; Moray, Gokhan; Haberal, Mehmet; 0000-0003-2498-7287; 0000-0002-3462-7632; 0000-0002-0993-9917; 0000-0003-3163-7429; 30119617; AAE-1041-2021; AAJ-8097-2021; AAC-5566-2019; AAJ-3047-2021
Objectives: The risk of some cancer types increases after organ transplant compared with that shown in the general population; this has been well documented in clinical studies. With patients having longer survival and with the higher number of transplant procedures, cancer is an increasing health concern at high-volume transplant centers. Malignancy has an important effect on short- and long-term graft and patient survival. In this study, we evaluated cancer frequency during transplant patient follow-up. Materials and Methods: This single-center retrospective study included patients who underwent solid-organ transplant at the Baskent University Medical Faculty Hospital from 1997 to 2017. Renal and hepatic transplant patients older than 16 years at the time of transplant and diagnosed with cancer after transplant were included the study. In total, 1176 of 2018 renal transplant recipients and 274 of 548 hepatic transplant recipients met the inclusion criteria. Results: We determined that 52 of 1176 renal transplant (4.5%) and 9 of 274 hepatic transplant patients (3.3%) developed posttransplant cancer during followup. Of 61 total patients with cancer posttransplant, 44 were males (72.1%) and 17 were females (27.9%), with median age at transplant of 39.2 years. Overall, the incidence of cancer in transplant recipients was 4.2%. The most frequent cancers were basal and squamous skin cancers, which were seen in 18 patients (29%), and Kaposi sarcoma, which was seen in 11 patients (18%). Of the 61 patients who developed cancer, 43 (70%) were still alive at the time of this study. Conclusions: Despite recent positive developments in the use of immunosuppressive drugs, posttransplant malignancy is still a health problem. Fortunately, most cancers in this patient group have good prognosis and can be cured by surgical resection. Transplant physicians should aim for early detection of these diseases.
Posttransplant Malignancies in Liver Transplant Recipients
(2014) Akdur, Aydincan; Kirnap, Mahir; Yildirim, Sedat; Altundag, Ozden; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-5735-4315; https://orcid.org/0000-0003-0197-6622; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635818; AAA-3068-2021; AAH-9198-2019; AAF-4610-2019; W-9219-2019; AAE-1041-2021; AAJ-8097-2021
Objectives: The incidence of malignancy is higher in solid-organ transplant recipients compared with the general population. In the present study, we present our experience with de novo malignancies encountered after both deceased-donor and living-donor liver transplants. Materials and Methods: We retrospectively reviewed the medical records of 335 patients who underwent an orthotopic liver transplant at our institution between September 2001 and December 2012 to identify subjects with de novo malignancies. Results: Fourteen patients (4.1%) developed de novo malignancies after liver transplant. De novo malignancies included lymphoproliferative disorders after liver transplant in 7 patients (treated with chemotherapy), thyroid papillary carcinoma in 1 patient (treated with total thyroidectomy and radioactive iodine therapy), squamous cell carcinoma in 2 patients (treated with surgical resection), gastric stromal tumor in 1 patient (treated with surgical resection), ovarian carcinomas in 1 patient (treated with radical surgical resection and chemotherapy, who died within 1 year of diagnosis), lung cancer in 1 patient (treated with chemotherapy, but he had bone metastasis and died within 1 year of diagnosis), and neuroblastoma in 1 patient (treated with chemotherapy). In all patients, immunosuppression was changed to sirolimus. Conclusions: Transplant recipients generally have advanced stage cancers at the time of diagnosis with a poor prognosis. Because some neoplasms are common, early detection of cancer is important to decrease cancer-related mortality and morbidity.
The Preoperative Albumin Level Is an Independent Prognostic Factor for Optimally Debulked Epithelial Ovarian Cancer
(2017) Ayhan, Ali; Gunakan, Emre; Alyazici, Irem; Haberal, Nihan; Altundag, Ozden; Dursun, Polat; https://orcid.org/0000-0003-0197-6622; 28875365; AAJ-5802-2021; W-9219-2019
Purpose A low albumin level has been reported to be a prognostic factor for various cancers. The aim of this study was to determine the association between preoperative serum albumin level and survival in patients with epithelial ovarian cancer (EOC). Methods Records of 337 patients with EOC that underwent optimal cytoreductive surgery were retrospectively reviewed. Threshold albumin level was planned as 32.5 g L-1 due to the statistical analyses. Results Mean overall survival was 51.5 months. Area under the ROC curve was found statistically significant for the discriminative role of albumin for survival outcome (AUC = 0.857, 95% CI 0.813-0.90, P < 0.001). The best cut-off point for albumin was determined as 32.5 g L-1. The sensitivity rate, specificity rate, positive and negative predictive values, and accuracy rate for this cut-off level were found 67.2, 91.2, 81.2, 83.1, and 82.5%, respectively. Preoperative hypoalbuminemia was noted in 101 (30.0%) of the patients, of which 6.2% had an albumin level < 25 g L-1. The albumin level was independently and significantly associated with overall survival (HR 2.6; 95% CI 2.1-3.1; P < 0.001). Subgroup analysis showed that patients with an albumin level < 32.5 and >= 32.5 g L-1 had mean estimated overall survival of 40.6 and 96.0 months, respectively. Age, stage, and presence of ascites were the other independent significant factors. Conclusions The preoperative albumin level is an independent prognostic factor for overall survival in optimally debulked EOC patients. Further investigations about preoperative albumin level in prognostic models will contribute to the literature.
RECURRENCE AND THE SURVIVAL ANALYSIS OF LIVER TRANSPLANTED HEPATOCELLULAR CARCINOMA PATIENTS
(2020) Rahatli, Samed; Oguz, Arzu; Altundag, Ozden; Soy, Ebru H. Ayvazoglu; Haberal, Mehmet A.
The Relationship Between Thyroid Volume and Malignant Thyroid Disease
(2014) Duran, Ayse Ocak; Anil, Cuneyd; Gursoy, Alptekin; Nar, Asli; Altundag, Ozden; Inanc, Mevlude; Bozkurt, Oktay; Tutuncu, Neslihan Bascil; https://orcid.org/0000-0003-3802-9733; https://orcid.org/0000-0003-0998-8388; https://orcid.org/0000-0003-0197-6622; https://orcid.org/0000-0002-1816-3903; 24338169; AAA-2743-2021; W-9219-2019; ABG-5027-2020
The present retrospective study aimed to investigate the relationship between thyroid volume and prevalence of thyroid cancer. We investigated the data of 3,850 patients who underwent fine-needle aspiration biopsy (FNAB). Biopsy results were evaluated as diagnostic or nondiagnostic, and diagnostic results were classified as benign, malignant, and indeterminate. We included 2,672 patients who underwent FNAB firstly in our hospital and evaluated as diagnostic biopsy except subgroup of indeterminate. We obtained cytologic data, levels of serum thyroid-stimulating hormone (TSH), and thyroid volumes of those patients retrospectively. Among 2,672 patients with thyroid nodule, 2,562 (95.9 %) patients had benign cytology and 110 (%4,1) patients had malignant cytology. There was no correlation between the malignancy and gender (p = 0.935), and patients with malignant cytology were younger (52 vs 59, p < 0.001). Also, TSH levels were higher in patients with malignant than benign cytology (p = 0.017). Median volume of right part, left part, and total thyroid for patients who had malignant cytology was significantly lower than patients who had benign cytology (8.3, 7.1, 15.9 vs 10.8 ml, 9.0 mml, 20.6 ml, respectively, p <= 0.001 for all parameters). The results demonstrated that thyroid cancer prevalence was higher in patients with low thyroid volume. According to our results, thyroid volume should be considered as a risk factor for malignancy in the evaluation of thyroid nodules.
Response Rates of Taxane Rechallenge in Metastatic Breast Cancer Patients Previously Treated with Adjuvant Taxanes
(2016) Kucukoztas, Nadire; Oguz, Arzu; Rahatli, Samed; Altundag, Ozden; Altundag, Kadri; 0000-0003-0197-6622; 0000-0001-5588-0306; 0000-0003-3163-7429; 0000-0001-6512-6534; 27837607; W-9219-2019; AAM-3226-2021; AAJ-3047-2021; W-8004-2019
Purpose: This study was conducted to determine the efficacy of taxane-based regimens in patients with metastatic breast cancer pre-treated with taxanes in adjuvant treatment and also to assess the response rates of taxanes in each treatment line. Methods: The data of 939 breast cancer patients, who had received adjuvant taxane-based chemotherapy, were reviewed retrospectively. In 191 of them local/distant recurrences were detected. The treatments that were given when metastases occurred and the responses were recorded. Response rates (RRs), clinical benefit rates/CBR (complete response/CR + partial response/PR + stable disease/SD) and progression-free (PFS) and overall survival (OS) values were determined. RRs to the most frequently used protocols in our institutes (capecitabine-based and taxane-based regimens) were compared. Results: Of 191 patients, 11 didn't receive treatment and for the remaining 180 patients 45 (24%) received taxane-based therapies, 89 (49.4%) received capecitabine-based therapies, 28 (15.6%) received hormonotherapy and 18 (10%) received other chemotherapeutics. The RR for first-line taxane regimen was 58.5%, consisting of 5 CRs (12%) and 19 PRs (46%). Menopausal status, histological grade, estrogen/progesterone receptors, cerbB2 status, having PFS > ors 2 years and the site of metastases did not predict response to first-line taxane treatment. For the 2nd and 3rd or later line therapies, RRs of taxane rechallenge were above 40%. Conclusion: Rechallenging with taxanes after (neo)adjuvant taxane exposure seems to be a reasonable option even in 3rd or further line treatments with high response rates.
Response Rates of Taxane Rechallenge in Metastatic Breast Cancer Patients, Previously Treated with Adjuvant Taxanes
(2014) Oguz, Arzu; Babacan, Taner; Dizdar, Omer; Kucukoztas, Nadire; Rahatli, Samed; Keskin, Gul Sema Yildiran; Altundag, Ozden; Altundag, Kadri; https://orcid.org/0000-0001-6512-6534; https://orcid.org/0000-0001-5588-0306; https://orcid.org/0000-0003-3163-7429; https://orcid.org/0000-0003-0197-6622; W-8004-2019; AAM-3226-2021; AAJ-3047-2021; W-9219-2019
Single-Center Experience of Recurrence Patterns and Survival Analyses of Patients With Hepatocellular Carcinoma and Liver Transplant
(2020) Rahatli, Samed; Soy, Ebru H. Ayvazoglu; Oguz, Arzu; Altundag, Ozden; Moray, Gokhan; Haberal, Mehmet; 0000-0003-0197-6622; 0000-0002-3462-7632; 0000-0003-2498-7287; 0000-0003-3163-7429; 0000-0001-6512-6534; 0000-0002-0993-9917; 32279656; W-9219-2019; AAJ-8097-2021; AAE-1041-2021; AAJ-3047-2021; W-8004-2019; AAC-5566-2019
Objectives: Hepatocellular carcinoma remains a major health problem with increased rates of mortality. The curative treatment options are resection or liver transplant. Because the Milan criteria are restrictive for candidates, they have been expanded into alternative sets of criteria. We aimed to evaluate our indications for liver transplant and their results for hepatocellular carcinoma. Materials and Methods: Between December 1988 and January 2020, we performed 652 liver transplant procedures (443 living donors, 209 deceased donors) at Baskent University (Ankara, Turkey). At Baskent University, we developed liver transplant criteria for patients with hepatocellular carcinoma. For our criteria, liver transplant for hepatocellular carcinoma was performed in patients without major vascular invasion and distant metastasis. Clinical data on cancer demographics, recurrence patterns, and survival outcomes were evaluated retrospectively. Results: Of 652 total patients, 49 adult patients (8%) with diagnosis of hepatocellular carcinoma were included in this study. Median age was 55 years. Hepatocellular carcinoma recurrence after liver transplant was detected in 13 patients. Median overall survival was 64.3 months for all study patients; however, median survival was significantly lower in patients who had recurrence (126.3 vs 43.4 mo for nonrecurrent vs recurrent groups; P = .024). In the expanded criteria group (n = 25), 7 patients (28%) had hepatocellular carcinoma recurrence during follow-up, whereas this ratio was 25% (6/24 patients) in the Milan criteria group, with median time to recurrence of 12.6 versus 11.7 months, respectively (not significantly different). Conclusions: Multidisciplinary treatment modalities, including surgery, interventional radiology techniques, and medical treatments, will probably lead to prolonged survival in patients with hepatocellular carcinoma. According to our center's expanded criteria, recurrence rates and time to recurrence were similar to those shown with the Milan group. We showed that Milan criteria can be safely expanded with promising results even in patients beyond Milan criteria.
Survival impact of number of removed para-aortic lymph nodes in stage I epithelial ovarian cancer
(2021) Gunakan, Emre; Akilli, Huseyin; Kara, Atacan Timucin; Altundag, Ozden; Haberal, Asuman Nihan; Meydanli, Mehmet Mutlu; Ayhan, Ali; 0000-0002-5240-8441; 0000-0003-0197-6622; 0000-0001-8854-8190; 34410474; AAX-3230-2020; W-9219-2019; ABI-1707-2020
Purpose The survival effect of presence or absence of lymphadenectomy in early-stage epithelial ovarian cancer (EOC) was priorly shown but the effect of number of removed lymph nodes kept in background. We aimed to evaluate the survival impact of number of removed lymph nodes and their localizations in stage I EOC. Methods This study included 182 patients. The best cut-off levels for number of pelvic and para-aortic lymph nodes (PaLN) were 24 and 10, respectively. Univariate and multivariate survival analyses were performed for these cut-offs and other prognostic factors. Results The median age of the patients was 49. The median number of removed pelvic and paraartic lymph nodes were 29 and 9, respectively. The median overall (OS) and progression-free survival (PFS) were 67 and 50 months, respectively. The 5-year OS rate was 89.6%. Recurrence occured in 24 (19.5%) patients. In univariate analyses tumor grade (p: 0.005), pelvic LN number (p: 0.041) and PaLN number (p: 0.004) were the factors that were significantly associated with PFS. Tumor grade and PaLN number were independently and significantly associated with PFS in multivariate analyses (p: 0.015 and p: 0.017, respectively). In OS analyses, age, tumor grade, presence of LVI, number of pelvic and PaLNs were the significantly associated factors (p < 0.05 for all). In multivariate analyses, age and PaLN number were independently and significantly associated with OS (p: 0.011 and p: 0.021, respectively). Conclusions The number and localizations of removed lymph nodes may have a survival affect in stage I EOC. We also think that this study may constitute a kernel point for larger prospective series on lymph node number and lymphatic regions.
Survival In Recurrent Ovarian Cancer Patients Before And After The Bevacizumab Era: An Observational Single-Centre Study
(2022) Akilli, Huseyin; Rahatli, Samed; Aliyeva, Khayala; Altundag, Ozden; Kuscu, Ulku Esra; Ayhan, Ali; https://orcid.org/0000-0002-5240-8441; https://orcid.org/0000-0003-0197-6622; 35260031; AAX-3230-2020; W-9219-2019
A retrospective observational study was carried out in Baskent University School of Medicine, Ankara, Turkey. Recurrent ovarian cancer patients treated between 2007 and 2017 were divided into two groups according to their bevacizumab status. The primary endpoints were overall survival (OS) and safety. Three hundred and ninety-six patients enrolled in this study, 200 (50.5%) received bevacizumab while 196 (49.5%) patients never received bevacizumab. The median follow-up time was 48.2 and 47.6 months, respectively. The 5-year OS was 61% and 46%, respectively (p=.007). In multivariate analysis, only platinum-sensitivity (HR: 3.75, 95% CI: 3.0-5.32; p<.001) was identified as independent prognostic factors. In subgroup analyses according to platinum status, bevacizumab did not affect the 5 year OS in platinum sensitive patients (64% versus 68% p=.28) but increased survival in platinum resistant patients (36% versus 44%, p=.00). The rate of grade III-IV haematologic toxicities was 13.7% in the bevacizumab group and 11% in the other group (p=.6).Impact Statement What is already known on this subject? Bevacizumab increases the progression-free survival in platinum-sensitive and resistant recurrent ovarian cancer patients without changing overall survival. What do the results of this study add? Bevacizumab did not affect OS in platinum sensitive recurrent ovarian cancer patients however improved OS in platinum resistant patients with mild toxicity. What are the implications of these findings for clinical practice and/or further research? This study emphasised the crucial role of bevacizumab in the treatment of recurrent ovarian cancer patients.