Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Oncologic and Obstetric Outcomes of Early-Stage Epithelial Ovarian Cancer Patients Who Underwent Fertility-Sparing Surgery: A Retrospective Study(2023) Ayhan, Ali; Tunc, Mehmet; Atasoy Karakas, Latife; Tekelioglu, Tugba; Haberal Reyhan, Asuman Nihan; Onalan, Gogsen; Kuscu, Esra; 0000-0002-8646-0619; 0000-0001-7369-5470; 36825554; AAA-6962-2022; AAI-8793-2021ObjectiveThis study aimed to assess the long-term oncologic and obstetric outcomes of women with epithelial ovarian cancer who underwent fertility-sparing surgery. MethodsA total of 68 patients observed between March 2007 and July 2021 were included in this retrospective study. Unilateral salpingo-oophorectomy and uterine preservation with staging surgery were the main procedures for fertility-sparing surgery. Disease-free, overall survival, and obstetric outcomes were measured as primary outcomes. ResultsThe median age of the patients was 30.5 years. The median follow-up time was 60.5 months. Disease recurrence occurred in 15 (22.1%) of the patients. Five-year disease-free survival and overall survival (OS) percentages were 75.6% and 83.3%, respectively, for all stages. The FIGO (International Federation of Gynecology & Obstetrics) stage was the only significant factor that affected OS (P = 0.001). Twenty-three patients tried to conceive, and 15 (65.2%) patients became pregnant. Twelve (80%) pregnancies reached term and resulted in 15 live births. Chemotherapy administration and surgical intervention (cystectomy or unilateral salpingo-oophorectomy) showed no difference in pregnancy results (P = 0.806 and P = 0.066, respectively). ConclusionFertility preservation is safe for invasive epithelial ovarian cancer at early stages for women in the reproductive era. Disease recurrence and OS results are similar to standard treatment at early stages with decent obstetric outcomes.Item Papanicolaou Smear Findings in Solid-Organ Transplant Recipients Compared With Normal Subjects According to the Bethesda 2001 System(2015) Atilgan, Alev Ok; Tepeoglu, Merih; Haberal, A. Nihan; Durukan, Elif; Kuscu, Esra; Haberal, Mehmet; 0000-0002-9894-8005; 0000-0002-3462-7632; 0000-0001-9852-9911; 0000-0001-8595-8880; 0000-0002-0992-6980; 0000-0002-8579-5564; 25894158; AAK-5222-2021; AAJ-8097-2021; AAK-4587-2021; AAK-3333-2021; AAI-8792-2021; AAJ-8621-2021Objectives: Solid-organ transplant recipients are at increased risk of developing cancer including cervical cancer compared with woman in the general population, mostly due to long-term immunosuppressive therapy. The Papanicolaou smear remains the primary method of screening cervical pathology including preinvasive and invasive lesions. The objective of this study was to evaluate Pap smear findings in solid-organ transplant recipients, determine the prevalence of abnormal smears, and compare these patients with the general population. Materials and Methods: We retrospectively examined 111 women patients who received liver or kidney transplant between January 1990 to December 2012 at Baskent University Ankara Hospital. Pap smear findings were compared with normal control patients matched for same age and technical procedure of cervical cytology. To selection of control patients, propensity score matching program was performed. All Pap smears were re-examined according to Bethesda 2001 criteria. Results: In 111 transplant patients, 2 patients (1.8%) had atypical squamous cells of undetermined significance, 8 patients (7.2%) had low-grade squamous intraepithelial lesion, 15 patients (13.5%) had Candida infection, 2 patients (1.8%) had Trichomonas vaginalis, 1 patient (0.9%) had herpes simplex infection, 13 patients (11.7%) had bacterial vaginosis, 15 patients (13.5%) had reactive changes due to inflammation, and 18 patients (16.2%) had atrophy. When we compared our results with the control group, there were statistically significant differences (P <= .05) between the 2 groups in epithelial cell abnormalities (low-grade squamous intraepithelial lesion), Candida infection, bacterial vaginosis, and atrophy. Conclusions: Pap smear screening potentially may help recognize cervical preinvasive and invasive lesions. The risk of developing cervical intraepithelial neoplasia is greater in transplant recipients because of immunosuppressive therapy. The incidence of low-grade squamous intraepithelial lesion was significantly greater in transplant recipients than the general population. Intensive follow-up with Pap smear in transplant recipients is important in the early detection of these lesions.Item Is Colposcopic Evaluation Necessary in All Women with Postcoital Bleeding?(2015) Gulumser, Cagri; Tuncer, Aykut; Kuscu, Esra; Ayhan, Ali; 0000-0002-5434-1025; 0000-0002-0992-6980; 26254856; K-1760-2018; AAJ-5802-2021; AAI-8792-2021Objective: To evaluate what extent postcoital bleeding (PCB) is an indicator of cervical cancer (CIN2 (+)). Methods: This is a retrospective cohort study. Between 2007 and 2013, amongst all referred patients, a total of 1491 consecutive women who had both conventional cytology and cervical biopsy were enrolled in the study. Of those 237 women have PCB, according to biopsy results, subjects were divided into two groups: CIN1 (-) and CIN2 (+). Multiple logistic regressions was used to construct a model to predict the occurrence of CIN 2 (+) based on age, menopause, marriage status, smoking, PCB, HPV and cytology. Results: Among the all women with CIN 2 (+) colposcopy guided biopsy result, PCB was 13.1% (53/406). The relationship between biopsy results and age, parity, menopausal status, marital status, smoking, presence of PCB, HPV DNA, and cytology is statistically significant (p = 0.012, p = 0.001, p = 0.023, 0.013, p > 0.001, p = 0.038, p < 0.001, p < 0.001, respectively). According to regression analysis only smoking, HPV (+) and abnormal cytology increase the probability of CIN2 (+); 1.687 times (p = 0.018), 4.065 times (p < 0.001), 5.787 times (p = 0.001) respectively. Having PCB only does not indicate an increased risk of CIN2 (+). Conclusion: Colposcopic examination and biopsy should be performed only in the situation where women have PCB and any of the following: smoking, positive HPV, or abnormal cytology. (C) 2015 Published by Elsevier Ireland Ltd.Item Possible Impact of Immunosuppressive Therapy Regimens on Histopathologic Outcomes of Abnormal Uterine Bleeding in Solid-Organ Transplant Recipients(2018) Tohma, Yusuf Aytac; Akilli, Huseyin; Kirnap, Mahir; Haberal, Asuman Nihan; Akyel, Dilan; Zengin, Hatice Yagmur; Zeyneloglu, Hulusi Bulent; Kuscu, Esra; Ayhan, Ali; Haberal, Mehmet; https://orcid.org/0000-0001-9418-4733; https://orcid.org/0000-0002-5240-8441; https://orcid.org/0000-0001-9852-9911; https://orcid.org/0000-0002-9855-2449; https://orcid.org/0000-0002-0289-2642; https://orcid.org/0000-0002-3462-7632; 29851156; AAE-6482-2021; AAX-3230-2020; AAH-9198-2019; AAK-4587-2021; ABA-3224-2021; B-6487-2009; AAJ-8097-2021Background: In this study, we aimed to determine the frequency of histopathologic outcomes of solid-organ transplantation in women with abnormal uterine bleeding (AUB) receiving immunosuppressive therapies. Methods: This is a retrospective study including a single-center experience. Data were extracted from hospital records, and solid-organ transplant recipients who were diagnosed with AUB were included. Results: Fifty-five of these patients were renal transplant recipients (79.7%), and 14 were liver transplant recipients (20.3%). Histopathologic examination showed various histopathologic patterns of endometrium in patients with AUB consisting of normal histopathologic findings of endometrium in 31 patients (48.4%); 29 hormonal imbalance during proliferative and secretory phases of menstrual cycle and two atrophic endometrium. Endometrial hyperplasia without atypia was observed in 11 patients (17.2%). Polyp was seen in 22 patients (34.4%); 21 endometrial polyp and one endocervical polyp. There were significant differences in terms of histopathologic findings among the three groups of patients according to different immunosuppressive regimens (P = .029). There was no endometrial hyperplasia in women receiving sirolimus-based immunosuppressive regimens. Moreover, there was no endometrial hyperplasia in the liver transplant recipient group. Conclusions: Sirolimus-based immunosuppressive regimens may be administered to patients who have risk factors for endometrial precancerous lesions, such as endometrial hyperplasia. However, additional well-designed, large-scale studies are warranted to confirm our findings.Item Risk Factors for Residual Disease After Cervical Conization in Patients with Cervical Intraepithelial Neoplasia Grades 2 and 3 and Positive Surgical Margins(2016) Ayhan, Ali; Tuncer, Hasan Aykut; Reyhan, Nihan Haberal; Kuscu, Esra; Dursun, Polat; 0000-0001-9852-9911; 0000-0002-5434-1025; 0000-0002-0992-6980; 27038228; AAK-4587-2021; K-1760-2018; AAJ-5802-2021; AAI-8792-2021Objective: To evaluate risk factors for the persistence of cervical intraepithelial neoplasia (CIN) grade >= 2 following repeat surgical procedures in patients with CIN grades 2 and 3 and positive surgical margins. Study design: This study included patients with CIN grades 2 and 3 and positive surgical margins following loop electrosurgical excision procedures (LEEP), who had undergone additional surgery between 2007 and 2014. Factors associated with CIN grade >= 2 on biopsy results after the second operation were assessed by multiple logistic regression analysis. Factors considered included patient age, parity, menopausal status, smoking, referral cytology, initial LEEP pathology, time interval between LEEP and surgical procedures, presence of disease on endocervical sampling, endocervical surgical margins, glands, disease surrounding >= 50% of the cervical circumference and requirement for multiple sweeps on initial LEEP to excise a lesion. The forward likelihood ratio method was used and significance was set at p < 0.05. Results: Repeat surgical procedures were performed in 104 patients, 75 with CIN 2 and 29 with CIN 3, with 43 (41.3%) reported as normal or CIN 1. However, 57 (54.8%) patients had CIN >= 2 lesions and four (3.8%) had previously undiagnosed cervical cancer. Factors associated with CIN >= 2 lesions included requirement for multiple sweeps (vs. a single sweep; odds ratio [OR] 5.967; 95% confidence interval [CI] 2.183-16.311, p < 0.001) and involvement of >= 50% of the cervical circumference (vs. <50%; OR 5.073; 95% CI 1.501-17.146, p = 0.009). Conclusion: As lesions requiring multiple sweeps for excision and/or surrounding >= 50% of the cervical circumference during initial conization are associated with recurrent CIN >= 2 lesions, attention should be paid during resection to prevent margin positivity. If surgical margins are positive, however, repeat surgical procedures should be considered in patients with CIN 2 and CIN 3 lesions and these risk factors. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Item Evaluation of a New Oncogynecologic Training Program(2016) Tuncer, Hasan Aykut; Ozgul, Nejat; Kuscu, Esra; Dursun, Polat; Ayhan, Ali; 0000-0002-0992-6980; 0000-0002-5434-1025; 27465887; AAJ-5802-2021; AAI-8792-2021; K-1760-2018Objective The first cohort of Turkish fellows has begun to graduate from a newly accredited training program on gynecologic oncology. This study aimed to investigate the value of experience on the confidence of these fellows to perform surgical procedures. Methods We assessed the characteristics of 32 fellows, including the perceived adequacy of their fellowship training, the facilities of the clinics at which they were trained, and their levels of exposure and confidence in performing a total of 44 procedures. Exposure levels were performing, assisting with, observing, or no exposure. Confidence was assessed by asking whether they could perform each procedure. Correlation analysis was used to determine the link between exposure levels and confidence. Results The confidence of fellows to perform a surgical procedure increased with exposure to that procedure (r = 0.820, P < 0.001). Performing, assisting with, and observing a procedure created a sense of confidence in 97.2%, 54.1%, and 31.1% of fellows. The majority of fellows (>75%) had performed type 2 hysterectomy, total omentectomy, and pelvic and para-aortic lymphadenectomy. None of the fellows had ever performed a trachelectomy. Conclusions Efforts should be made in accredited systems for gynecologic oncology surgical training to provide more opportunities for trainees to perform surgical procedures, rather than assisting with and observing them.Item Prognostic Factors and Patterns of Recurrence in Lymphovascular Space Invasion Positive Women With Stage IIIC Endometriod Endometrial Cancer(2018) Cuylan, Zeliha F.; Oz, Murat; Ozkan, Nazli T.; Comert, Gunsu K.; Sahin, Hanifi; Turan, Taner; Akbayir, Ozgur; Kuscu, Esra; Celik, Husnu; Dede, Murat; Gungor, Tayfun; Meydanli, Mehmet M.; Ayhan, Ali; https://orcid.org/0000-0002-0992-6980; 29516573; AAI-8792-2021; AAL-1923-2021; AAJ-5802-2021AimThe purpose of this study was to determine the prognostic factors and patterns of failure in lymphovascular space invasion (LVSI)-positive women with stage IIIC endometrioid endometrial cancer (EC). MethodsA multicenter, retrospective, department database review was performed to identify LVSI-positive patients with stage IIIC endometrioid EC at five gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. ResultsWe identified 172 LVSI-positive women with stage IIIC endometrioid EC during the study period; 75 (43.6%) were classified as Stage IIIC1 and 97 (56.4%) as Stage IIIC2. The median age at diagnosis was 59 years, and the median duration of follow up was 34.5 months. The total number of recurrences was 46 (26.7%). We observed 14 (8.1%) locoregional recurrences, 12 (7.0%) retroperitoneal failures and 20 (11.6%) distant relapses. For the entire study cohort, 5-year progression-free survival (PFS) was 67.4%, while the 5-year overall survival (OS) rate was 75.1%. Grade 3 histology (hazard ratio [HR] 2.62, 95% confidence interval [CI] 1.34-5.12; P = 0.005), cervical stromal invasion (HR 2.33, 95% CI 1.09-4.99; P = 0.028) and myometrial invasion (MMI) 50% (HR 4.0, 95% CI 1.16-13.69; P = 0.028) were found to be independent prognostic factors for decreased OS. ConclusionUterine factors such as grade 3 disease, cervical stromal invasion and deep MMI seem to be independently associated with decreased OS in LVSI-positive women with stage IIIC endometrioid EC. The high distant recurrence rate in this subgroup of patients warrants further studies in order to identify the most effective treatment strategy for those patients.Item Risk Factors for Lymph Node Metastasis among Lymphovascular Space Invasion-Positive Women with Endometrioid Endometrial Cancer Clinically Confined to the Uterus(2018) Sari, Mustafa Erkan; Meydanli, Mehmet Mutlu; Yalcin, Ibrahim; Sahin, Hanifi; Coban, Gonca; Celik, Husnu; Kuscu, Esra; Gungor, Tayfun; Ayhan, Ali; 0000-0002-3285-5519; 0000-0002-0992-6980; 30419557; AAD-8494-2019; AAI-9974-2021; AAL-1923-2021; AAI-8792-2021; AAJ-5802-2021Introduction: We aimed to assess risk factors for lymph node (LN) metastasis among lymphovascular space invasion(LVSI)-positive women with pure endometrioid endometrial cancer (EC) clinically confined to the uterus. Methods: Medical records of women who underwent primary surgery for EC between 2007 and 2016 at either of 2 gynecological oncology centers were retrospectively reviewed. Patient data were analyzed with respect to LN involvement, and predictive factors for LN metastasis were investigated. Results: 280 patients with surgically staged endometrioid-type EC with LVSI were identified. LN involvement was detected in 88 patients (31.4%) with a systematic LN dissection. In multivariate analysis, elevated baseline serum CA 125 levels, deep myometrial invasion (MMI), adnexal involvement and positive peritoneal cytology were found to be independent risk factors for LN metastasis. In women without deep MMI and elevated baseline serum CA 125 levels, the rate of LN metastasis was 19%. The presence of solely deep MMI increased this probability up to 29.1%. The rate of LN metastasis was found to be 46.8% for women with both deep MMI and elevated baseline serum CA 125 levels. Conclusion: These findings may be useful in the decision- making process for LVSI-positive women who are unstaged. (c) 2018 S. Karger GmbH, FreiburgItem Is the extent of lymphadenectomy a prognostic factor in International Federation of Gynecology and Obstetrics stage II endometrioid endometrial cancer?(2021) Cuylan, Zeliha Firat; Akilli, Huseyin; Gungorduk, Kemal; Demirkiran, Fuat; Oz, Murat; Salman, Mehmet Coskun; Sozen, Hamdullah; Celik, Husnu; Gokcu, Mehmet; Bese, Tugan; Meydanli, Mehmet Mutlu; Ozgul, Nejat; Topuz, Samet; Kuscu, Esra; Kuru, Oguzhan; Gokmen, Sibel; Gultekin, Murat; Ayhan, Ali; 33426779Aim This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (>= 10 pelvic lymph nodes (LNs) and >= 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC). Methods A multicenter department database review was performed to identify patients who had been operated and diagnosed with stage II EEC at seven centers in Turkey retrospectively. Demographic, clinicopathological, and survival data were collected and analyzed. Results We identified 284 women with stage II EEC. There were 170 (59.9%) patients in the adequate lymph node dissection (LND) group and 114 (40.1%) in the inadequate LND group. The 5-year overall survival (OS) rate of the inadequate LND group was significantly lower than that of the adequate LND group (84.1% vs. 89.1%, respectively; p = 0.028). In multivariate analysis, presence of lymphovascular space invasion (LVSI) (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.23-4.63; p = 0.009), age >= 60 (HR: 3.30, 95% CI: 1.65-6.57; p = 0.001], and absence of adjuvant therapy (HR: 2.74, 95% CI: 1.40-5.35; p = 0.003) remained as independent risk factors for decreased 5-year disease-free survival (DFS). Inadequate LND (HR: 2.34, 95% CI: 1.18-4.63; p < 0.001), age >= 60 (HR: 2.67, 95% CI: 1.25-5.72; p = 0.011), and absence of adjuvant therapy (HR: 4.95, 95% CI: 2.28-10.73; p < 0.001) were independent prognostic factors for decreased 5-year OS in multivariate analysis. Conclusion Adequate LND and adjuvant therapy were significant for the improvement of outcomes in FIGO stage II EEC patients. Furthermore, LVSI was associated with worse 5-year DFS rate in stage II EEC.Item Prognostic factors and survival outcomes of women with uterine leiomyosarcoma: A Turkish Uterine Sarcoma Group Study-003(2021) Ayhan, Ali; Celik, Husnu; Tunc, Mehmet; Kuscu, Esra; Akilli, Huseyin; 0000-0002-5240-8441; 0000-0002-8646-0619; 33685725; AAX-3230-2020; AAA-6962-2022To assess the clinicopathological features, prognostic factors, and survival rates associated with uterine leiomyosarcoma (uLMS). Databases from 15 participating gynecological oncology centers in Turkey were searched retrospectively for women who had been treated for stage I-IV uLMS between 1996 and 2018. Of 302 consecutive women with uLMS, there were 234 patients with Federation of Gynecology and Obstetrics (FIGO) stage I disease and 68 with FIGO stage II-IV disease. All patients underwent total hysterectomy. Lymphadenectomy was performed in 161 (54.5%) cases. A total of 195 patients received adjuvant treatment. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 42% and 54%, respectively. Presence of lymphovascular space invasion (LVSI), higher degree of nuclear atypia, and absence of lymphadenectomy were negatively correlated with DFS, while LVSI, mitotic count, higher degree of nuclear atypia, FIGO stage II-IV disease, and suboptimal surgery significantly decreased OS. LVSI and higher degree of nuclear atypia appear to be prognostic indicators for uLMS. Lymphadenectomy seems to have a significant effect on DFS but not on OS. (c) 2021 Elsevier Inc. All rights reserved.