Wos Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10754
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Item Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study(2017) Sari, Mustafa Erkan; Meydanli, Mehmet Mutlu; Turkmen, Osman; Comert, Gunsu Kimyon; Turan, Ahmet Taner; Karalok, Alper; Sahin, Hanifi; Kocaman, Eda; Akbayir, Ozgur; 0000-0002-1741-7035; 28541637Objective: To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. Methods: A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. Results: A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). Conclusion: Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.Item Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone(2017) Haberal, Ali; Celik, Husnu; Coban, Gonca; Ozkan, Nazli Topfedaisi; Meydanli, Mehmet Mutlu; Sari, Mustafa Erkan; Demirkiran, Fuat; Kahramanoglu, Ilker; Bese, Tugan; Arvas, Macit; Sahim, Hanifi; Ozge, Tufan; Yalcin, Omer Tarik; Akbayir, Ozgur; Erdem, Baki; Numanoglu, Ceyhun; Ozgul, Nejat; Boyraz, Gokhan; Salman, Mehmet Coskun; Yuce, Kunter; Dede, Murat; Yenen, Mufit Cemal; Taskin, Salih; Altin, Duygu; Ortac, Ugur Firat; Ayik, Hulya Aydin; Simsek, Tayup; Gungor, Tayfun; Gungorduk, Kemal; Sanci, Muzaffer; Ayhan, Ali; 0000-0002-1486-7209; 0000-0002-3285-5519; 0000-0003-1185-9227; 28657226; AAI-9331-2021; AAJ-5802-2021; AAL-1923-2021; AAI-9974-2021Objective: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone. Methods: A multicenter, retrospective department database review was performed to identify patients with recurrent "low-risk EC" (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected. Results: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5-34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7-105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR >= 36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65-43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69-12.58; p=0.003) were significant predictors. Conclusion: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.Item Does the primary route of spread have a prognostic significance in stage III non-serous epithelial ovarian cancer?(2018) Coban, Gonca; Sahin, Hanifi; Meydanli, Mehmet Mutlu; Sari, Mustafa Erkan; Yalcin, Ibrahim; Ozkan, Nazli Topfedaisi; Cuylan, Zeliha Firat; Erdem, Baki; Gungorduk, Kemal; Akbayir, Ozgur; Dede, Murat; Salman, Mustafa Coskun; Gungor, Tayfun; Ayhan, Ali; 0000-0002-3285-5519; 29506569; AAI-9974-2021Background: The purpose of this retrospective study was to determine the prognosis of non-serous epithelial ovarian cancer (EOC) patients with exclusively retroperitoneal lymph node (LN) metastases, and to compare the prognosis of these women to that of patients who had abdominal peritoneal involvement. Methods: A multicenter, retrospective department database review was performed to identify patients with stage III non-serous EOC at 7 gynecologic oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. The patients were divided into three groups based on the initial sites of disease: 1) the retroperitoneal (RP) group included patients who had positive pelvic and / or para-aortic LNs only. 2) The intraperitoneal (IP) group included patients with > 2 cm IP dissemination outside of the pelvis. These patients all had a negative LN status, 3) The IP / RP group included patients with > 2 cm IP dissemination outside of the pelvis as well as positive LN status. Survival data were compared with regard to the groups. Results: We identified 179 women with stage III non-serous EOC who were treated at 7 participating centers during the study period. The median age of the patients was 53 years, and the median duration of follow-up was 39 months. There were 35 (19.6%) patients in the RP group, 72 (40.2%) in the IP group and 72 (40.2%) in the IP/RP group. The 5-year disease-free survival (DFS) rates for the RP, the IP, and IP/ RP groups were 66.4%, 37.6%, and 25.5%, respectively (p = 0.002). The 5-year overall survival (OS) rate for the RP group was significantly longer when compared to those of the IP, and the IP/RP groups (74.4% vs. 54%, and 36%, respectively; p = 0.011). However, we were not able to define "RP only disease" as an independent prognostic factor for increased DFS or OS. Conclusions: Primary non-serous EOC patients with node-positive-only disease seem to have better survival when compared to those with extra-pelvic peritoneal involvement.Item Comparison of stage III mucinous and serous ovarian cancer: a case-control study(2018) Ayhan, Ali; Cuylan, Zeliha Fırat; Karabuk, Emine; Oz, Murat; Turan, Ahmet Taner; Meydanli, Mehmet M.; Taskin, Salih; Sari, Mustafa Erkan; Sahin, Hanifi; Ulukent, Suat C.; Akbayir, Ozgur; Gungorduk, Kemal; Gungor, Tayfun; Kose, Mehmet F.; 30376858Background: The purpose of this case-control study was to compare the prognoses of women with stage III mucinous ovarian carcinoma (MOC) who received maximal or optimal cytoreduction followed by paclitaxel plus carboplatin chemotherapy to those of women with stage III serous epithelial ovarian cancer (EOC) treated in the similar manner. Methods: We performed a multicenter, retrospective review to identify patients with stage III MOC at seven gynecologic oncology departments in Turkey. Eighty-one women with MOC were included. Each case was matched to two women with stage III serous EOC in terms of age, tumor grade, substage of disease, and extent of residual disease. Survival estimates were measured using Kaplan-Meier plots. Variables predictive of outcome were analyzed using Cox regression models. Results: With a median follow-up of 54months, the median progression-free survival (PFS) for women with stage III MOC was 18.0months (95% CI; 13.8-22.1, SE: 2.13) compared to 29.0 months (95% CI; 24.04-33.95, SE: 2.52) in the serous group (p = 0.19). The 5-year overall survival rate of the MOC group was significantly lower than that of the serous EOC group (44.9% vs. 66.3%, respectively; p < 0.001). For the entire cohort, presence of multiple peritoneal implants (Hazard ratio [HR] 2.39; 95% confidence interval [CI], 1.38-4.14, p = 0.002) and mucinous histology (HR 2.28; 95% CI, 1.53-3.40, p < 0.001) were identified as independent predictors of decreased OS. Conclusion: Patients with MOC seem to be 2.3 times more likely to die of their tumors when compared to women with serous EOC.Item Impact of lymph node ratio on survival in stage III ovarian high-grade serous cancer: a Turkish Gynecologic Oncology Group study(2018) Ayhan, Ali; Ozkan, Nazli Topfedaisi; Sari, Mustafa Erkan; Celik, Husnu; Dede, Murat; Akbayir, Ozgur; Gungorduk, Kemal; Sahin, Hanifi; Haberal, Ali; Gungor, Tayfun; Arvas, Macit; Meydanli, Mehmet Mutlu; 29185270Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in patients with stage III ovarian high-grade serous carcinoma (HGSC). Methods: A multicenter, retrospective department database review was performed to identify patients with ovarian HGSC at 6 gynecologic oncology centers in Turkey. A total of 229 node-positive women with stage III ovarian HGSC who had undergone maximal or optimal cytoreductive surgery plus systematic lymphadenectomy followed by paclitaxel plus carboplatin combination chemotherapy were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 3 groups: LNR1 (<10%), LNR2 (10%<= LNR<50%), and LNR3 (>= 50%). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results: Thirty-one women (13.6%) were classified as stage IIIA1, 15 (6.6%) as stage IIIB, and 183 (79.9%) as stage IIIC. The median age at diagnosis was 56 (range, 18-87), and the median duration of follow-up was 36 months (range, 1-120 months). For the entire cohort, the 5-year overall survival (OS) was 52.8%. An increased LNR was associated with a decrease in 5-year OS from 65.1% for LNR1, 42.5% for LNR2, and 25.6% for LNR3, respectively (p<0.001). In multivariate analysis, women with LNR >= 0.50 were 2.7 times more likely to die of their tumors (hazard ratio [HR]= 2.7; 95% confidence interval [CI]= 1.42-5.18; p<0.001). Conclusion: LNR seems to be an independent prognostic factor for decreased OS in stage III ovarian HGSC patients.Item Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study(2018) Ayhan, Ali; Ozkan, Nazli Topfedaisi; Oz, Murat; Comert, Gunsu Kimyon; Cuylan, Zeliha Fırat; Coban, Gonca; Turkmen, Osman; Erdem, Baki; Sahin, Hanifi; Akbayir, Ozgur; Dede, Murat; Turan, Ahmet Taner; Celik, Husnu; Gungor, Tayfun; Haberal, Ali; Arvas, Macit; Meydanli, Mehmet Mutlu; 29770619Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC). Methods: A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 (<= 0.15), and LNR2 (> 0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results: One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30-82) and the median duration of follow-up was 40 months (range, 1-228 months). There were 167 (80.7%) women with LNR <= 0.15, and 40 (19.3%) women with LNR > 0.15. The 5-year progression-free survival (PFS) rates for LNR <= 0.15 and LNR > 0.15 were 76.1%, and 58.5%, respectively (p= 0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR <= 0.15 to 62.3% for LNR > 0.15 (p= 0.005). LNR > 0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]= 2.05; 95% confidence interval [CI]= 1.07-3.93; p= 0.03) and OS (HR= 3.35; 95% CI= 1.57-7.19; p= 0.002). Conclusion: LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC.