PubMed Kapalı Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10764
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Item OPEC Study: An International Multicenter Study Of Ovarian Preservation In Endometrial Cancers(2022) Akgor, Utku; Ayhan, Ali; Shushkevich, Alexander; Ozdal, Bulent; Angelou, Kyveli; Akbayir, Ozgur; Kaidarova, Dilyara; Ulrikh, Elena; Stepanyan, Artem; Ortac, Firat; Aliyev, Shamistan; Ozgul, Nejat; Taranenka, Siarhei; Haberal, Ali; Salman, Coskun; Seyhan, Alper; Selcuk, Ilker; Haidopoulos, Dimitrios; Akilli, Huseyin; Bolatbekova, Raikhan; Alaverdyan, Areg; Taskin, Salih; Murshudova, Sabina; Batur, Meltem; Berlev, Igor; Gultekin, Murat; https://orcid.org/0000-0002-5240-8441; 35323994; AAX-3230-2020Objective To evaluate the feasibility and oncological safety of ovarian preservation in early stage endometrial adenocarcinoma (EC) patients aged 40 and below. Methods A total of 11 institutions from eight countries participated in the study. 169 of 5898 patients aged <= 40 years were eligible for the study. Patients with EC treated between March 2007 and January 2019 were retrospectively assessed. Results The median duration of follow-up after EC diagnosis was 59 months (4-187). Among 169 participants, ovarian preservation surgery (OPS) was performed in 54 (31.9%), and BSO was performed in 115 (68.1%) patients. Although patients younger than 30 years of age were more likely to have OPS than patients aged 30 to 40 years (20.4% vs. 9.6%, P = 0.021), there was no significant difference by the mean age. There were no other relevant baseline differences between OPS and BSO groups. The Kaplan-Meier analysis revealed no difference in either the overall survival (P = 0.955) or recurrence-free survival (P = 0.068) among patients who underwent OPS, and BSO. Conclusion OPS appears to be safe without having any adverse impact on survival in women aged <= 40 years with FIGO Stage I EC.Item Prognostic Value of the Number of the Metastatic Lymph Nodes in Locally Early-Stage Cervical Cancer: Squamous Cell Carcinoma Versus Non-Squamous Cell Carcinoma(2021) Aslan, Koray; Haberal, Ali; Akilli, Huseyin; Meydanli, Mehmet Mutlu; Ayhan, Ali; 0000-0002-5240-8441; 33772630; AAX-3230-2020Purpose To clarify the prognostic value of the number of metastatic lymph nodes (mLNs) in squamous and non-squamous histologies among women with node-positive cervical cancer. Methods One hundred ninety-one node-positive cervical cancer patients who had undergone radical hysterectomy plus systematic pelvic and para-aortic lymphadenectomy followed by concurrent radiochemotherapy were retrospectively reviewed. The prognostic value of the number of mLNs was investigated in squamous cell carcinoma (SCC) v (n = 148) and non-SCC (n = 43) histologies separately with univariate log-rank test and multivariate Cox regression analyses. Results In SCC cohort, mLNs > 2 was significantly associated with decreased 5-year disease-free survival (DFS) [hazard ratio (HR) = 2.06; 95% confidence interval (CI) 1.03-4.09; p = 0.03) and overall survival (OS) (HR = 2.35, 95% CI 1.11-4.99; p = 0.02). However mLNs > 2 had no significant impact on 5-year DFS and 5-year OS rates in non-SCC cohort (p = 0.94 and p = 0.94, respectively). We stratified the entire study population as SCC with mLNs <= 2, SCC with mLNs > 2, and non-SCC groups. Thereafter, we compared survival outcomes. The non-SCC group had worse 5-year OS (46.8% vs. 85.3%, respectively; p < 0.001) and 5-year DFS rates (31.6% vs. 82.2%, respectively; p < 0.001) when compared to those of the SCC group with mLNs <= 2. However, the non-SCC group and the SCC group with mLNs > 2 had similar 5-year OS (46.8% vs. 65.5%, respectively; p = 0.16) and 5-year DFS rates (31.6% vs. 57.5%, respectively; p = 0.06). Conclusion Node-positive cervical cancer patients who have non-SCC histology as well as those who have SCC histology with mLNs > 2 seem to have worse survival outcomes when compared to women who have SCC histology with mLNs <= 2.Item 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-9219-2019Objective 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.Item Nulliparity and postmenopausal status are independent factors of malignancy potential of endometrial intraepithelial neoplasia in polyps(2020) Karakas, Latife Atasoy; Atilgan, Alev Ok; Akilli, Huseyin; Kuscu, Ulku Esra; Haberal, Ali; Ayhan, Ali; 0000-0001-8595-8880; 0000-0002-0992-6980; 0000-0001-7369-5470; 0000-0002-1486-7209; 33118172; AAK-3333-2021; AAI-8792-2021; AAI-8793-2021; AAI-9331-2021; AAX-3230-2020; AAJ-5802-2021Objective To estimate the risk of concurrent endometrial cancer in endometrium when endometrial intraepithelial neoplasia (EIN) is found within an endometrial polyp and to identify the possible predictive factors for concurrent endometrial cancer. Methods Histopathologic data of women who underwent hysteroscopy for resection of endometrial polyps at Ankara Baskent University Hospital, between 2011 and 2019 were screened. Patients whose polypectomy report was EIN in a polyp, and who had a final report of the hysterectomy specimen were included. Patients were divided into two groups according to the presence of concurrent cancer in the hysterectomy material: group 1, concurrent cancer present and group 2, concurrent cancer absent. Statistical analyses were performed using SPSS. Results A total of 4125 women underwent hysteroscopy for the resection of endometrial polyps. Of those women, 161 (3.9%) were diagnosed as having EIN and 115 met the criteria. The rate of concurrent endometrial cancer was 28.6% (33/115). According to multivariate analysis, nulliparity (odds ratio [OR] 0.38; 95% confidence interval [CI] 1.04-3.67; p = 0.036) and postmenopausal status (OR 0.64; 95% CI 0.42-0.98; p = 0.042) were found to be independent factors significantly associated with concurrent endometrial cancer. Conclusion The incidence of concurrent cancer is higher in postmenopausal or nulliparous women when EIN is detected in a polyp.Item Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer(2019) Ayhan, Ali; Sahin, Hanifi; Sari, Mustafa Erkan; Yalcin, Ibrahim; Haberal, Ali; Meydanli, Mehmet Mutlu; 30665899Objective The purpose of this study was to assess the prognostic significance of lymphovascular space invasion in women with low-risk endometrial cancer. Methods A dual-institutional, retrospective department database review was performed to identify patients with 'low-risk endometrial cancer' (patients having <50% myometrial invasion with grade 1 or 2 endometrioid endometrial cancer according to their final pathology reports) at two gynecologic oncology centers in Ankara, Turkey. Demographic, clinicopathological and survival data were collected. Results We identified 912 women with low-risk endometrial cancer; 53 patients (5.8%) had lymphovascular space invasion. When compared with lymphovascular space invasion-negative patients, lymphovascular space invasion-positive patients were more likely to have post-operative grade 2 disease (p<0.001), deeper myometrial invasion (p=0.003), and larger tumor size (p=0.005). Patients with lymphovascular space invasion were more likely to receive adjuvant therapy when compared with lymphovascular space invasion-negative women (11/53 vs 12/859, respectively; p<0.001). The 5-year recurrence-free survival rate for lymphovascular space invasion-positive women was 85.5% compared with 97.0% for lymphovascular space invasion-negative women (p<0.001). The 5-year overall survival rate for lymphovascular space invasion-positive women was significantly lower than that of lymphovascular space invasion-negative women (88.2% vs 98.5%, respectively; p<0.001). Age >= 60 years (HR 3.13, 95% CI 1.13 to 8.63; p=0.02) and positive lymphovascular space invasion status (HR 6.68, 95% CI 1.60 to 27.88; p=0.009) were identified as independent prognostic factors for decreased overall survival. Conclusions Age >= 60 years and positive lymphovascular space invasion status appear to be important prognostic parameters in patients with low-risk endometrial cancer who have undergone complete surgical staging procedures including pelvic and para-aortic lymphadenectomy. Lymphovascular space invasion seems to be associated with an adverse prognosis in women with low-risk endometrial cancer; this merits further assessment on a larger scale with standardization of the lymphovascular space invasion in terms of presence/absence and quantity.Item Are There Any Predictors of Endometrial Premalignancy/Malignancy within Endometrial Polyps in Infertile Patients?(2019) Tohma, Yusuf Aytac; Onalan, Gogsen; Esin, Sertac; Sahin, Hanifi; Aysun, Dide; Kuscu, Esra; Haberal, Ali; Zeyneloglu, Hulusi Bulent; 0000-0001-9418-4733; 31311015Background: In the literature, there is no detailed analysis on the prediction factors for premalignancy/malignancy within endometrial polyps (EPs) in infertile patients. In this study, we aimed to determine the frequency of endometrial premalignancy/malignancy within EPs in infertile patients undergoing office hysteroscopic polypectomy and identify the factors that can potentially predict an endometrial premalignancy/malignancy within EPs. Method: A total of 957 infertile patients undergoing office hysteroscopy were diagnosed with EPs between February 2011 and August 2018. Patients were divided into 2 groups according to the pathological examination of EPs as benign (Group 1; n = 939) and premalignant/malignant (Group 2; n = 18). The medical records of all patients included in the study were reviewed retrospectively. Results: In this cohort, prevalence of endometrial premalignancy/malignancy within EPs was 18/957 (1.88%). On univariate analysis, age, polyp size, diabetes, hypertension, and causes of infertility did not differ between the 2 groups. On multivariate analysis, diffuse polypoid appearance of the endometrial cavity on office hysteroscopy (hazard ratio [HR] 4.1; 95% CI 1.576-10.785), duration of infertility, (HR 4; 95% CI 1.279-12.562), and body mass index (HR 7.9; 95% CI 2.591-24.258) were found to be independent predictors of endometrial premalignancy/malignancy within polyps in infertile patients. Conclusion: When diffuse polypoid appearance of the endometrial cavity is detected in an infertile patient during office hysteroscopy, hysteroscopy-guided resection and endometrial curettage should be performed. The pathological specimen should be sent for histopathological evaluation to diagnose possible endometrial premalignancy/malignancy within polyps.Item Is the revised 2018 FIGO staging system for cervical cancer more prognostic than the 2009 FIGO staging system for women previously staged as IB disease?(2019) Ayhan, Ali; Aslan, Koray; Bulut, Ayca Nazli; Akilli, Huseyin; Oz, Murat; Haberal, Ali; Meydanli, Mehmet Mutlu; 0000-0002-7495-5470; 31325847Objective: The purpose of this study was to compare the prognostic value of the revised FIGO staging system with that of the 2009 FIGO staging system for women previously staged as IB disease. Methods: Institutional cervical cancer databases of two high-volume gynecologic cancer centers in Ankara, Turkey, were retrospectively analyzed. Only women with 2009 FIGO stage IB1 or 1B2 disease who underwent primary surgery were included. Survival curves were generated using Kaplan-Meier plots, and the log-rank test was used for survival comparisons. The Cox proportional hazards regression model was used to obtain hazard ratios (HRs) and 95% confidence interval (CI). Results: Data from 425 women were analyzed. The 2009 FIGO stage IB2 (n = 131) disease was associated with a nearly three-fold increased risk of mortality when compared to the 2009 FIGO stage IB1 (n = 294) disease (HR: 2.72, 95% CI: 1.69-4.37; p < 0.001). Stage migration was observed in 372 (87.5%) patients, according to the revised FIGO staging system, leading to no significant difference in five-year overall survival rates between stage IB1 (n=53) and IB2 (n=127) disease (95.2% vs. 89.3%, respectively; p = 0.23),or between stage IB2 (n=127) and IB3 (n=95) disease (89.3% vs. 84.2%, respectively; p = 0.12). Similarly, there was no significant difference in five-year overall survival rates between stage IIIC1 (n=114) and IIIC2 (n=36) disease (79.0% vs. 67.2%, respectively; p = 0.34). Conclusion: When compared to the 2009 FIGO staging system, the revised staging system has more substages, which leads to fewer patients in each sub-stage, resulting in diminished statistical power. (C) 2019 Elsevier B.V. All rights reserved.