Fakülteler / Faculties
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Item Can Predict Intraoperative Vaginal Irrigation Cytology Vaginal Spillage on Endometrial Cancer(2016) Coban, Gonca; Alemdaroglu, Songul; Yetkinel, Selcuk; Bolat, Filiz Aka; Celik, Husnu; 0000-0003-4335-6659; 0000-0002-3285-5519; 0000-0002-2165-9168; 0000-0003-2031-7374; AAI-8400-2021; AAI-9974-2021; AAL-1530-2021; HJZ-1654-2023; AAL-1923-2021Item 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 Sarcoidosis and Sarcoid Reactions in Endometrial Cancer Cases Mas-querading Advanced Stage Malignancy(2022) Akis, Serkan; Kabaca, Canan; Keles, Esra; Cetiner, Handan; Akay, HaticeBackground: Sarcoidosis is usually diagnosed by ruling out other granulomatous inflammatory diseases. Rarely, it may be suspected with a pathological examination after surgical intervention for another disease. The sarcoid reaction is noninfectious granulomatous lymphadenitis, which can occur at nodes draining a neoplasm. We demonstrated granulomatous lesions masquerading metastasis by Positron Emission Tomography/Computed Tomography (PET/CT) in endometrial cancer. We presented two cases of endometrial cancer with sarcoidosis and sarcoid-like reactions because of their challenging clinical and radiological findings. Cases: In case 1, there was diffuse granulomatous inflammation (no metastasis) in lymph nodes (n=92) and giant cells containing calcifications (Schaumann bodies). In case 2, PET/CT revealed hypermetabolism with malignancy suspicion in the pelvic lymph nodes (maximum standardized uptake value= 13) and pathological evaluation reported a 4.5 cm tumor within the uterine cavity without any nodal metastasis. Results: PET/CT has no role in the evaluation of differential diagnosis between granulomatous lymphadenitis and metastatic disease. Conclusion: Granulomatous lesions might mimic the metastasis of coexisting malignant diseases.Item Impact of lymph node ratio in patients with stage IIIC endometrial carcinoma treated with postoperative radiotherapy(2021) Onal, Cem; Sari, Sezin Yuce; Yavas, Guler; Guler, Ozan Cem; Yiğit, Ecem; Oymak, Ezgi; Gultekin, Melis; Yildiz, Ferah; 0000-0002-2742-9021; 34355983; D-5195-2014Aim: To evaluate the prognostic value of the lymph node ratio (LNR) and other clinicopathological factors in patients with stage IIIC endometrial cancer. Methods: Factors affecting overall survival (OS) and progression-free survival (PFS) were assessed in 397 patients with stage IIIC endometrial cancer treated with postoperative radiotherapy. Patients undergoing the removal of at least ten lymph nodes were included in the study. Results: The 5-year OS and PFS rates were 58% and 52%, respectively, with a median follow-up time of 35.7 months. The LNR cutoff value was 9.6%. In the multivariate analysis, advanced age (>= 60 years), grade III tumor, presence of cervical stromal invasion, higher LNR and lack of adjuvant chemotherapy were independent predictors for worse OS and PFS. Conclusion: The LNR is an independent predictor for OS and PFS in patients with stage IIIC endometrial cancer treated with postoperative radiotherapy.Item Prognostic factors of endometrial cancer in elderly patient group and their effects on survival(2021) Alemdaroglu, Songul; Durdag, Gulsen Dogan; Baran, Safak Yilmaz; Simsek, Seda Yuksel; Yetkinel, Selcuk; Yaginc, Didem Alkas; Guler, Ozan Cem; Celik, Husnu; 0000-0003-4335-6659; 34585068; AAI-8400-2021OBJECTIVE: The objective of the study was to investigate the prognostic factors of the elderly group and their effects on survival by examining the histopathological features, surgical treatment protocols, and treatment modalities of patients diagnosed with endometrial cancer (EC). METHODS: The records of 397 EC patients who completed their treatment and follow-up at a single center between 2012 and 2019 were evaluated retrospectively. The patients were evaluated in two groups as <70 years old (n: 301; 75.8%) and >70 years old (n: 96; 24.2%). Following the evaluation of histopathological features and treatment protocols, independent risk factors influencing survival were investigated with the Cox regression model. RESULTS: The incidence of non-endometrioid histology (16.3% vs. 32.3%, p: 0.001), high-grade tumors (50.5% vs. 69.8%; p: 0.001), and >50 myometrial invasion (19.6% vs. 36.5%, p: 0.003) in the >70 age group was more frequent than that in the <70 age group. The independent risk factors on overall survival in the >70 age group were determined as non-endometrioid histology (HR: 5.9; 95% CI: 1.4- 24.7) and lymph node metastasis (HR: 6.4; 95% CI: 1.6-25.0). In the <70 age group, non-endometrioid histology (HR: 11.3; 95% CI: 4.0-32.0) was identified as the only independent risk factor affecting 5-year survival. CONCLUSION: EC, with non-endometrioid histology, which is observed at a higher rate in elderly patients despite equal surgery and adjuvant therapy, is the primary factor that affects survival.Item 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-5802-2021In 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.Item Treatment outcomes of endometrial cancer patients with paraaortic lymph node metastasis: a multi-institutional analysis(2019) Onal, Cem; Yildirim, Berna Akkus; Sari, Sezin Yuce; Yavas, Guler; Gultekin, Melis; Guler, Ozan Cem; Yildiz, Ferah; Akyurek, Serap; 0000-0002-2742-9021; 0000-0001-6908-3412; 30640689; D-5195-2014; AAC-5654-2020Objective To analyze the prognostic factors and treatment outcomes in endometrial cancer patients with paraaortic lymph node metastasis. Methods Data from four centers were collected retrospectively for 92 patients with endometrial cancer treated with combined radiotherapy and chemotherapy or adjuvant radiotherapy alone postoperatively, delivered by either the sandwich or sequential method. Prognostic factors affecting overall survival and progression-free survival were analyzed. Results The 5-year overall survival and progression-free survival rates were 35 % and 33 %, respectively, after a median follow-up time of 33 months. The 5-year overall survival and progression-free survival rates were significantly higher in patients receiving radiotherapy and chemotherapy postoperatively compared with patients treated with adjuvant radiotherapy alone (P < 0.001and P < 0.001, respectively). In a subgroup analysis of patients treated with adjuvant combined chemotherapy and radiotherapy, the 5-year overall survival and progression-free survival rates were significantly higher in patients receiving chemotherapy and radiotherapy via the sandwich method compared with patients treated with sequential chemotherapy and radiotherapy (P = 0.02and P = 0.03, respectively). In the univariate analysis, in addition to treatment strategy, pathology, depth of myometrial invasion, and tumor grade were significant prognostic factors for both overall survival and progression-free survival. In the multivariate analysis, grade III disease, myometrial invasion greater than or equal to 50%, and adjuvant radiotherapy alone were negative predictors for both overall survival and progression-free survival. Conclusion We demonstrated that adjuvant combined treatment including radiotherapyand chemotherapy significantly increases overall survival and progression-free survival rates compared with postoperative pelvic and paraaortic radiotherapy.Item A novel prediction method for lymph node involvement in endometrial cancer: machine learning(2019) Gunakan, Emre; Atan, Suat; Haberal, Asuman Nihan; Kucukyildiz, Irem Alyazici; Gokce, Ehad; Ayhan, Ali; 30718313Objective The necessity of lymphadenectomy and the prediction of lymph node involvement (LNI) in endometrial cancer (EC) have been hotly-debated questions in recent years. Machine learning is a broad field that can produce results and estimations. In this study we constructed prediction models for EC patients using the Naive Bayes machine learning algorithm for LNI prediction. Methods The study assessed 762 patients with EC. Algorithm models were based on the following histopathological factors: V1: final histology; V2: presence of lymphovascular space invasion (LVSI); V3: grade; V4: tumor diameter; V5: depth of myometrial invasion (MI); V6: cervical glandular stromal invasion (CGSI); V7: tubal or ovarian involvement; and V8: pelvic LNI. Logistic regression analysis was also used to evaluate the independent factors affecting LNI. Results The mean age of patients was 59.1 years. LNI was detected in 102 (13.4%) patients. Para-aortic LNI (PaLNI) was detected in 54 (7.1%) patients, of which four patients had isolated PaLNI. The accuracy rate of the algorithm models was found to be between 84.2% and 88.9% and 85.0% and 97.6% for LNI and PaLNI, respectively. In multivariate analysis, the histologic type, LVSI, depth of MI, and CGSI were independently and significantly associated with LNI (p<0.001 for all). Conclusions Machine learning may have a place in the decision tree for the management of EC. This is a preliminary report about the use of a new statistical technique. Larger studies with the addition of sentinel lymph node status, laboratory findings, or imaging results with machine learning algorithms may herald a new era in the management of EC.Item 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)(2020) Altin, Duygu; Taskin, Salih; Tokgozoglu, Nedim; Vatansever, Dogan; Guler, Adbul H.; Gungor, Mete; Tasci, Tolga; Turan, Hasan; Kahramanoglu, Ilker; Yalcin, Ibrahim; Celik, Cetin; Kose, Faruk; Ortac, Firat; Arvas, Macit; Ayhan, Ali; Taskiran, Cagatay; 33259650Background 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.Item Definitive Brachytherapy in Inoperable Endometrial Cancer(2019) Onal, CemIn elderly patients with medical comorbidities that increase perioperative risks, surgery cannot be performed, and definitive radiotherapy (RT) is a therapeutic option. Although staging for endometrial cancer is based on surgical findings, clinical and radiological imaging has not been standardized yet. For a radiological evaluation of inoperable endometrial cancer, magnetic resonance imaging (MRI) is preferred for local tumor infiltration, and positron emission tomography is accepted as the most accurate modality for assessing lymph node and distant metastases. External RT alone is inadequate, and intracavitary brachytherapy with or without external RT is recommended depending on the disease stage in patients with inoperable endometrial cancer. However, there is currently no standard treatment approach for patients with inoperable endometrial cancer. For patients with inoperable endometrial cancer treated with definitive RT, there are some problems including the RT technique, treatment volumes, and systemic treatment. Based on clinical practice, image-based brachytherapy using computed tomography and magnetic resonance imaging is highly recommended.