Scopus İndeksli Açık & Kapalı Erişimli Yayınlar
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Item The Impact Of Serum Albumin-To-Alkaline Phosphatase Ratio In Cervical Cancer Patients Treated With Definitive Chemoradiotherapy(2022) Onal, Cem; Gultekin, Melis; Yavas, Guler; Oymak, Ezgi; Sari, Sezin Yuce; Guler, Ozan Cem; Yigit, Ecem; Yildiz, Ferah; 35653776We retrospectively analysed the prognostic significance of serum albumin, alkaline phosphatase (ALP) and albumin to ALP ratio (AAPR) and other prognostic factors affecting the overall survival (OS) and progression-free survival (PFS) in 200 cervical cancer patients treated with definitive chemoradiotherapy (CRT). The prognostic factors for OS and DFS, in addition to the predictive factors of albumin, ALP and AAPR, were investigated. Older age, lymph node metastasis, non-complete response (CR) to treatment and low serum albumin levels emerged as predictors of poor OS and PFS in multivariate analysis. However, with a cut-off value of 0.51, AAPR was not a significant prognostic factor of survival in multivariable analysis. There were no significant differences in clinicopathological factors between patients with low and high AAPR, except for lymph node metastasis, where lymph node metastasis rate was significantly higher in patients with a low AAPR compared to those with a high AAPR. Patients with CR had a significantly higher serum albumin level and AAPR compared to patients without CR. The pre-treatment serum albumin level was independent predictive for survival; therefore, it could be a suitable biomarker to guide systemic therapy and predict patient outcomes. Impact Statement What is already known on this subject? Two major determinants of tumour progression are nutritional status and inflammation. The albumin-to-alkaline phosphatase ratio (AAPR), which was originally proposed as a marker for nutritional status and immune response, was recently discovered to be a prognostic factor for various cancer types. However, its utility in the treatment of cervical cancer has not been established. What do the results of this study add? Low serum albumin levels were associated with a significantly shorter OS and PFS in cervical cancer patients treated definitively with CRT. AAPR, on the other hand, was not a significant prognostic factor for survival with a cut-off value of 0.51. Regional lymph node metastasis was significantly more common in patients with a low AAPR than in those with a high AAPR. What are the implications of these findings for clinical practice and/or further research? Patients with multiple clinicopathological risk factors and low serum albumin levels had an increased risk of disease recurrence and a poorer prognosis, highlighting the importance of additional adjuvant treatment strategies in these patients. Due to the preliminary nature of our findings, additional research is required to corroborate them.Item Should We Accept the HPV Type 66 into a Probable High-Risk Group? The Prevalence, Clinical and Histopathological Evaluation of HPV Type 66 in Gazi University, Ankara(2021) Kazanci, Ferah; Kocak, Aylin Altay; Colak, Meryem; Erdem, Ozlem; Onan, M. Anil; Bozdayi, Gulendam; 0000-0002-0451-0142; AAI-8012-2021Introduction: The prevalence of infection by different genotypes of human papillomavirus (HPV) varies among different geographic areas. The objective of the study is to determine the prevalence and distribution of HPV66 genotype among women with normal or abnormal Pap smear tests. Methods: This retrospective study was conducted in a tertiary care university hospital between January 2017 and February 2018, in central Anatolia of Turkey. This study included 288 women, 66 (%22.9) of whom had HPV DNA positive. HPV DNA screening was done by an automatized system using real time PCR method (Cobas 4800 System, Roche Diagnostics Ltd, Switzerland) and this method distinguishes types 16 and 18, while the other 12 oncogene types are reported as high-risk HPV (HR-HPV: 31,33,35,39,45,51,52,56,58,59,66,68). For the genotyping of other oncogene types, a commercial real time PCR method (NLM Genotypes 14 Real-TM Quant, NLM Diagnostic, Italy) was used. Results: The most common identified HPV types were HPV16 (%6.3), HPV 56 (%3.8), HPV 18(%3.1), HPV 66 (%3.1), HPV 51 (%2.8), HPV 52(%2.1). HPV type 66 which has admitted recently other-subtypes with their unclear oncogenicity is the third most identified type in our study. In our study 9 (%3.1) women had type 66 and 2 (%0.7) of whom had abnormal Pap smear results. One patient with syphilis whose pap smear test results was ASC-H/HSIL was evaluated by colposcopic examination and LEEP (Loop Electrosurgical Excision Procedure) and ECC (Endocervical Curettage) were performed. The result of histopatological report was benign. The other patient whose Pap smear test result was LSIL evaluated by colposcopic examination and found no pathological finding. Conclusion: The frequency of HPV 66 infection was found to be higher in our study compared to previous reports. In 2 patients out of 9 cases (% 2.4) who were detected HPV 66 had normal pap test results.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 MiR-25 and KLF4 relationship has early prognostic significance in the development of cervical cancer(2021) Polat, Aysegul Yucel; Ayva, Ebru Sebnem; Gurdal, Hakan; Ozdemir, Binnaz Handan; Dedeoglu, Bala Gur; 0000-0002-7528-3557; 33862560; X-8540-2019Cervical squamous cell carcinoma (SCC) is one of the common cancer types among women. MicroRNAs (miRNAs) are small non-coding RNAs that play an important role in the formation and development of many cancer types by regulating expression of their targets. While many studies have investigated the relationship between miRNAs and cervical cancer, no robust miRNA biomarkers have been defined yet for diagnosis of cervical lesions. In this study, we performed a statistical meta-analysis to identify miRNAs and a class compassion analysis to evaluate mRNAs with the power to discriminate between normal, intraepithelial lesions and invasive cancer samples. Differentially expressed (DE) mRNAs were compared with the targets of meta-miRNAs. After bioinfomatics analysis and qRT-PCR validations with cytology samples and FFPE tissues, we defined miR-25 and its target KLF4 (Kruppel-like factor 4) as candidate biomarkers for in vitro studies. Our results showed that miR-25 expression was significantly higher in precancerous lesions and invasive carcinoma while presenting consistent expression patterns in both cytological and FFPE tissue samples. In line with this, its direct target KLF4 expression decreased in precancerous lesions in cytological samples and also in the invasive cancer group in FFPE tissues. Furthermore, in vitro studies showed that mir-25 inhibition decreased proliferation and motility of HeLa cells and promoted an increase in the protein level of KLF4. We conclude that inhibition of miR-25 may upregulate KLF4 expression and regulate cell proliferation and motility in cervical cancer.Item The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer(2021) Kim, Sarah H.; 34666213Purpose: Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. Methods: Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. Results: Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. Conclusion: The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally. (c) 2021 Elsevier Ltd. All rights reserved.