Wos İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Is the Oncological Outcome of Early Stage Uterine Carcinosarcoma Different from That of Grade 3 Endometrioid Adenocarcinoma?(2021) Gungorduk, Kemal; Plett, Helmut; Gulseren, Varol; Meydanli, Mutlu; Boyraz, Gokhan; Ozdemir, Isa Aykut; Sahin, Hanifi; Senol, Taylan; Yildirim, Nuri; Turan, Taner; Oge, Tufan; Gokcu, Mehmet; Taskin, Salih; Ayhan, Ali; Ataseven, Beyhan; 33249415; AAJ-5802-2021Aim: The clinicopathologic characteristics, recurrence patterns, and survival of patients with grade 3 endometrial cancer (G3-EAC) and uterine carcinosarcoma (UCS) were compared. Materials and Methods: The medical records of patients treated for G3-EAC and UCS between January 1996 and December 2016 at 11 gynecologic oncology centers in Turkey and Germany were analyzed. Results: Of all patients included in the study, 161 (45.1%) were diagnosed with UCS and 196 (54.9%) with G3-EAC at FIGO stage I-II (early stage) disease. The recurrence rate was higher in patients with UCS than in those with G3-EAC (17.4 vs. 9.2%, p = 0.02). The 5-year disease-free survival (DFS; 75.2 and 80.8%, respectively; p = 0.03) and overall survival (OS; 79.4 and 83.4%, respectively; p = 0.04) rates were significantly lower in the UCS group compared to the G3-EAC group. UCS histology was an independent prognostic factor for decreased 5-year DFS (HR 1.8, 95% CI 1.2-3.2; p = 0.034) and OS (HR 2.7, 95% CI 1.3-6.9; p = 0.041) rates. Conclusions: The recurrence rate was higher in UCS patients than in G3-EAC patients, regardless of disease stage. DFS and OS were of shorter duration in UCS than in G3-EAC patients. Adequate systematic lymphadenectomy and omentectomy were an independent prognostic factor for increased 5-year DFS and OS rates.Item Accuracy of intra-operative frozen section in guiding surgical staging of endometrial cancer(2021) Dogan Durdag, Gulsen; Alemdaroglu, Songul; Aka Bolat, Filiz; Yilmaz Baran, Safak; Yuksel Simsek, Seda; Celik, Husnu; 0000-0002-5064-5267; 0000-0003-4335-6659; 0000-0001-5874-7324; 0000-0003-3191-9776; 0000-0003-1185-9227; 33608802; AAI-9594-2021; AAI-8400-2021; AAK-7016-2021Purpose Surgery consists the main treatment of endometrial cancer; however, decision of lypmhadenectomy is controversial. Intra-operative frozen section (FS) is commonly used in guiding surgical staging; nevertheless, there are different reports regarding its adequacy and reliability. Aim of this study is to assess accuracy of FS in predicting paraffin section (PS) results in patients with endometrium cancer. Methods Data of 223 cases, who were operated for endometrial cancer at a tertiary hospital in 2012-2019, were analyzed retrospectively. Histological type, grade, tumor diameter, depth of myometrial invasion, and cervical and adnexal involvement in frozen and paraffin section were evaluated. Positive and negative predictive values and accuracy of frozen results in predicting paraffin results for each parameter was assessed. Statistical significance was taken as 0.05 in all tests. Results Accuracy of FS in predicting PS results were 76.23% for histology, 75.45% for grade, 85.31% for depth of myometrial invasion, and 95.45% for tumor diameter. Surgery, based on FS results, caused undertreatment in 4 patients, while metastatic lymph node ratios were found in only 35.3-50.0% of cases who had high risk parameters at FS. Conclusion Our FS results have reasonable accuracy rates in predicting PS results, in comparison with the previous literature. However, even if the high risk parameters detected in FS predict PS accurately, absence of lymph node involvement in all cases with high risk parameters indicates that FS-based triage cannot prevent unnecessary lymphadenectomies.Item Comparison of two intraoperative examination methods for the diagnosis of sentinel lymph node metastasis in clinically early stage endometrial cancer: A Turkish Gynecologic Oncology Group Study (TRSGO-SLN-003)(2021) Taskin, Salih; Varli, Bulut; Altin, Duygu; Takmaz, Ozguc; Vatanseverc, Dogan; Ersoz, Cevriye Cansiz; Turan, Hasan; Bulutay, Pinar; Zeren, Handan; Havare, Semiha Battal; Karabuk, Emine; Naki, Murat; Gungor, Mete; Kose, Faruk; Ortac, Firat; Arvas, Macit; Ayhan, Ali; Taskiran, Cagatay; 33894621Objective: This study evaluated diagnostic accuracy of intraoperative sentinel lymph node (SLN) frozen section examination and scrape cytology as a possible solution for management of SLN positive patients. Study design: Clinically early-stage endometrial cancer patients who underwent SLN algorithm and intraoperative SLN examination were analyzed. Findings were compared with final pathology results and diagnostic accuracy of frozen section and scrape cytology were evaluated. Results: Of the 208 eligible patients, 100 patients (48 %) had frozen section examination and 108 (52 %) had scrape cytology of the SLN. Intraoperative examination and final pathology were negative for metastasis in 187/208 (90 %) cases. The rest 21 cases had metastatic SLNs according to final pathology. 12 of 21 (57 %) metastases were classified as macrometastasis. Intraoperative examination of SLNs correctly identified 13 cases (true positive) and missed 8 cases (false negative). Five of 8 false negative cases had micrometastasis or isolated tumor cells. Considering identification of macrometastasis, sensitivity and negative predictive value were 85.71 % and 98.94 %, respectively, for the frozen section and 60.00 % and 98.15 %, respectively, for the scrape cytology. Conclusion: Frozen section examination of SLN has higher sensitivity in detecting macrometastasis compared to scrape cytology and it could help the surgeon in decision for further lymphadenectomy intraoperatively. (C) 2021 Elsevier B.V. All rights reserved.Item Is there any benefit of paraaortic field irradiation in pelvic lymph node positive endometrial cancer patients? A propensity match analysis(2020) Onal, Cem; Yuce Sari, Sezin; Akkus Yildirim, Berna; Gultekin, Melis; Guler, Ozan Cem; Yildiz, Ferah; 0000-0002-2742-9021; 0000-0001-6908-3412; 31793400; D-5195-2014; AAC-5654-2020We evaluated the survival outcomes and recurrence patterns of endometrial cancer (EC) patients with pelvic lymph node metastases who received postoperative radiotherapy (RT) to the pelvis (P-RT) or to the pelvis plus paraaortic lymph nodes (PA-RT) with or without systemic chemotherapy (ChT). The data from 167 patients with stage IIIC1 EC treated with postoperative RT or RT and ChT were collected retrospectively. Those patients with pelvic lymph node metastases were treated with either P-RT (106 patients, 63%) or PA-RT (61 patients, 37%). The median follow-up time for the entire cohort was 49 (range = 5-199) months. The patients receiving adjuvant ChT and RT had significantly higher 5-year OS rates (77% vs. 33%, p < .001) and 5-year PFS rates (71% vs. 30%, p < .001) when compared to those receiving adjuvant RT alone. The patients receiving P-RT and ChT had significantly higher 5-year OS rates and 5-year PFS rates when compared to those treated with adjuvant PA-RT in the entire cohort and matched cohort. Adjuvant ChT together with RT is the strongest predictor of the OS and PFS. Prophylactic PA-RT is unnecessary, even if ChT is used together with P-RT in EC patients with pelvic lymph node metastasis.Impact statement What is already known on this subject? Local and distant recurrence risks are relatively higher in patients with stage IIIC disease, postoperative adjuvant treatment is required to reduce the recurrence risk. Adjuvant RT is a common approach for patients with locally advanced EC. Optimal target volume for RT in patients with stage IIIC EC remains controversial. We demonstrated that extended field RT is unnecessary, even if ChT is used together with pelvic RT in stage IIIC EC patients. What do the results of this study add? We demonstrated that adjuvant ChT together with RT is the strongest predictor of the OS and PFS for EC patients with pelvic lymph node metastases. Extended field RT is unnecessary, even if ChT is used together with pelvic RT in EC patients with pelvic lymph node metastases.Item Does Polyp-Originated Growing have Prognostic Significance for Stage 1 Endometrioid-Type Endometrial Cancer?(2020) Kucukyildiz, Irem Alyazici; Gunakan, Emre; Akilli, Huseyin; Haberal, Asuman Nihan; Kuscu, Esra; Haberal, Ali; Ayhan, Ali; 0000-0002-5240-8441; 0000-0002-0992-6980; 0000-0001-9852-9911; 0000-0002-1486-7209; AAX-3230-2020; AAI-8792-2021; AAK-4587-2021; AAI-9331-2021Purpose Endometrioid-type endometrial cancer is usually diagnosed in the early stages and has a good prognosis. Patients with stage 1 disease have survival rates over 95%. Tumor factors affect survival in these patients, but polyp-originated growing has not been sufficiently discussed in the literature. This study aimed to determine the effect of polyp-originated growing in stage 1 endometrioid-type endometrial cancer and to provide a review of the literature. Methods This study includes 318 stage 1 endometrioid-type endometrial cancer patients. The patients were divided into two groups based on the tumor origin. Group I included patients with polyp-originated growing tumors, and Group II included patients with endometrial surface-originated growing tumors. Results Groups I and II included 39 and 279 patients, respectively. The general properties of the patients were similar; there were no significant differences. The univariate survival analyses showed that overall survival for Groups I and II was 65.5 and 83.6 months, respectively; this difference was statistically significant (p = 0.002). The multivariate analysis of age, maximum tumor diameter, tumor origin, lymphovascular space involvement, myometrial invasion depth and tumor grade showed that polyp-originated growing was independently and significantly associated with overall survival (HR 4.05; 95% CI 1.2-13.5; p = 0.023). Conclusion Polyp-originated growing may be a prognostic factor for early stage endometrioid-type endometrial cancer. The prognostic effect of polyp-originated growing is not well known, and further investigation is necessary.Item Recurrence patterns and prognostic factors in lymphovascular space invasion-positive endometrioid endometrial cancer surgically confined to the uterus(2019) Sahin, Hanifi; Meydanli, Mehmet Mutlu; Sari, Mustafa Erkan; Kocaman, Eda; Cuylan, Zeliha Fırat; Yalcin, Ibrahim; Coban, Gonca; Ozen, Ozlem; Sirvan, Levent; Gungor, Tayfun; Ayhan, Ali; 30638487Objective: The purpose of this study was to determine the patterns of failure and prognostic factors for lymphovascular space invasion (LVSI)-positive endometrioid endometrial cancer (EC) patients in the setting of negative lymph nodes (LNs). Materials and methods: A multicenter, retrospective department database review was performed to identify LVSI-positive patients with disease surgically confined to the uterus at two gynecologic oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. Results: We identified 185 LVSI-positive women with negative LNs during the study period. Fifty-five (29.7%) were classified as Stage IA, 94 (50.8%) as Stage IB, and 36 (19.5%) as Stage II. The median age at diagnosis was 59 years and the median duration of follow-up was 44 months. The total number of the recurrences was 12 (6.5%). We observed 5 (2.9%) loco-regional recurrences, 3 (1.5%) retroperitoneal failures, and 4 (2.0%) distant relapses. The 5-year progression-free survival (PFS) was 86.1% while the 5-year overall survival (OS) rate was 87.7%. Grade 3 histology (Hazard Ratio [HR] 2.9, 95% Confidence Interval [CI] 1.02-8.50; p = 0.04), cervical stromal invasion (HR 4.5, 95% CI 1.61-12.79; p = 0.004) and age > 60 years (HR 5.8, 95% CI 1.62-21.32; p = 0.007) were found to be independent prognostic factors for decreased OS. Adjuvant treatment did not appear as a prognostic factor for OS even in univariate analysis. Conclusion: The recurrence rate among LVSI-positive endometrioid EC patients is low in the setting of negative LNs. However, one out of three patients with a recurrence experiences distant relapses which usually portend worse outcomes. (C) 2018 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V.Item Oncological Outcomes of Stage IIIA Endometrioid Type Endometrial Cancer: A Multicenter Study(2019) Sahin, Hanifi; Yalcin, Ibrahim; Sari, Mustafa Erkan; Sahin, Eda Adeviye; Aslan, Koray; Aglamis, Ozgur; Gulseren, Varol; Gungorduk, Kemal; Meydanli, Mehmet Mutlu; Ayhan, AliThe objective of this retrospective study was to evaluate Stage IIIA endometrioid type endometrial carcinomas (ECCs) and to analyze clinical and pathological determinants of prognosis in three tertiary hospitals between January 2007 and January 2017. Forty-seven patients with a median age of 61 (range: 31 to 76) years were diagnosed with Stage IIIA disease. Median follow-up was 45 (range: 6 to 116) months. The five-year disease-free survival (DFS) rate was 57.2%, and the overall survival (OS) rate was 59.7%. In the univariate analysis, age and grade of the disease (1-2 versus 3) disease were found to be significant factors for DFS. Univariate analysis also revealed the presence of cervical stromal involvement and grade of the disease were associated with decreased OS. In the multivariate analysis, however, only patients with an advanced histological grade had a reduced risk for OS (hazard ratio [FIR] 2.9; 95% confidence interval [CI] 1.020-8.615; p= 0.040). In conclusion, histological grade seems to be an independent prognostic factor for OS in patients with Stage IIIA ECCs.Item Serum ischemia modified albumin and endometrial cancer: a prospective case-control study(2019) Sahin, H.; Ayhan, S.; Sari, M.E.; Tohma, V.A.; Yaman, S.; Yalcin, I.; Candar, T.; Gungor, T.Objective: To investigate the importance of ischemia modified albumin (IMA) in the diagnosis and evaluation of endometrial carcinoma. Material and Methods: Serum IMA levels of patients with and without endometrial cancer were measured by the calorimetric assay technique and their absorbance units were compared. Results: A total of 128 women were included in the study; 64 of these women were endometrial cancer patients and 64 of them were in the control group. The median age for these groups were 58.5 and 56 years, respectively. There was no significant difference in terms of age, body mass index, and serum albumin levels between the groups (p > 0.05). In the endometrial cancer group, the median serum IMA level was 0.489 (0.401-0.611), while in the control group the median serum IMA level was 0.490 (0.407-0.589). There was no significant difference between these two groups (p = 0.467). In the type 1 endometrial cancer group, the median serum IMA level was 0.452 (0.401-0.590), while in the type 2 endometrial cancer group the median serum IMA level was 0.559 (0.462-0.611) A significant difference was found between types 1 and 2 endometrial cancers (p < 0.001). Conclusions: The IMA level does not appear to be an additional predictive marker of preoperative diagnosis and evaluation of endometrioid type endometrial cancer when compared to the healthy control group; on the other hand, IMA may be a marker for the detection of type 2 endometrium cancers when compared with type 1 endometrium tumors. However, further randomized controlled trials are required to make a comparison between type1 and type2 endometrial cancers.Item Analysis of Bcl-2, PTEN, p53, and Ki-67 expressions in endometrial cancer arising from endometrial polyp(2019) Karakas, L. A.; Tohma, Y. A.; Kuscu, E.; Ozen, O.; Ayhan, A.Objective: To compare the expression of the proliferation marker Ki-67, the antiapoptotic protein Bcl-2, and the tumor suppressor genes p53 and PTEN between endometrial cancer arising from endometrial polyp and benign endometrial polyps. Materials and Methods: The study was performed retrospectively in 40 patients treated at the present institution between 2006-2011. A total of 20 cases that had endometrial cancer arising from endometrial polyp that met study criteria were included consecutively in the study. For each malign case, one case that had a benign endometrial polyp diagnosed at hysterectomy specimen was included in the study. Results: The Ki-67 score was significantly higher in endometrial cancer arising from endometrial polyp group in comparison to the benign polyps (p < 0.05). However, the Bcl-2 expression was significantly lower in the endometrial cancer arising from endometrial polyp when compared to the benign polyps (p < 0.05). PTEN and p53 expressions were not different between groups (p > 0.05). in patients with endometrial cancer, Ki-67, Bcl-2, PTEN, and p53 expressions were not different among histological type, stage, grade, myometrial invasion, polyp size, and lymphovascular space invasion, with an exception of p53. p53 expression was significantly increased in higher grade tumors (p < 0.05). Conclusion: The results of the present study indicate that there is an inhibition of apoptosis and a decrease in proliferation in benign endometrial polyps. Possibly, at carcinogenesis step of endometrial cancer developed from benign polyp, other additional mutations cause a reverse effect and they increase proliferation and prevent the apoptosis inhibition.Item Clinicopathologic characteristics of recurrent endometrioid endometrial cancer patients and analysis of methods used duriing surveillance(2019) Simsek, S.Y.; Serbetcioglu, G.; Alemdaroglu, S.; Yetkinel, S.; Durdag, G.D.; Celik, H.; 31212025Objective: To determine cilinicopathologic characteristics of recurrent endometrioid type endometrial cancer patients and analyze the methods applied in detection of recurrent disease during follow-up period. Methods: We have retrospectively reviewed the file records of the 226 patients who had endometrioid type carcinoma. Bimanual pelvic examination, speculum examination, carcinogenic antigen-125 (CA125) testing, vaginal cuff cytologic screening, transabdominal ultrasound (TAUS) and transvaginal ultrasound (TVUS) imagings were performed within the context of routine follow-up control examinations in the post-treatment period in every 3 months within the first 2 years and in every 6 months in the following 2 years and with annual control in the consecutive years. Results: Mean follow-up durations was 25.7 +/- 18.9 months while recurrence rate was 3.1%. The study patient group underwent totally 1116 times TVUS and 1084 times whole TA-US evaluations, 973 times vaginal cuff cytological screening, 1125 times pelvic and general physical examinations beside 1060 times CA-125 testings were performed in accordance with our routinely performed follow-up protocol. The asymptomatic recurrent cases; one of those was dignosed with pelvic examination while diagnosis was established using TA-USG evaluation in the other asymptomatic patient. The other 5 cases were symptomatic. Pelvic examination, Computed Tomograhy and Magnetic Resonance Imaging were utilized in diagnosing 1, 3 and 1 of those patients, respectively. Conclusion: The presence of symptoms and pelvic examination seem to be the most effective modalities in detecting recurrence in follow-up of endometrial cancer. It would be reasonable to optimize intervals between follow-up visits and to determine the appropriate evaluations by considering risk levels of the patients. (C) 2019 Elsevier Masson SAS. All rights reserved.