Wos İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Post-Recurrence Survival In Patients With Cervical Cancer(2022) Cibula, David; Dostalek, Lukas; Jarkovsky, Jiri; Mom, Constantijne H.; Lopez, Aldo; Falconer, Henrik; Scambia, Giovanni; Ayhan, Ali; Kim, Sarah H.; Isla Ortiz, David; Klat, Jaroslav; Obermair, Andreas; Di Martino, Giampaolo; Klat, Jaroslav; Obermair, Andreas; Di Martino, Giampaolo; Pareja, Rene; Manchanda, Ranjit; Kos'un, Jan; dos Reis, Ricardo; Meydanli, Mehmet Mutlu; Odetto, Diego; Laky, Rene; Zapardiel, Ignacio; Weinberger, Vit; Benesova, Klara; Borcinova, Martina; Cardenas, Fernando; Wallin, Emelie; Borcinova, Martina; Cardenas, Fernando; Wallin, Emelie; Anchora, Luigi Pedone; Akilli, Huseyin; Abu-Rustum, Nadeem R.; Barquet-Munoz, Salim Abraham; Javurkova, Veronika; Fischerova, Daniela; van Lonkhuijzen, Luc R. C. W.; https://orcid.org/0000-0002-5240-8441; 34955236; AAX-3230-2020Background. Up to 26% of patients with early-stage cervical cancer experience relapse after primary surgery. However, little is known about which factors influence prognosis following disease recurrence. Therefore, our aims were to determine post-recurrence disease-specific survival (PR-DSS) and to identify respective prognostic factors for PR-DSS. Methods. Data from 528 patients with early-stage cervical cancer who relapsed after primary surgery performed between 2007 and 2016 were obtained from the SCANN study (Surveillance in Cervical CANcer). Factors related to the primary disease and recurrence were combined in a multivariable Cox proportional hazards model to predict PR-DSS. Results. The 5-year PR-DSS was 39.1% (95% confidence interval [CI] 22.7%-44.5%), median disease-free interval between primary surgery and recurrence (DFI1) was 1.5 years, and median survival after recurrence was 2.5 years. Six significant variables were identified in the multivariable analysis and were used to construct the prognostic model. Two were related to primary treatment (largest tumour size and lymphovascular space invasion) and four to recurrence (DFI1, age at recurrence, presence of symptoms, and recurrence type). The C-statistic after 10-fold cross-validation of prognostic model reached 0.701 (95% CI 0.675-0.727). Three risk-groups with significantly differing prognoses were identified, with 5-year PR-DSS rates of 81.8%, 44.6%, and 12.7%. Conclusions. We developed the robust model of PR-DSS to stratify patients with relapsed cervical cancer according to risk profiles using six routinely recorded prognostic markers. The model can be utilised in clinical practice to aid decision-making on the strategy of recurrence management, and to better inform the patients.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 Approach to recurrence of atrial fibrillation after catheter ablation(2021) Yilmaz, Mustafa; Candemir, Basar; 33691388Atrial fibrillation (AF) is the most commonly observed sustained rhythm disorder during adult ages. Since it has been shown that the ectopic beat initiating AF is usually caused by pulmonary veins, AF ablation has become the mainstay of therapy worldwide. Cryoballoon and radiofrequency ablation are the most commonly used methods in today's technologies. However, despite technological advances, the success of a single procedure in AF ablation is still limited and multiple procedures may be required for the majority of patients. In cases in which a redo ablation is required, pulmonary vein isolation is still the main target, but non-pulmonary vein targets should also be considered in AF episodes that continue despite multiple ablations. Many issues are still unclear as to which energy to choose in the first procedure, and what ablation strategy will be utilized when a redo ablation is required. The studies on this subject are very limited but, it still seems feasible and a rational approach to utilize a customized treatment strategy in each specific patient subgroup.Item Sinonasal inverted papilloma: Recurrence, surgical management, and mini review(2021) Olgun, LeventObjective: Sinonasal inverted papilloma (SIP) has a high rate of recurrence and a potential to be transformed into a malignant disease, hence surgery is the treatment of choice. In this study, we aimed to identify the preoperative features of patients diagnosed with SIP and discuss treatment options, recurrence rates, and postoperative clinical outcomes. Methods: Twenty-six patients who were diagnosed with SIP between 2010 and 2014 in a training and research hospital were included in the study. Their charts were reviewed retrospectively. The complaints at admission, findings of anterior rhinoscopy, nasal endoscopy, and radiological examinations were recorded along with histopathological features. Different surgical treatment modalities and recurrence rates were analyzed regarding tumor characteristics and postoperative outcome. Results: The average postoperative follow-up was 32.1 +/- 20 months. According to Krouse classification, 15 (57.7%) patients were staged as T3, eight (30.8%) were T2, and three (11.5%) were T1. Endoscopic sinus surgery was performed in 21 patients. Medial maxillectomy via lateral rhinotomy (classical technique) was performed in five patients. Two patients (7.7%) who had endoscopic surgery had a recurrence of SIP; however, the rate was not statistically significant when compared with that of patients who underwent the classical technique. Histopathological examination revealed chronic rhinosinusitis with nasal polyposis (19.2%), squamous metaplasia (3.8%), and squamous cell carcinoma (7.7%) concurrent with SIP. Conclusion: Endoscopic surgery should be the first choice for the treatment of SIP. It may be combined with classical methods in some patients with advanced stage disease, especially when the tumor spreads to areas that are difficult to reach. Following surgical intervention, the patients should be followed carefully to identify recurrence or malignant transformation as early as possible.Item Prognostic Factors in Squamous Cell Carcinoma of the Vulva: a Retrospective Multicenter Study(2020) Kuru, Oguzhan; Akgor, Utku; Cakir, Ilker; Tosun, Ozgur; Yuksel, Ilkbal Temel; Ulker, Volkan; Meydanli, Mutlu; Sanci, Muzaffer; Gokcu, Mehmet; Topuz, Samet; Yildiz, Ferah; Sakinci, Mehmet; Salman, Mehmet Coskun; Ozgul, Nejat; Yuce, Kunter; Ayhan, Ali; AAJ-5802-2021The study aim to determine the clinicopathological factors for disease-free survival (DFS) and overall survival (OS) in women with vulvar cancer and to analyze the the possible effect of metformin on survival of the patients. From 2011 to 2017, medical records of 142 patients who underwent primary radical surgery for VC at 6 referral centers in Turkey were collected, retrospectively. The median age of the cohort was 67.0 years. 124 patients underwent radical surgery and inguinofemoral lymphadenectomy. The overall recurrence rate was 33.8% within a median follow-up time of 22 months. Five-year DFS and OS rates were 55.8% and 62.6%, respectively. Multivariate analysis showed surgical margin (HR:6.4, p= 0.017 for DFS; HR: 13.6, p=0.009 for OS) and lymph node metastasis (HR: 4.1, p= 0.014 for DFS; HR: 6.3, p= 0.020 for OS) were the independent prognostic factors. There was no statistically difference in DFS and OS for patients who had used metformin.Item Our experience on management of failed pediatric pyeloplasty(2020) Ceyhan, Erman; Dogan, Hasan Serkan; Tekgul, Serdar; 0000-0001-8223-6399; 32542506; ABI-2513-2020Purpose The purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention. Methods 40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions were assessed including redo pyeloplasty, endopyelotomy and balloon dilatation. Results Children's mean age at initial intervention for failed pyeloplasty was 45.9 (+/- 46.4) months. Our mean follow-up time after the initial intervention was 46.9 (+/- 46.6) months. The success rate of our initial treatment methods was 48.7% (20/41). Although redo pyeloplasty was the most successful intervention (83.3%) than DJS placement (45.5%), endopyelotomy (50%) and balloon dilatation (30.8%), the statistical difference was not significant in the initial operations. The overall success rates of redo pyeloplasty, double-J stent placement, endopyelotomy and balloon dilatation were 78.9%, 46.1%, 38.8% and 29.4%, respectively (p < 0.05). Conclusions Redo pyeloplasty provides the best improvement in recurrent ureteropelvic junction obstruction in children. In selected patients, minimal invasive methods such as endopyelotomy and balloon dilatation offer alternative treatment.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 Uterine smooth muscle tumor of uncertain malignant potential: fertility and clinical outcomes(2019) Sahin, Hanifi; Karatas, Funda; Coban, Gonca; Ozen, Ozlem; Erdem, Ozlem; Onan, Mehmet Anil; Ayhan, Ali; 0000-0002-3285-5519; 31074239Objective: In this study, we aimed to evaluate the clinicopathological features, obstetric, and oncological outcomes of patients diagnosed with a uterine smooth muscle tumors of uncertain malignant potential (STUMP). Methods: A dual-institutional, database review was carried out to screen patients with STUMP who were treated with upfront surgery between January 2006 and December 2017. Data including age at the time of diagnosis, recurrence rate, disease-free survival, overall survival, and fertility outcomes were retrospectively analyzed. Results: Fifty-seven patients with STUMPs were included in the study. The median age at the time of diagnosis was 42 (range, 16 to 75) years. The median follow-up was 57 (range, 16 to 125) months. Eight patients (14%) had recurrence during follow-up. Recurrent STUMPs were seen in seven patients and leiomyosarcoma after 14 months in one patient. Seven patients with a recurrent STUMP survived, while the remaining patient died. Recurrence rates were similar for women who underwent myomectomy and those who underwent hysterectomy. The presence of uterine localization of tumor (subserosal vs intramural-submucosal) statistically significantly affected recurrence rates (odds ratio=5.72; 95% confidence interval=1.349-24.290; p=0.018). Ten of 27 patients who underwent myomectomy for uterine myoma had fertility desire. Seven pregnancies were recorded. Conclusions: Our study results suggest that fertility-sparing approaches are feasible in patients with STUMP, although recurrence may be seen.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.