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Çakır İ, Gülseren V, Özdemir İA, Abacı H, Talu ECK, Çakır ZE, Ata C, Kuru O, Gökçü M, Sancı M, Güngördük K. Characteristics of patients with late recurrence endometrial cancer. J Cancer Res Ther 2024; 20:232-237. [PMID: 38554326 DOI: 10.4103/jcrt.jcrt_888_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/18/2022] [Indexed: 04/01/2024]
Abstract
AIM We planned this study to assess endometrial cancer (EC) patients who had late metastasis. MATERIALS AND METHODS This retrospective study constituted a review of the records of patients who were diagnosed with EC and underwent hysterectomy at the Gynecologic Oncology Clinic between 1996 and 2018. Relapses occurring after the first three years following primary treatment of EC are considered late recurrences. Post-relapse survival (PRS) refers to the time to the last follow-up or the patient's death after relapse. RESULTS Late metastases were identified in 42 patients, 20 (47.6%) of whom had locoregional recurrence and 22 of whom (52.4%) had extrapelvic recurrence. Median disease-free survival (DFS) times were 61 (range: 43-78) and 65 (range: 48-81) months for the groups with locoregional and extrapelvic recurrences, respectively (P = 0.462). The 5-year PRS rate for the patients was 61.1%, with 63.8% having locoregional and 59.4% having extrapelvic late metastasis (P = 0.969). CONCLUSION Among the patients with late metastases, those with endometrioid type EC were found to have a better prognosis. It has been shown that locoregional or extrapelvic organ recurrence does not significantly affect survival in patients with late relapse. Although our results are not statistically significant for cases of locoregional late metastases, surgical resection increases survival rates.
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Affiliation(s)
- İlker Çakır
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Varol Gülseren
- Department of Obstetrics and Gynecology, Faculty of Medicine, Division of Gynecologic Oncology, Erciyes University, Kayseri, Turkey
| | - İsa Aykut Özdemir
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Hüseyin Abacı
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, İzmir, Turkey
| | | | | | - Can Ata
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Oğuzhan Kuru
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Gökçü
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Muzaffer Sancı
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Kemal Güngördük
- Department of Obstetrics and Gynecology, Faculty of Medicine, Division of Gynecologic Oncology, Sıtkı Koçman University, Muğla, Turkey
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Gülseren V, Çakır İ, Özdemir İA, Gökçü M, Sancı M, Görgülü G, Kuru O, Dağgez M, Güngördük K. Prognostic value of lymph node features in patients diagnosed with stage IIIC endometrial adenocancer. J Cancer Res Ther 2023; 19:1831-1836. [PMID: 38376286 DOI: 10.4103/jcrt.jcrt_2378_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/29/2022] [Indexed: 02/21/2024]
Abstract
AIM Our study investigated the lymph node (LN) features most affecting survival in endometrial adenocancer (EAC) patients with LN involvement. MATERIALS AND METHODS This retrospective study was based on a review of the records of patients diagnosed with EAC, who underwent hysterectomy and systematic retroperitoneal lymphadenectomy at the gynecologic oncology clinics of three centers between January 2009 and January 2019. RESULTS A total of 120 stage IIIC endometrioid-type EAC patients were included in the study. The patients were divided into small (<10 mm) and large (≥10 mm) groups according to the size of the largest metastatic LN. Patients were divided into single and multiple metastasis groups according to the number of metastatic LNs. The patients were divided into pelvic and paraaortic groups according to the location of the metastatic LNs. The effects of prognostic factors on disease-free survival (DFS) and overall survival (OS) were evaluated by Cox regression analysis. Large-sized metastatic LNs were an independent prognostic factor for DFS (hazard ratio [HR] = 5.4, 95% confidence interval [CI]: 1.-26.2; P = 0.035) and OS (HR = 9.0, 95% CI: 1.1-68.0; P = 0.033). The number (P = 0.093 for DFS, P = 0.911 for OS) and location (P = 0.217 for DFS, P = 0.124 for OS) of metastatic LNs were not independent prognostic factors for DFS or OS. CONCLUSIONS Large-sized metastatic LNs were an independent prognostic factor for survival in patients with stage IIIC EAC. Larger prospective studies including similar patient populations are required to verify these findings.
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Affiliation(s)
- Varol Gülseren
- Department of Obstetrics and Gynecology, Faculty of Medicine, Division of Gynecologic Oncology, Erciyes University, Kayseri, Turkey
| | - İlker Çakır
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - İsa Aykut Özdemir
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Mehmet Gökçü
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Muzaffer Sancı
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Gökşen Görgülü
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Oğuzhan Kuru
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mine Dağgez
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Kemal Güngördük
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Sıtkı Koçman University, Muğla, Turkey
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Çakır İ, Gülseren V, Büyüktalancı E, Çakır ZE, Özer M, Ata C, Sancı M, Gökçü M, Erkılınç S, Güngördük K. The clinical significance of lymphovascular space invasion in patients with low-risk endometrial cancer. Rev Assoc Med Bras (1992) 2023; 69:e20221730. [PMID: 37466592 DOI: 10.1590/1806-9282.20221730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The aim of this study was to assess the effect of lymphovascular space invasion on recurrence and disease-free survival in patients with low-risk endometrial cancer. METHODS The study included patients with stage 1A, grade 1-2 endometrioid endometrial cancer who underwent a total hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Independent prognostic predictors of endometrial cancer recurrence were assessed using the Cox regression model. Binary logistic regression analysis was used to identify the predictors of distant recurrence. Kaplan-Meier analysis was used to describe survival curves, and the log-rank test was used to compare the differences in survival curves. RESULTS A total of 189 patients met the inclusion criteria, of whom 24 (12.7%) had lymphovascular space invasion. The median follow-up time was 60 (3-137) months. Distant recurrence was present in 11 of 22 patients who developed recurrence. Kaplan-Meier survival analysis showed that the 5-year disease-free survival rates of patients with lymphovascular space invasion(+) and lymphovascular space invasion(-) were 62.5 and 91.9%, respectively, which were significantly lower (p<0.001). In multivariate Cox regression analysis, the presence of lymphovascular space invasion (p<0.001) and age ≥60 years (p=0.017) remained as prognostic factors for reduced disease-free survival. In binary logistic regression analysis, only lymphovascular space invasion (adjusted OR=13, 95%CI=1.456-116.092, p=0.022) was a prognostic factor for distant recurrence. CONCLUSION lymphovascular space invasion is a prognostic risk factor for recurrence and distant metastasis and also a predictor of poorer disease-free survival outcomes in low-risk endometrial cancer.
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Affiliation(s)
- İlker Çakır
- Buca Seyfi Demirsoy Education and Research Hospital, Department of Obstetrics and Gynecology - Izmir, Turkey
| | - Varol Gülseren
- Erciyes University, Department of Obstetrics and Gynecology - Kayseri, Turkey
| | - Emin Büyüktalancı
- Tepecik Education and Research Hospital, Department of Pathology - Izmir, Turkey
| | | | - Mehmet Özer
- Tepecik Education and Research Hospital, Department of Obstetrics and Gynecology - Izmir, Turkey
| | - Can Ata
- Buca Seyfi Demirsoy Education and Research Hospital, Department of Obstetrics and Gynecology - Izmir, Turkey
| | - Muzaffer Sancı
- Tepecik Education and Research Hospital, Department of Obstetrics and Gynecology - Izmir, Turkey
| | - Mehmet Gökçü
- İzmir University of Economics, Department of Obstetrics and Gynecology - Izmir, Turkey
| | - Selçuk Erkılınç
- Buca Seyfi Demirsoy Education and Research Hospital, Department of Obstetrics and Gynecology - Izmir, Turkey
| | - Kemal Güngördük
- Muğla Sıtkı Koçman University, Department of Obstetrics and Gynecology - Muğla, Turkey
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Görgülü G, Doğan Özdaş E, Özdaş E, Sayhan S, Kuru O, Gökçü M, Sancı M. Analysis of vanishing endometrial cancer by pathological types. J Obstet Gynaecol Res 2022; 48:2175-2179. [PMID: 35686358 DOI: 10.1111/jog.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/25/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We asked why endometrial cancer sometimes vanishes. METHODS A total of 454 patients diagnosed with endometrioid-type endometrial cancer (EC) (via endometrial sampling) and treated in our clinic over the past 5 years were enrolled. The patients were divided into two groups: vanishing and residual, depending on whether a tumor was detected in the postoperative hysterectomy specimen. Patient age, numbers of pregnancies and deliveries, menopausal status, systemic disease status, hemogram parameters, International Federation of Gynecology and Obstetrics (FIGO) grade, and invasion status (evident on magnetic resonance imaging [MRI]) were compared between the groups. RESULTS ECs vanished in 42 (9.25%) patients. The vanishing rates were 19.7% (37/187) in FIGO grade 1 patients, 2.1% (5/238) in grade 2 patients, and 0% (0/29) in grade 3 patients. The average age was lower in the vanishing than the residual group, but the premenopausal status and grade 1 tumor rates were higher (both p < 0.001). An absence of invasion (as revealed by MRI) was more common in the vanishing group (p < 0.001). No recurrence developed in the vanishing group, but recurrences were noted in 3.3% (14/412) of the residual group. There were no significant between-group differences in any of the numbers of pregnancies or births, systemic disease status, or hemogram parameters (all p > 0.05). CONCLUSION Vanishing EC is more likely in premenopausal women with endometrioid grade 1 EC (as revealed by endometrial biopsy) who lack myometrial invasion on MRI.
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Affiliation(s)
- Gökşen Görgülü
- İzmir Tepecik Training and Research Hospital, Gynecologic Oncology Clinic, University of Health Sciences, İzmir, Turkey
| | - Emel Doğan Özdaş
- İzmir Tepecik Training and Research Hospital, Gynecologic Oncology Clinic, University of Health Sciences, İzmir, Turkey
| | - Erol Özdaş
- İzmir Tepecik Training and Research Hospital, Gynecologic Oncology Clinic, University of Health Sciences, İzmir, Turkey
| | - Sevil Sayhan
- İzmir Tepecik Training and Research Hospital, Pathology Clinic, University of Health Sciences, İzmir, Turkey
| | - Oğuzhan Kuru
- İzmir Tepecik Training and Research Hospital, Gynecologic Oncology Clinic, University of Health Sciences, İzmir, Turkey
| | - Mehmet Gökçü
- İzmir Tepecik Training and Research Hospital, Gynecologic Oncology Clinic, University of Health Sciences, İzmir, Turkey
| | - Muzaffer Sancı
- İzmir Tepecik Training and Research Hospital, Gynecologic Oncology Clinic, University of Health Sciences, İzmir, Turkey
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Karataşlı V, Erkılınç S, Çakır İ, Can B, Karadeniz T, Gökçü M, Sancı M. The effect of lymph node metastasis on overall survival and disease-free survival in vulvar cancer patients. Ginekol Pol 2021; 91:62-67. [PMID: 32141050 DOI: 10.5603/gp.2020.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/19/2019] [Accepted: 12/25/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To examine the effect of lymphadenectomy on survival in patients with squamous cell vulvar carcinoma. MATERIAL AND METHODS Patients with squamous cell vulvar cancer who underwent surgery were retrospectively analyzed. All procedures were performed according to current recommendations/standard of treatment. The clinical and pathological features were examined. Sixty-eight patients were studied. The mean age was 64.7 ± 10.9 years. Twenty-three (33.8%) patients had nodal metastasis. Most patients (60.3%) were in stage IB. Adjuvant radiotherapy and chemo-radiotherapy were administered to 33.8% and 25% of the patients, respectively. The median follow-up time was 28.5 (4-183) months. Recurrence occurred in 18 (26.5%) cases. RESULTS There was no significant difference between node-positive and node-negative patients in terms of age, number of dissected lymph nodes and recurrence. Tumor diameter was significantly higher in the metastatic group. Age and surgical margin positivity were independent prognostic factors for overall survival (OS). Surgical margin positivity and lymph node metastasis had no effect on disease-free survival (DFS). CONCLUSIONS Our results showed that age and surgical margin positivity were independent prognostic factors for OS. Although surgical margin positivity increased the risk of recurrence in univariate analysis, it was not a significant factor affecting DFS. OS was significantly lower in patients with lymph node metastasis.
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Affiliation(s)
- Volkan Karataşlı
- Department of Gynecologic Oncology,University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey.
| | - Selçuk Erkılınç
- Department of Gynecologic Oncology,University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - İlker Çakır
- Department of Gynecologic Oncology,University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Behzat Can
- Department of Gynecologic Oncology,University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Tuğba Karadeniz
- Department of Pathology,University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology,University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Muzaffer Sancı
- Department of Gynecologic Oncology,University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
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Ayhan A, Gungorduk K, Khatib G, Fırat Cüylan Z, Boran N, Gökçü M, Çelik H, Özgül N, Akbayir Ö, Şimşek T, Bakay A, Faruk Köse M, Tunç M, Küçükgöz Güleç Ü, Koç S, Kuşçu E, Vardar MA, Akilli H, Taskiran C, Mutlu Meydanlı M. Prognostic factors and survival outcomes of women with uterine leiomyosarcoma: A Turkish Uterine Sarcoma Group Study-003. Curr Probl Cancer 2021; 45:100712. [PMID: 33685725 DOI: 10.1016/j.currproblcancer.2021.100712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/16/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Abstract
To assess the clinicopathological features, prognostic factors, and survival rates associated with uterine leiomyosarcoma (uLMS). Databases from 15 participating gynecological oncology centers in Turkey were searched retrospectively for women who had been treated for stage I-IV uLMS between 1996 and 2018. Of 302 consecutive women with uLMS, there were 234 patients with Federation of Gynecology and Obstetrics (FIGO) stage I disease and 68 with FIGO stage II-IV disease. All patients underwent total hysterectomy. Lymphadenectomy was performed in 161 (54.5%) cases. A total of 195 patients received adjuvant treatment. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 42% and 54%, respectively. Presence of lymphovascular space invasion (LVSI), higher degree of nuclear atypia, and absence of lymphadenectomy were negatively correlated with DFS, while LVSI, mitotic count, higher degree of nuclear atypia, FIGO stage II-IV disease, and suboptimal surgery significantly decreased OS. LVSI and higher degree of nuclear atypia appear to be prognostic indicators for uLMS. Lymphadenectomy seems to have a significant effect on DFS but not on OS.
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Affiliation(s)
- Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Kemal Gungorduk
- Department of Gynecologic Oncology, Muğla Sıtkı Kocman University Teaching and Research Hospital, Mugla, Turkey.
| | - Ghanim Khatib
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Zeliha Fırat Cüylan
- Department of Gynecologic Oncology, Ankara State Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Nurettin Boran
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Hüsnü Çelik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Nejat Özgül
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özgür Akbayir
- Department of Gynecologic Oncology, Kanuni Sultan Suleyman Teaching and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Tayup Şimşek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Abdülkadir Bakay
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ondokuz Mayıs University, Ankara, Turkey
| | - Mehmet Faruk Köse
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Acibadem University School Of Medicine, Istanbul, Turkey
| | - Mehmet Tunç
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ümran Küçükgöz Güleç
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Sevgi Koç
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Esra Kuşçu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Mehmet Ali Vardar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Hüseyin Akilli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Cagatay Taskiran
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Koc University School of Medicine, İstanbul, Turkey.
| | - Mehmet Mutlu Meydanlı
- Department of Gynecologic Oncology, Ankara State Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Güngördük K, Plett H, Gülseren V, Meydanlı M, Boyraz G, Özdemir İ, Şahin H, Şenol T, Yıldırım N, Turan T, Öge T, Gökçü M, Taşkın S, Ayhan A, Ataseven B. Is the Oncological Outcome of Early Stage Uterine Carcinosarcoma Different from That of Grade 3 Endometrioid Adenocarcinoma? Oncol Res Treat 2020; 44:43-51. [PMID: 33249415 DOI: 10.1159/000511288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022]
Abstract
AIM 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.
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Affiliation(s)
- Kemal Güngördük
- Department of Gynecologic Oncology, Mugla Sıtkı Kocman University Education and Research Hospital, Izmir, Turkey
| | - Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Varol Gülseren
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey,
| | - Mutlu Meydanlı
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Gökhan Boyraz
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - İsaAykut Özdemir
- Department of Gynecologic Oncology, Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Hanifi Şahin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Taylan Şenol
- Department of Gynecologic Oncology, Zenyep Kamil Women's Health Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Nuri Yıldırım
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Tufan Öge
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Eskişehir Osman Gazi University, Eskişehir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Salih Taşkın
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Beyhan Ataseven
- Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Karataşlı V, Çakır İ, Can B, Erkılınç S, Karadeniz T, Kuru O, Gökçü M, Sancı M. Does ovarian preservation have an effect on recurrence of early stage low-grade endometrial stromal sarcoma? J OBSTET GYNAECOL 2020; 41:797-802. [PMID: 33063586 DOI: 10.1080/01443615.2020.1803238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Surgical treatment of low-grade endometrial stromal sarcoma consists of hysterectomy. The role of oophorectomy is yet to be established. We aimed to examine the effect of preserving the ovaries on the pattern of recurrences in patients with stage I disease. Thirty-four patients with stage I low-grade endometrial stromal sarcoma were retrospectively analysed. Based on ovarian preservation the whole cohort was divided into two groups. Recurrence (liver, lung, groin and bone) was detected in 4 (11.8%) cases. No significant differences in overall survival or disease-free survival (DFS) were observed between the ovarian preservation and bilateral salpingo-oophorectomy (BSO) groups. Subset analysis revealed no significant difference in DFS between the ovarian preservation and BSO groups in the premenopausal arm. And also, the performance of pelvic (n = 2) or para-aortic lymphadenectomy (n = 6) or adjuvant hormonal therapy did not alter DFS significantly. The 5-year DFS rate for the group which received adjuvant radiotherapy was 62.5 and 94.4% for those which did not (p = .014). Preserving the ovaries had no adverse effect on the recurrence of stage I disease.IMPACT STATEMENTWhat is already known on this subject? Due to the rarity of the disease and the common postoperative diagnosis, only retrospective studies have been reported on low-grade endometrial stromal sarcoma. This disease is commonly diagnosed in premenopausal patients during the early stage. There is no consensus on preserving the ovaries, particularly in young patients, due to the tumour's hormonal characteristics and the risk of late recurrences.What do the results of this study add? Ovarian preservation had no effect on the recurrence of stage I low-grade endometrial stromal sarcoma. Lymphadenectomy and adjuvant hormonal treatment had no effect on DFS, and adjuvant radiotherapy decreased DFS in the current study.What are the implications of these findings for clinical practice and/or further research? Ovarian preservation should be considered, to prevent the negative effects of surgical menopause, particularly in young patients.
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Affiliation(s)
- Volkan Karataşlı
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - İlker Çakır
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Behzat Can
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Selçuk Erkılınç
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tuğba Karadeniz
- Department of Pathology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Oğuzhan Kuru
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Muzaffer Sancı
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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Karataşlı V, Can B, Çakır İ, Erkılınç S, Kuru O, Gökçü M, Sancı M. Life quality of endometrioid endometrial cancer survivors: a cross-sectional study. J OBSTET GYNAECOL 2020; 41:621-625. [PMID: 32811229 DOI: 10.1080/01443615.2020.1787969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endometrial cancer is the most common gynaecologic malignancy in developed countries with increasing incidence worldwide. A total of 201 patients were enrolled and a cross-sectional study was performed using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and Female Sexual Functioning Index (FSFI) after the approval by an institutional review board (University of Health Sciences, Tepecik Education and Research Hospital, Turkey, March 13, 2019, Approval no. 2019/4-27). Morbidly obese patients (body mass index (BMI) ≥40 kg/m2) had lower physical functioning scores compared to non-obese (BMI < 30 kg/m2; p = .008) and non-morbidly obese patients (BMI < 40 kg/m2; p = .011). The overall sexual dysfunction rate was high (94.5%). No significant sexual function differences were observed among the study groups.IMPACT STATEMENTWhat is already known on this subject? Previous efforts to assess the influence of obesity and BMI on endometrial cancer patient quality of life have indicated that obesity adversely affects physical function and the effects of obesity on sexual function remains vague. In addition, the influence of patient age, surgical approach, adjuvant therapy type and time after diagnosis on quality of life and sexual function have not been clearly defined.What do the results of this study add? Increased BMI is associated with impaired physical function in endometrial cancer patients. However, BMI does not appear to affect sexual function in this population.What are the implications of these findings for clinical practice and/or further research? After endometrial cancer treatment, lifestyle interventions aimed at weight loss should be implemented to improve the quality of life.
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Affiliation(s)
- Volkan Karataşlı
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Behzat Can
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - İlker Çakır
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Selçuk Erkılınç
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Oğuzhan Kuru
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Muzaffer Sancı
- Department of Gynecologic Oncology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
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Aslan K, Meydanli MM, Akilli H, Durmuş Y, Gökçü M, Kayıkçıoğlu F, Demirkiran F, Ayhan A. Does lymph node ratio have any prognostic significance in maximally cytoreduced node-positive low-grade serous ovarian carcinoma? Arch Gynecol Obstet 2020; 302:183-190. [DOI: 10.1007/s00404-020-05580-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/01/2020] [Indexed: 01/06/2023]
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Karataşlı V, Can B, Çakır İ, Erkılınç S, Karabulut A, Ayaz D, Kuru O, Gökçü M, Sancı M. Effect of tumor size on the accuracy of frozen section in the evaluation of mucinous borderline ovarian tumors. J Gynecol Obstet Hum Reprod 2020; 49:101765. [PMID: 32325272 DOI: 10.1016/j.jogoh.2020.101765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aims to evaluate the accuracy of frozen section (FS) in mucinous borderline ovarian tumors (BOTs) and to examine the factors associated with misdiagnosis. METHODS In this retrospective study, cases diagnosed as mucinous BOTs by FS or final pathologic (FP) results were studied. The results of FS and FP were compared, and the factors associated with misdiagnosis were analyzed. RESULTS Seventy-nine cases were examined. The median tumor diameter was 16 (6-50) cm, and 89.9 % of cases had tumors ≥10 cm. The overall agreement ratio between FS and FP was 79.7 %. Over-diagnosis and under-diagnosis rates were 3.8 % and 16.5 %, respectively. The sensitivity and positive predictive values were both 88.7 %. None of the underdiagnosed patients (13 cases) had recurrence during the 100-month median follow-up (9-222). Misdiagnosis was more common in tumors <10 cm (p = 0.025). The under-diagnosis rate for tumors <10 cm was 30.8 %. Tumor size <10 cm was significantly associated with misdiagnosis in univariate and multivariate analyses (Odds ratio {OR} 4.92, 95 % Confidence Interval {CI} (1.08-22.45) p = 0.040; OR 5.17, 95 % CI (1.07-25.05) p = 0.041, respectively). Laterality and preoperative CA 125 levels were not associated with misdiagnosis. CONCLUSION Tumor size <10 cm is associated with misdiagnosis in mucinous BOTs. Laterality and CA 125 levels do not affect diagnostic accuracy. The evaluation of FS by gynecologic pathologists can help to increase the accuracy of FS.
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Affiliation(s)
- Volkan Karataşlı
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey.
| | - Behzat Can
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - İlker Çakır
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Selçuk Erkılınç
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Alaattin Karabulut
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Duygu Ayaz
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Oğuzhan Kuru
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Gökçü
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Muzaffer Sancı
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
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Gülseren V, Çakır İ, Özdemir İA, Sancı M, Gökçü M, Güngördük K. The role of changes in systemic inflammatory response markers during neoadjuvant chemotherapy in predicting suboptimal surgery in ovarian cancer. Curr Probl Cancer 2020; 44:100536. [PMID: 31980146 DOI: 10.1016/j.currproblcancer.2020.100536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/15/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to investigate the possibility of using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and platelet count and their dynamic changes during chemotherapy to predict suboptimal interval debulking surgery (IDS) in stage IIIC-IVA serous ovarian cancer (OC). METHOD Patients who underwent IDS after neoadjuvant chemotherapy (NAC) for stage IIIC-IVA serous OC at 3 centers between January 2008 and March 2018 were analyzed retrospectively. All women with complete blood counts both at diagnosis (T0) and after the completion of NAC but prior to IDS (T1) were included. An average of 3 weeks passed between IDS and the last cycle of NAC. RESULTS A total of 214 patients were found suitable for the study. Suboptimal surgery was performed in 25.2% of the patients and optimal surgery was performed in 74.8%. The rate of change in NLR was calculated as [(NLR T0 - NLR T1)/NLR T0] × 100. A higher rate of change in NLR was found in the optimal surgery group. Recovery of thrombocytosis (When platelet count before NAC was >400,000/mm3, recovery of thrombocytosis was defined as ≤400,000/mm3 after NAC.) was found to have 85.7% sensitivity and 64.8% specificity in predicting suboptimal surgery (P < 0.001). According to both multivariate and univariate regression analysis, a large change in NLR (>17%) and recovery of thrombocytosis significantly predicted suboptimal surgery. CONCLUSION To identify the likelihood of suboptimal surgery in advanced stage OC patients who undergo IDS after NAC, the dynamic change in NLR values can be examined.
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Affiliation(s)
- Varol Gülseren
- Mersin State Hospital, Department of Obstetrics and Gynecology, Mersin, Turkey.
| | - İlker Çakır
- Tepecik Education and Research Hospital, Department of Gynecologic Oncology, Izmir, Turkey
| | - İsa Aykut Özdemir
- Bakirkoy Sadi Konuk Research and Training Hospital, Department of Gynecologic Oncology, Istanbul, Turkey
| | - Muzaffer Sancı
- Tepecik Education and Research Hospital, Department of Gynecologic Oncology, Izmir, Turkey
| | - Mehmet Gökçü
- Tepecik Education and Research Hospital, Department of Gynecologic Oncology, Izmir, Turkey
| | - Kemal Güngördük
- Muğla Sitki Koçman University Education and Research Hospital, Department of Gynecologic Oncology, Muğla, Turkey
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Karataşlı V, Erkılınç S, Can B, Çakır İ, Temel O, Gökçü M, Sancı M. Cervical carcinosarcoma presented in advanced stage after high grade cervical displasia. J Exp Ther Oncol 2019; 13:165-167. [PMID: 31881134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/27/2018] [Indexed: 06/10/2023]
Abstract
Cervical carcinosarcomas (Malignant Mixed Mullerian Tumour [MMMT] ) are very rare neoplasms. Fewer than 100 cases were documented until recently. Because of the rarity, etiologic factors, prognosis and treatment modalities are unclear. A 53 year-old woman presented with postmenauposal vaginal bleeding and abnormal cervical cytology. Cervical biopsy followed by loop electrosurgical excision procedure (LEEP) and cold knife conisation (CKC) was documented as cervical intraepithelial neoplasia III (CIN III). Without follow-up, two years later, the patient was referred with a cervical 6,5 cm mass invading vagina, parametriums and rectum. Biopsy was reported as cervical carcinosarcoma with squmous carcinoma and homologous sarcoma component. Neoadjuvant chemotherapy provided partial response. Subsequently external beam whole pelvis radiotherapy with chemotherapy and brachytherapy was applied. In despite of the treatment, the patient developed sistemic recurrence and died of disease within 10 months. In previous reports most of the patients were in early stage and had better prognosis than uterine carcinosarcomas. Here in we present a case who had a history of high-grade cervical displasia and presented at advanced stage, managed with neoadjuvant chemotherapy and definitive chemoradiotherapy.
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Affiliation(s)
- Volkan Karataşlı
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Selçuk Erkılınç
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Behzat Can
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - İlker Çakır
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Orhan Temel
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Gökçü
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | - Muzaffer Sancı
- University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
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Güngördük K, Aşıcıoğlu O, Gülseren V, Özdemir İA, Kocaer M, Çakır İ, Gökçü M, Sancı M. Evaluation of the optimal laparoscopic method for benign ovarian mass extraction: a transumbilical route using a bag made from a surgical glove versus a lateral transabdominal route employing a standard endobag. J OBSTET GYNAECOL 2019; 40:378-381. [PMID: 31584305 DOI: 10.1080/01443615.2019.1623765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We compared two transumbilical (TU) routes of surgical specimen retrieval in women with ovarian masses treated via laparoscopy: a bag made from a surgical glove and lateral transabdominal (LTA) retrieval employing a standard endobag. A total of 109 women undergoing laparoscopic surgery to treat benign adnexal masses were retrospectively evaluated between 2014 and 2017. In total, 57 masses were removed via the TU route and 52 via the LTA route. We recorded the ovarian mass size; additional postoperative analgesic drug requirements. Postoperative incisional pain scores were assessed using a 10-cm visual analogue scale (VAS), time to discharge and procedure type. The mean VAS scores at 1 h (5.0 ± 1.7 vs. 6.3 ± 1.3; p < .001); 12 h (0.7 ± 0.8 vs. 1.2 ± 1.1; p = .004); and 24 h (0.1 ± 0.3 vs. 0.7 ± 0.6; p < .001) were lower in the TU-removal group. Furthermore, additional postoperative analgesic drug requirements were significantly higher in the LTA-removal group (10 (19.2%) vs. 3 (5.3%); p = .03). During laparoscopic surgery, removal of an ovarian mass via an umbilical port (compared to a lateral port) causes less postoperative pain and does not increase the risk of wound complications such as infection or hernia.Impact statementWhat is already known on this subject? Laparoscopy has been used for the last 30 years. Constant improvement in the technique and equipment has allowed extensive, laparoscopic pelvic and abdominal surgery affording better outcomes than open surgery, an improved recovery, less pain, and fewer postoperative complications. However, mass removal remains a concern. Most laparoscopic specimens are larger than the initial trocar incision. Minimally invasive, adnexal mass surgery usually requires a trocar at least 10 mm wide to remove the mass. Alternatively, adnexal mass extraction from the abdominal cavity can proceed via a suprapubic, umbilical, or vaginal route.What do the results of this study add? During laparoscopic surgery, ovarian mass removal through an umbilical port using an endobag made from a surgical glove is useful due to the method requiring little funds, is easy to do, and results in a lower amount of postoperative pain than a removal via a lateral port using a standard endobag.What are the implications of these findings for clinical practice and/or further research? A transumbilical route using a bag made from a surgical glove is easy, economical, and causes less postoperative pain to the patient than removal via a lateral port employing a standard endobag.
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Affiliation(s)
- Kemal Güngördük
- Department of Gynecologic Oncology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Osman Aşıcıoğlu
- Department of Obstetrics and Gynecology, Hamidiye Şişli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Varol Gülseren
- Department of Obstetrics and Gynecology, Mersin State Hospital, Mersin, Turkey
| | - İsa Aykut Özdemir
- Department of Gynecology, Bakirkoy Sadi Konuk Research and Training Hospital, Oncology, Istanbul, Turkey
| | - Mustafa Kocaer
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - İlker Çakır
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sancı
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
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Erkılınç S, Taylan E, Temel O, Karadeniz T, Gökçü M, Sancı M. Yüksek dereceli servikal displazi hastalarında endoservikal glandüler tutulumun rezidüel ve tekrarlayan hastalık üzerine etkisi. Cukurova Medical Journal 2019. [DOI: 10.17826/cumj.394448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Erkılınç S, Taylan E, Karataşlı V, Uzaldı İ, Karadeniz T, Gökçü M, Sancı M. Does lymphadenectomy effect postoperative surgical morbidity and survival in patients with adult granulosa cell tumor of ovary? J Obstet Gynaecol Res 2019; 45:1019-1025. [PMID: 30761709 DOI: 10.1111/jog.13928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effect of lymphadenectomy on surgical morbidity and survival in adult granulosa cell tumor (AGCT) of the ovary. METHODS Patients who underwent surgical treatment for AGCT between January 1993 and January 2016 were identified. Data were collected for patient age, menopausal status, surgical staging, lymphadenectomy, postoperative complications (anemia, wound infection, incisional hernia), length of hospital stay, follow-up duration, site and time for recurrence, management of recurrence and vital status. Histopathological records were also evaluated for number of cellular mitosis. RESULTS Lymphadenectomy (pelvic-paraaortic) was performed in 53 (53%) of 98 patients. Decrease in postoperative hemoglobin level and increased wound infection and longer hospital stay were significantly higher in lymphadenectomy group (P = 0.003, 0.043 and <0.001, respectively). Tumor stage (HR 95% CI 14.9 [2.43-92.8]) and number of mitoses >5 (HR 95% CI 14.9 [2.43-92.8]) were significantly associated with recurrence (P = <0.001 and 0.02, respectively). Tumor stage was the only prognostic factor for predicting overall survival (HR 95% CI 8.47 [2.17-33.2]). Lymphadenectomy showed no effect on disease-free survival and overall survival both in multivariate Cox regression analyses (P = 0.46 and 0.69, respectively). Disease-free survival and overall survival were similar in lymphadenectomy and no lymphadenectomy groups (Log Rank P = 0.382, 0.741, respectively). CONCLUSION Lymphadenectomy had no improved effect on survival and had negative effect on surgical morbidity in patients with AGCT.
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Affiliation(s)
- Selçuk Erkılınç
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Enes Taylan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Volkan Karataşlı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - İpek Uzaldı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Tuğba Karadeniz
- Division of Pathology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Gökçü
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sancı
- Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey
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Gülseren V, Kocaer M, Güngördük Ö, Özdemir İA, Gölbaşı C, Budak A, Çakır İ, Gökçü M, Sancı M, Güngördük K. Stage IB1 cervical cancer treated with modified radical or radical hysterectomy: does size determine risk factors? Ginekol Pol 2019; 89:667-671. [PMID: 30618033 DOI: 10.5603/gp.a2018.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/16/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study was performed to investigate prognostic factors status at smaller tumors in patients with stageIB1 cervical cancer (CC) who underwent modified radical or radical hysterectomy. MATHERIAL AND METODS Data from patients diagnosed with CC between January 1995 and January 2017 at the GynecologicalOncology Department, Tepecik Training and Research Hospital and Bakirkoy Dr. Sadi Konuk Training and Research Hospital,Istanbul, Turkey, were investigated. A total of 182 stage IB1 CC cases were evaluated retrospectively. RESULTS Patients were divided into two groups according to tumor size (< 2 cm and ≥ 2 cm). There were no complicationsassociated with the operation in patients with a tumor size < 2 cm. Among patients with a tumor size ≥ 2 cm, however, 0.9% (n = 1) developed bladder laceration, 0.9% (n = 1) rectum laceration, and 0.9% (n = 1) pulmonary emboli (P = 0.583). The rates of intermediate risk factors (depth of stromal invasion and lymphovascular space invasion) were significantly higher and lymph node involvement significantly more frequent in patients with a tumor size ≥ 2 cm. However, there were no significant differences in parametrial invasion or vaginal margin involvement between the two groups. CONCLUSIONS Intermediate risk factors and lymph node metastasis were significantly less frequent in patients with small tumors measuring < 2 cm. However, although parametrial involvement and vaginal margin involvement were less common in patients with small tumors compared with large tumors (≥ 2 cm), the differences were not significant.
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Affiliation(s)
- Varol Gülseren
- Mersin State Hospital, Department of Obstetrics and Gynecology, Mersin, Turkey.
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Gülseren V, Kocaer M, Güngördük Ö, Özdemir İA, Gölbaşı C, Budak A, Gökçü M, Sancı M, Güngördük K. Isolated pulmonary metastases in patients with cervical cancer and the factors affecting survival after recurrence. Ginekol Pol 2018; 89:593-598. [DOI: 10.5603/gp.a2018.0102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/14/2018] [Accepted: 10/14/2018] [Indexed: 11/25/2022] Open
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Kebapcı E, Gülseren V, Tuğmen C, Gökçü M, Solmaz U, Sert İ, Kocaer M, Özer M, Ölmez M, Sancı M. Outcomes of patients with advanced stage ovarian cancer with intestinal metastasis. Ginekol Pol 2018; 88:537-542. [PMID: 29192414 DOI: 10.5603/gp.a2017.0098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/29/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the results of advanced stage (stage IIIB-IVB) ovarian cancer (OC) patients with intestinal metastasis, and to investigate the factors that affect survival. MATERIAL AND METHODS Patients who underwent cytoreductive surgery (CS) for FIGO stage IIIB-IVB OC with metastasis in the intestinal system, at Tepecik Research and Treatment Hospital between 2008-2014, were analyzed retrospectively. Patients with borderline ovarian tumor; those who had previously undergone radiation therapy and/or hysterectomy and patients having secondary or tertiary cytoreduction were excluded and 49 patients were included and analyzed in this study. Hysterectomy, bilateral salpingo-oopherectomy, pelvic and para-aortic lymph node sampling, resection of bulky lymph nodes and omentectomy were performed. Optimal cytoreduction was accepted as that which left residual tumor ≤ one cm maximum size. RESULTS The risk factors affecting OS interval were investigated according to Cox' regression analysis. Optimality of the primary CS (P = 0.008 and HR = 5.202) and cancer stage (P = 0.016 and HR = 6.083) were found to be statistically significant factors. CONCLUSIONS Achieving optimal CS is the most important aim for the general surgeon carrying out an intestinal resection procedure. Although resection procedures are superior in providing the desired optimal results when compared to excision surgery, their higher complication rates and subsequent lower quality of life must be taken into consideration when choosing either resection or excision methods; surgical intervention should always be kept to the minimum possible.
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Sarı ME, Meydanlı MM, Türkmen O, Cömert GK, Turan AT, Karalök A, Şahin H, Haberal A, Kocaman E, Akbayır Ö, Erdem B, Numanoğlu C, Güngördük K, Sancı M, Gökçü M, Özgül N, Salman MC, Boyraz G, Yüce K, Güngör T, Taşkın S, Altın D, Ortaç UF, Ayık HA, Şimşek T, Arvas M, Ayhan A. Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study. J Gynecol Oncol 2017; 28:e49. [PMID: 28541637 PMCID: PMC5447148 DOI: 10.3802/jgo.2017.28.e49] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/13/2017] [Accepted: 04/09/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. METHODS A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. RESULTS A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). CONCLUSION Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.
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Affiliation(s)
- Mustafa Erkan Sarı
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
| | - Mehmet Mutlu Meydanlı
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Osman Türkmen
- Department of Gynecologic Oncology, Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Günsü Kimyon Cömert
- Department of Gynecologic Oncology, Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Ahmet Taner Turan
- Department of Gynecologic Oncology, Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Alper Karalök
- Department of Gynecologic Oncology, Etlik Zubeyde Hanım Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Hanifi Şahin
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ali Haberal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Eda Kocaman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Özgür Akbayır
- Department of Gynecologic Oncology, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey
| | - Baki Erdem
- Department of Gynecologic Oncology, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey
| | - Ceyhun Numanoğlu
- Department of Gynecologic Oncology, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey
| | - Kemal Güngördük
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sancı
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Nejat Özgül
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Coşkun Salman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gökhan Boyraz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kunter Yüce
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tayfun Güngör
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Salih Taşkın
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Duygun Altın
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Uğur Fırat Ortaç
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Hülya Aydın Ayık
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Tayup Şimşek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Macit Arvas
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Gungorduk K, Ozdemir A, Gökçü M, Sancı M. Does lubrication of the vaginal speculum reduce pain during a gynecologic oncology examination? Eur J Obstet Gynecol Reprod Biol 2015; 184:84-8. [DOI: 10.1016/j.ejogrb.2014.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/29/2014] [Accepted: 11/11/2014] [Indexed: 11/30/2022]
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Adiyeke M, Sanci M, Karaca I, Gökçü M, Töz E, Ocal E. Surgical management of intrauterine devices migrated towards intra-abdominal structures: 20-year experience of a tertiary center. CLIN EXP OBSTET GYN 2015; 42:358-360. [PMID: 26152011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS To share surgical management experiences of intra-abdominal intrauterine devices (IUDs) in tertiary center. MATERIAL AND METHODS A total of 27 patients were retrospectively analyzed. This retrospective study was conducted between September 1992 and April 2013 at Department of Obstetrics and Gynecology Tepecik Research and Training Hospital, Izmir, Turkey. Demographic findings, diagnostic methods, and operative notes of patients were obtained from the patient file. FINDINGS Of the 27 IUDs, nine (33.3%) were in omentum, four (15%) were in Douglas pouch, one in left sacrouterine ligament, one in uterovesical space and one in fundus posterior, six (22%) in left adnexial region, one in abdominal wall, one was subdiaphragmatic, one in ligamentum latum, and one in jejunum. Almost all of the patients had TCu-380 A IUDs. Seventeen patients (63%) were managed by laparoscopy, whereas laparotomy was required in ten (37%). Adhesions were found in 23 of 27 (85%) patients with varying degrees. In four cases the incision was extended due to adhesions. CONCLUSION A missing string was the first finding of an intra-abdominal IUD. Pelvic ultrasonography, X-ray, and hysteroscopy methods should be performed in order to detect the localization of IUD in case of a missing string. Surgical approach should be the first treatment option for intra-abdominal IUDs.
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