Ali Ayhan

Response to: Author's reply to: Effect of adjuvant treatment on survival in 2023 FIGO stage IIC endometrial cancer

High-grade endometrial stromal sarcoma versus undifferentiated uterine sarcoma: a Turkish uterine sarcoma group study-001

Prognostic factors associated with high-grade endometrial stromal sarcoma (HGESS) and undifferentiated uterine sarcoma (UUS) have not been distinctly determined due to the repetitive changes in the World Health Organization (WHO) classification. We aimed to compare clinicopathologic features and outcomes of patients with HGESS with those of patients with UUS. A multi-institutional, retrospective, cohort study was conducted including 71 patients, who underwent surgery at 13 centers from 2008 to 2017. An experienced gynecopathologist from each institution re-evaluated the slides of their own cases according to the WHO The median disease-free survival (DFS) for HGESS and UUS was 12 months and 6 months, respectively. While the median overall survival was not reached in HGESS group, it was 22 months in the UUS group. Kaplan-Meier analyses revealed that patients with UUS had a significantly poorer DFS than those with HGESS (p = 0.016), although OS did not differ between the groups (p = 0.135). Lymphovascular-space involvement (LVSI) was the sole significant factor associated with progression, recurrence or death for HGESS (Hazard ratio: 9.353, 95% confidence interval: 2.539-34.457, p = 0.001), whereas no significant independent factor was found for UUS. UUS has a more aggressive behavior than HGESS. While no significant predictor of prognosis was found for UUS, LVSI is the sole independent prognostic factor for HGESS, with patients 9.3 times more likely to experience refractory/progressive disease, recurrence or death.

Multi-institutional validation of the ESMO-ESGO-ESTRO consensus conference risk grouping in Turkish endometrial cancer patients treated with comprehensive surgical staging

In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statement

Timing and survival benefits of cytoreduction in patients with recurrent leiomyosarcoma

Leiomyosarcoma is characterized by its aggressive behavior, poor prognosis, resistance to chemotherapeutic drugs, and high recurrence rate. This study aimed to identify prognostic factors affecting the effectiveness of cytoreductive surgery (CRS) on overall survival (OS) in patients with recurrent leiomyosarcoma (LMS). A retrospective analysis was conducted at Başkent University Ankara Hospital from 2007 to 2016, involving 59 patients with uterine LMS who underwent surgery. We assessed demographic and clinical variables, disease recurrence intervals, and treatment outcomes. The median age of the patients was 50.0 (23-78) years, and the median follow-up time was 25.0 (2-87) months. Median disease-free survival (DFS) and OS were 15.0 and 37.0 months, respectively. Disease recurrence occurred in 44 patients (74.6%). After recurrence, 34 (77.3%) patients underwent CRS and chemotherapy (CT), while 10 (22.7%) patients received only CT. The median OS was 19.0 months for patients who underwent CRS and received CT and 15.0 months for those who received only CT (p = 0.132). Notably, OS was significantly longer for patients whose recurrence occurred after 6 months compared to those with early recurrence (19 versus 8 months, p = 0.049). CRS provided a modest survival benefit for patients with recurrent LMS, although statistical significance was not achieved. The results of this study indicate that the timing of recurrence plays a crucial role in survival.

Fertility‐sparing approach to malignant ovarian germ cell tumors – Oncologic and obstetric outocome: A retrospective study

AbstractObjectiveTo evaluate oncologic (such as disease‐free and overall survival) and obstetric outcomes in patients diagnosed with malignant ovarian germ cell tumors (MOGCTs).MethodsPatients diagnosed with MOGCTs between March 2007 and February 2022 were evaluated and patients who underwent fertility sparing surgery were included in this retrospective study. The obstetric and oncologic outcomes were evaluated by collecting data up until the patient's last follow‐up visit from the hospital records and patient files. The study was approved by Başkent University Institutional Review Board (KA23/124).ResultsSeventy FSS patients were included in this study. The median age of the patients was 22.5 years (range: 11–37). The median follow‐up time was 92.0 months (10–189). Immature teratoma was the most common histological subtype (32.9%). Bilateral involvement was detected in only one patient with immature teratoma (1.4%). The 5‐year DFS rates of immature teratoma, dysgerminoma, yolk sac, and mixed germ cell histologic types were 91.1%, 94.1%, 82.4%, and 88.9%, respectively (P: 0.716).The 5‐year OS rates of the same histologic types were 95.7%, 100%, 88.2%, and 88.9%, respectively (P = 0.487). All patients (100%) had a regular menstrual cycle after the completion of adjuvant treatment. The mean time between the last chemotherapy and menstruation was 4.38 months. To date, a total of 34 patients tried to conceive after the completion of disease treatment. A total of 23 (67.6%) patients conceived, resulting in 27 live births in 22 (100%) patients.ConclusionFertility preservation should be the first treatment option in MOGCTs in young patients due to the unilateral involvement of the disease and its chemosensitive nature.

Oncologic and obstetric outcomes of early‐stage epithelial ovarian cancer patients who underwent fertility‐sparing surgery: A retrospective study

AbstractObjectiveThis study aimed to assess the long‐term oncologic and obstetric outcomes of women with epithelial ovarian cancer who underwent fertility‐sparing surgery.MethodsA total of 68 patients observed between March 2007 and July 2021 were included in this retrospective study. Unilateral salpingo‐oophorectomy and uterine preservation with staging surgery were the main procedures for fertility‐sparing surgery. Disease‐free, overall survival, and obstetric outcomes were measured as primary outcomes.ResultsThe median age of the patients was 30.5 years. The median follow‐up time was 60.5 months. Disease recurrence occurred in 15 (22.1%) of the patients. Five‐year disease‐free survival and overall survival (OS) percentages were 75.6% and 83.3%, respectively, for all stages. The FIGO (International Federation of Gynecology & Obstetrics) stage was the only significant factor that affected OS (P = 0.001). Twenty‐three patients tried to conceive, and 15 (65.2%) patients became pregnant. Twelve (80%) pregnancies reached term and resulted in 15 live births. Chemotherapy administration and surgical intervention (cystectomy or unilateral salpingo‐oophorectomy) showed no difference in pregnancy results (P = 0.806 and P = 0.066, respectively).ConclusionFertility preservation is safe for invasive epithelial ovarian cancer at early stages for women in the reproductive era. Disease recurrence and OS results are similar to standard treatment at early stages with decent obstetric outcomes.

Hyperthermic intraperitoneal chemotherapy in the treatment of recurrent ovarian cancer: When, and for whom?

AbstractObjectiveThe aim of this study is to evaluate the progression‐free survival (PFS) of recurrent ovarian cancer (ROC) patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC).Materials and MethodsROC patients who underwent cytoreductive surgery plus HIPEC between 2015 and 2021 were retrospectively evaluated. Patients' demographic information and clinicopathological characteristics including cancer type, histology, platinum status, presence of ascites, type of surgery, complications, chemotherapy history, and disease progression were documented. PFS was calculated using the Kaplan–Meier method.ResultsA total of 104 patients with ROC were included. The median age was 57 years and the median follow‐up time was 15 months (range: 5–69 months). In Cox regression multivariate analyses, platinum resistance (hazard ratio [HR]: 3.32, 95% confidence interval [CI]: 1.91–5.76, p = 0.00), more than one relapse prior HIPEC (HR: 2.81, 95% CI: 1.65–4.87, p = 0.024), and presence of ascites (HR: 1.88, 95% CI: 1.08–3.26, p = 0.00) were found to be negative prognostic factors for PFS. In subgroup analyses of patients with the first recurrence, the median PFS was 21 months for platinum‐sensitive patients and 6 months for platinum‐resistant patients (p = 0.032).ConclusionHIPEC at the time of first platinum‐sensitive relapse may lead to favorable PFS in the treatment ROC. However, HIPEC as salvage treatment even with R0 cytoreductive surgery does not seem effective.

Survival in recurrent ovarian cancer patients before and after the bevacizumab era: an observational single-centre study

A retrospective observational study was carried out in Baskent University School of Medicine, Ankara, Turkey. Recurrent ovarian cancer patients treated between 2007 and 2017 were divided into two groups according to their bevacizumab status. The primary endpoints were overall survival (OS) and safety. Three hundred and ninety-six patients enrolled in this study, 200 (50.5%) received bevacizumab while 196 (49.5%) patients never received bevacizumab. The median follow-up time was 48.2 and 47.6 months, respectively. The 5-year OS was 61% and 46%, respectively (