Alper Kahraman

Utility of serum NAMPT concentrations in clinical management of HPV-infected patients

The expression of nicotinamide-phosphoribosyl transferase (NAMPT) was demonstrated to increase in various dysplastic and malignant conditions, usually consistent with the severity of the disease. This study was conducted to assess the utility of extracellular NAMPT (eNAMPT) in the management of cervical dysplasia in human papillomavirus (HPV) infected women. Circulating eNAMPT concentrations in high-risk HPV-infected women who were diagnosed with high-grade squamous intraepithelial lesion (HSIL) or invasive cancer (cervical intraepithelial neoplasia 2+ (CIN2+) lesions) and who were revealed to have no cervical dysplasia or low-grade squamous intraepithelial lesion (LSIL) were evaluated and compared. One hundred fifty nine high-risk HPV-infected patients for cervical biopsies under colposcopy guidance between February 2022 and February 2023 were included in this case–control study. Study group composed of consecutively enrolled 84 women with histological diagnosis of HSIL or cervical cancer (CIN2+ lesions) and control group composed of consecutively enrolled 75 women with LSIL or normal cervical biopsies. Circulating eNAMPT concentrations of cases with CIN2+ lesions and cases with LSIL or normal cervical biopsies were compared. No significant difference was found between median peripheral venous blood eNAMPT concentration of cases with histologic diagnosis of CIN2+ lesions and cases with LSIL or normal cervical biopsies (9.4 ng/mL (0.19–192) vs 8.9 ng/mL (0.19–176.9); p = 0.07, respectively). Multivariate linear regression analysis revealed no independent predictor of circulating eNAMPT concentrations among possible predictor variables. In conclusion, circulating eNAMPT concentrations of cases with CIN2+ lesions and cases with LSIL or normal cervical biopsies were found to be similar. Further research that evaluates cervical fluid eNAMPT concentrations might define novel noninvasive tools in cervical dysplasia management.

Does HPV‐18 co‐infection increase the risk of cervical pathology in individuals with HPV‐16?

Abstract Objective We aimed to investigate differences between HPV‐16 mono‐ and HPV‐16/18 co‐infections in terms of cervical dysplasia and invasive cancer. Methods This multicentre, retrospective study spanned from December 2017 to December 2020, involving women who visited gynaecological oncology clinics for colposcopy with either HPV‐16 or HPV‐16/18 positivity. A total of 736 patients, 670 in Group 1 (HPV‐16 positivity) and 66 in Group 2 (HPV‐16/18 positivity), were compared for the presence of CIN2+ lesions detected by colposcopic biopsy or endocervical curettage (ECC). Exclusions included hysterectomized patients, those with prior gynaecological cancers, and patients with HPV positivity other than types 16 and 18. Results Among the included patients, 42.4% had a diagnosis of CIN2+ lesions. The cytology results demonstrated abnormal findings in 45.3% in Group 1 and 42.2% in Group 2, with no significant difference between the groups. ECC revealed CIN2+ lesion in 49 (8.7%) patients in group 1, while only 1 (1.7%) patient had CIN2+ lesion in group 2. There was no difference between 2 groups in terms of ECC result ( p  = 0.052). In group 1, 289 (43.1%) patients had CIN2+ lesion, while 23 (34.8%) patients had CIN2+ lesions in group 2. There was no difference between group 1 and 2 in terms of diagnosis of CIN2+ lesions ( p  = 0.19). Conclusion This multicentre retrospective study found no significant differences between HPV‐16 mono‐ and HPV‐16/18 co‐infections regarding cervical pathologies. Larger studies are needed to validate and further explore these findings.

Prognostic factors of adult granulosa cell tumors of the ovary: a Turkish retrospective multicenter study

To define the clinical, histopathological features and the prognostic factors affecting survival in patients with adult granulosa cell tumors of the ovary (AGCT). A 322 patients whose final pathologic outcome was AGCT treated at nine tertiary oncology centers between 1988 and 2021 participated in the study. The mean age of the patients was 51.3±11.8 years and ranged from 21 to 82 years. According to the International Federation of Gynecology and Obstetrics 2014, 250 (77.6%) patients were stage I, 24 (7.5%) patients were stage II, 20 (6.2%) patients were stage III, and 3 (7.8%) were stage IV. Lymphadenectomy was added to the surgical procedure in 210 (65.2%) patients. Lymph node involvement was noted in seven (3.3%) patients. Peritoneal cytology was positive in 19 (5.9%) patients, and 13 (4%) had metastases in the omentum. Of 285 patients who underwent hysterectomy, 19 (6.7%) had complex hyperplasia with atypia/endometrial intraepithelial neoplasia, and 8 (2.8%) had grade 1 endometrioid endometrial carcinoma. It was found that 93 (28.9%) patients in the study group received adjuvant treatment. Bleomycin, etoposide, cisplatin was the most commonly used chemotherapy protocol. The median follow-up time of the study group was 41 months (range, 1-276 months). It was noted that 34 (10.6%) patients relapsed during this period, and 9 (2.8%) patients died because of the disease. The entire cohort had a 5-year disease-free survival (DFS) of 86% and a 5-year disease-specific survival of 98%. Recurrences were observed only in the pelvis in 13 patients and the extra-abdominal region in 7 patients. The recurrence rate increased 6.168-fold in patients with positive peritoneal cytology (95% confidence interval [CI]=1.914-19.878; p=0.002), 3.755-fold in stage II-IV (95% CI=1.275-11.063; p=0.016), and 2.517-fold in postmenopausal women (95% CI=1.017-6.233; p=0.046) increased. In this study, lymph node involvement was detected in 3.3% of patients with AGCT. Therefore, it was concluded that lymphadenectomy can be avoided in primary surgical treatment. Positive peritoneal cytology, stage, and menopausal status were independent prognostic predictors of DFS.