Hamdullah Sözen

Prognostic value of chemotherapy response score in advanced ovarian cancer: a single-center retrospective analysis

ABSTRACT BACKGROUND: The chemotherapy response score (CRS) is a histopathological tool used to assess the tumor response in patients with high-grade serous ovarian carcinoma (HGSC) undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). DESIGN AND SETTING: This single-center retrospective study was conducted at the Faculty of Medicine at Istanbul University. The study included patients treated between January 1, 2010, and December 31, 2017 at a tertiary care hospital specializing in gynecologic oncology. OBJECTIVES: This study aimed to evaluate the prognostic significance of omental and adnexal CRS in predicting overall survival (OS) and disease-free survival (DFS) in patients with advanced HGSC undergoing NACT followed by IDS. METHODS: Data from 79 patients with advanced HGSC treated with NACT followed by IDS between 2010 and 2017 were analyzed. CRS was applied to both omental and adnexal samples, and its association with OS and DFS was evaluated. Statistical analyses were performed using univariate and multivariate methods with a significance level of P < 0.05. RESULTS: Omental CRS 1-2 was identified as an independent predictor of decreased OS (hazard ratio 2.69; 95% confidence interval 1.26–5.76, P = 0.010), whereas adnexal CRS 1-2 did not significantly impact DFS or OS in multivariate analysis. Patients with omental CRS 3 had superior outcomes, with a 5-year OS rate of 72%, compared to 30.8% in the CRS 1–2 group. The median DFS of the CRS 1–2 group was 19 months, whereas that of the CRS 3 group was 35 months (P = 0.005). CONCLUSIONS: Omental CRS is a strong independent predictor of OS in patients with advanced HGSC, whereas adnexal CRS has limited prognostic value. CRS should be considered in clinical practice to guide treatment decisions, and further research is warranted to refine its use by using molecular and radiological markers.

Effectiveness of adjuvant systemic therapy following complete cytoreductive surgery in patients with recurrent granulosa cell tumours of the ovary

AbstractAim of the present analysis is to compare the impact of antihormonal therapy versus cytotoxic chemotherapy versus a watch a wait approach on disease-free survival (DFS) in the adjuvant setting of patients who underwent complete cytoreductive surgery(CRS) for recurrent adult type granulosa cell tumours of the ovary (GCT). Moreover, we wished to identify prognostic risk factors for recurrence. We included recurrent GCT-patients who underwent CRS resulting in total macroscopic tumour clearance, treated in two gynaecological cancer centres over a 20-year period (2000–2020). CRS was performed for 51 recurrences in 26 GCT-patients. Adjuvant systemic treatments were as follows: chemotherapy in 21 cases, hormonotherapy in 10 cases, no systemic treatment in 20 cases. There were no statistically significant differences in DFS between chemotherapy, hormonotherapy and no systemic treatment: median DFS was 57, 36 and 57 months, respectively (p = 0.616). Extra-pelvic and/or multifocal tumour dissemination were found to be independent predictive factors for subsequent recurrences. In the cases with both lower and upper abdominal involvement (n = 18), patients who received chemotherapy (n = 9) had longer DFS than those who had hormonotherapy (n = 2) or no adjuvant therapy (n = 7) at all: median DFS was 36, 13 and 15 months, respectively (p = 0.9). Our findings do not encourage the administration of adjuvant therapy following complete CRS for GCT-relapse. Selected high-risk patients with disseminated disease may derive clinical benefit from additional chemotherapy, larger-scale multicentre studies are warranted to define treatment algorithms for this rare disease.

Predictors of high-grade residual disease after repeat conization in patients with positive surgical margins

No consensus exists on the subsequent management strategy of patients who exhibit positive surgical margin (PSM) after re-excision of high-grade cervical intraepithelial neoplasia (CIN). The aim of the study is to examine the predictors related to the persistence of high-grade CIN lesions after re-excision, where PSM was left behind. The present retrospective study included patients with PSM who underwent repeated conization due to residual high-grade CIN lesions between January 2005 and December 2019. The SPSS software v20.0 was used for data interpretation and statistical analysis. P values less than 0.05 were accepted as statistically significant. Repeat conization was performed in 91 patients, 43 (47.3%) presented with PSM with high-grade CIN, 6 (6.5%) presented with micro-invasive carcinoma, and 42 (46.2%) presented with clear surgical margin or CIN 1 at the surgical margin. At the time of conization, patients who presented with lesions > 5 mm in repeat cone specimens, exhibited a significantly higher rate of residual disease (p < 0.001). Besides, the involvement of the endocervical margin with high-grade CIN was the predictor of residual disease in repeat cone specimens (p = 0.006). In the cone specimen, the presence of lesion size greater than 5 mm and involvement of the endocervical margin were the predictors of high-grade residual disease after re-excision. Whether it is the first or second procedure, great care must be given to excise the lesion entirely at the time of the conization, preferably in one piece.