Ibrahim Yalçin

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.

Challenges in Fertility Preservation for p53abn Grade 2 Endometrioid Endometrial Cancer: A Case Report and Literature Review

Endometrial carcinoma, the second most common gynecological cancer, is increasingly affecting younger women, particularly due to rising obesity rates. The need for precise molecular tools is paramount for better categorization and risk stratification, especially in fertility preservation, as current methods often fall short. Fertility preservation is considered for early-stage, nonmetastatic cases, but the role of molecular classifications in this area remains underexplored. We present the case of a 35-year-old woman with grade 2 p53abn endometrioid endometrial cancer who sought fertility preservation. Her initial treatment involved hysteroscopy-guided resection, hormonal therapy with megestrol acetate (MA), and close monitoring, but the disease recurred within six months. A literature review reveals that fertility preservation in p53abn endometrial carcinoma is poorly documented, with variable outcomes. Many cases indicate a poor response to progestin therapy and a heightened risk of recurrence, highlighting the need for personalized treatment approaches. Additionally, our case identifies "a novel PTEN somatic mutation (Tier 2C)" that has not been previously reported in endometrial cancer. This case underscores the essential role of molecular profiling in clinical decision-making and the need for ongoing research into molecular pathways. Integrating molecular classifiers into routine practice is crucial for improving risk stratification and treatment outcomes, especially in young women pursuing fertility preservation.

Sentinel SENECA risk factors for unsuccessful bi-lateral sentinel lymph node mapping in endometrial cancer

Our study aims to assess the risk factors associated with bi-lateral sentinel lymph node (SLN) mapping failure in endometrial cancer. The SENECA study was a retrospective multi-center international observational study that reviewed data from 2139 women with clinical stage I-to-II endometrial cancer across 64 centers in 17 countries. Between January 2021 and December 2022, patients underwent surgical treatment with SLN assessment, following the guidelines of the European Society of Gynaecological Oncology. Risk factors associated with the absence of bi-lateral mapping were analyzed using χ Among the 2139 patients, the bi-lateral lymph node detection rate was 82.7%, whereas the unilateral detection rate was 97.3%. In multi-variate analysis, 5 risk factors remained statistically associated with unsuccessful bi-lateral lymph node mapping: high-grade histology (OR 1.35, 95% CI 1.02 to 1.79, p=.03), myometrial invasion >50% (OR 1.37, 95% CI 1.07 to 1.75, p=.012), low-volume surgeon <20 cases/year (OR 2.11, 95% CI 1.55 to 2.89, p<.01), open surgical approach (OR 1.72, 95% CI 1.06 to 2.78 , p=.03), and non-indocyanine green tracer (OR 4.59, 95% CI 2.64 to 7.99, p<.01). The addition of bi-lateral pelvic lymphadenectomy and/or paraaortic lymphadenectomy to SLN biopsy caused an increased rate of intra-operative complications (2% vs 8.4%, p<.01) and all-grade post-operative complications (4.1% vs 11.2%, p<.01). Our study identifies 5 risk factors associated with unsuccessful lymph node mapping in endometrial cancer. Efforts should be made to perform this technique with indocyanine green, through minimally invasive surgery, and performed or supervised by an experienced surgeon with ≥20 endometrial cancer cases per year.

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.

Risk factors for the involvement of sentinel lymph nodes in endometrial cancer (TRSGO-SLN-010)

This research was undertaken to identify risk factors for the involvement of sentinel lymph nodes (SLNs) in cases of endometrial cancer. From February 2016 to April 2021, the cases of 874 women with endometrial cancer treated with the SLN algorithm at 11 institutions were analyzed in this retrospective study. Clinical and pathologic data were reviewed, and logistic regression was applied to identify predictive factors for SLN involvement. After the exclusion of 81 patients, the remaining cohort of 793 patients was analyzed. The involvement of SLNs occurred in 9.2% of these cases (n = 73). In univariate analysis, the risk of SLN involvement was seen to be significantly higher among patients aged >60 years and those with high-grade tumors, non-endometrioid histology, lymphovascular space invasion, deep myometrial invasion, tumor diameters of ≥2 cm, and cervical stromal invasion. Multivariate analysis identified the occurrence of deep myometrial invasion (OR 2.42, 95% CI 1.29 to 4.56; p = .006), cervical stromal invasion (OR 2.18, 95% CI 1.13 to 4.21; p = .020), and lymphovascular space invasion (OR 7.27, 95% CI 3.82 to 13.81; p < .001) as risk factors independently predictive of SLN involvement in the treatment of endometrial cancer. Deep myometrial invasion, cervical stromal invasion, and lymphovascular space invasion were found to be independently predictive of the involvement of SLNs in cases of endometrial cancer. For cases in which SLN dissection was not or could not be performed, the identified independent risk factors are crucial for guiding adjuvant therapy.