Koray Aslan

What is the prognostic importance of lymphovascular space invasion in the absence of lymph node metastasis for early-stage endometrial cancer?

Does lymph node ratio have any prognostic significance in maximally cytoreduced node-positive low-grade serous ovarian carcinoma?

To determine the prognostic impact of the lymph node ratio (LNR) in node-positive low-grade serous ovarian cancer (LGSOC). We retrospectively reviewed women with LGSOC who had undergone maximal cytoreduction followed by standard chemotherapy in 11 centers from Turkey during a study period of 20 years. Sixty two women with node-positive LGSOC were identified. LNR was defined as the number of metastatic lymph nodes (LNs) divided by the number of total LNs removed. We grouped patients pursuant to the LNR as LNR ≤ 0.09 and LNR > 0.09. The prognostic value of LNR was investigated by employing the univariate log-rank test and multivariate Cox-regression model. With a median follow-up of 45 months, the 5-year progression-free survival (PFS) rates were 61.7% for women with LNR ≤ 0.09 and 32.0% for those with LNR > 0.09 (p = 0.046) whereas, the 5-year overall survival (OS) rates were 72.8% for LNR ≤ 0.09 and 54.7% for LNR > 0.09 (p = 0.043). On multivariate analyses, lymphovascular space invasion (LVSI) (Hazard Ratio [HR] 4.18, 95% confidence interval [CI] 1.88-9.27; p  0.09 (HR 3.51, 95% CI 1.54-8.03; p = 0.003) were adverse prognostic factors for PFS. Additionally, LVSI (HR 6.56, 95% CI 2.33-18.41; p  0.09 (HR 7.20, 95% CI 2.33-22.26; p = 0.001) were independent prognostic factors for decreased OS. LNR > 0.09 seems to be an independent prognosticator for decreased survival outcomes in LGSOC patients who received maximal cytoreduction followed by standard adjuvant chemotherapy.

Prognostic value of the number of the metastatic lymph nodes in locally early-stage cervical cancer: squamous cell carcinoma versus non-squamous cell carcinoma

To clarify the prognostic value of the number of metastatic lymph nodes (mLNs) in squamous and non-squamous histologies among women with node-positive cervical cancer. One hundred ninety-one node-positive cervical cancer patients who had undergone radical hysterectomy plus systematic pelvic and para-aortic lymphadenectomy followed by concurrent radiochemotherapy were retrospectively reviewed. The prognostic value of the number of mLNs was investigated in squamous cell carcinoma (SCC) v (n = 148) and non-SCC (n = 43) histologies separately with univariate log-rank test and multivariate Cox regression analyses. In SCC cohort, mLNs > 2 was significantly associated with decreased 5-year disease-free survival (DFS) [hazard ratio (HR) = 2.06; 95% confidence interval (CI) 1.03-4.09; p = 0.03) and overall survival (OS) (HR = 2.35, 95% CI 1.11-4.99; p = 0.02). However mLNs > 2 had no significant impact on 5-year DFS and 5-year OS rates in non-SCC cohort (p = 0.94 and p = 0.94, respectively). We stratified the entire study population as SCC with mLNs ≤ 2, SCC with mLNs > 2, and non-SCC groups. Thereafter, we compared survival outcomes. The non-SCC group had worse 5-year OS (46.8% vs. 85.3%, respectively; p  2 had similar 5-year OS (46.8% vs. 65.5%, respectively; p = 0.16) and 5-year DFS rates (31.6% vs. 57.5%, respectively; p = 0.06). Node-positive cervical cancer patients who have non-SCC histology as well as those who have SCC histology with mLNs > 2 seem to have worse survival outcomes when compared to women who have SCC histology with mLNs ≤ 2.

Implementation of enhanced recovery after surgery in gynaecologic oncology surgery: where should we start?

Compliance with elements of an enhanced recovery after surgery (ERAS) protocol is associated with better outcomes, including decreased length of hospital stay (LHS), but complete implementation is challenging. This study aimed to identify the role of individual ERAS elements on LHS to facilitate the implementation process. This retrospective single-centre study included 233 women with gynaecological cancers who underwent surgery between 1 February 2021 and 31 July 2023. The first 120 consecutive patients after implementation of the ERAS programme were defined as the ERAS group, and the other patients were in the pre-ERAS group. The groups were compared in terms of LHS. Univariate and multi-variate analyses were used to define independent predictors of decreased LHS (≤5 days). The median LHS was 6 [interquartile range (IQR) 1-29] days for the ERAS group and 7 (IQR 3-23) days for the pre-ERAS group (p = 0.006). Avoidance of mechanical bowel preparation (p = 0.007), avoidance of surgical site drainage (p < 0.001), removal of urinary drainage before postoperative day 3 (p = 0.02), regular diet initiation on postoperative day 0 (p = 0.02), and reduction in total opioid dose (p = 0.006) were significantly associated with LHS ≤ 5 days on univariate analysis. On multi-variate analysis, avoidance of surgical site drainage (p = 0.014), removal of urinary drainage before postoperative day 3 (p = 0.037), and reduction in total opioid dose (p = 0.045) remained significant for LHS ≤ 5 days. Avoidance of surgical site drainage, removal of urinary drainage before postoperative day 3, and reduction in total opioid dose were found to be independent predictors of decreased LHS among ERAS items. Special consideration should be given to these items during the adoption of ERAS programmes.

Evaluation of metabolic uptake in gynecological organs using FDG-PET in women diagnosed with non-gynecological malignancies

Gynecological malignancies, including those affecting the uterus, cervix, vagina, vulva, and adnexa, pose significant physical and psychosocial burdens. Early detection and effective management of these malignancies are critical for improving outcomes. This study aims to evaluate metabolic uptake patterns in gynecological organs using fluorodeoxyglucose positron emission tomography (FDG-PET) and to analyze their malignancy potential in women with nongynecological cancers. A retrospective analysis was conducted on 221 women with nongynecological malignancies who exhibited pathological FDG uptake in gynecological organs on FDG-PET/CT imaging. Lesions were evaluated based on the standardized uptake value maximum (SUVmax), morphological characteristics on contrast-enhanced CT, and further gynecological assessment using ultrasonography, biopsy, and endometrial sampling. Statistical analyses, including the receiver operating characteristics curve and descriptive statistics, were performed using SPSS software, with significance set at p 10.11 predicted malignancy in uterine lesions with 86% sensitivity and 82% specificity. Among patients with uterine involvement, malignancy was confirmed in 10 cases, all of whom were on tamoxifen therapy. Endometrial thickness was significantly higher in malignancy cases (10.6 mm vs. 5.8 mm, p = 0.014). Ultrasonography and biopsy findings largely confirmed the benign nature of other lesions, highlighting the role of multimodal diagnostic approaches. FDG-PET imaging is a valuable tool for identifying metabolic activity in gynecological organs and for differentiating malignant lesions from benign ones. High SUVmax values and endometrial thickness are significant indicators of malignancy, particularly in patients undergoing hormonal therapy. This study underscores the importance of integrating metabolic imaging with clinical and morphological assessments for the early detection and management of gynecological malignancies.