Mehmet Tunç

Prognostic factors in ovarian cancer patients with brain metastases: A retrospective analysis

Brain metastases (BM) from epithelial ovarian cancer (EOC) are rare but clinically significant due to their poor prognosis. This study aimed to investigate prognostic factors influencing survival in EOC patients who developed BM and to evaluate treatment-related outcomes. A retrospective review was conducted on 1123 patients with EOC treated between 2008 and 2021. Among them, 27 patients (2.4 %) developed BM. Demographic, clinical, and treatment-related data were collected. Overall survival after BM diagnosis was assessed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed on 21 patients who received active treatment (surgery and/or radiotherapy). The median time from ovarian cancer diagnosis to BM was 27 months, and the median post-BM survival was 12 months. Survival was significantly longer in platinum-sensitive patients (38 vs. 7 months, p = 0.04). Median survival was 30 months with combined therapy, 13 months with radiotherapy alone, and 1 month with palliative care (p = 0.01). Within the radiotherapy group, the median survival was 13 months in patients treated with stereotactic radiosurgery (SRS) and 6 months in those who received whole-brain radiotherapy (WBRT). Univariate analysis identified platinum sensitivity (p = 0.075), number of metastases (p = 0.017), and lesion localization (p = 0.021) as factors associated with survival. In multivariate analysis, platinum sensitivity remained the only independent predictor of improved survival (HR: 0.34; 95 % CI: 0.16-0.71; p = 0.04). Platinum sensitivity is a key prognostic determinant in ovarian cancer patients with BM. Early identification and tailored multimodal treatment strategies may contribute to prolonged survival in selected patients.

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.

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.