Mustafa Albayrak

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.

Carbon dye versus indocyanine green for sentinel lymph node mapping in endometrial cancer: a prospective dual-center study

To compare the detection rates and diagnostic accuracy of sentinel lymph node (SLN) mapping using carbon dye and indocyanine green (ICG) in patients with early-stage endometrial cancer. The present study was a dual-center, prospective cohort study conducted between September 2021 and August 2022 involving patients with early-stage endometrial cancer. For SLN mapping, one center exclusively used carbon dye, while the other solely used ICG. Subsequently, all patients underwent complete systematic pelvic lymphadenectomy. The detection rates, sensitivity, and negative predictive value of SLN mapping were analyzed. This study included 179 patients, of whom 89 (49.7%) were mapped using carbon dye and 90 (50.3%) were mapped using ICG laparoscopically. Unilateral detection rates of SLNs were similar, 94.4% (84/89) for carbon dye and 97.8% (88/90) for ICG (p = .25). In contrast, bilateral detection rates were significantly higher with carbon dye compared to ICG (82.0% [73/89] vs 64.4% [58/90], p = 0.008). The sensitivity and negative predictive value were both 100% for ICG and 83.3% and 98.8% for carbon dye, respectively. The empty node packet rate was 5.6% (5/90) for ICG and 0% (0/89) for carbon dye (p = .17). Although this difference did not reach statistical significance, all cases of empty node packets were observed in patients with successful unilateral but failed bilateral detection. Carbon dye is a safe and effective agent for SLN mapping, demonstrating adequate detection rates, satisfactory sensitivity, and a high negative predictive value in patients with early-stage endometrial cancer. The use of carbon dye might reduce the rate of empty node packets, thereby enhancing the accuracy of nodal evaluation. While carbon dye may be a promising alternative tracer, particularly in low-resource settings, further comparative studies are needed to evaluate its cost-effectiveness relative to other widely used tracers, including blue dyes.