Ozlem Moraloglu Tekin

Neoadjuvant chemotherapy in patients with stage IVB uterine serous carcinoma: a Turkish multicentric study

The aim of this study was to evaluate the prognostic factors for and determine the effect of neoadjuvant chemotherapy (NACT) on oncologic outcome in stage IVB pure serous endometrial carcinoma patients who received taxane and platinum. Forty-two patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IVB uterine serous carcinoma were enrolled from six gynecologic oncology centers and a study group was created. The study group had a 2-year disease-free survival (DFS) of 32% and 2-year disease-specific survival (DSS) of 73%. On univariate analysis; lymphadenectomy (not performed vs. performed), paraaortic lymph node metastasis (positive vs. negative) and number of metastatic lymph node count (≤5 vs. >5) were found to have statistical significance for DFS (

The prognostic value of squamous differentiation in endometrioid type endometrial cancer: a matched analysis

We aimed to examine the effect of the squamous differentiation on survival outcomes of women with endometrioid adenocarcinoma. We retrospectively reviewed the patients with endometrioid adenocarcinoma who underwent primary surgical treatment in a tertiary referral hospital. Sixty-nine patients having squamous differentiation constituted the case group. Each woman in the case group was matched with two patients in the control group based on age, disease stage, tumour grade, lymphovascular space invasion, tumour size, myometrial invasion, type of surgery and adjuvant therapy. During the follow-up, the recurrence rates were similar between the case (5/69, 7.2%) and control (10/138, 7.2%) groups (

Prognostic value of systemic inflammatory response markers in cervical cancer

We investigated the association between preoperative ratios of inflammatory markers and the prognosis in patients with invasive cervical cancer (CC). In this single-centre study, we retrospectively enrolled 163 CC patients who underwent radical hysterectomy between February 2008 and October 2018. Among the evaluated ratios, a high neutrophil-to-lymphocyte ratio (N/L) was significantly associated with deep stromal invasion and tumour size larger than 2 cm, whereas a high M/L was significantly related to advanced-stage CC (IB3-IIIC2), lymphatic metastasis (total) and pelvic lymph node metastasis (

Assessment of the differences in oncologic outcomes between patients with high‐grade serous ovarian carcinoma and uterine serous carcinoma

AbstractAimTo evaluate whether the recurrence rates, recurrence patterns, and survival outcomes differed according to the primary site of the tumor in patients with high‐grade serous ovarian carcinoma (HGSOC) and uterine serous carcinoma (USC).MethodsThe population of this multicenter retrospective study consisted of patients who had USC or HGSOC. Progression‐free survival (PFS) and disease‐specific survival (DSS) estimates were determined using the Kaplan–Meier method. Survival curves were compared using the log‐rank test.ResultsThe study cohort consisted of 247 patients with HGSOC and 34 with USC. Recurrence developed in 118 (51.1%) in the HGSOC group and 14 (42.4%) in the USC group (p = 0.352). The median time to recurrence was 23.5 (range, 4–144) and 17 (range, 4–43) months in the HGSOC and USC groups, respectively (p = 0.055). The 3‐year PFS was 52% in the HGSOC group and 47% in the USC group (p = 0.450). Additionally, 3‐year DSS was 92% and 82% in the HGSOC and USC groups, respectively (p = 0.060).ConclusionsHGSOC and USC are aggressive tumors with high recurrence and mortality rates in advanced stages. These two carcinomas, which are similar in molecular features and clinical management, may also have similar recurrence patterns, disease failure, and survival rates.

Surgery for patients with endometrioid-type endometrial cancer: is lymphadenectomy above the inferior mesenteric artery necessary?

The primary objective of this study was to identify the risk of metastasis to lymph nodes above the inferior mesenteric artery (IMA) in endometrioid-type endometrial cancer (EC) and the factors that influence metastasis. The study included patients who had been operated on for endometrioid-type EC in three gynecological oncology centers between 2007 and 2023. The supramesenteric lymph node (SM-LN) is the region between the left renal vein and the IMA, whereas the inframesenteric lymph node (IM-LN) is the region between the IMA and the aortic bifurcation, as determined by the level of the IMA. The study sample comprised 412 patients. The median number of lymph nodes excised per patient was 58. The median count was 37 for pelvic lymph nodes, 21 for para-aortic lymph nodes, 8 for IM-LN, and 13 for SM-LN. In the univariate analysis, the factors that were found to be statistically significant in determining SM-LN metastasis included tumor size, depth of myometrial invasion, uterine serosal invasion, lymphovascular space invasion (LVSI), cervical invasion, peritoneal cytology, adnexal metastasis, omental metastasis, non-nodal extrauterine metastasis, pelvic lymph node metastasis, and IM-LN metastasis. In the multivariate analysis, SM-LN metastasis was independently associated with tumor size, LVSI, pelvic lymph node metastasis, and IM-LN metastasis. In conclusion, in cases of intermediate-high risk EC, it is important to know that the disease spreads to SM-LN in 7.3% of patients. The efficacy of postoperative adjuvant treatment may be inadequate due to a lack of information regarding the SM-LN region.

Measurement of thiol/disulfide homeostasis and ischemic modified albumin levels in patients with uterine leiomyomas

AbstractObjectiveThe aim is to contrast the serum levels of thiol‐disulfide homeostasis and ischemic modified albumin between patients with leiomyoma and healthy individuals and to assess the impact of oxidative stress on the etiopathogenesis of leiomyoma.MethodsIn this prospective case‐control study, a total of 154 participants were included, consisting of 77 cases diagnosed with leiomyoma and 77 healthy individuals without leiomyoma. The demographic characteristics and ultrasonographic findings of the participants were recorded, and parameters such as albumin, ischemia‐modified albumin, and thiol‐disulfide homeostasis were evaluated. The results obtained from the analyses were compared between the two groups.ResultsNo significant differences were observed in the demographic characteristics between the groups. A significant difference was observed between the leiomyoma and control groups regarding serum albumin parameters, serum ischemic modified albumin, and serum dynamic thiol‐disulfide parameters (P < 0.001). No significant difference was found in the ratios of disulfide/total thiol, disulfide/native thiol, native thiol/total thiol (P > 0.05).ConclusionThere was a notable contrast in the levels of albumin, ischemic modified albumin, albumin/ischemic modified albumin ratio, total thiol, native thiol, and disulfide between individuals with uterine leiomyomas and healthy individuals in the control group. Oxidative stress is believed to play a causative role in the etiopathogenesis of uterine leiomyomas.

Defining the relationship between ovarian adult granulosa cell tumors and synchronous endometrial pathology: Does ovarian tumor size correlate with endometrial cancer?

Abstract Objective The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. The primary goal of this study is to identify synchronized endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy. Materials and Methods The study cohort comprised retrospectively of 316 AGCT patients from 10 tertiary gynecological oncology centers. AGCT surgery consisted of bilateral salpingo‐oophorectomy, hysterectomy, peritoneal cytology, omentectomy, and the excision of any suspicious lesion. The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated. Results Endometrial intraepithelial neoplasia, or hyperplasia with complex atypia, was detected in 7.3% of patients, and endometrial cancer in 3.1% of patients. Age, menopausal status, tumor size, International Federation of Gynecology and Obstetrics stage, ascites, and CA‐125 level were not statistically significant factors to predict endometrial cancer. There was no endometrial cancer under the age of 40, and 97.8% of women diagnosed with endometrial hyperplasia were over the age of 40. During the menopausal period, the endometrial cancer risk was 4.5%. Developing endometrial cancer increased to 12.1% from 3.2% when the size of the tumor was >150 mm in menopausal patients ( p  = 0.036). Conclusion Endometrial hyperplasia, or cancer, occurs in approximately 30% of AGCT patients. Patients diagnosed with AGCT, especially those older than 40 years, should be evaluated for endometrial pathologies. There may be a relationship between tumor size and endometrial cancer, especially in menopausal patients.

Prognostic factors of adult granulosa cell tumors of the ovary: a Turkish retrospective multicenter study

To define the clinical, histopathological features and the prognostic factors affecting survival in patients with adult granulosa cell tumors of the ovary (AGCT). A 322 patients whose final pathologic outcome was AGCT treated at nine tertiary oncology centers between 1988 and 2021 participated in the study. The mean age of the patients was 51.3±11.8 years and ranged from 21 to 82 years. According to the International Federation of Gynecology and Obstetrics 2014, 250 (77.6%) patients were stage I, 24 (7.5%) patients were stage II, 20 (6.2%) patients were stage III, and 3 (7.8%) were stage IV. Lymphadenectomy was added to the surgical procedure in 210 (65.2%) patients. Lymph node involvement was noted in seven (3.3%) patients. Peritoneal cytology was positive in 19 (5.9%) patients, and 13 (4%) had metastases in the omentum. Of 285 patients who underwent hysterectomy, 19 (6.7%) had complex hyperplasia with atypia/endometrial intraepithelial neoplasia, and 8 (2.8%) had grade 1 endometrioid endometrial carcinoma. It was found that 93 (28.9%) patients in the study group received adjuvant treatment. Bleomycin, etoposide, cisplatin was the most commonly used chemotherapy protocol. The median follow-up time of the study group was 41 months (range, 1-276 months). It was noted that 34 (10.6%) patients relapsed during this period, and 9 (2.8%) patients died because of the disease. The entire cohort had a 5-year disease-free survival (DFS) of 86% and a 5-year disease-specific survival of 98%. Recurrences were observed only in the pelvis in 13 patients and the extra-abdominal region in 7 patients. The recurrence rate increased 6.168-fold in patients with positive peritoneal cytology (95% confidence interval [CI]=1.914-19.878; p=0.002), 3.755-fold in stage II-IV (95% CI=1.275-11.063; p=0.016), and 2.517-fold in postmenopausal women (95% CI=1.017-6.233; p=0.046) increased. In this study, lymph node involvement was detected in 3.3% of patients with AGCT. Therefore, it was concluded that lymphadenectomy can be avoided in primary surgical treatment. Positive peritoneal cytology, stage, and menopausal status were independent prognostic predictors of DFS.