M. Faruk Köse

Endometrial stromal sarcoma of the uterus: analysis of 25 patients

OBJECTIVE To analyze the prognostic factors in endometrial stromal sarcoma (ESS). METHODS Prognostic factors and adjuvant treatment of endometrial stromal sarcoma in 25 patients were evaluated retrospectively. RESULTS The mean age of the group was 43. In 58% of the patients, the presenting sign was vaginal bleeding. The median total survival was 55 months while the disease free survival (DFS) was 49 months. Disease recurred in eight patients, in three of whom tumors were confined to the pelvis. Seventeen patients were alive without disease. Four patients died because of the disease. The 5-year survival rate for patients with low-grade (LGESS) disease was 92%, and 85% in high-grade (HGESS) disease. CONCLUSION In multivariate analyzes, tumor grading was the only prognostic factor in endometrial stromal sarcoma (P=0.0026).

Accuracy of frozen-section examination for myometrial invasion and grade in endometrial cancer

OBJECTIVE To evaluate the accuracy of frozen section (FS) analysis in endometrial cancer. STUDY DESIGN The medical records of 816 patients with stage IA-IVB endometrial carcinoma were evaluated. Concordance of the frozen section examination and postoperative evaluation in terms of the depth of myometrial invasion (MI) and grade was assessed. RESULTS The mean age of the patients was 58.1 years. Postoperative pathology revealed endometrioid type tumor in 756 patients. Concordance of intraoperative and postoperative pathology results in terms of grade was 89%. This rate was 96.8% for grade 1, 86% for grade 2 and 91.3% for grade 3 tumors. Sensitivity and specificity of intraoperative evaluation for grade 1, grade 2 and grade 3 were 89.3%, 91.2%, 77.8% and 93.1%, 96.1%, 99.5%, respectively. Intraoperative and postoperative determination of MI was consistent in 85.4% of patients. MI was assessed accurately in 78.5% of patients with no involvement of myometrium and in 90.5% and 95.3% of patients with myometrial invasion <1/2 and ≥1/2, respectively. Sensitivity and specificity of FS in prediction of the absence of MI, MI<1/2 and ≥1/2 were 60%, 91.5%, 88.8% and 96.6%, 88.3%, 98.3%, respectively. The accuracy of myometrial invasion was affected by the postoperative grade. Concordance was higher in grade 2 and 3 than grade 1 tumors. CONCLUSION The accuracy of intraoperative pathologic evaluation in endometrial cancer is reasonably high. For that reason, results of the intraoperative pathologic examination should be taken into consideration primarily in the management for lymphadenectomy.

Embolization of Uterine Artery in Terminal Stage Cervical Cancers

Ligation of the hypogastric artery has been a standard and effective procedure in controlling massive bleeding in advanced cervical carcinoma. The authors wanted to demonstrate the selective use of embolization of hypogastric or uterine artery to achieve the same end result—the stoppage of vaginal bleeding. In a number of cases, surgical approach may not be appropriate either because of the critically ill patient or because of the highly deformed pelvic anatomy due to radiotherapy or to the recurrence of cancerous tissue. As an alternative therapy, we used selective embolization of the uterine artery in eight patients. In all the patients, embolization served to control bleeding. As the bleeding was brought under control, a gradual recovery of the patient was generally observed. The most common side-effect was temporary severe pain related to ischemia of tumoral tissue. Embolization may be regarded as an effective procedure, which can be used to control massive bleeding in selected cervical cancer patients.

Best predictors of survival outcome after tertiary cytoreduction in patients with recurrent platinum-sensitive epithelial ovarian cancer

OBJECTIVE To evaluate the efficacy of tertiary cytoreduction (TCR) on survival and to determine prognostic factors which may influence surgical and survival outcome. STUDY DESIGN Twenty-three consecutive patients who had recurrent platinum-sensitive epithelial ovarian cancer and underwent TCR between January 1999 and January 2011 were evaluated. Factors which impact on TCR outcome and survival were determined by statistical analysis. RESULTS TCR was optimal (< 1cm residual tumor) in 15 of the 23 patients (65.2%) and suboptimal in 8 patients (34.8%). None of the clinicopathologic factors was associated with TCR outcome. On the contrary, TCR outcome (optimal vs suboptimal) was independently associated with survival in univariate analysis (P=0.018). CONCLUSION There is not a good predictor of TCR outcome but TCR seems to be beneficial for patients in whom optimal surgery can be achieved. Therefore, preoperative assessment of patients and weighing the potential survival benefit against potential surgical risks are very important for patient selection.

Comparison of advanced stage mucinous epithelial ovarian cancer and serous epithelial ovarian cancer with regard to chemosensitivity and survival outcome: a matched case-control study

Objective The aim of this study was to compare clinicopathologic characteristics, surgery outcomes and survival outcomes of patients with stage III and IV mucinous epithelial ovarian cancer (mEOC) and serous epithelial ovarian carcinoma (sEOC). Methods Patients who had surgery for advanced stage (III or IV) mEOC were evaluated retrospectively and defined as the study group. Women with sEOC who were matched for age and stage of disease were randomly chosen from the database and defined as the control group. The baseline disease characteristics of patients and platinum-based chemotherapy efficacy (response rate, progression-free survival and overall survival [OS]) were compared. Results A total of 138 women were included in the study: 50 women in the mEOC group and 88 in the sEOC group. Patients in the mEOC group had significantly less grade 3 tumors and CA-125 levels and higher rate of para-aortic and pelvic lymph node metastasis. Patients in the mEOC group had significantly less platinum sensitive disease (57.9% vs. 70.8%; p=0.03) and had significantly poorer OS outcome when compared to the sEOC group (p=0.001). The risk of death for mEOC patients was significantly higher than for sEOC patients (hazard ratio, 2.14; 95% confidence interval, 1.34 to 3.42). Conclusion Advanced stage mEOC patients have more platinum resistance disease and poorer survival outcome when compared to advanced stage sEOC. Therefore, novel chemotherapy strategies are warranted to improve survival outcome in patients with mEOC.

Staining characteristics of p16INK4a: Is there a correlation with lesion grade or high-risk human papilloma virus positivity?

Aim:  The aims of this study were to evaluate the efficiency of p16INK4a in showing cervical lesions and to determine any relationship between lesion grade and high‐risk human papilloma virus (HR‐HPV) infection and p16INK4a staining characteristics.

Gemcitabine plus carboplatin in platinum-sensitive recurrent ovarian carcinoma

Although the general intent of treatment for patients with recurrent ovarian cancer is palliative, and cure does not seem to be a realistic objective in this setting, median overall survival is greater than 12 months in platinum-sensitive recurrent ovarian cancer. Patients with ovarian cancer can now expect that the time from first relapse of their disease to death will be longer than the period from diagnosis to that first relapse. There is current evidence from prospective randomized trials that carboplatin combined with either paclitaxel or gemcitabine confers a progression-free survival advantage over platinum monotherapy for patients with platinum-sensitive relapsed ovarian cancer. Since the efficacy of paclitaxel/platinum and gemcitabine/carboplatin regimens appears to be comparable based on similar progression-free survival (both combinations confer a 3-month advantage), toxicity profiles should be taken into account when deciding on the combination to be used. The gemcitabine/carboplatin combination should be preferred in patients with underlying peripheral neuropathy. Since alopecia associated with paclitaxel can diminish the overall quality of life, the gemcitabine plus carboplatin combination may be preferable for patients in whom alopecia is a major consideration. This review provides an update on the role of the gemcitabine/carboplatin combination in platinum-sensitive recurrent ovarian cancer.

Secondary cytoreductive surgery outcomes of selected patients with paclitaxel/platinum sensitive recurrent epithelial ovarian cancer†

The aim of this study was to evaluate the effect of secondary cytoreductive surgery (SCRS) on survival and to determine prognostic factors that may predict surgical and survival outcome.

A retrospective analysis of the diameter of metastatic lymph nodes in apparently early stage endometrial cancer

Aims and background The objective of this retrospective study was to assess the diameter of metastatic lymph nodes in a population of women with apparently early stage endometrial cancer at laparotomy. Methods and study design Among 700 cases with endometrial cancer, 27 cases with disease clinically limited to the uterus in the laparotomy and found to have retroperitoneal node metastasis after pathologic examination were included in this study. Pathologic characteristics of the tumors, pelvic and paraaortic node counts and the largest diameter of each metastatic node were evaluated. Results The median number of nodes removed was 38; median number of pelvic and para-aortic nodes was 29 and 8, respectively. A total of 85 metastatic nodes were identified. Mean diameter of the metastatic para-aortic and pelvic nodes was 6.8 mm and 9 mm, respectively. Nine patients had single metastatic nodes, and the diameters of the single metastatic para-aortic lymph node was 1 mm in one case, 2 mm in one case, 3 mm in one case and 4 mm in one, and 5 mm in two patients. Two cases had isolated para-aortic lymph node metastasis without pelvic lymph node metastasis. Diameters of the metastatic para-aortic lymph nodes were 4 and 5 mm in one case and 4 mm in the other case. Conclusions The diameters of metastatic nodes may be as small as 1 mm. By sampling or selective para-aortic and/or pelvic lymphadenectomy, some of the nodes might go undiagnosed, and such understaged cases cannot take adjuvant therapy (chemotherapy-radiotherapy). For correct staging of cases with endometrial cancer, complete systematic para-aortic and/or pelvic lymphadenectomy might be appropriate.

Early and Late Complications after Inguinofemoral Lymphadenectomy for Vulvar Cancer.

BACKGROUND We aimed to determine the frequency of early and late complications following groin surgery for vulvar cancer and analyze possible risk factors. MATERIALS AND METHODS This retrospective cohort study included 99 women who underwent for vulvar cancer. The early (≤1 month) complications were wound infection, breakdown and lymphocyst and late (>1 month) complications were lower limb lymphedema, incontinence and erysipelas. The risk factors for developing each of the complications were analyzed with regression analysis. RESULTS In the entire cohort, 29 (29.3%) women experienced early and 12 (12.1%) had late complications. Wound complications including infection and breakdown were the leading early complications (23.2%). In the multivariate analysis, both obesity (body mass index≥30 kg/m2) and advanced age (≥65 years) were found as independent predictive factors for early complications. Obese women of advanced age had 6.32 times more risk of experiencing any of the early complications, when compared to non-obese and young women (55.6% vs 8.7%). The most common late complication was lower limb lymphedema (10.1%) that was more frequently seen in young women. However, neither age nor lymph node count were significantly associated with the occurrence of lower limb lymphedema. CONCLUSIONS More than 40% of the women suffered from postoperative complications after inguinofemoral lymphadenectomy in the current study. While advanced age and obesity were the significant predictors for any of the early complications, there was no identified risk factor for lower limb lymphedema.