Taner Turan

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.

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.

Accuracy of Frozen Sections for Intraoperative Diagnosis of Complex Atypical Endometrial Hyperplasia

OBJECTIVE The purpose of this study was to correlate the histological diagnosis made during intraoperative frozen section (FS) examination of hysterectomy samples with complex atypical endometrial hyperplasia (CAEH) diagnosed with definitive paraffin block histology. METHODS FS pathology results of 125 patients with a pre- operative biopsy showing CAEH were compared retrospectively with paraffin block pathology findings. RESULTS Paraffin block results were consistent with FS in 78 of 125 patients (62.4%). The FS sensitivity and specificity of detecting cancer were 81.1% and 97.9%, with negative and positive predictive values of 76.7%, and 98.4%, respectively. Paraffin block results were reported as endometrial cancer in 77 of 125 (61.6%) patients. Final pathology was endometrial cancer in 45.3% patients diagnosed at our center and 76.9% for patients who had their diagnosis at other clinics (p=0.018). Paraffin block results were consistent with FS in 62.4% of all cases Consistence was 98.4% in patients who had endometrial cancer in FS. CONCLUSION FS does not exclude the possibility of endometrial cancer in patients with the preoperative diagnosis of CAEH. In addition, sufficient endometrial sampling is important for an accurate diagnosis.

The Factors Predicting Recurrence in Patients With Serous Borderline Ovarian Tumor.

Objective In this study, we aimed to demonstrate the characteristics, recurrence rates, survival, and factors associated with survival of patients with serous borderline ovarian tumor (BOT) who were operated on in a single institution. Our secondary goal was to evaluate the necessity of staging surgery and the importance of a comprehensive lymphadenectomy in these patients. Materials and Methods The patients who were diagnosed in our institution between January 1990 and April 2014 with a final diagnosis of serous BOT were evaluated retrospectively. Kaplan-Meier method was used for analysis of progression-free survival (PFS). Univariate Cox proportional hazards model and log rank test were used for analysis of continuous and categorical variables affecting survival, respectively. Results One hundred twenty-one (75%) patients underwent staging surgery. Stage I disease was observed in 63%, stage III was observed in 11% of the patients, and only 0.6% of patients had stage II disease. Among 162 patients, 72 patients (44%) had conservative surgery. Eight (4.9%) patients had recurrence, one of which was invasive. All recurrences were in the patients who had conservative surgery. Median follow-up of the patients was 57 months (range, 37–270 years). Five- and 10-year PFS rates were 94.9% and 92.8%, respectively. In the univariate analysis of patients with serous BOT, PFS was worse in the presence of positive para-aortic lymph nodes, positive abdominal cytology, and conservative surgery (P = 0.008, P < 0.001, P = 0.007, respectively). The patients having noninvasive implant and advanced-stage disease had a tendency to have worse PFS (P = 0.067, P = 0.069, respectively). Conclusions Staging surgery generally gives us an idea of the probability of recurrence but not an idea of overall survival. Therefore, staging surgery including lymphadenectomy could be suggested to have information about the probability of recurrence and to be able to detect patients with an invasive implant that is the only probable factor affecting overall survival.

Clinical outcomes of uterine carcinosarcoma: results of 94 patients.

Objective We aimed to determine the clinicopathologic features and identify prognostic factors of patients with uterine carcinosarcoma. Materials and Methods A total of 94 patients with uterine carcinosarcoma who were diagnosed between January 1993 and October 2013 were included. Staging surgery consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, peritoneal cytology, and omentectomy. Staging is undertaken according to the 2009 International Federation of Gynecology and Obstetrics staging system. Kaplan-Meier survival analysis was used to determine the effects of variables on disease-free survival (DFS) and overall survival (OS). Results Seventy-nine patients underwent staging surgery and none of them had residual tumor after surgery. Three-year DFS and 3-year OS were 42.7% and 59.2%, respectively. In the univariate analysis, stage, presence of para-aortic metastatic lymph nodes, uterine serosal spread, positive peritoneal cytology, and extrapelvic metastases were associated with 3-year DFS and stage, presence of para-aortic metastatic lymph nodes, uterine serosal spread, positive peritoneal cytology, adnexal involvement, and extrapelvic metastases were associated with 3-year OS. Seventy-four patients received adjuvant therapy. Adjuvant therapy did not reduce recurrence or improve survival. Any of the chemotherapy regimens was not superior to the others. In the multivariate analysis, only age was an independent prognostic factor for 3-year DFS and no parameter was statistically significant for 3-year OS. Conclusions Age was an independent prognostic factor for 3-year DFS. Older age was associated with poor survival. Extrauterine spread was associated with survival. The aims of surgery should be both staging and providing tumoral debulking. Prospective randomized trials are needed to better define the necessity and modality of the administered adjuvant therapy.

Small cell carcinoma of the endometrium: A report of three cases.

Small cell carcinoma (SCC) is a tumour that occurs mostly in the lung, but may be found in any organ in the body. Since SCC of the endometrium is rare, clinical behaviour and management of the disease is not well-defined. The only known prognostic factor is the stage of the disease. Here, we reported three patients with SCC of the endometrium, their management and the follow-up period.

Multicenter analysis of gestational trophoblastic neoplasia in Turkey.

BACKGROUND To evaluate the incidence, diagnosis and management of GTN among 28 centers in Turkey. MATERIALS AND METHODS A retrospective study was designed to include GTN patients attending 28 centers in the 10-year period between January 2003 and May 2013. Demographical characteristics of the patients, histopathological diagnosis, the International Federation of Gynecology and Obstetrics (FIGO) anatomical and prognostic scores, use of single-agent and multi-agent chemotherapy, surgical interventions and prognosis were evaluated. RESULTS From 2003-2013, there were 1,173,235 deliveries and 456 GTN cases at the 28 centers. The incidence was calculated to be 0.38 per 1,000 deliveries. According to the evaluated data of 364 patients, the median age at diagnosis was 31 years (range, 15-59 years). A histopathological diagnosis was present for 45.1% of the patients, and invasive mole, choriocarcinoma and PSTTs were diagnosed in 22.3% (n=81), 18.1% (n=66) and 4.7% (n=17) of the patients, respectively. Regarding final prognosis, 352 (96.7%) of the patients had remission, and 7 (1.9%) had persistence, whereas the disease was mortal for 5 (1.4%) of the patients. CONCLUSIONS Because of the differences between countries, it is important to provide national registration systems and special clinics for the accurate diagnosis and treatment of GTN.

Prognostic effect of different cut-off values (20 mm, 30 mm and 40 mm) for clinical tumor size in FIGO stage IB cervical cancer

OBJECTIVE The aim of this study is to evaluate whether applying cut-off values of 20mm, 30mm and 40mm for tumor size have prognostic value in terms of survival or not. MATERIAL AND METHODS Medical records of 193 patients with FIGO stage IB cervical cancer (IB1: 173, IB2: 20) undergoing radical hysterectomy were evaluated. Tumor size was defined as the greatest tumor diameter determined by rectovaginal examination under general anesthesia. The influence of cut-off values (20mm, 30mm, and 40mm) on surgical-pathologic risk factors and survival rates was evaluated. RESULTS Tumor size was <or=20mm in 71, <or=30mm in 125 and <or=40mm in 174 patients. Only 40mm was associated with the presence of metastasis in at least one of pelvic or para-aortic lymph nodes. Depth of stromal invasion was affected by 20mm and 30mm. For parametrial and surgical margin involvement, only 30mm had a statistically significant effect. Probability of receiving adjuvant radiotherapy was similar with all of the cut-off values. Neither cut-off value had a statistically significant effect in terms of survival rates. It was observed that lymph node metastasis and age affected 5-year disease-free survival (DFS) and 5-year overall survival (OS) rates. OS, but not DFS, was affected by lymphovascular space invasion. Stage, cell type, grade, parametrial invasion, presence of tumor at surgical margin and depth of stromal invasion did not affect recurrence or survival rates. Age and pelvic lymph node involvement were independent prognostic factors. DISCUSSION The present study did not find a single cut-off value for tumor size that can predict all surgical-pathologic risk factors. Recurrence and survival were not affected by any of these values.

Analysis of patients with stage IIIC endometrial cancer.

Objective We aimed to define the factors that are related to recurrence and survival in patients with stage IIIC endometrial carcinoma in this study. Materials and Methods A total of 147 patients who underwent staging surgery and had a diagnosis of stage IIIC1 to IIIC2 endometrial cancer according to the International Federation of Gynecology and Obstetrics 2009 were included. Patients whose data could not be obtained and patients with a diagnosis of uterine sarcoma and with synchronous tumors were excluded. Results Mean age of the patients was 58.6 years. Among these patients, 63 had stage IIIC1 and 84 had stage IIIC2 disease. Extrauterine spread was detected in 22% of the patients. Median number of paraaortic (PA) and pelvic lymph nodes removed were 16.5 and 38, respectively. Paraaortic and pelvic nodal involvements were detected in 84 patients and 125 patients, respectively. Radiotherapy was applied more commonly as an adjuvant therapy. Three-year progression-free survival (PFS) and 3-year disease-specific survival (DSS) were 65% and 84%, respectively. Seventy percent of the recurrences were outside the pelvis. Site of metastatic lymph nodes and the number of metastatic PA lymph nodes were associated with 3-year PFS and lymphovascular space invasion; site of metastatic lymph nodes and the presence of recurrence were associated with 3-year DSS in the univariate analysis. Although any surgicopathological factor was not related to 3-year PFS, only the presence of recurrence was an independent prognostic factor for a 3-year DSS in the multivariate analysis (hazard ratio, 0.017; 95% confidence interval, 0.002–0.183). Conclusions The number of debulked metastatic lymph nodes and PA involvement were associated with recurrence in the univariate analysis. The presence of recurrence was the only independent prognostic factor detecting survival. Therefore, systematic lymphadenectomy involving PA lymph nodes instead of sampling should be performed in patients with high risk for nodal involvement in endometrial cancer.