1.Comparison of total plasma lysophosphatidic acid and serum CA-125 as a tumor marker in the diagnosis and follow-up of patients with epithelial ovarian cancer.
Tugan BESE ; Merve BARBAROS ; Elif BAYKARA ; Onur GURALP ; Salih CENGIZ ; Fuat DEMIRKIRAN ; Cevdet SANIOGLU ; Macit ARVAS
Journal of Gynecologic Oncology 2010;21(4):248-254
OBJECTIVE: To evaluate the role of lysophosphatidic acid (LPA) as a tumor marker in diagnosis and follow-up of patients with epithelial ovarian cancer. METHODS: Eighty-seven epithelial ovarian cancer patients, 74 benign ovarian tumor patients, and 50 healthy women were enrolled in the study. Twenty-nine of 87 epithelial ovarian cancer patients were followed up for 6 cycles of paclitaxel-carboplatin chemotherapy. CA-125 and total plasma LPA levels were measured preoperatively and before each chemotherapy cycle. RESULTS: Preoperative total plasma LPA and serum CA-125 levels were significantly higher in patients with epithelial ovarian cancer compared to patients with benign ovarian tumors and healthy women. Cut-off value for LPA was determined as 1.3 micromol/L and sensitivity, specificity, positive predictive value and negative predictive value were 95%, 92%, 95% and 92%, respectively. Mean total plasma LPA level of 29 patients who received chemotherapy was 7.21+/-6.63 micromol/L preoperatively and 6.84+/-6.34 micromol/L, 6.34+/-5.92 micromol/L, 6.14+/-5.79 micromol/L, 5.86+/-5.68 micromol/L, 5.23+/-5.11 micromol/L and 5.21+/-5.32 micromol/L in measurements held just before the 1st, 2nd, 3rd, 4th, 5th and 6th chemotherapy cycles, respectively (ANOVA, p=0.832). Total plasma LPA levels decreased slightly with chemotherapy administration and there was a weak negative correlation (Spearman, rs=-0.151, p=0.034), compared to a significant negative correlation in CA-125 (Spearman, rs=-0.596, p<0.001). CONCLUSION: LPA is a better biomarker for diagnosis of epithelial ovarian cancer compared to CA-125. However, measurement of total plasma LPA levels during chemotherapy administration have no superiority to the serum CA-125 levels.
Female
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Follow-Up Studies
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Humans
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Lysophospholipids
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Neoplasms, Glandular and Epithelial
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Ovarian Neoplasms
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Plasma
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Sensitivity and Specificity
2.Impact of lymph node ratio on survival in stage III ovarian high-grade serous cancer: a Turkish Gynecologic Oncology Group study
Ali AYHAN ; Nazlı Topfedaisi OZKAN ; Mustafa Erkan SARI ; Husnu CELIK ; Murat DEDE ; Ozgür AKBAYIR ; Kemal GÜNGÖRDÜK ; Hanifi ŞAHIN ; Ali HABERAL ; Tayfun GÜNGÖR ; Macit ARVAS ; Mehmet Mutlu MEYDANLI
Journal of Gynecologic Oncology 2018;29(1):e12-
OBJECTIVE: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in patients with stage III ovarian high-grade serous carcinoma (HGSC). METHODS: A multicenter, retrospective department database review was performed to identify patients with ovarian HGSC at 6 gynecologic oncology centers in Turkey. A total of 229 node-positive women with stage III ovarian HGSC who had undergone maximal or optimal cytoreductive surgery plus systematic lymphadenectomy followed by paclitaxel plus carboplatin combination chemotherapy were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 3 groups: LNR1 (<10%), LNR2 (10%≤LNR<50%), and LNR3 (≥50%). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. RESULTS: Thirty-one women (13.6%) were classified as stage IIIA1, 15 (6.6%) as stage IIIB, and 183 (79.9%) as stage IIIC. The median age at diagnosis was 56 (range, 18–87), and the median duration of follow-up was 36 months (range, 1–120 months). For the entire cohort, the 5-year overall survival (OS) was 52.8%. An increased LNR was associated with a decrease in 5-year OS from 65.1% for LNR1, 42.5% for LNR2, and 25.6% for LNR3, respectively (p<0.001). In multivariate analysis, women with LNR≥0.50 were 2.7 times more likely to die of their tumors (hazard ratio [HR]=2.7; 95% confidence interval [CI]=1.42–5.18; p<0.001). CONCLUSION: LNR seems to be an independent prognostic factor for decreased OS in stage III ovarian HGSC patients.
Carboplatin
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Cohort Studies
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Diagnosis
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Drug Therapy, Combination
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Female
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Follow-Up Studies
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Humans
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Lymph Node Excision
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Lymph Nodes
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Methods
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Multivariate Analysis
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Paclitaxel
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Proportional Hazards Models
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Retrospective Studies
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Survival Analysis
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Turkey
3.Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study.
Ali AYHAN ; Nazlı TOPFEDAISI OZKAN ; Murat ÖZ ; Günsu KIMYON COMERT ; Zeliha FIRAT CUYLAN ; Gonca ÇOBAN ; Osman TURKMEN ; Baki ERDEM ; Hanifi ŞAHIN ; Ozgür AKBAYIR ; Murat DEDE ; Ahmet Taner TURAN ; Husnu CELIK ; Tayfun GÜNGÖR ; Ali HABERAL ; Macit ARVAS ; Mehmet Mutlu MEYDANLI
Journal of Gynecologic Oncology 2018;29(4):e48-
OBJECTIVE: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC). METHODS: A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 (≤0.15), and LNR2 (>0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. RESULTS: One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30–82) and the median duration of follow-up was 40 months (range, 1–228 months). There were 167 (80.7%) women with LNR ≤0.15, and 40 (19.3%) women with LNR >0.15. The 5-year progression-free survival (PFS) rates for LNR ≤0.15 and LNR >0.15 were 76.1%, and 58.5%, respectively (p=0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR ≤0.15 to 62.3% for LNR >0.15 (p=0.005). LNR >0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]=2.05; 95% confidence interval [CI]=1.07–3.93; p=0.03) and OS (HR=3.35; 95% CI=1.57–7.19; p=0.002). CONCLUSION: LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC.
Carcinoma, Endometrioid
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Diagnosis
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Disease-Free Survival
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Endometrial Neoplasms*
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Female
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Follow-Up Studies
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Humans
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Lymph Node Excision
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Lymph Nodes*
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Methods
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Proportional Hazards Models
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Retrospective Studies
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Survival Rate
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Turkey
4.Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study.
Mustafa Erkan SARI ; Mehmet Mutlu MEYDANLI ; Osman TÜRKMEN ; Günsü Kimyon CÖMERT ; Ahmet Taner TURAN ; Alper KARALÖK ; Hanifi ŞAHIN ; Ali HABERAL ; Eda KOCAMAN ; Ozgür AKBAYIR ; Baki ERDEM ; Ceyhun NUMANOĞLU ; Kemal GÜNGÖRDÜK ; Muzaffer SANCI ; Mehmet GÖKÇÜ ; Nejat ÖZGÜL ; Mehmet Coşkun SALMAN ; Gökhan BOYRAZ ; Kunter YÜCE ; Tayfun GÜNGÖR ; Salih TAŞKIN ; Duygun ALTIN ; Uğur Fırat ORTAÇ ; Hülya Aydın AYIK ; Tayup ŞIMŞEK ; Macit ARVAS ; Ali AYHAN
Journal of Gynecologic Oncology 2017;28(4):e49-
OBJECTIVE: To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. METHODS: A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. RESULTS: A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). CONCLUSION: Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.
Adenocarcinoma, Clear Cell
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Chemotherapy, Adjuvant
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Cohort Studies
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Disease-Free Survival
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Endometrium
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Female
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Humans
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Neoplasm Invasiveness
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Omentum
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Prognosis
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Retrospective Studies
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Standard of Care
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Uterine Diseases
5.Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone.
Nazli TOPFEDAISI OZKAN ; Mehmet Mutlu MEYDANLI ; Mustafa Erkan SARI ; Fuat DEMIRKIRAN ; Ilker KAHRAMANOGLU ; Tugan BESE ; Macit ARVAS ; Hanifi ŞAHIN ; Ali HABERAL ; Husnu CELIK ; Gonca COBAN ; Tufan OGE ; Omer Tarik YALCIN ; Özgür AKBAYIR ; Baki ERDEM ; Ceyhun NUMANOĞLU ; Nejat ÖZGÜL ; Gökhan BOYRAZ ; Mehmet Coşkun SALMAN ; Kunter YÜCE ; Murat DEDE ; Mufit Cemal YENEN ; Salih TAŞKIN ; Duygu ALTIN ; Uğur Fırat ORTAÇ ; Hülya AYDIN AYIK ; Tayup ŞIMŞEK ; Tayfun GÜNGÖR ; Kemal GÜNGÖRDÜK ; Muzaffer SANCI ; Ali AYHAN
Journal of Gynecologic Oncology 2017;28(5):e65-
OBJECTIVE: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone. METHODS: A multicenter, retrospective department database review was performed to identify patients with recurrent “low-risk EC” (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected. RESULTS: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5–34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7–105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65–43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69–12.58; p=0.003) were significant predictors. CONCLUSION: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.
Cohort Studies
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Endometrial Neoplasms*
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Female
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Humans
;
Multivariate Analysis
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Neoplasm Recurrence, Local
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Recurrence*
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Retrospective Studies
;
Survival Analysis
;
Turkey