1.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
;
Cohort Studies
;
Diagnosis
;
Drug Therapy, Combination
;
Female
;
Follow-Up Studies
;
Humans
;
Lymph Node Excision
;
Lymph Nodes
;
Methods
;
Multivariate Analysis
;
Paclitaxel
;
Proportional Hazards Models
;
Retrospective Studies
;
Survival Analysis
;
Turkey
2.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
;
Diagnosis
;
Disease-Free Survival
;
Endometrial Neoplasms*
;
Female
;
Follow-Up Studies
;
Humans
;
Lymph Node Excision
;
Lymph Nodes*
;
Methods
;
Proportional Hazards Models
;
Retrospective Studies
;
Survival Rate
;
Turkey
3.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
;
Chemotherapy, Adjuvant
;
Cohort Studies
;
Disease-Free Survival
;
Endometrium
;
Female
;
Humans
;
Neoplasm Invasiveness
;
Omentum
;
Prognosis
;
Retrospective Studies
;
Standard of Care
;
Uterine Diseases