Özgür Akbayır

Aims: This study evaluated the clinical, laboratory, ultrasonographic, histopathological, treatment, and follow-up characteristics of patients with molar pregnancy and assessed the clinical relevance of baseline factors associated with the development of postmolar gestational trophoblastic neoplasia (GTN) in a contemporary single-center cohort.Methods: This retrospective cohort included 259 patients with hydatidiform mole. Demographic, clinical, laboratory, ultrasonographic, histopathological, treatment, and follow-up data were reviewed. Patients with unknown GTN status were excluded from comparative analyses. Group comparisons used the Mann-Whitney U, Chi-square, or Fisher’s exact test. Multivariable logistic regression was used to evaluate factors independently associated with postmolar GTN development. Firth-penalized logistic regression and a sensitivity analysis restricted to patients with adequate follow-up were additionally performed to assess the robustness of the findings.Results: Among 259 patients, partial hydatidiform mole was diagnosed in 163 patients (62.9%), complete hydatidiform mole in 80 (30.9%), and hydatidiform mole of unspecified subtype in 16 (6.2%). Postmolar GTN developed in 39 patients (15.1%), while GTN status was unknown in 12 (4.6%). Chemotherapy was administered to 33 patients (12.7%); all received a methotrexate folinic acid regimen. Overall, normalization of beta-human chorionic gonadotropin (β-hCG) was achieved in 247 patients (95.4%). In multivariable analysis, initial β-hCG level per 100.000 mIU/ml increase (adjusted OR, 1.34; 95% CI, 1.15-1.56; p

Risk factors for parametrial invasion in early-stage cervical cancer: Toward less radical surgery - Turkish Journal of Obstetrics and Gynecology

Background: Endometrial cancer (EC) is often presents in the postmenopausal period. Among the risk elements are obesity, early menarche, late menopause, unopposed estrogen exposure associated with nulliparity, diabetes, advanced age (>55 years), and tamoxifen use. Endometrial biopsy is the gold standard diagnostic method. The typical surgical process comprises a complete removal of the uterus, a bilateral salpingo-oophorectomy, and cytological examination of peritoneal washing. Invasion of the myometrium (MI) is intricately linked to lymph node metastasis, which is observed in approximately 20% of deep MI cases and in 5% of cases with superficial MI. Therefore, a comprehensive assessment of women with EC, especially those with MI, is important before treatment. The assessment for myometrial invasion (MI) and cervical stromal invasion often involves the use of transvaginal ultrasound (TVUS). The diagnostic accuracy of TVUS varies in reported studies, and some findings are comparable to those obtained through magnetic resonance imaging (MRI). The size of intraoperative tumors and MI is provided to surgeons by frozen section examination, offering crucial information. This study aimed to compare the preoperative TVUS and MRI findings, intraoperative frozen sections, and postoperative final results for 321 patients diagnosed with EC. Methods: Individuals who underwent surgery at the third-stage tertiary gynecologic-oncology clinic for EC were included in the study. The study excluded cases lacking preoperative biopsy, TVUS, and magnetic resonance imaging (MRI), as well as cases featuring obvious extrauterine lesions. Non-endometrioid cases, endometrial hyperplasia, and cases with an identification of organ involvement outside the uterus during surgery were also excluded. The TVUS and MRI findings were compared with the intraoperative frozen sections using McNemar’s test. The concordance of the assessments was determined using the kappa coefficient. The statistical significance level, represented by alpha (α), was set at p < 0.05. Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa values for TVUS were 100%, 94.3%, 21.7%, 100%, and 0.34, respectively. For MRI, these values were 100%, 97.8%, 41.7%, 100%, and 0.579, and for frozen section, they were 100%, 99.7%, 83.3%, 100%, and 0.908, respectively. Conclusions: In addition to the gold standard frozen section, TVUS and MRI played an important preoperative role in determining the depth of invasion. While MRI is expensive, TVUS stands out for its practical nature and easy accessibility. In the preoperative examination, TVUS provided acceptable results in guiding intraoperative decisions for lymphadenectomy, with similar sensitivity to MRI and frozen sections.

Aims: Endometrial cancer stands as the most prevalent gynecological malignancy in developed nations, often detected at an early stage, and generally carries a positive prognosis. The stage of the disease is important for survival, but many factors such as tumor grade, histopathology, myometrial invasion, age, and spread are also effective. Our objective was to assess the significance of preoperative Cancer antigen 125 (CA-125) concentrations in the prediction of lymph node metastasis in patients with endometrial cancer and to identify a suitable threshold value. Methods: This retrospective analysis was carried out on 286 female patients diagnosed with endometrial cancer at a specialized gynecologic oncology facility from 2012 to 2022. We examined clinical-pathological and demographic attributes, including preoperative serum CA-125 concentrations, surgical interventions conducted for each patient, post-treatment physical assessments, imaging findings, and cytological outcomes. CA-125 was measured using electrochemiluminescence immunoassay. Results: Statistically significant differences were observed in CA-125 levels among patients in terms of grade, invasion depth, lymph node involvement, cervical involvement, and stage (respectively, p<0.001, p=0.042, p<0.001, p<0.001, p<0.001). The FIGO advanced stage ratio was 30.6 times higher for serum CA-125 concentrations above the cutoff of 21 IU/ml (95% CI: 10.7-87.6) (p<0.001). Lymph node involvement was 29.7 times more likely for serum CA-125 values above the cutoff of 35 IU/ml (95% CI: 25.3-74.8) (p<0.001). Conclusion: Early identification of high-risk endometrial cancer patients is vital for prognosis and guiding adjuvant therapy. CA-125, a tumor marker, has been found useful in assessing myometrial invasion depth, lymph node involvement, stage differentiation, and tumor grade.

Aims: To investigate whether there is a difference between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well-staged patients with borderline ovarian tumors (BOTs). Methods: Over the past 20 years (January 2001 to January 2021), the results of four tumor markers (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) have been clinically analyzed for for this retrospective cohort study of 156 patients who underwent surgery and were diagnosed with histopathology consistent with a borderline ovarian tumor. Results: The average age of patients with borderline ovarian tumors was determined to be 51.67 (4.726) years. Before the first surgery, high CA 125 levels (>35 U/l) were found in 53 patients (34%), high CEA levels (>4 ng/ml) were found in 24 patients (15.4%), high CA 19-9 levels (>37 U/ml) were found in 29 patients (18.6%), and high CA 15-3 (>30 ng/ml) levels were found in 12 patients (7.7%). The average CA 125 levels in tumors with serous histopathology [372.8 (1805.2)] were higher than those in tumors with mucinous histopathology (p=0.006). There was no statistically significant difference in tumor markers between tumors smaller than 8 cm and larger than 8 cm [(CA 125 p=0,257), (CEA p=0.9), (CA 19-9 p=0.295), (CA 15-3 p=0.404)]. Conclusion: Our primary outcome of the study is an increase in CA 125 levels, which indicates serous histopathology. Our secondary outcome is the higher levels of tumor markers, but it does not suggest larger tumors.

To evaluate the clinicopathological characteristics of mismatch repair (MMR) deficiency and its clinical outcomes by performing immunohistochemistry (IHC) for MMR genes in the serous ovarian cancer (SOC) tumour sections. A retrospective case-control study. Place and Duration of the Study: Gynecology Department of Kanuni Sultan Süleyman Training and Research Hospital, and Department of Medical Oncology of Medipol University, between March 2001 and January 2020. IHC was carried out for MLH1, MSH2, MSH6, and PMS2 on full-section slides from 127 SOCs to evaluate the MMR status. MMR-negative and MMR-low groups together were defined as MMR deficient and called microsatellite instability-high (MSI-H). The MSI status and expression of programmed cell death-1 (PD-1) were compared in SOCs with different MMR statuses. A significantly higher frequency of MMR-deficient SOCs was diagnosed at early stages compared with the patients in the MSS group (38.6% and 20.6%, respectively, p=0.022). The frequency of cases with PD-1 expression was significantly higher in the MSI-H group (76.2%) than in the MSS counterparts (58.8%, p=0.028). Patients in the MSI-H group had significantly longer DFS (25.6 months) and OS (not reached) than those in the MSS group (16 months and 48.9 months, p=0.039 and p=0.026, respectively). MSI-H SOCs were diagnosed at an earlier stage as compared to MMR proficient cases. The presence of PD-1 expression was significantly higher in cases presenting MMR deficiency compared with MMR-proficient cases. MSI status was significantly associated with DFS and OS. Serous ovarian cancer, Microsatellite instability, Mismatch repair deficiency.

Aim: To evaluate the predictive value of preoperative ratio of neutrophils to lymphocytes (NLR) in distinguishing between benign and malignant masses, as inflammation plays a significant role in the development and emergence of cancer. Material and Method: This retrospective study included 155 patients who underwent surgery due to an adnexal mass between December 2020 and December 2021 (55 were malignant, 100 were benign). Age, parity, tumor stage, chemotherapy, CA 125, CRP, neutrophils, lymphocytes, NLR, were recorded. The Mann-Whitney, the Chi-square test and multiple linear regression were used. The cut-off values of the variables were determined by calculating the areas under the receiver operating characteristic curve (ROC) for the purposes of differential diagnosis in the presence of malignancy, and by analyzing the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood-ratio (LR) (+) values. A P-value of 2.79 for NLR; sensitivity was found to be 59.36%, specificity 75.51%, positive predictive value (PPV) 58.44, negative predictive value 75.58, LR (+) value 2.3. At cut-off> 36.9 for CA-125; sensitivity was 80.00%, specificity was 78.63%, positive predictive value was 67.72%, negative predictive value was 87.53%, LR (+) value was 3.73. Conclusion: The primary outcome of our study is that the likelihood of malignancy in a patient with an NLR value of>2.79 is 2.3 times higher than in a patient with an NLR value of 36.9 is 3.73 times higher than in a patient with a CA-125 value of <36.9.

Cervical fibroids are rare neoplasms of uterine origin whose management has not been standardized. Cervical fibroids, which can be challenging in surgical management, can become a difficult problem for the surgeon when neglected or asymptomatic and reach gigantic dimensions. Suspending the aorta abdominalis or arteria illiaca communis with vascular tapes and balloting the uterus with the help of vaginal taping while searching for the correct cleavage may reduce the risk of intraoperative hemorrhage and adjacent organ injury, as well as may be guide for the steps of the operation. Management of neglected giant cervical fibroids may not be suitable for testing alternative treatment methods to surgery used in the treatment of uterine neoplasms. However, surgical management will also be challenging. For this reason, the technique we describe can help the surgeon with clues that should be considered in the surgical management of these patients.

The current study assesses programmed death-1 (PD-1) receptor expression and CD3, CD4, and CD8 tumor-infiltrating lymphocytes (TILs) in high-grade serous ovarian cancer (HGSOC) and associates our results with neoadjuvant chemotherapy history and disease prognosis. We included cases diagnosed with primary HGSOC with biopsy or surgical resection materials in this study. The immunoreactivity of CD3, CD4, CD8, and PD1 was assessed immunohistochemically in tumor tissue. We analyzed TILs in two predetermined groups of high and low TIL. The relationships between clinical characteristics, PD-1, and TIL were assessed. by the χ⁽²⁾ test or Fisher’s Exact test. We used Kaplan-Meier survival analysis and Cox proportional hazards regression model to the connection between survival and the amounts of TIL, and PD1. Univariate analysis demonstrated that optimal debulking (p<0.001), early International Federation of Gynecology and Obstetrics stage (p=0.046), and higher scores of stromal CD8+ TIL expression (p=0.028) in tumor cells were all substantially correlated with longer disease-free survival (DFS), whereas the remaining variables analyzed, including PD-1 positivity, stromal CD3+, and CD4+ TILs, and intraepithelial CD3+, CD4+, and CD8+ TILs, were not correlated with DFS. Also, univariate analysis revealed that optimal debulking (p=0.010), and higher scores of stromal CD8+ TIL expression (p=0.021) in tumor cells were all substantially correlated with longer overall survival (OS). Higher scores of stromal CD8+ TILs are substantially correlated with DFS and OS in univariate analyses, whereas scores of stromal CD3+ and CD4+ TILs, and intraepithelial CD3+, CD4+, and CD8+ TILs are not correlated with DFS and OS in both univariate and multivariate analyses. Also, we found a significant association between PD-1 positivity and the scores of stromal CD3+ TILs and intraepithelial CD8+ TILs. However, no remarkable relationship was revealed between PD-1 positivity and the survival of HGSOC cases.