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Background: Neoadjuvant chemotherapy followed by interval debulking surgery is an established treatment strategy for selected patients with advanced epithelial ovarian cancer. However, simple postoperative prognostic tools integrating pre-treatment disease extent and post-treatment pathological stage remain limited. The neoadjuvant rectal (NAR) score was originally developed as a composite stage-migration endpoint in rectal cancer and has subsequently been explored in other solid tumors. We evaluated the feasibility and prognostic value of an ovarian NAR-like score (oNAR) in patients with advanced ovarian cancer treated with neoadjuvant chemotherapy and interval debulking surgery. Methods: This single-center retrospective cohort included patients with advanced ovarian cancer treated with platinum-taxane-based neoadjuvant chemotherapy followed by interval debulking surgery. The oNAR score was calculated using clinical T category before neoadjuvant chemotherapy and pathological T and N categories after interval surgery: oNAR = [5 × ypN − 3 × (cT − ypT) + 12]²/9.61. The primary analysis evaluated oNAR as a continuous score. Low, intermediate, and high oNAR categories based on the original rectal NAR thresholds were used only for exploratory visualization. The primary endpoint was progression-free survival (PFS). Cox regression, Kaplan–Meier analysis, log-rank testing, Harrell concordance index, and exploratory ROC analysis were used. Results: Among 74 reviewed records, 73 patients had sufficient cT, ypT, and ypN data for oNAR calculation and were included in the primary analysis. Thirty-one PFS events and 10 deaths occurred. The median oNAR was 14.98 (IQR, 14.98–30.07). As a continuous variable, higher oNAR was associated with shorter PFS (HR per 1-point increase, 1.036; 95% CI, 1.010–1.061; p = 0.0055), corresponding to an HR of 1.42 per 10-point increase. The Harrell C-index for PFS was 0.669. In a parsimonious comparison, oNAR showed higher discrimination than ypN alone and discrimination comparable to a combined ypT/ypN model. PFS differed significantly across low-, intermediate-, and high-oNAR groups (log-rank p = 0.0053). Median PFS was not reached in the low-oNAR group, compared with 13.47 months in the intermediate group and 12.09 months in the high group. The association persisted in sensitivity analyses restricted to patients with complete/optimal cytoreduction, maximal cytoreduction, and high-grade serous histology. Conclusions: The oNAR score was feasible to calculate using routinely available clinical and pathological staging variables and was significantly associated with PFS after neoadjuvant chemotherapy and interval debulking surgery. These findings support oNAR as a feasible stage-migration-based prognostic summary that may help capture post-NACT pathological T/N information and warrants external validation in larger ovarian cancer cohorts.

Aims: To evaluate the clinical and pathological factors associated with invasive cervical cancer in patients referred for colposcopy after abnormal cervical smear screening. Methods: This retrospective cohort study included 5,033 patients aged 18 years and older who underwent colposcopic evaluation between September 2019 and December 2025 at a tertiary gynecologic oncology center after an abnormal cervical smear result. Patients were classified according to the presence or absence of histopathologically documented invasive cervical cancer based on the highest-grade diagnosis available during follow-up. Age, smear category, human papillomavirus (HPV) status, colposcopic biopsy findings, endocervical curettage (ECC) findings, and final pathology results were analyzed. Logistic regression analysis was performed to identify variables independently associated with invasive cervical cancer. Results: Invasive cervical cancer was identified in 32 of 5,033 patients (0.64%). Patients with invasive cancer were significantly older than those without invasive disease (49.8 ± 11.0 vs 41.8 ± 11.3 years, p=0.00026). High-risk smear findings were more common in the invasive cancer group than in the non-invasive group (46.9% vs 6.1%, p<0.001). Invasive cancer was detected in 4.34% of patients with high-grade squamous intraepithelial lesion or worse (HSIL+) on colposcopic biopsy versus 0.07% of those with non-HSIL biopsy findings (OR 65.99, 95% CI 20.04-217.25, p<0.001). Similarly, invasive cancer was identified in 11.6% of patients with HSIL+ on ECC compared with 0.31% of those with non-HSIL ECC results (OR 42.47, 95% CI 20.76-86.88, p<0.001). In multivariable analysis, older age, high-risk smear findings, HSIL+ on colposcopic biopsy, and HSIL+ on ECC remained significantly associated with invasive cervical cancer. Some invasive cancers were identified only in final pathology specimens, suggesting that preoperative assessment may underestimate invasive disease in a subset of patients. Conclusion: Invasive cervical cancer was uncommon but clinically relevant in patients referred for colposcopy after abnormal cervical smear screening. Older age, high-risk smear findings, HSIL+ on colposcopic biopsy, and HSIL+ on ECC were the variables most strongly associated with invasive disease. An integrated interpretation of cytology, HPV status, biopsy, ECC, and clinical context may improve recognition of patients at increased risk for invasive cervical cancer.

Background: Liver function tests change after liver mobilization.Aim: Evaluate the fluctuation of aminotransferase levels after liver mobilization forgynecologic cancers and determine the effect of liver metastasectomy on this change.Materials and Methods: We retrospectively evaluate the patients who underwent livermobilization for gynecologic cancers from 09/2019 to 10/2022. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin serum levels were monitored.Results: 69 patients were enrolled in the study. Liver function tests (LFTs) immediatelytended to increase following surgery. ALT levels peaked at the postoperative 6 th hour(median: 119.5 U/L; range: 13-762) and AST peaked in the 2 nd hour after the surgery(median: 204 U/L; range: 11-717). Both ALT and AST tended to normalize on the 6 thpostoperative day (24/28 U/L). Liver tumor resection was performed on 26 patients.Liver metastasectomy caused high both AST and ALT levels (p=0.013 and p=0.022,respectively) on the 2 nd postoperative day. This effect continued especially in ALT fromthe 2 nd day to the 10 th postoperative day. Subsequently, both groups became similar.Liver metastasectomy caused higher AST and ALT on the 2 nd postoperative daycompared with the non-metastasectomy group.Conclusion: Both liver mobilization and liver metastasectomy procedures areassociated with a transient increase in LFTs. Although liver mobilization in itself causeshigh LFTs in the immediate postoperative period, this effect is more significant in livermetastasectomy. High LFTs returned to normal values within 2 weeks in both twogroups. Fluid replacement and avoidance of hepatotoxic drugs can prevent theaggravation of the clinical course.

Aim: Human papillomavirus (HPV) type 52 is a high-risk genotype. However, oncogenic potential of HPV 52 remains controversial. This study aimed to evaluate the cervical pathological outcomes associated with HPV 52 infection and to determine whether the risk of high-grade lesions differs between isolated HPV 52 positivity and coinfection with other high risk HPV types.Methods: A retrospective analysis was conducted on 3546 women who underwent colposcopic evaluation. A total of 102 (2.9%) patients with HPV 52 positivity were included. In the study, isolated HPV 52 positivity was defined as the presence of only HPV 52, while combined HPV 52 positivity was defined as the presence of HPV 52 along with other high risk HPV genotypes.Results: In our cohort, 39.2% had isolated HPV 52 infection. High-grade squamous intraepithelial lesions (HSIL) or cancer were detected in 11.8% of women. In addition, with isolated HPV 52 or combined HPV 52 infection didn’t effect final pathological result (p=0.657). One case of stage IB1 cervical squamous cell carcinoma was identified in a patient with isolated HPV 52.Conclusion: The rate of ≥HSIL among HPV 52 positive women was found to be over 10%. Additionally, no significant difference was observed regarding the risk of developing ≥HSIL lesions between patients with isolated HPV 52 and combined HPV 52 infections. Our study underscores the need to include HPV 52 in individualized risk assessment models for cervical cancer screening programme.

Aims: To assess the prevalence of cervical human papillomavirus (HPV) infection and related cytologic or histopathologic abnormalities in patients with vulvar squamous cell carcinoma (VSCC), and to explore their association with HPV-related and HPV-independent tumor subtypes. Methods: This retrospective study included 41 surgically treated VSCC patients at Ankara Bilkent City Hospital (2019-2024). Clinical, cytologic, and pathologic data, including vulvar and cervical HPV status, were analyzed. Cervical HPV testing was performed by Polymerase Chain Reaction (PCR), and cytology was classified according to the Bethesda system. Results: HPV-associated VSCC was identified in 17.1% of patients, and cervical HPV positivity in 7.1%. Among 34 cytology results, 32.4% showed abnormalities (ASCUS, ASC-H, or HSIL). Cervical biopsy revealed LSIL or HSIL in 6 patients and invasive carcinoma in 1. Preinvasive or invasive cervical lesions were more frequent in HPV-associated VSCC (57.1%) than in HPV-independent cases (28.6%), though not statistically significant (p=0.204). Conclusion: Cervical HPV infection and cytologic abnormalities were uncommon, likely reflecting the predominance of HPV-independent tumors in this older cohort. Nevertheless, abnormal cytology in a subset of patients supports comprehensive cervical assessment and risk-adapted surveillance, particularly in HPV-associated VSCC.

Endometrium kanseri, kadınlarda en sık görülen jinekolojik malignite olup, en sık görülen histolojik alt tip endometrioid adenokarsinomdur. Evre II hastalıkta servikal tutulum mevcuttur. 51 yaşında, postmenopozal hasta kliniğimize son 6 aydır olan düzensiz sıkılıkta olan vajinal kanama şikayeti ile başvurdu. Hastanın dış merkezde endometrium biyopsisi servikal kitle nedenli yapılamamış. Servikal biopsi patoloji sonucu servikal adenokarsinom olarak raporlandı. Hastanın preop görüntülemeleri amacıyla pelvik manyetik rezonans (MR) ve pozitron emisyon tomografisi (PET) tetkikleri planlandı. Radyolojik görüntüleme sonucunda hastaya operasyon kararı verildi. Nihai patoloji sonucu; Grade 3 endometrioid endometrium kanseri şeklinde raporlandı. Hastalığın evresi Evre II idi ve hastaya buna uygun adjuvan tedavi verildi. Bu sunum servikal malign lezyonların ayırıcı tanısında endometrial kanser invazyonunun dikkate alınması gerektiğini vurgulamaktadır.

Background: To identify prognostic factors related to survival in patients with early-stage cervical cancer treated with radical surgery in six high-volume gynecologic oncology centers in Turkey. Methods: This retrospective analysis examined a cohort of 612 patients diagnosed with cervical cancer who underwent type II/III radical hysterectomy and pelvic lymphadenectomy, with or without para-aortic lymphadenectomy at six gynecologic oncology centers. A total of 537 patients between 1993 and 2023 were included. According to the 2009 FIGO staging system, 411 patients (76.5%) were stage IB1, 76 (14.2%) were stage IB2, 40 (4.7%) were stage IIA1, and 10 (1.9%) were stage IIA2. Patients underwent either type II or type III radical hysterectomy with pelvic lymphadenectomy, with para-aortic lymphadenectomy performed in 93.1% of cases. Among the 537 patients, 258 (48%) underwent type II radical hysterectomy and 279 (52%) underwent type III. Univariate and multivariate analyses of 5-year overall survival (OS) and 5-year disease-free survival (DFS) were performed. Results: In the entire cohort, 258 (48%) patients underwent radical surgery alone, while 279 (52%) patients underwent radical surgery followed by adjuvant therapy. The 5-year DFS and 5-year OS rates were 85.3% and 98.4%, respectively. In the multivariate logistic analysis, lymph node metastasis was identified as an independent prognostic factor for DFS and OS. Conclusions: Lymph node metastasis was the most important prognostic factor for survival in this large multicenter Turkish cohort. These findings highlight the prognostic value of nodal status, stromal invasion, margin status, and LVSI, while underscoring the importance of tailored adjuvant treatment strategies.

Background/aim: Epithelial ovarian cancer is the second most prevalent type of gynecological cancer. We aimed to investigate prognostic factors related to survival in patient with 2014 FIGO stage IIIC high-grade serous ovarian cancer (HGSOC). Materials and methods: Two hundred fifty eight patients were evaluated retrospectively. The absence of a visible tumor was determined as maximum cytoreduction, and a residual tumor size of 1 cm or less was determined as optimal cytoreduction. Patients who underwent cytoreduction followed by a combination of platinum and taxane adjuvant chemotherapy were included. Exclusion criteria for the study were patients taking neoadjuvant chemotherapy and those with suboptimal surgery. Results: Optimal cytoreduction was performed in 107 and maximal cytoreduction was performed in 151 patients. The five-year PFS rate was 27% and the five-year DSS rate was 76%. While high ascites volume and optimal cytoreduction were identified as independent prognostic factors for disease failure, only optimal cytoreduction was an independent prognostic factor for survival. Conclusion: The maximal cytoreduction is improves PFS and DSS in patients with 2014 FIGO stage IIIC HGSOC as our study results. Therefore, maximum surgical effort and radical cytoreductive procedures should be performed.

Objective: To evaluate the diagnostic value of shear wave elastography (SWE) in assessing endometriomas and its correlation with clinical symptoms. Furthermore, the study investigates the use of machine learning (ML) models to predict clinical outcomes based on SWE‐derived mean shear wave velocity (SWV). Methods: This prospective study included 94 women aged 20–35 years diagnosed with unilateral ovarian endometriomas. SWE was used to assess tissue stiffness in meters per second (m/s). Clinical characteristics such as dysmenorrhea, dyspareunia, infertility, and non‐cyclic chronic pelvic pain were evaluated. Statistical analyses were performed using SPSS, and ML models, including Logistic Regression, Random Forest, Gradient Boosting, and Support Vector Machine (SVM), were employed to predict clinical outcomes based on mean SWV. Results: Shear wave elastography‐derived mean SWV was significantly higher in patients with dysmenorrhea (4.79 ± 1.08 vs. 3.22 ± 0.65 m/s; P = 0.024), dyspareunia (5.78 ± 1.9 vs. 3.01 ± 0.94 m/s; P = 0.016), and infertility (5.42 ± 1.44 vs. 3.93 ± 1.03 m/s; P = 0.014). ML models demonstrated high predictive accuracy for dysmenorrhea (receiver operating characteristic [ROC]‐area under the curve [AUC] 0.94) and dyspareunia (ROC‐AUC 0.98), with Logistic Regression and SVM outperforming other algorithms. Conclusion: Shear wave elastography combined with ML offers a non‐invasive, cost‐effective approach to diagnosing and predicting clinical outcomes in endometriomas. The integration of imaging and computational tools paves the way for precision medicine in gynecology.