Defining the relationship between ovarian adult granulosa cell tumors and synchronous endometrial pathology: Does ovarian tumor size correlate with endometrial cancer?

OBJECTIVE

The main feature of adult granulosa cell tumors (AGCT) is their capacity to secrete hormones, with nearly all of them capable of synthesizing oestradiol. The primary goal of this study is to identify synchronized endometrial pathologies, particularly endometrial cancer, in AGCT patients who had undergone a hysterectomy.

MATERIALS AND METHODS

The study cohort comprised retrospectively of 316 AGCT patients from 10 tertiary gynecological oncology centers. AGCT surgery consisted of bilateral salpingo-oophorectomy, hysterectomy, peritoneal cytology, omentectomy, and the excision of any suspicious lesion. The median tumor size value was used to define the relationship between tumor size and endometrial cancer. The relationship between each value and endometrial cancer was evaluated.

RESULTS

Endometrial intraepithelial neoplasia, or hyperplasia with complex atypia, was detected in 7.3% of patients, and endometrial cancer in 3.1% of patients. Age, menopausal status, tumor size, International Federation of Gynecology and Obstetrics stage, ascites, and CA-125 level were not statistically significant factors to predict endometrial cancer. There was no endometrial cancer under the age of 40, and 97.8% of women diagnosed with endometrial hyperplasia were over the age of 40. During the menopausal period, the endometrial cancer risk was 4.5%. Developing endometrial cancer increased to 12.1% from 3.2% when the size of the tumor was >150 mm in menopausal patients (p = 0.036).

CONCLUSION

Endometrial hyperplasia, or cancer, occurs in approximately 30% of AGCT patients. Patients diagnosed with AGCT, especially those older than 40 years, should be evaluated for endometrial pathologies. There may be a relationship between tumor size and endometrial cancer, especially in menopausal patients.

Assessment of the differences in oncologic outcomes between patients with high-grade serous ovarian carcinoma and uterine serous carcinoma

AIM

To evaluate whether the recurrence rates, recurrence patterns, and survival outcomes differed according to the primary site of the tumor in patients with high-grade serous ovarian carcinoma (HGSOC) and uterine serous carcinoma (USC).

METHODS

The population of this multicenter retrospective study consisted of patients who had USC or HGSOC. Progression-free survival (PFS) and disease-specific survival (DSS) estimates were determined using the Kaplan-Meier method. Survival curves were compared using the log-rank test.

RESULTS

The study cohort consisted of 247 patients with HGSOC and 34 with USC. Recurrence developed in 118 (51.1%) in the HGSOC group and 14 (42.4%) in the USC group (p = 0.352). The median time to recurrence was 23.5 (range, 4-144) and 17 (range, 4-43) months in the HGSOC and USC groups, respectively (p = 0.055). The 3-year PFS was 52% in the HGSOC group and 47% in the USC group (p = 0.450). Additionally, 3-year DSS was 92% and 82% in the HGSOC and USC groups, respectively (p = 0.060).

CONCLUSIONS

HGSOC and USC are aggressive tumors with high recurrence and mortality rates in advanced stages. These two carcinomas, which are similar in molecular features and clinical management, may also have similar recurrence patterns, disease failure, and survival rates.

Neoadjuvant chemotherapy in patients with stage IVB uterine serous carcinoma: a Turkish multicentric study

The aim of this study was to evaluate the prognostic factors for and determine the effect of neoadjuvant chemotherapy (NACT) on oncologic outcome in stage IVB pure serous endometrial carcinoma patients who received taxane and platinum. Forty-two patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IVB uterine serous carcinoma were enrolled from six gynecologic oncology centers and a study group was created. The study group had a 2-year disease-free survival (DFS) of 32% and 2-year disease-specific survival (DSS) of 73%. On univariate analysis; lymphadenectomy (not performed vs. performed), paraaortic lymph node metastasis (positive vs. negative) and number of metastatic lymph node count (≤5 vs. >5) were found to have statistical significance for DFS (p < 0.001, p = 0.026 and p = 0.044, respectively). Adnexal metastasis (positive vs. negative) and type of cytoreductive surgery (maximal vs. optimal and suboptimal) had statistical significance for DSS (p = 0.041 and p = 0.015, respectively). Receiving NACT did not affect DFS and DSS in stage IVB uterine serous carcinoma patients. As our sample size was small, precise conclusions could not be made for suggesting the use of NACT in advanced stage uterine serous carcinoma. For more accurate results, more randomized controlled studies are needed in this patient group.IMPACT STATEMENTWhat is already known on this subject? Endometrial carcinoma is the most common type of gynecologic tract malignancies and usually it is diagnosed at early stages. Although the favorable prognosis, uterine serous carcinoma (USC), one of the rarest subtypes, has a poorer prognosis when compared to other histological subtypes. USC has a propensity to spread beyond pelvis. Due to this aggressive behavior, surgical intervention could not be feasible in advanced stage disease.What do the results of this study add? Our study evaluated the prognostic factors that affect survival in advanced stage USC patients. Also we investigated that neoadjuvant chemotherapy (NACT) could improve oncologic outcomes. Performing lymphadenectomy, presence of paraaortic lymph node and adnexal metastasis, number of metastatic lymph nodes and type of cytoreductive surgery improved survival in advanced stage USC patients. However, NACT did not have a statistical significance as a predictor for disease-specific survival (DSS) and disease-free survival (DFS).What are the implications of these findings for clinical practice and/or further research? Maximal surgical effort should be performed in advanced stage USC according to our results. On the other hand, NACT had no impact on DSS and DFS rates. For this reason, we could not be able to suggest the routine use of NACT in advanced stage USC. But more randomized controlled trials are warranted for confirmation of our results.

Is adjuvant chemotherapy necessary for 2014 FIGO stage IC adult granulosa cell tumor?: Multicentric Turkish study

AIM

The aim of our study is to examine the clinical, surgical, and pathological factors of stage 1C adult granulosa cell tumor (AGCT) patients and to investigate the effects of adjuvant therapy on recurrence and survival rates in this patient group.

METHODS

Out of a total of 415 AGCT patients treated by 10 tertiary oncology centers participating in the study, 63 (15.2%) patients with 2014 FIGO stage IC constituted the study group. The FIGO 2014 system was used for staging. Patient group who received adjuvant chemotherapy was compared with patient group who did not receive adjuvant chemotherapy in terms of disease-free survival (DFS), and disease-specific survival.

RESULTS

The 5-year DFS of the study cohort was 89%, and the 10-year DFS was 85%. Those who received adjuvant chemotherapy and those who did not were similar in terms of clinical, surgical and pathological factors, except for peritoneal cytology. In the univariate analysis, none of the clinical, surgical or pathological factors were significant for DFS. Adjuvant chemotherapy and type of treatment protocol had no impact on DFS.

CONCLUSION

Adjuvant chemotherapy was not associated with improved DFS and overall survival in stage IC AGCT. Multicentric and randomized controlled studies are needed for early stage AGCT in order to confirm these results and reach accurate conclusions.

Clinicopathological features of atypical glandular cells, not otherwise specified, on cervicovaginal pap smears

OBJECTIVE

The Papanicolaou (Pap) smear test is a standard screening test that detects cervical lesions and cancers. In this multicentric study, we performed a retrospective analysis of cytological results associated with atypical glandular cells, not otherwise specified (AGC-NOS).

METHODS

We retrospectively reviewed Pap smear tests that resulted as AGC-NOS. A total of 254 women who underwent colposcopy due to a Pap smear result of AGC-NOS were included the study between 2003 and 2021. The ages, Pap smear results, HPV results if any, colposcopic biopsy results, endocervical and endometrial pathology results, and management of these patients were analysed.

RESULTS

Two hundred fifty-four patients with AGC-NOS Pap smear results were included in the study. A total of 70 (27.6%) patients had cervical and endometrial premalignant or malignant lesions. Malignancy was observed in 17 (6.7%) patients (endometrium, n = 11 [4.3%]; cervix, n = 6 [2.4%]). Isolated premalignant or malignant lesions of the cervix and endometrium were detected in 57 (22.4%) and 12 (4.7%) patients, respectively.

CONCLUSIONS

Patients diagnosed with AGC-NOS should undergo a careful evaluation with all clinicopathological features. Because cancer of the cervix and endometrium is not rare in patients diagnosed with AGC-NOS, colposcopic examination with endocervical sampling should be a priority based on a cervicovaginal smear. Endometrial sampling is also required according to the patient's clinic, age, and examination characteristics.

Oncologic outcome in patients with 2018 FIGO stage IB cervical cancer: Is tumor size important?

BACKGROUND

To evaluate the prognostic factors and oncologic outcome in patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer (CC) after radical hysterectomy and lymphadenectomy.

MATERIALS AND METHODS

This study included 290 patients with type II or III radical hysterectomy + pelvic ± para-aortic lymphadenectomy and 2018 FIGO stage IB1-3 epithelial CC. Disease-free survival (DFS) estimates were determinate by using the Kaplan-Meier method. Survival curves were compared using the log-rank test. Multivariate analysis was performed using a Cox proportional hazards models.

RESULTS

The mean age of study cohort was 52 ± 10.25 years. Five-year DFS was 93% in entire cohort. On univariate analysis, surgical border involvement (p = 0.007), lymphovascular space invasion (LVSI) (p = 0.040), uterine involvement (p = 0.040), and depth of cervical stromal invasion (p = 0.007) were found to have statistical significance for DFS. However, none of them were independent prognostic factors for the risk of recurrence. Tumor size according to 2018 FIGO staging criteria was not related with recurrence.

CONCLUSIONS

Surgical border involvement, LVSI, depth of cervical stromal invasion, and uterine involvement were predictors for DFS on univariate analysis. Tumor size was not predicting to recurrence in patient with 2018 FIGO stage IB1-3 CC.

The effect of adjuvant radiotherapy on oncological outcomes in patients with early-stage cervical carcinoma with only intermediate-risk factors: a propensity score matching analysis

We aimed to evaluate whether adjuvant radiotherapy had a survival benefit for patients with early-stage cervical carcinoma with intermediate-risk factors. This study included patients who underwent radical hysterectomy and lymphadenectomy according to Wertheim-Okabayashi for stage IB1-IIA2 cervical carcinoma. Each patient had at least one intermediate-risk factor including tumour diameter ≥4 cm, deep stromal invasion, and positive lymphovascular space invasion (LVSI). Patients with lymph node metastasis, parametrial invasion, and positive surgical margins according to the final paraffin section were excluded. In total, 183 patients were included. Seventy-three (39.9%) patients had one, 85 (46.4%) had two, and 25 (13.7%) had three intermediate risk factors. Sixty-seven (36.6%) patients received adjuvant radiotherapy. There was a statistically significant difference in terms of stage, LVSI, and endometrial/uterine invasion between the groups that did and did not receive adjuvant radiotherapy (p = .024, p = .018, and p = .001, respectively). These two groups were homogenised by performing propensity score matching (PSM) analysis. In the new matched cohort (n = 134), 5-year disease-free survival (DFS) was 89.5% in the group that received adjuvant radiotherapy and 82% in the group that did not (HR: 0.484, 95% CI: [0.171-1.369]; p = .171). Also, receiving adjuvant radiotherapy was not associated with an improvement in oncologic outcomes in patients with one, two, or more intermediate risk factors. In univariate analysis, none of the risk factors was associated with DFS. In conclusion, adjuvant radiotherapy had no favourable effect on survival outcomes in patients with early-stage cervical carcinoma with only intermediate risk factors.IMPACT STATEMENTWhat is already known on this subject? Radiotherapy after radical hysterectomy in cervical carcinoma is accepted as the standard of care when high-risk factors - positive surgical margins, lymph node metastasis, and parametrial involvement - are found in the surgical specimen. However, the necessity of adjuvant radiotherapy in patients with intermediate-risk factors - deep stromal invasion, positive LVSI, tumour diameter ≥4 cm - is controversial.What do the results of this study add? We compared patients who received adjuvant radiotherapy and those who did not. No significant difference was found between the two groups in terms of oncologic outcomes. There was no difference between the two groups in terms of pelvic and extrapelvic recurrence rates. The number of positive intermediate-risk factors did not affect survival. Moreover, age, tumour type, stage, number of removed lymph nodes, grade, bilateral salpingo-oophorectomy, and endometrial/uterine invasion were not associated with DFS among patients with stage IB-IIA cervical carcinoma with only intermediate-risk factors.What are the implications of these findings for clinical practice and/or further research? Debate remains over the prognostic factors and the adjuvant treatment options in patients with early-stage cervical carcinoma who possess intermediate-risk factors. Adjuvant radiotherapy can be ignored if initial adequate surgery has been performed in this patient group.

P-320 The Effects of Endometriosis on Oocyte Morphology and Embryo Development

Study question

What is the effect of the endometriosis on oocytes morphological abnormalities in intracytoplasmic sperm injection cycles.?

Summary answer

An increase in the detection rate of refractile body and polar body fragmentation was observed in the morphology of oocytes obtained from endometriosis patient.

What is known already

The quality of the oocyte is suspected for the lower clinical success in endometriosis patients compared to other patient groups. The oocyte quality is determined by its morphological, cellular, and molecular evaluations. However, there are limited studies on the association between endometriosis and oocyte morphology.

Study design, size, duration

This was a retrospective cohort study, conducted between January 2020 and August 2021, at a tertiary care hospital. The women aged 24-35 years and BMI 19-30 kg/m2 ranges who underwent fresh GnRH antagonist cycles and stimulated with 150-300 IU dose of recombinant FSH (rFSH) and then trigerred with 250 micrograms/0.5 ml of rhCG were included.

Participants/materials, setting, methods

The patients who were cycled with the etiology of endometriosis (n = 46 cycles, Group 1) and those who were cycled with the etiology of male infertility (n = 64 cycles, Group 2) were included in this study. In addition to the comparison of intracytoplasmic and extracytoplasmic (polar body, perivitelline space, zona pellisuda) anomalies observed in oocyte morphology between groups, morphology anomalies that affect fertilization and blastocyst development within the group were evaluated.

Main results and the role of chance

The patient age, BMI, antral follicle counts, duration of infertility, and basal endocrine parameters among patients who were cycled with the etiology of endometriosis (n = 46 cycles, Group 1) and those who were cycled with the etiology of male infertility (n = 64 cycles, Group 2) were not different (p&gt;0.05). As a result of the comparison of intracytoplasmic anomalies of 800 oocytes in total (n = 263 Group 1; n = 537 Group 2) between the groups; the refractile body determination (OR:1.23; 95% CI 1.08 -1.4, p &lt;0.00) was higher in the endometriosis group compared to the other group. As a result of the comparison of extracytoplasmic anomalies between the groups; the polar body fragmentation (OR:1.3; 95% CI 1.01 - 1.85, p&gt; =0.03) determination was higher in the endometriosis group compared to the other group. When the effect of oocyte morphology anomalies on fertilization and blastocyst development within the groups was evaluated by logistic regression analysis, it was found that granulation of the perivitelline space had a negative effect on blastocyst development only in the endometriosis group (β  = -0.69; p&gt; =0.31).

Limitations, reasons for caution

The main limitation of our study was its retrospective design, which precludes us from reaching a more definitive conclusion on the relation between oocyte morphology of endometriosis an fertility outcomes.

Wider implications of the findings

The previous studies indicate that PVS and PBI abnormalities may be ascribed to over-mature oocytes and also be negatively correlated with fertilization rate and embryo quality. Our study suggest that endometriosis seems to negatively affect oocyte quality and maturation process.

Trial registration number

not applicable

AB1178 THE COMPARISON OF EXECUTIVE FUNCTIONS OF RECOVERED COVID-19 PATIENTS WITH HEALTHY CONTROLS

Background

The epidemiological and clinical features of COVID-19 patients are currently well characterized. However the subacute and long-term effects of COVID-19 are not clear. Cognitive disturbance is one of the residual effects of COVID-19 infection besides fatigue, dyspnea, chest pain, arthralgia, and decline in quality of life. It has been stated that patients with COVID-19 may have cognitive dysfunction, but it still remains unknown whether the COVID-19 infection is associated with cognitive impairment.

Objectives

The aims of this study were to compare the executive functions of recovered COVID-19 patients with healthy controls, and to evaluate the relation of the executive functions with sleep quality, emotional status, disease severity, and post COVID-19 duration in these patients.

Methods

Twenty-five patients aged 18-60 with a previous diagnosis of COVID-19 infection and 25 gender-age matched healthy individuals as a control group participated this study. The executive functions of participants were evaluated by the Wisconsin Card Sorting Task (WCST), Stroop Test-TBAG Form, and N-back test. Data on sleep quality by Pittsburgh Sleep Quality-Index (PSQI), depression by Beck Depression-Inventory (BDI), anxiety by Worry and Anxiety Questionnaire were collected in all participants. In patients, disease severity, COVID symptoms, and post-covid duration were noted. Data were analyzed by SPSS using Kolmogorov Smirnov test, chi-square test, Student-t test, and Pearson correlation analysis.

Results

In terms of WCST; patients’ number of trials administered, total errors, and nonperseverative-errors scores were statistically higher; categories achieved and percentage of conceptual-level responses scores were statistically lower than controls (p<0.05). Patients’ N-back test scores were statistically lower than controls (p=0.012). BDI, PSQI total, sleep quality, sleep latency, duration of sleep scores were significantly different in patients and controls (p<0.05). Patients were divided into three groups according to the severity of the disease and there was no significant difference between the three groups in terms of WCST, Stroop test, and N-back test (p>0.05). There were negative correlations between WCST-total errors and duration of sleep, WCST-number of trials administered and sleep efficiency, Stroop-number of errors and total PSQI scores. No correlation was found between the executive functions and emotional status of the patients (p>0.05).

Conclusion

According to the results of this study, executive functions may be effected in the patients recovered from COVID-19. After COVID-19 infection patients may have sleep problems, and executive dysfunctions may be correlated with sleep disorders in these patients. Since the executive functions were not associated with clinical findings of COVID-19 infection in this study, we suggest that it is not predicted in which patients executive functions will be impaired. Regardless of the COVID-19 infection severity, executive functions should be considered in the follow-up of these patients.

References

[1]Zhou H, Lu S, Chen J, et al. The landscape of cognitive function in recovered COVID-19 patients. Journal of Psychiatric Research, 2020;129: 98-102.

[2]Varatharaj A, Thomas N, Ellul MA et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. The Lancet Psychiatry.2020;7(10): 875-82.

[3]Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.

Disclosure of Interests

None declared

What is the impact of corpus uterine invasion on oncologic outcomes in surgically treated cervical cancer?

AIM

To investigate the clinical significance of uterine corpus involvement in patients with surgically treated cervical cancer.

METHODS

Patients (n = 354) with clinical early-stage (stage IB1-IIA2) cervical cancer who underwent radical hysterectomy and pelvic ± paraaortic lymphadenectomy were evaluated.

RESULTS

Uterine invasion was detected in 60 (16.9%) patients. Patients with uterine invasion had a higher rate of pelvic lymph node metastasis than those without uterine invasion (35% vs 22.8%, p = 0.046). In multivariate analysis, no statistically significant difference was identified between patients with and without uterine invasion for pelvic lymph node metastasis (p = 0.953). Uterine invasion was identified as an independent risk factor for paraaortic lymph node metastasis in multivariate analysis (p = 0.012). The presence of pelvic lymph node metastasis was found to be another significant predictor of paraaortic lymph node involvement (p = 0.022). In addition, uterine invasion and lymph node metastasis were identified as an independent risk factors regarding poor prognosis in cancer-specific survival (hazard ratio [HR]: 4.537; 95% confidence interval [CI], 1.304-15.782; p = 0.017 and HR: 5.598; 95% CI, 1.581-19.823; p = 0.008, respectively).

CONCLUSIONS

Uterine invasion is an independent predictor of decreased survival and the presence of paraaortic lymph node metastasis in cervical cancer. The presence of the uterine invasion in cervical cancer should be considered as a poor prognostic factor in the decision of treatment.

Analysis of the prognostic factors determining the oncological outcomes in patients with high-risk early-stage cervical cancer

We aimed to evaluate clinicopathological data in high-risk early-stage cervical cancer and to define the prognostic factors determining the oncological outcomes. This retrospective study included 158 patients with stage IB-IIA cervical cancer who underwent radical hysterectomy plus lymph node dissection. Each patient had at least one high-risk factor. The median tumour diameter of the study group was 30 mm (range, 6-80). Seventy-five (47.5%) patients had parametrial invasion, 32 (20.3%) had positive surgical margins, and 108 (68.4%) had lymph node metastasis. The median duration of follow-up was 42 months (range, 1-228). During this period, 28 patients developed recurrence, and the recurrent disease occurred in a distant area in 18 patients. Five-year disease-free survival was 77.5%, and five-year disease-specific survival was 85%. In multivariate analysis, adjuvant radiotherapy was identified as an independent prognostic factor for recurrence and death. The recurrence (Odds ratio: 10.139, 95% CI: 1.477-69.590, p = .018) and mortality rates (Odds ratio: 16.485, 95% CI: 2.484-109.408, p =.004) were higher in patients who did not receive adjuvant therapy.IMPACT STATEMENTWhat is already known on this subject? The decision to proceed with adjuvant therapy in the patients with early-stage disease treated with surgery depends on the presence of risk factors in pathological examination. Various prognostic factors have been identified in cervical cancer (CC). However, there is a limited number of studies describing the prognostic factors in early-stage CC with high-risk factors.What do the results of this study add? In current study, the recurrence and mortality rates were higher in patients who did not receive adjuvant therapy. No relationship was found between the survival outcomes and the number of high-risk factors. Most of the patients who developed recurrence had the recurrence in the distant localisation. This result questioned the adequacy of adjuvant therapy.What are the implications of these findings for clinical practice and/or further research? There is still a debate over the prognostic factors and the adjuvant treatment options in the patients with early-stage cervical cancer who possess high-risk factors. Adjuvant RT or adjuvant concomitant chemoradiotherapy must definitely be used in this patients. However, adjuvant therapy fails approximately 14-32%, thus multimodal treatment modalities must be developed to improve the recurrence rates and the survival.

Glutamate receptor antagonist suppresses the activation of nesfatin-1 neurons following refeeding or glucose administration

BACKGROUND

Nesfatin-1 is a newly identified satiety peptide that has regulatory effects on food intake and glucose metabolism, and is located in the hypothalamic nuclei, including the supraoptic nucleus (SON). In this study, we have investigated the hypothesis that nesfatin-1 neurons are activated by refeeding and intraperitoneal (ip) glucose injection and that the glutamatergic system has regulatory influences on nesfatin-1 neurons in the SON.

MATERIALS AND METHODS

The first set of experiments analyzed activation of nesfatin-1 neurons after refeeding as a physiological stimulus and the effectiveness of the glutamatergic system on this physiological stimulation. The subjects were randomly divided into three groups: fasting group, refeeding group and antagonist (CNQX+refeeding) group. The second set of experiments analyzed activation of nesfatin-1 neurons by glucose injection as a metabolic stimulus and the effectiveness of the glutamatergic system on this metabolic stimulation. The subjects were randomly divided into three groups: saline group, glucose group and antagonist (CNQX+glucose) group.

RESULTS

Refeeding significantly increased the number of activated nesfatin-1 neurons by approximately 66%, and intraperitoneal glucose injection activated these neurons by about 55%, compared to the fasting and saline controls. The injections of glutamate antagonist (CNQX) greatly decreased the number of activated nesfatin-1 neurons.

CONCLUSIONS

This study suggested that nesfatin-1 neurons were activated by peripheral and/or metabolic signals and that this effect was mediated through the glutamatergic system.

Recurrence pattern and prognostic factors for survival in cervical cancer with lymph node metastasis

AIM

The aim of this study is to evaluate the recurrence pattern and oncological outcomes in cervical cancer (CC) patients with lymph node metastasis.

METHODS

This study included 224 International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-IIIB CC patients with pathologically proven lymph node metastasis. Surgical intervention was grouped as hysterectomy performed/not performed. Adjuvant therapy decision was made by the tumor board. Radiotherapy was applied to all patients with lymph node metastasis.

RESULTS

Only paraaortic lymph node metastasis was determined as an independent prognostic factor for recurrence. Presence of paraaortic lymph node metastasis increased the risk of recurrence more than two times (odds ratio: 2.129; 95% confidence interval: 1.011-4.485; p = 0.047). An independent prognostic factor for death because of disease was age only. Risk of death was nearly doubled with younger age (odds ratio: 2.693; 95% confidence interval: 1.064-6.184; p = 0.037).

CONCLUSION

The most of recurrences were located at distant sites and multiple regions. Paraaortic lymph node metastasis was the only independent prognostic factor for recurrence, in spite of that age was an independent predictor for risk of death in patients with early stage or locally advanced CC and also with surgically proven metastatic lymph nodes. Furthermore, the presence of the paraaortic lymph node metastasis was significantly associated with distant recurrence. Therefore, more appropriate and individualized therapy strategy focusing on intenser systemic chemotherapy options in addition to radiotherapy should be taken into consideration according to paraaortic lymph node metastasis and age.

Spotlight on oncologic outcomes and prognostic factors of pure endometrioid ovarian carcinoma

AIM

To determine the prognostic factors related to recurrence and survival, and to evaluate the need for adjuvant chemotherapy in patients with endometrioid type epithelial ovarian cancer (EEOC).

METHODS

This study included 63 EEOC patients who were surgically staged.

RESULTS

The FIGO 2014 stage was stage I in 41 (65 %) patients, stage II in 8 (12.5 %) patients, stage III in 14 (22.5 %) patients. 5-year failure-free survival (FFS) was 78 % in the entire cohort. 15 (23.8 %) patients had disease failure. In univariate analysis, advanced stage (II&III), high grade tumor, presence of ascites, bilateral tumor, presence of omental metastasis, positive peritoneal cytology were prognostic factors for poor FFS. Only the stage was determined to be an independent prognostic factor for disease-failure. According to multivariate analysis, stage II&III was related to a statistically significant hazard ratio for a disease failure of 3.49 (95 % confidence interval: 1.029-11.841; p = 0.045). The effectiveness of adjuvant chemotherapy was assessed for 41 patients with stage I. Eleven (26.8 %) patients with stage I did not receive adjuvant chemotherapy. Whereas 5-year FFS was 88 % in patients receiving adjuvant chemotherapy, that was 91 % in patients without adjuvant chemotherapy (p = 0.923).

CONCLUSION

The independent prognostic factor for recurrence in EEOC was stage only. Adjuvant chemotherapy was not related to improvement in FFS in the early stage EEOC that were completely staged.

Expression of the ionotropic glutamate receptors on neuronostatin neurons in the periventricular nucleus of the hypothalamus

BACKGROUND

Neuronostatin, a newly identified peptide, is accepted as an anorexigenic peptide since it suppresses food intake when given intracerebroventricularly. Although the effect mechanisms of neuronostatin have been shown in different studies, there are no reports in the literature describing the mechanisms controlling neuronostatin neurons. In this study, we aimed to determine the presence of the ionotropic glutamate receptor subunits (iGluRs) in neuronostatin neurons in the periventricular nucleus of the hypothalamus.

MATERIALS AND METHODS

The presence of glutamate receptors in neuronostatin neurons was investigated by dual immunohistochemistry. Immunohistochemistry was performed on 40 µm thick coronal brain sections with antibodies against AMPA (GluA1-4), kainate (GluK1/2/3, and GluK5), and NMDA (GluN1 and GluN2A) receptor subunits.

RESULTS

The results showed that the neuronostatin neurons expressed most of the NMDA and non-NMDA receptor subunits. The neuronostatin neurons in the anterior hypothalamic periventricular nucleus were particularly immunopositive for GluA1, GluA4, GluK1/2/3, GluK5 and GluN1 antibodies. No expression was observed for GluA2, GluA3 and GluN2A antibodies.

CONCLUSIONS

For the first time in the literature, our study demonstrated that the neuronostatin neurons express glutamate receptor subunits which may form homomeric or heteromeric functional receptor complexes. Taken together, these results suggest that multiple subunits of iGluRs are responsible for glutamate transmission on neuronostatin neurons in the anterior hypothalamic periventricular nucleus.

Cytoreductive surgery including distal pancreatectomy with splenectomy in advanced stage ovarian cancer: Two centers analysis

OBJECTIVE

Complex procedures such as distal pancreatectomy and splenectomy (DPS) may be required for R0 resection in patients with ovarian cancer (OC). These procedures can increase survival and cause serious morbidity. We aimed to present our experience in this field.

MATERIALS AND METHODS

Thirteen patients who underwent DPS for OC between January 2004 and July 2018 in two centers (Hacettepe University Hospital, Etlik Hospital) were evaluated. Statistical analysis was performed using SPSS.

RESULTS

The mean operative time was 310 min (220-570 min). None of the patients required transfusion. No perioperative mortality was observed. The mean postoperative hospital stay was 12 days (ranging from 8 to 33 days). The number of patients with early postoperative complications was four (30.7%). One of these patients was complicated by intestinal perforation, one with pancreatic fistula, one with pneumonia and the other with atelectasis. Other complications were observed conservatively. Ten patients underwent 6 cycles of platinum-based chemotherapy postoperatively. The median value of the postoperative chemotherapy period was 20 days (range 11-47 days). The median follow-up period was 46 months (2-144 months). Ten patients had recurrence. Eleven patients died of disease. Two patients are stil alive. Disease-free (DFS) and overall (OS) survival were 16 and 63 months, respectively.

CONCLUSION

DPS for cytoreductive surgery is a procedure that increases morbidity, but most of the complications can be treated conservatively. Considering the increase in survival, it is considered to be a valuable procedure in upper abdominal disease.

Ovarian Dysgerminoma: A Tertiary Center Experience

Purpose: The aim of this study is to evaluate the oncologic outcome in patients with pure ovarian dysgerminomas treated and followed-up in our hospital. Methods: This study included 18 ovarian dysgerminoma patients with unilateral and/or bilateral salpingo-oophorectomy (BSO) ± hysterectomy+omentectomy+bilateral pelvic ± para-aortic lymphadenectomy+peritoneal cytologic sampling. Results: Four (22%) patients underwent definitive surgery, including type I hysterectomy and BSO. Only one of the remaining 14 patients underwent BSO because of bilateral streak gonad presence during intraoperative examination. Thirteen patients (72%) had conservative surgeries. In addition, staging surgeries were performed to all patients except for one patient with 16 weeks of pregnancy (patient #3) in the study group. Retroperitoneal lymphadenectomy was part of the staging procedure except for this pregnant patient. Lymph node metastasis was positive in four (22%) patients. Three (16%) patients recurred and none of them died because of disease during follow-up period. Two of the relapsed patients were treated with combination of surgery and chemotherapy, whereas the third patient received only chemotherapy for treatment. Conclusions: Fertility sparing surgery should be the choice of treatment in patients with pure ovarian dysgerminoma. In addition, staging surgery, including retroperitoneal lymph node dissection is obligatory for determining stage IA patients who are exempt from adjuvant chemotherapy. Close surveillance policy enables early detection of patients with recurrences in whom salvage therapy is highly curable.

Relations between second-trimester aneuploidy screening results and prediction of labour induction success in term pregnancies

We aimed to assess whether the second-trimester maternal serum markers could be used for the prediction of labour induction success. This prospective study enrolled women planned labour induction at term. Women were assigned to one of two groups: vaginal prostaglandin or balloon dilatation. All patients were evaluated for Bishop score, maternal serum oestriol, human chorionic gonadotropin and progesterone at the time of second-aneuploidy screening. The total successful rate for induction of labour was 63.9% in both groups. Maternal serum oestriol multiple of median (MoM) values were significantly lower among the caesarean section group compared to the vaginal delivery group (p < .001). A MoM value of 0.74 for oestriol was associated with a sensitivity of 75.9%, specificity of 41.0%, a positive predictive value of 76.6% and a negative predictive value of 58.0% for a successful induction of labour. Oestriol had a good performance in the prediction of successful induction of labour at term.IMPACT STATEMENTWhat is already known on this subject? Induction of labour is a common procedure undertaken whenever the benefits of prompt delivery outweigh the risks of expectant management. Previous studies have reported that a decreased progesterone/oestradiol ratio and increased maternal plasma oestriol levels are associated with successful labour. What the results of this study add? The results of this study showed that second-trimester oestriol multiple of median (MoM) value provide a significant contribution to the efforts of the prediction of successful induction of labour in term pregnancy, having a sensitivity of 69.8%, specificity of 92.4%, positive predictive value of 83.3% and negative predictive value of 82.5%.What the implications are of these findings for clinical practice and/or further research? This finding can be used as an additional method for prediction of labour induction as well as multiparity and Bishop score. This adds new valuable data to the literature which could be used for systematic reviews and for implementing guidelines and protocols on labour induction.

Primary leiomyosarcoma of the ovary: a report of three cases and a systematic review of literature

Primary ovarian leiomyosarcomas (POLMs) comprise <0.1 % of all ovarian malignancies. Here we aimed to define the clinical, surgical, and pathological features, as well as the oncologic outcome, of POLM. A systematic review of the medical literature was performed to identify articles about POLMs. An electronic literature search was conducted for English language abstracts of articles published between 1975 and December 2018.51 articles were included in the study. The primary endpoint of the study was disease-free survival (DFS) and overall survival (OS), whereas the secondary endpoint was clinicopathological features. Five-year DFS and OS for the entire cohort was 15 % and 26 %, respectively. The DFS and OS were significantly related to paraaortic lymphadenectomy, a mitotic index>10/high power field, and advanced cancer stages. Eventually, we were unable to obtain clear results, this might be due to the limited number of cases at the literature.With more authors presenting their own cases, it will be possible to have clearer results.

Primary leiomyosarcoma of the uterine cervix: report of 4 cases, systematic review, and meta-analysis

BACKGROUND

Primary cervical leiomyosarcomas (CLMS) constitute 21% of all cervical sarcomas. Because of their rarity, to our knowledge, fewer than 40 cases have been reported. The aim of this study is to evaluate the clinical and surgical-pathological features, prognosis, treatment options, and survival of primary CLMS.

METHODS

A systematic review of the medical literature was conducted to evaluate articles about primary CLMS. The literature was searched between 1959 and May 2019. On final evaluation, there were 29 articles (one consisted of 8 cases; one consisted of 3 cases) and 42 cases with the addition of our 4 cases.

RESULTS

Age (⩾48 versus ⩽47 years) (hazard ratio.HR], 4.528; 95% confidence interval.CI], 1.550-13.227; p=0.006) and mitoses count (<10/10 high-power field [HPF] versus ⩾10/10 HPF) (HR, 3.865; 95% CI, 1.046-14.278; p=0.043) are independent prognostic factors for recurrence and age (HR, 5.318; 95% CI, 1.671-16.920; p=0.005) and hysterectomy (performed versus not performed) (HR, 4.377; 95% CI, 1.341-14.283; p=0.014) are independent prognostic factors for death because of disease on multivariate analysis.

CONCLUSIONS

Information on primary CLMS is sparse and obtained from rare case reports and case series. Hysterectomy must be the first choice of treatment in these patients according to our results on multivariate analysis. The type of hysterectomy does not have an effect on oncologic outcome. Radical hysterectomy is not obligatory and more data are needed to make more accurate conclusions.

Pulmonary recurrence after radical hysterectomy for uterine cervical carcinoma

Pulmonary spread from carcinoma of the uterine cervix, though uncommon, has been reported in 2.2-9.1% of all cervical cancers. The aim of this study was to evaluate the surgical, clinical, pathological factors and clinical outcomes of cervical cancer patients with pulmonary recurrence (PR).This study included 17 cervical cancer patients with PR after radical hysterectomy. The entire cohort consisted of 413 patients whose surgeries (type III radical hysterectomy + pelvic ± para-aortic lymphadenectomy) had been performed in our Gynaecologic Oncology Clinic between 1993 and 2018. Tumour size, lymph node metastasis and receiving adjuvant therapy were found to be effective for PR on univariate analyses in the main cohort (p = .042, p < .001 and p = .001, respectively). Therefore, performing adjuvant therapy to reduce the PR must be assessed properly with the information of lymph node status and tumour size obtained from the final pathology reports.Impact StatementWhat is already known on this subject? Pulmonary spread from carcinoma of the uterine cervix has been reported in 2.2-9.1% of all cervical cancers. Data related to clinico-pathological features of patients with pulmonary recurrence (PR) is limited. Diagnosis of a PR is considered to worsen the prognosis.What do the results of this study add? Tumour size, lymph node metastasis and receiving adjuvant therapy were found to be effective for PR on univariate analyses.What are the implications of these findings for clinical practice and/or further research? Performing adjuvant therapy to reduce the PR must be assessed properly with the information of lymph node status and tumour size obtained from the final pathology reports in patients with uterine cervical carcinoma.

Which factors predict parametrial involvement in early stage cervical cancer? A Turkish multicenter study

OBJECTIVE

To evaluate the clinical and pathological factors for predicting the parametrial involvement (PI) in early stage cervical cancer.

STUDY DESIGN

This study included 406 patients with type III radical hysterectomy + pelvic ± para-aortic lymphadenectomy and FIGO stage I and II cervical adenocarcinoma, squamous type, and adenosquamous type cervical cancer.

RESULTS

The entire cohort of patients had lymphadenectomy performed. Early stage cervical cancer patients were evaluated. FIGO 2014 stage, uterine invasion, LVSI, surgical border involvement, vaginal metastasis, stromal invasion and lymph node metastasis were found to be effective for PI on univariate analyses. However; age, tumor type and tumor size did not determine the parametrial invasion. LVSI (HR: 4.438, 95%CI: 1.771-11.121; p = 0.001), lymph node metastases (HR: 2.418, 95%CI: 1.207-4.847; p = 0.013) and vaginal involvement (HR: 4.109, 95%CI: 1.674-10.087; p = 0.02) are independent prognostic factors on multivariate analysis.

CONCLUSION

Lymph node metastases, LVSI and surgical border involvement are independent prognostic factors for PI in early stage cervical cancer patients. Therefore, less radical surgical approaches for early stage tumors with no nodal spread, negative LVSI and no surgical border involvement are applicable.

Is hyperandrogenemia protective for fibrocystic breast disease in PCOS?

The aim of this study is to evaluate the fibrocystic breast disease rates and its association with different clinical, endocrine and metabolic parameters between main polycystic ovary syndrome (PCOS) phenotypes. One hundred thirty two consecutive women were included in the study. Body mass index, serum follicle-stimulating hormone, luteinizing hormone (LH), progesterone, estradiol, testosterone, dehydroepiandrosterone sulphate, fasting glucose, low density lipoprotein (LDL-C), total cholesterol, high density lipoprotein, insulin, insulin sensitivity and fibrocystic breast disease rates were compared among different phenotypes of PCOS. Group 1: Polycystic ovaries (PCO)-anovulation (n = 32), Group 2: Hyperandrogenemia (HA)-anovulation (n = 28), Group 3: HA-PCO (n = 29), Group 4: HA-PCO-anovulation (n = 43). There were statistically significant differences between the different phenotype groups in terms of waist-hip ratio (p = 0.006), serum LDL-C (p = 0.008), LH (p = 0.002), estradiol (p = 0.022), fasting glucose (p = 0.001), progesterone (p = 0.007), free testosterone levels (p < 0.001) and Ferriman-Gallwey (FG) scores (p < 0.001). Different phenotype groups had significantly different fibrocystic breast disease rates. (p = 0.016). Higher free testosterone >3 pg/dl was protective for fibrocystic disease (RR = 0.316, 95:% CI 0.109-0.912, p = 0.033). Higher FG scores were more protective for fibrocystic disease (RR = 0.005, 95:% CI 0.001-0.042, p < 0.001). Group 3 ovulatory PCOS patients with PCO and hyperandrogenemia phenotype had lower risk to develop fibrocystic disease, while higher rates were observed in group 1 anovulatory-normoandrogenemic PCOS patients. Hyperandrogenemia is protective for fibrocystic diseases in PCOS.

Impact of hot flashes and night sweats on carotid intima-media thickness and bone mineral density among postmenopausal women

OBJECTIVE

To determine whether postmenopausal women with vasomotor symptoms have a lower bone mineral density (BMD) and a higher carotid intima-media thickness (CIMT) than those without vasomotor symptoms.

METHODS

Postmenopausal women with (n=87) or without (n=117) vasomotor symptoms who did not receive hormone therapy were included. The CIMT and BMD were determined and the relationship with vasomotor symptoms evaluated.

RESULTS

The presence of both hot flashes and night sweats was associated with a CIMT of more than 0.80 mm after adjusting for age, time since menopause, and body mass index (adjusted odds ratio 3.2; 95% confidence interval [CI], 2.3-4.5; P<0.001). The adjusted odds ratio for a CIMT higher than 0.80 mm in women with night sweats was 3.6 (95% CI 1.5-8.9; P=0.006); the adjusted odds ratio in women with hot flashes was 23.1 (95% CI 9.1-58.4; P<0.001). The mean CIMT was 0.65±0.08 mm in the asymptomatic group and 0.81±0.06 mm in the symptomatic group (P<0.001). The mean lumbar (L1, L2, and L3) and total hip BMD values were lower in the symptomatic group (P<0.05).

CONCLUSION

Hot flashes and night sweats in postmenopausal women are associated with a higher CIMT and a lower BMD.

A unique case of anomalous coronary origin detected by 64-row multislice computed tomography coronary angiography

The anomalous origin of the left coronary artery from the right sinus of valsalva is an anatomical abnormality that is usually associated with myocardial ischaemia and sudden death. We report on a case in which three different diagnostic techniques were used to find the cause of the ischaemic symptoms in a patient whose left coronary artery originated anomalously in the right sinus of valsalva and followed a course between the aorta and the pulmonary trunk. The techniques were treadmill exercise test for ischaemia, conventional angiography, which was used for the initial diagnosis, and 64-row multislice computerised tomography, used to determine the anomalous course of the artery.

Systemic Modulation of Gene Expression in Tomato by Trichoderma hamatum 382

ABSTRACT A light sphagnum peat mix inoculated with Trichoderma hamatum 382 consistently provided a significant (P = 0.05) degree of protection against bacterial spot of tomato and its pathogen Xanthomonas euvesicatoria 110c compared with the control peat mix, even though this biocontrol agent did not colonize aboveground plant parts. To gain insight into the mechanism by which T. hamatum 382 induced resistance in tomato, high-density oligonucleotide microarrays were used to determine its effect on the expression pattern of 15,925 genes in leaves just before they were inoculated with the pathogen. T. hamatum 382 consistently modulated the expression of genes in tomato leaves. We identified 45 genes to be differentially expressed across the replicated treatments, and 41 of these genes could be assigned to at least one of seven functional categories. T. hamatum 382-induced genes have functions associated with biotic or abiotic stress, as well as RNA, DNA, and protein metabolism. Four extensin and extensin-like proteins were induced. However, besides pathogenesis-related protein 5, the main markers of systemic acquired resistance were not significantly induced. This work showed that T. hamatum 382 actively induces systemic changes in plant physiology and disease resistance through systemic modulation of the expression of stress and metabolism genes.