Survival impact of number of removed para-aortic lymph nodes in stage I epithelial ovarian cancer.

PURPOSE: The survival effect of presence or absence of lymphadenectomy in early-stage epithelial ovarian cancer (EOC) was priorly shown but the effect of number of removed lymph nodes kept in background. We aimed to evaluate the survival impact of number of removed lymph nodes and their localizations in stage I EOC. METHODS: This study included 182 patients. The best cut-off levels for number of pelvic and para-aortic lymph nodes (PaLN) were 24 and 10, respectively. Univariate and multivariate survival analyses were performed for these cut-offs and other prognostic factors. RESULTS: The median age of the patients was 49. The median number of removed pelvic and paraartic lymph nodes were 29 and 9, respectively. The median overall (OS) and progression-free survival (PFS) were 67 and 50 months, respectively. The 5-year OS rate was 89.6%. Recurrence occured in 24 (19.5%) patients. In univariate analyses tumor grade (p: 0.005), pelvic LN number (p: 0.041) and PaLN number (p: 0.004) were the factors that were significantly associated with PFS. Tumor grade and PaLN number were independently and significantly associated with PFS in multivariate analyses (p: 0.015 and p: 0.017, respectively). In OS analyses, age, tumor grade, presence of LVI, number of pelvic and PaLNs were the significantly associated factors (p < 0.05 for all). In multivariate analyses, age and PaLN number were independently and significantly associated with OS (p: 0.011 and p: 0.021, respectively). CONCLUSIONS: The number and localizations of removed lymph nodes may have a survival affect in stage I EOC. We also think that this study may constitute a kernel point for larger prospective series on lymph node number and lymphatic regions.

Survival in recurrent ovarian cancer patients before and after the bevacizumab era: an observational single-centre study.

A retrospective observational study was carried out in Baskent University School of Medicine, Ankara, Turkey. Recurrent ovarian cancer patients treated between 2007 and 2017 were divided into two groups according to their bevacizumab status. The primary endpoints were overall survival (OS) and safety. Three hundred and ninety-six patients enrolled in this study, 200 (50.5%) received bevacizumab while 196 (49.5%) patients never received bevacizumab. The median follow-up time was 48.2 and 47.6 months, respectively. The 5-year OS was 61% and 46%, respectively (p=.007). In multivariate analysis, only platinum-sensitivity (HR: 3.75, 95% CI: 3.0-5.32; p<.001) was identified as independent prognostic factors. In subgroup analyses according to platinum status, bevacizumab did not affect the 5 year OS in platinum sensitive patients (64% versus 68% p=.28) but increased survival in platinum resistant patients (36% versus 44%, p=.00). The rate of grade III-IV haematologic toxicities was 13.7% in the bevacizumab group and 11% in the other group (p=.6).Impact StatementWhat is already known on this subject? Bevacizumab increases the progression-free survival in platinum-sensitive and resistant recurrent ovarian cancer patients without changing overall survival.What do the results of this study add? Bevacizumab did not affect OS in platinum sensitive recurrent ovarian cancer patients however improved OS in platinum resistant patients with mild toxicity.What are the implications of these findings for clinical practice and/or further research? This study emphasised the crucial role of bevacizumab in the treatment of recurrent ovarian cancer patients.

Multi-institutional validation of the ESMO-ESGO-ESTRO consensus conference risk grouping in Turkish endometrial cancer patients treated with comprehensive surgical staging.

In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statementWhat is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous.What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups.What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging.

Effect of increased number of neoadjuvant chemotherapy cycles on tumor resectability and pathologic response in advanced stage epithelial ovarian cancer.

PURPOSE: To identify the significance of the number of neoadjuvant chemotherapy (NACT) cycles on pathologic response and to define relationship between multiple cycles of NACT and the timing of interval debulking surgery (IDS) in epithelial ovarian cancer (EOC) patients. METHODS: This retrospective case-control study was carried out at the Baskent University in Ankara between 2007 and 2017. We reviewed 62 patients with advanced stage (IIIC-IV) EOC who received NACT in other institutes and operated in our clinic. On the basis of the number of NACT cycles, patients were divided into 2 groups: group 1 received 3 cycles and group 2 received 4 to 6 cycles.The influence of the number of NACT cycles on complete pathologic response, lymph node involvement, overall survival (OS), progression free survival (PFS), platinum resistance and residual tumor were evaluated. RESULTS: The median OS was 44.4 ±4.8 months and 48.8±4.49 months for group 1 and group 2 respectively (p=0.122). PFS was 19.3±3.75 months in group 1 and 24.3±4.67 months in group 2 (p=0.84). Tumor morphology according to lymph node involvement, no visible tumor and complete pathologic response were similar for both groups (p=0.49, p=0.79 and p=0.6 respectively). Pathological absence of residual disease were 13.6% vs 7.5% for group 1 and group 2 respectively (p=0.6) and total response rate was 6/62 (9.67%). Platinum resistance developed in 4 (18.2%) patients and 18(45%) patients in group1 and 2 respectively (p=0.031). Complete resection rates were similar for both groups (p=0.9). After multivariate survival analyses, complete resection remained significant (p=0.000, odds ratio/OR 2.28 [1.41-3.70]), and was independent of age, platinum resistance and number of NACT cycles. Complete resection rates were almost equal in each groups, (68.2% [15/22] and 67.5% [27/40] for group 1 and group 2 respectively (p=0.9)). CONCLUSIONS: Our data suggests that giving more than 3 cycles of NACT is unnecessary because increased number of cycles did not change the resectability and complete pathologic response, while it increased platinum resistance. Moreover OS and PFS remained similar.

The preoperative albumin level is an independent prognostic factor for optimally debulked epithelial ovarian cancer.

PURPOSE: A low albumin level has been reported to be a prognostic factor for various cancers. The aim of this study was to determine the association between preoperative serum albumin level and survival in patients with epithelial ovarian cancer (EOC). METHODS: Records of 337 patients with EOC that underwent optimal cytoreductive surgery were retrospectively reviewed. Threshold albumin level was planned as 32.5 g L-1 due to the statistical analyses. RESULTS: Mean overall survival was 51.5 months. Area under the ROC curve was found statistically significant for the discriminative role of albumin for survival outcome (AUC = 0.857, 95% CI 0.813-0.90, P < 0.001). The best cut-off point for albumin was determined as 32.5 g L-1. The sensitivity rate, specificity rate, positive and negative predictive values, and accuracy rate for this cut-off level were found 67.2, 91.2, 81.2, 83.1, and 82.5%, respectively. Preoperative hypoalbuminemia was noted in 101 (30.0%) of the patients, of which 6.2% had an albumin level <25 g L-1. The albumin level was independently and significantly associated with overall survival (HR 2.6; 95% CI 2.1-3.1; P < 0.001). Subgroup analysis showed that patients with an albumin level <32.5 and ≥32.5 g L-1 had mean estimated overall survival of 40.6 and 96.0 months, respectively. Age, stage, and presence of ascites were the other independent significant factors. CONCLUSIONS: The preoperative albumin level is an independent prognostic factor for overall survival in optimally debulked EOC patients. Further investigations about preoperative albumin level in prognostic models will contribute to the literature.

Response rates of taxane rechallenge in metastatic breast cancer patients previously treated with adjuvant taxanes.

PURPOSE: This study was conducted to determine the efficacy of taxane-based regimens in patients with metastatic breast cancer pre-treated with taxanes in adjuvant treatment and also to assess the response rates of taxanes in each treatment line. METHODS: The data of 939 breast cancer patients, who had received adjuvant taxane-based chemotherapy, were reviewed retrospectively. In 191 of them local/distant recurrences were detected. The treatments that were given when metastases occurred and the responses were recorded. Response rates (RRs), clinical benefit rates/CBR (complete response/CR + partial response/ PR + stable disease/SD) and progression-free (PFS) and overall survival (OS) values were determined. RRs to the most frequently used protocols in our institutes (capecitabine- based and taxane-based regimens) were compared. RESULTS: Of 191 patients, 11 didn't receive treatment and for the remaining 180 patients 45 (24%) received taxane-based therapies, 89 (49.4%) received capecitabine-based therapies, 28 (15.6%) received hormonotherapy and 18 (10%) received other chemotherapeutics. The RR for first-line taxane regimen was 58.5%, consisting of 5 CRs (12%) and 19 PRs (46%). Menopausal status, histological grade, estrogen/ progesterone receptors, cerbB2 status, having PFS > or ? 2 years and the site of metastases did not predict response to first-line taxane treatment. For the 2nd and 3rd or later line therapies, RRs of taxane rechallenge were above 40%. CONCLUSION: Rechallenging with taxanes after (neo)adjuvant taxane exposure seems to be a reasonable option even in 3rd or further line treatments with high response rates.

Oxaliplatin-Induced Immune Thrombocytopenia in a Patient with Pancreatic Cancer.

Oxaliplatin-induced immune thrombocytopenia is a rare but potentially serious complication of chemotherapy. We present the case of a 55-year-old man with stage 4 pancreatic carcinoma who developed immune thrombocytopenia during the 18th cycle of folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) chemotherapy, immediately after oxaliplatin infusion. Despite treatment with methylprednisolone and platelet infusion, the patient's platelet count remained low. Subsequent plasmapheresis and continued steroid therapy resulted in a gradual improvement in platelet count and resolution of symptoms. This case highlights the importance of considering immune thrombocytopenia in patients receiving oxaliplatin-based chemotherapy, and the potential role of plasmapheresis in refractory cases. Further research is needed to elucidate the optimal management of this rare complication. LEARNING POINTS: Oxaliplatin-induced immune thrombocytopenia is a rare but potentially life-threatening side effect of chemotherapy.Management of drug-induced immune thrombocytopenia involves discontinuation of the offending drug and the use of steroids.Monitoring and follow-up are crucial in patients receiving oxaliplatin-based chemotherapy to promptly detect and manage potential hematologic emergencies, including immune thrombocytopenia.

Incidence and Clinical Characteristics of Drug-Induced Lung Disease Among Chemotherapy Recipients.

Background Chemotherapeutic agents treat cancer and some inflammatory diseases due to their immunosuppressive effects. While effective, these drugs can cause drug-induced lung disease (DILD), a serious adverse effect with limited data regarding its incidence and clinical presentation. Methods This retrospective study included 20 patients diagnosed with DILD out of 1,231 patients treated with chemotherapeutic agents who presented with symptoms such as cough, fever, dyspnea, and chest pain at an oncology outpatient clinic. Patients underwent assessments including clinical examination, chest radiography, high-resolution computed tomography, and, in some cases, video-assisted thoracoscopic surgery. A statistical analysis was performed to determine the incidence and evaluate the clinical characteristics of DILD. Results The incidence of DILD among patients treated with chemotherapeutic agents was 0.27%. The female/male ratio was 11/9, with a mean age of 53.2 years. Common symptoms included cough (70%), dyspnea (60%), fever (50%), and sputum production (40%). Imaging revealed pleural effusion, reticular patterns, and consolidation in varying proportions. Common agents causing pulmonary toxicity included bleomycin, cyclophosphamide, and methotrexate, among others. Importantly, 95% of patients showed improvement with steroid treatment, although statistical significance was not achieved (p > 0.05). Conclusion The findings highlight the need for heightened awareness and monitoring of DILD in patients receiving chemotherapeutic treatments. Early diagnosis and prompt treatment initiation are crucial to managing this potentially severe complication. This study underscores the importance of considering pulmonary risks when prescribing chemotherapeutic agents and provides foundational data for future research.

Effect of surgical staging on 539 patients with borderline ovarian tumors: a Turkish Gynecologic Oncology Group study.

OBJECTIVE: The objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. METHODS: In a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan-Meier method. RESULTS: The median age at diagnosis was 40 years (range 15-84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36 months (range 1-120 months). Five-year survival rate was 100% and median survival time was 120 months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. CONCLUSION: Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management.

The relationship between glucose metabolism disorders and malignant thyroid disease.

BACKGROUND: Previous studies have shown a positive relationship between insulin resistance and several common adult cancers. The present retrospective study aimed to investigate the association between glucose metabolism disorders (GMDs) and the prevalence of thyroid cancer. METHODS: We investigated the data of 4272 patients who had undergone fine-needle aspiration biopsy (FNAB) of thyroid nodules. The biopsy results were evaluated as diagnostic or non-diagnostic and the diagnostic results were classified as benign, malignant, and indeterminate. In this study, we included 2234 of the above patients who had undergone FNAB at our hospital and whose biopsy results were evaluated as diagnostic and were classified as either benign or malignant. We obtained the cytologic data and the glucose metabolism status of these patients retrospectively. RESULTS: Of the 2234 patients, 629 (28.1 %) had GMD (impaired fasting glucose, impaired glucose tolerance). Malignant cytology was determined in 106 (4.7 %) patients overall. Of the 629 patients with GMD, 582 (92.5 %) patients had benign cytology and 47 (7.5 %) patients had malignant cytology. Fifty-nine (3.7 %) of the 1605 normoglycemic patients had malignant cytology. Malignant cytology was determined more frequently in the patients who had GMDs (p < 0.001). CONCLUSION: The results demonstrated that thyroid cancer prevalence was higher in patients with GMD. According to our results, GMD should be considered as a risk factor for malignancy in the evaluation of thyroid nodules.