The Cukurova score in the prediction of primary cytoreduction in ovarian cancer.

OBJECTIVE: Primary debulking surgery has been the preferred surgical route and is still considered a quality indicator for advanced ovarian cancer surgery. However, a significant number of patients are not amenable to upfront surgery. Neoadjuvant chemotherapy and interval debulking surgery may be the most suitable approach for this group. This study aimed to evaluate a novel score for prediction of the cytoreduction results at primary debulking surgery for ovarian cancer patients. METHODS: This observational prospective study was conducted at a tertiary gynecologic oncology center between December 2020 and August 2022. Presumed primary stage III-IV epithelial ovarian carcinoma cases were included. Borderline tumors, and metastatic or non-epithelial ovarian malignancies, were excluded. Based on imaging findings, points were assigned to each anticipated surgical procedure required for complete cytoreduction. The sum of these points was multiplied by the patient's Eastern Cooperative Oncology Group (ECOG) score, and thus, the Cukurova-clinic score was established. Furthermore, the required surgical procedures based on laparoscopic evaluation were recorded, and the score was readjusted and calculated to obtain the Cukurova score. RESULTS: One hundred and fourteen patients were included in the study. Primary debulking surgery was performed in 70% of cases. Among them, complete cytoreduction (Cukurova score ≤12) was obtained in 97.3% of cases. Complete cytoreduction was not achieved in cases with Cukurova score >12. The odds ratio of 90-day mortality was 13.4 for patients with Cukurova score >12, compared with those with Cukurova score ≤12. CONCLUSION: The Cukurova score is a model for classifying advanced ovarian cancer patients who may be candidates for primary debulking surgery.

Laparoscopic radical hysterectomy and total vaginectomy for vaginal malignant melanoma with cervical metastasis

The presented case is a 63-years-old multiparous woman admitted with the complaint of postmenopausal bleeding. On gynecologic examination multifocal lesions were detected, including 1 cm on lateral vaginal wall, 4 cm on posterior vaginal wall and 0.5 cm on the left lateral part of the cervix. Histopathology examination gave a diagnosis of epithelioid malignant melanoma. Consequently, laparoscopic radical hysterectomy and total vaginectomy with bilateral pelvic and inguinofemoral lymph node dissection were planned. On both sides, pararectal and paravesical spaces were created and the ureter was identified. Then, the vesicouterine and vesicovaginal spaces were developed. Uterine artery and superior vesical artery were coagulated, cut and the lateral parametrium was prepared. The left ureter was dissected and the ureteral tunnel was unroofed up to the bladder entrance. Subsequently, the anterolateral parametrium was transected. Then, the infundibulopelvic and sacrouterine ligaments were sealed and transected. At this time, the rectovaginal space was developed. Bilateral paracolpos were transected. The endopelvic fascia with the levator muscles were sealed and cut circumferentially. Anteriorly, the pubovesicocervical fascia was transected and the bladder was mobilized up to the uretrovesical junction. Thereafter, through a vaginal approach, the cervix and vagina were inverted by grasping the cervix with a tenaculum. An incision on the posterior vaginal wall at the introitus was made and the urogenital diaphragm was dissected to connect with the pelvic cavity. The vaginal entrance was cut circumferentially and the surgical specimen was extracted. In conclusion, laparoscopy can be considered as a feasible approach for radical hysterectomy and total vaginectomy in selected patients.

Predictability of lymph node involvement in uterus-confined endometrioid endometrial cancer by tumour size, pattern and location measured with transvaginal ultrasonography: can we save time?

We aimed to investigate whether transvaginal ultrasonography (TVUSG)-measured tumour size, pattern and location were significant predictors for lymph node metastasis in the uterus-confined endometrioid endometrial cancer (EEC) patients. A total of 213 patients with EEC were recruited and 73 of them were considered eligible and were analysed according to lymph node involvement. Tumour size, pattern and location measured by transvaginal ultrasound were recorded. Thereafter, patients were distributed according to their lymph node involvement and were compared with respect to these parameters. The patients' median age was 56 (27-80). Mean of the resected lymph nodes was 29.68 and 33.5 in lymph-node-negative and positive patients, respectively (p=.525). Tumour diameter was measured >2 cm on transvaginal ultrasound in 28 (48.3%) and 13 (86.7%) cases of the lymph node-negative and positive arms, respectively (p=.008). Transvaginal ultrasound revealed that 18 (31.0%) tumours in lymph node-negative and two (13.3%) in the node positive patients had polypoid pattern (p=.171). Seventeen (54.8%) tumours of the lymph node-negative group and three (42.9%) of the node positive group were determined in the lower uterine segment (p=.250). While tumour diameter measured with TVUSG was predictable for lymph node involvement in the uterus-confined EEC, its pattern and location were not.Impact StatementWhat is already known on this subject? In clinically early-stage endometrioid endometrial cancer (EEC), it has been recognised for decades that selective lymphadenectomy is a more acceptable strategy than the systematic lymphadenectomy, owing to the low rate of lymph node metastases in the patients. Preoperative imaging, frozen section and recently accepted lymph node concept are the prominent methods in designating appropriate candidates for lymphadenectomy. The measurement of tumour diameter or size obtained intraoperatively by frozen section assessment is one of the parameters used in MAYO criteria for selective lymphadenectomy in endometrial cancer patients.What do the results of this study add? In our study, tumour diameter measured with transvaginal ultrasonography was predictable for lymph node involvement in the uterus-confined EEC.What are the implications of these findings for clinical practice and/or further research? Transvaginal ultrasonography-measured tumour diameter can be considered in deciding to proceed with pelvic lymphadenectomy while waiting for the frozen section result. It should be remembered that this approach could be considered only in clinics using MAYO criteria for selective lymphadenectomy, and it needs to be confirmed with more prospective studies.

Uterine arcuate artery calcification as a potential marker of cardiovascular risk-a preliminary study.

OBJECTIVE: Atherosclerotic cardiovascular disease is the most common cause of death in postmenopausal women. As this is a progressive disease, it is important to identify markers at an early stage during the subclinical period. Arterial calcifications are an indicator of overall atherosclerotic disease and therefore may be used as a marker for the estimation of future atherosclerotic cardiovascular events. The aims of this study are to investigate the relationship between uterine myometrial calcification (UMC) and carotid artery intima-media thickness (CIMT) and to evaluate whether UMC can be a predictive marker for the estimation of future atherosclerotic cardiovascular risk in asymptomatic postmenopausal women. METHODS: In this cross-sectional study, we assessed 81 postmenopausal women without gynecological complaints for cardiovascular risk factors, UMC, and CIMT. Participants were divided into two risk groups according to their cardiovascular risk factors. The level of UMC was determined using a new scoring system, which was based on transvaginal ultrasonography. Demographic, clinical, and laboratory parameters, UMC scores, and measurements of CIMT were evaluated. RESULTS: A moderately positive correlation was detected between CIMT and UMC scores ( r = 0.62). There was a significant relationship between UMC scores and atherosclerotic cardiovascular risk; the risk of atherosclerosis was 15.4 times higher (OR: 15.4, 95% CI: 5.1-46.8; P = 0.001) in participants with a high UMC score (≥2). According to the multivariable logistic regression model adjusted by age and duration of menopause, the risk of cardiovascular atherosclerosis increased 27.8 fold for those with CIMT of 0.075 or greater (OR: 27.8, 95% CI: 5.3-147.1; P = 0.001) and 9.2 fold for those with a UMC score of 2 or greater (OR: 9.2, CI: 1.22-69.3; P = 0.032). CONCLUSIONS: The presence of UMC has been identified as an independent predictive factor for atherosclerotic risk. Accordingly, considering UMC as an atherosclerotic cardiovascular risk factor may provide an opportunity to identify cardiovascular disease in asymptomatic postmenopausal women. When UMC is detected, women should be assessed for cardiovascular risk.

GC-MS based metabolite fingerprinting of serous ovarian carcinoma and benign ovarian tumor.

The aim of this study is to identify urinary metabolomic profile of benign and malign ovarian tumors patients. Samples were analyzed using gas chromatography-mass spectrometry (GC-MS) and metabolomic tools to define biomarkers that cause differentiation between groups. 7 metabolites were found to be different in patients with ovarian cancer (OC) and benign tumors (BT). R2Y and Q2 values were found to be 0.670 and 0.459, respectively. L-tyrosine, glycine, stearic acid, turanose and L-threonine metabolites were defined as prominent biomarkers. The sensitivity of the model was calculated as 90.72% and the specificity as 82.09%. In the pathway analysis, glutathione metabolism, aminoacyl-tRNA biosynthesis, glycine serine and threonine metabolic pathway, primary bile acid biosynthesis pathways were found to be important. According to the t-test, 29 metabolites were found to be significant in urine samples of OC patients and healthy controls (HC). R2Y and Q2 values were found to be 0.8170 and 0.749, respectively. These results showed that the model has high compatibility and predictive power. Benzoic acid, L-threonine, L-pyroglutamic acid, creatinine and 3,4-dihydroxyphenylacetic acid metabolites were determined as prominent biomarkers. The sensitivity of the model was calculated as 93.81% and the specificity as 98.59%. Glycine serine and threonine metabolic pathway, glutathione metabolism and aminoacyl-tRNA biosynthesis pathways were determined important in OC patients and HC. The R2Y, Q2, sensitivity and specificity values in the urine samples of BT patients and HC were found to be 0.869, 0.794, 91.75, 97.01% and 97.18%, respectively. L-threonine, L-pyroglutamic acid, benzoic acid, creatinine and pentadecanol metabolites were determined as prominent biomarkers. Valine, leucine and isoleucine biosynthesis and aminoacyl-tRNA biosynthesis were significant. In this study, thanks to the untargeted metabolomic approach and chemometric methods, every group was differentiated from the others and prominent biomarkers were determined.

Cardiophrenic and costophrenic lymph node resection via subxiphoid approach only

When enlarged cardiophrenic lymph nodes (CPLN) are resected the impact on survival is still uncertain, but resection contributes to accurate staging and complete gross resection in advanced ovarian cancer. CPLN resection can be performed via video-assisted thoracic surgery or transabdominally through the subxiphoid or transdiaphragmatic routes. The subxiphoid approach is used to reach the prepericardiac nodes located in the anterior mediastinum. The transdiaphragmatic route is used to remove the costophrenic and supradiaphragmatic paracaval lymph nodes located in the middle and posterior mediastinum, respectively. However, the transdiaphragmatic approach necessitates diaphragm opening and, in most cases, liver mobilization. Costophrenic nodes can be resected through the subxiphoid route in appropriate patients without opening the diaphragm. Thus, the subxiphoid approach may be preferred to remove the costophrenic lymph nodes, in cases in whom diaphragm resection is not anticipated, and especially when the resection procedure is planned to include the prepericardiac nodes. In this video article, we present the method of resecting both prepericardiac and costophrenic lymph nodes using only the subxiphoid approach in a case of advanced ovarian cancer. The subxiphoid virtual space between the pericardium and diaphragm was developed. The observed and palpated CPLNs were dissected and excised from the prepericardiac and right latero-cardiac spaces. Thereafter, diaphragm peritoneum beneath the right costophrenic nodes was dissected. After identifying any enlarged costophrenic nodes by palpation, the sternal and costal diaphragmatic attachments were incised and the right latero-cardiac space was extended. When the single enlarged node was reached, it was grasped and pulled with curved-ring forceps and ultimately resected.

Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High-Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001).

This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high-intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high-intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high-intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high-intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high-intermediate- and high-risk endometrial cancer cases.

Perinatal outcomes of the antenatally diagnosed omphalocele cases: a single tertiary center experience.

OBJECTIVES: To evaluate the perinatal outcomes of antenatally diagnosed omphalocele cases. MATERIAL AND METHODS: This was a retrospective study conducted between July 2014 and February 2020 at the prenatal diagnosis center of a university clinic. Gestational week of diagnosis, associated anomalies, karyotype analysis results, complications during pregnancy, termination/delivery characteristics, and postnatal results were evaluated. RESULTS: The analysis was performed on 58 patients. The median diagnosis time was 14.5 weeks of gestation. Thirty-three cases (57%) were defined in the first trimester. 33 (57%) of 58 patients had one or more concomitant anomalies, while 25 patients (43%) had isolated omphalocele. The most common associated anomaly was a cardiac anomaly which was observed in 17 fetuses (30% of all omphalocele cases). Karyotype analysis was performed in forty-five patients (41 in the prenatal period, 4 in the postnatal period). A normal karyotype was detected in 27 cases (60%). Trisomy 18 was the most common chromosomal anomaly (n = 15, 33.3%). Thirty of 58 patients (52%) requested termination of pregnancy (TOP) in the early pregnancy period. Thirteen of the cases died in-utero (22%). Fifteen pregnancies resulted in live births (26%), of those eight were lost in the first year of life (six of them had additional anomalies, while two of them had isolated omphalocele but the omphalocele pouch was containing the liver in those two babies). CONCLUSIONS: Most of the cases with an omphalocele can be diagnosed in the first trimester. Cardiac anomalies were the most common associated anomalies, while trisomy 18 is the most common chromosomal anomaly. Thus, earlier and effective counseling can be made about the prognosis of pregnancy.

Clinicopathologic characteristics and prognosis comparison of the uterine high grade endometrial carcinomas.

OBJECTIVES: Grade 3 endometrioid adenocarcinomas (G3 EAC), type two endometrial carcinomas (Type 2 EC), and also uterine carcinosarcomas (UCS) are considered as high-grade endometrial adenocarcinomas. The aim of this study was to compare the clinicopathologic features and survival of patients with UCS, G3 EAC, Type2 EC. MATERIAL AND METHODS: We included two hundred and thirty-five patients in this study. Patients were divided into three groups according to the type of tumor as uterine G3 EAC (group 1, n = 62), Type 2 EC (serous, clear and mixed types; group 2, n = 93), and UCS (group 3, n = 80). We compared the groups according to age, initial symptom, surgical approach, stage, myometrial invasion (MI), lymph node invasion (LNI), lymphovascular space invasion (LVSI), adjuvant therapy, and survival. When comparing the survival outcomes the Kaplan-Meier analysis was performed. RESULTS: The groups were similar according to age, menopausal status, nulliparity, initial symptoms, stage, LVSI, and LNI. Positive cytology was determined significantly more in group 3. There was a significant difference between the groups in terms of myometrial invasion degree. Optimal cytoreduction was similar among the groups. The primary adjuvant treatment was chemotherapy for UCS and Type2 EAC whereas radiotherapy was the main adjuvant treatment for G3 EAC. There were no significant differences among the groups according to overall survival (OS) (p = 0.290). CONCLUSIONS: Although the survival difference among the groups can not be revealed, these patients have different clinical and pathological features and they should be considered as different groups.

Prognostic factors and survival outcomes of women with uterine leiomyosarcoma: A Turkish Uterine Sarcoma Group Study-003.

To assess the clinicopathological features, prognostic factors, and survival rates associated with uterine leiomyosarcoma (uLMS). Databases from 15 participating gynecological oncology centers in Turkey were searched retrospectively for women who had been treated for stage I-IV uLMS between 1996 and 2018. Of 302 consecutive women with uLMS, there were 234 patients with Federation of Gynecology and Obstetrics (FIGO) stage I disease and 68 with FIGO stage II-IV disease. All patients underwent total hysterectomy. Lymphadenectomy was performed in 161 (54.5%) cases. A total of 195 patients received adjuvant treatment. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 42% and 54%, respectively. Presence of lymphovascular space invasion (LVSI), higher degree of nuclear atypia, and absence of lymphadenectomy were negatively correlated with DFS, while LVSI, mitotic count, higher degree of nuclear atypia, FIGO stage II-IV disease, and suboptimal surgery significantly decreased OS. LVSI and higher degree of nuclear atypia appear to be prognostic indicators for uLMS. Lymphadenectomy seems to have a significant effect on DFS but not on OS.

The impact of morbid obesity on survival of endometrial cancer.

OBJECTIVE: Morbid obesity is identified as patients with a body mass index more than 40 kg/m2. Obesity is known as a risk factor for endometrial cancer due to the increase of the deposited estrogen. This study was conducted to evaluate the effect of morbid obesity on the survival of endometrial cancer. MATERIALS AND METHODS: The archival records and pathologic reports of patients with endometrial cancer who underwent surgery and were followed up in Çukurova University Gynecologic Oncology Center between January 1996 and December 2018 were reviewed, retrospectively. Data regarding body mass index and survival was reported in 520 patients. These patients were stratified into two groups according to their body mass index, <40 and ≥40 kg/m2. The groups' clinic, pathologic features, and survival rates were compared. RESULTS: There were 146 patients in the morbidly obese group and 374 patients in the obese group. The mean age of the groups was 58.5 and 56.2 years, respectively. The mean follow-up time was 51.6 months. Comorbidities were significantly higher in the morbidly obese group. The five-year disease-free and overall survival rates were 78.3% and 85.3% in the morbidly obese group, and 81.6% and 90.1% in the obese group, respectively. Although the groups' clinical and pathologic features were homogeneously distributed, disease-free and overall survival rates were significantly different (p=0.053 and p=0.054, respectively). CONCLUSION: Morbidly obese patients with endometrial cancer were associated with 2.7-fold increased risk of death and 1.7-fold increased risk of recurrence compared with those who had body mass index <40 kg/m2. It is important to deal with the frequent comorbidities in this special group, which could be simply altered by lifestyle changes. Morbidly obese patients with endometrial cancer should be encouraged in lifestyle changes and consulted by dieticians and endocrinologists.

Challenges on the morbidly obese endometrial cancer surgery: Laparotomy or laparoscopy, lymphadenectomy or no lymphadenectomy?

OBJECTIVES: A considerable proportion of endometrial cancer patients are morbidly obese. Management of these cases is a serious dilemma. The aim of this study was to investigate the relevance of laparoscopic route and omission of lymphadenectomy as morbidity-reducing strategies in this special population. MATERIAL AND METHODS: Endometrial cancer patients' archival records were retrospectively reviewed and cases with body mass index ≥ 40 kg/m2 were selected. A comparative evaluation of their characteristics and survival rates were performed. Firstly, according to the surgical approach; laparoscopy or laparotomy, and then regarding to performing lymphadenectomy or not. RESULTS: There were 146 patients enrolled in this study. Whereas, significantly higher postoperative complications and longer hospital stays were determined in the laparotomy compared to laparoscopy groups. Five years disease-free and overall survival were not significantly different (83.6% vs 70.7%, p = 0.184 and 83.9% vs 86.6%, p = 0.571, respectively). On the other hand, operation length, postoperative hospitalization time, both intraoperative and postoperative complications were significantly lower in the non-lymphadenectomy compared to the lymphadenectomy groups. However, five-years disease-free and overall survival were not significantly different (77.3% vs 81.3%, p = 0.586 and 87.5% vs 78%, p = 0.479, respectively). CONCLUSIONS: Laparoscopic approach and omission of lymphadenectomy are worthy policies in the morbidly obese endometrial cancer patients.

Prognostic significance of programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) expression in uterine carcinosarcoma.

OBJECTIVE: The aim of this study was to evaluate the clinical and prognostic importance of programmed death-1 (PD-1) and/ or programmed death-ligand 1 (PD-L1) in uterine carcinosarcoma (UCS). STUDY DESIGN: Formalin-fixed, paraffin-embedded tissue samples from 59 cases with UCS were analyzed. PD-1 and PD-L1 expressions in tumor tissue and microenvironment were detected by immunohistochemistry. Clinical and pathological characteristics including age, stage, initial symptom, surgical approach, myometrial invasion, lymphovascular space invasion (LVSI), lymph node invasion, adjuvant therapy, and survival were evaluated. The Kaplan-Meier and Cox proportional hazards models were used to compare the outcomes and prognostic factors. RESULTS: PD-1 expression in tumor tissue and microenvironment was detected in 15 (25 %) and 18 (30 %) cases, respectively. PD-L1 expression in tumor tissue and microenvironment was detected in 15 (25 %) and 12 cases (20 %), respectively. PD-L1 expression in tumor was associated with longer survival and median survival was 38 and 15 months in cases with and without PD-L1 expressions, respectively (p = 0.019). Lymphovascular space invasion (LVSI) (p = 0.014), myometrial invasion (p = 0.008) and PD-L1 expression were found to be prognostic for UCS's. PD-L1 expression was found to be an independent good prognostic factor with Cox regression analysis (OR 3.9; 95 % CI: 1.4-11.0) for overall survival. CONCLUSION: PD-1 and/or PD-L1 expression are important due to their expressions in one fourth of the cases with UCS and PD-1/PD-L1 blockade may be a new avenue in UCS.

Programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) expressions in type 2 endometrial cancer.

PURPOSE: The aim of this study was to evaluate prognostic importance of programmed death-1 (PD-1) and/ or programmed death-ligand 1 (PD-L1) expressions in type 2 endometrial cancer. Study design Formalin-fixed, paraffin-embedded tissue samples from 53 cases with type 2 endometrial cancer were analyzed. One-third of our cases had serous adenocarcinoma (32%), 11 had clear cell (21%) and 25 had mixed-type adenocarcinoma (47%). PD-1 and PD-L1 expressions in tumor tissue and microenvironment were detected by immunohistochemistry. Clinical and pathological characteristics including age, stage, initial symptom, surgical procedure, myometrial invasion, lymphovascular space invasion (LVSI), lymph node invasion, adjuvant therapy, and survival were reviewed. The Kaplan-Meier and Cox proportional hazards models were used to evaluate the prognostic factors. RESULTS: PD-1 expression in tumor tissue and microenvironment was detected in 22 (42%) and 28 (53%) cases, respectively. PD-L1 expression was detected in tumor and microenvironment in 8 (15%) and in 15 cases (28%), respectively. Expression of PD-1 and PD-L1 expressions in tumor area was associated with shorter survival (p = 0.006 and 0.001, respectively) but PD-1 and PD-L1 expressions in microenvironment were not found to be related with survival. PD-1 (p = 0.006) and PD-L1 expressions (p = 0.001) in addition to LVSI (p = 0.005), myometrial invasion (p = 0.015), lymph node involvement (p = 0.019), and suboptimal cytoreduction (p = 0.042), were found to be associated with poor prognostic indicators. PD-1 and PD-L1 expressions in tumor and lymph node involvement were determined as independent prognostic factors. CONCLUSION: PD-1 and PD-L1 expressions in type 2 endometrial cancers were found to be poor prognostic indicators.

Prognostic value of pre-operative neutrophil/lymphocyte ratio, monocyte count, mean platelet volume, and platelet/lymphocyte ratio in endometrial cancer.

OBJECTIVE: Cancer-related inflammation is associated with poor long-term outcomes in various solid tumors. The aim of this study is to investigate the prognostic significance of pre-operative neutrophil lymphocyte ratio (NLR), monocyte count (MC), mean platelet volume (MPV), and platelet lymphocyte ratio (PLR) in endometrial cancer. STUDY DESIGN: In this study, 763 patients with endometrial cancer were evaluated, who were followed between January 1996 and February 2016. Preoperative values of NLR, MC, MPV, and PLR were evaluated in terms of clinico-pathologic prognostic factors and overall survival (OS). RESULTS: NLR, MC, and PLR were detected to be statistically significant with regard to advanced stage of the disease (p = 0.001, p = 0.02, and p = 0.001, respectively), but only MC was significant in terms of grade (p = 0.035). Higher NLR and PLR values were found to be associated with advanced stage of the disease, deep myometrial invasion, cervical involvement, lymphovascular space invasion (LVSI), and nodal involvement. When the cut-off value was considered as 3, sensitivity and specificity for NLR were found to be 68% and 69%, respectively, to predict lymph node metastasis. NLR was found as a prognostic factor for survival (p = 0.01). Age, the presence of comorbidity, stage, and cervical involvement were determined to be independent prognostic factors for OS in our cohort. CONCLUSION: NLR was detected to be a prognostic factor for survival. Moreover, NLR and PLR are a predictive value for lymph node involvement and also for cervical invasion in endometrial cancer.

Spot Urine Protein-to-Creatinine Ratio to Predict the Magnitude of 24-Hour Total Proteinuria in Preeclampsia of Varying Severity.

OBJECTIVE: The predictive value of spot urine protein-to-creatinine ratio (PCR) for estimating total 24-hour proteinuria in severe preeclampsia is unclear. This study aimed to assess the diagnostic accuracy of spot urine PCR for ascertaining the magnitude of proteinuria in women with preeclampsia of varying severity. METHODS: A total of 205 patients with prediagnosed preeclampsia were included in this prospective cohort study. Patients were allocated into one of the three groups categorized by severity of disease, as follows: gestational hypertension, group 1 (n = 41); preeclampsia, group 2 (n = 88); and severe preeclampsia, group 3 (n = 76). We assessed the spot urine PCRs to determine significant proteinuria and the magnitude of proteinuria in these groups. RESULTS: The spot urine PCR was 0.53, with 81% sensitivity and 93% specificity to detect significant proteinuria. A significant correlation was found between PCR and 24-hour total proteinuria in group 1 (r = 0.473, P = 0.002). There were also significant correlations in group 2 (r = 0.814, P < 0.001) and group 3 (r = 0.912, P < 0.001). The established formula using spot urine PCR to estimate 24-hour total proteinuria in severe preeclampsia was Y = 832.02X + 378.74 mg (r2 = 0.8304). CONCLUSION: Although 24-hour urine collection remains a merely reliable test to determine the degree of total proteinuria, our findings suggest that it is likely to assess the magnitude of proteinuria by the spot urine PCR, especially in severe preeclampsia. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.govNCT01623791.

A Single-Institution Radical Surgery Results in Stage IB2/IIA2 (Bulky) Cervical Cancer.

OBJECTIVE: The aim of this study is to evaluate the results of radical surgery in patients with stage IB2 to IIA2 cervical cancer who were operated on at our center between 2002 and 2015. MATERIALS AND METHODS: Forty-seven cases of patients with stage IB2/IIA2 cervical cancer who underwent primary radical surgery between 2002 and 2015 were enrolled in this study. Patients' files and pathological reports were retrospectively reviewed. Surgical, pathological, and clinical variables were analyzed and their impact on survival period was researched. Disease-free survival and overall survival periods were determined using the Kaplan-Meier test. The P value was considered significant if less than 0.05. RESULTS: Type C2 radical hysterectomy with lymphadenectomy (5 pelvic, 42 pelvic and para-aortic) was performed for all of the 47 patients in accordance with the Querleu-Morrow classification. Thirty-three of the cases were stage Ib2 and 14 cases were IIa2. Five years of overall survival was 80%. Recurrence was noted in 10 (7 pelvic, 3 extrapelvic) patients. Adjuvant therapies were needed for 83% of the patients. A univariate analysis was made for all included variables in this research and, other than recurrence, none of them was found to be statistically significant on OS and DFS. CONCLUSIONS: Although adjuvant therapies are often resorted to, primary radical surgery is also a reasonable treatment option for stage IB2/IIA2 cervical cancer, especially in young premenopausal patients when preserving ovarian functions is desired.