Clinical features of gestational choriocarcinoma: A retrospective bicentric study.

OBJECTIVE: To investigate the clinicopathological features, prognostic factors, treatment, clinical response, and outcome of gestational choriocarcinoma (GCC). MATERIALS AND METHODS: A retrospective review was made of the clinicopathological and survival data of 13 patients who were diagnosed and treated for GCC in two referral centers in Turkey between 1992 and 2020. RESULTS: The median age of patients was 36 years (range, 27-54 years), and seven were ≤39 years. The antecedent pregnancy was a term in nine (69.2%) cases, and the risk score was ≥7 in 11 (84.6%). According to the International Federation of Gynecology and Obstetrics 2009 staging, eight cases were in stage I, two in stage III, and three in stage IV. With the exception of one patient, all the others received combination chemotherapy (CT), and two of those were also treated with radiotherapy. Chemoresistance developed in 50% (6/12), and second-line CT was given to four of these. The overall complete response rate was 69.2%. Four patients died of chemoresistance and disease progression, all of them were with antecedent-term pregnancy, had high scores ≥7, and had metastases. CONCLUSION: GCC is a unique subtype of gestational trophoblastic neoplasia, which differs from others in terms of poor prognosis, a frequent tendency to early metastasis, and resistance to treatment. To be able to achieve the most efficient therapy and prognosis, histopathology-based risk models should be developed.

The oncologic outcomes of endometrial cancer metastasizing to the adrenal gland and kidney: from case to analysis.

Objective: To evaluate the oncologic outcomes of endometrial cancer metastasis to the adrenal gland and kidney, based on a case study and review of the literature. Material and Methods: A systematic review of the medical literature was performed to identify articles about metastatic endometrial cancer to the adrenal gland and kidney from 1975 until 2021. Results: A 55-year-old female patient was admitted to our center. On pelvic examination, a mass protruding out of the cervix was observed, which was shown to be endometrioid carcinoma on biopsy. Disease stage was IVB, based on radiological and pathological results and the International Federation of Gynecology and Obstetrics 2018 staging. Neo-adjuvant chemotherapy was given. After therapy, the patient underwent type 2 hysterectomy, bilateral salpingo-oophorectomy, total omentectomy and lymph node dissection. Left nephrectomy, left adrenalectomy and left hemicolectomy were also performed because the conglomerate tumor invaded the left kidney, left adrenal gland, and left colon mesentery. Pathological findings were consistent with metastasis of endometrioid carcinoma in the left adrenal gland, left kidney parenchyma and hilum. Conclusion: Metastasis of endometrial cancer to the adrenal gland and kidney is extremely rare and metastasis to the kidney has been reported in only two previous cases. When there is an intraperitoneal spread of endometrial cancer, as well as ovarian cancer, cytoreductive surgery without leaving a residual tumor should be undertaken andshould include adrenalectomy and nephrectomy, if necessary.

A study on the relationship between sociodemographic characteristics and job stress and satisfaction among healthcare workers in Turkey during the COVID-19 pandemic.

The aim of this study was to determine the sociodemographic characteristics that affect job stress and job satisfaction in 454 healthcare workers (physicians, nurses, midwives, technicians, and other healthcare personnel) working with COVID-19 patients in primary healthcare institutions in Turkey with a cross-sectional, web-based survey between 9 and 30 August 2021. The survey included a personal information form, a standard job stress scale, and the Minnesota Satisfaction Questionnaire. The levels of job stress and job satisfaction did not differ between male and female respondents. Singles reported lower job stress and higher job satisfaction than the married respondents. Job stress did not differ between departments, but respondents on the front line who worked in a COVID-19 intensive care unit (ICU) (at any point and/or at the time of the study) or the emergency department reported lower job satisfaction than those working in other departments. Similarly, while stress did not differ by educational status, satisfaction of respondents with bachelor's or master's degree was lower than that of the rest. Our findings also suggest that working in a COVID-19 ICU and age are significant predictors of higher stress, whereas lower education, working in a COVID-19 ICU, and being married are good predictors of lower satisfaction. Further research should include other sociodemographic variables that may affect stress and satisfaction at work, and similar studies should follow up to see what was left in the wake of the pandemic.

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.

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.

Post-recurrence survival analysis of patients with pulmonary recurrence from gynaecologic cancers: a multi-institutional analysis of 122 patients.

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1-84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0-18.9; p < .001). When squamous cell carcinoma was compared with the other tumour types, the risk of death increased more than three times (hazard ratio: 3.7, 95% CI: 1.4-9.6; p = .007).IMPACT STATEMENTWhat is already known on this subject? Pulmonary recurrence (PR) from gynaecologic malignancies is rare and can cause major clinical problem. Therefore, defining the clinical and pathologic characteristics and recurrence patterns are essential.What the results of this study add? This study demonstrates non-squamous subtype and salvage chemotherapy at PR were associated with improved survival.What of these findings for clinical practice and/or further research? To the best of our knowledge, our study is the largest study to investigate the clinico-pathologic characteristics, recurrence patterns, treatment options, and post-recurrence survival (PRS) in patients with PR from epithelial gynaecologic cancers. Future research should examine the underlying causes of these findings.

A rare case of intracardiac leiomyomatosis in a patient who underwent complete tumor resection only using the laparotomic approach.

Intracardiac leiomyomatosis (ICLM) is a rare tumor that usually originates from the mesenchymal cells of the uterus. If left untreated, it may lead to cardiac symptoms and sudden death. The present case was a 45-year-old female patient who presented with occasional palpitations. The imaging methods revealed a heterogeneous mass likely to be leiomyoma with intense enhancement in the arterial phase in the uterus, extending from the ovarian and uterine veins to the heart through the inferior vena cava. The tumor council attributed these findings to intravenous leiomyomatosis with intracardiac extension. Accordingly, a multidisciplinary surgical team performed complete excision of the intracardiac leiomyomatosis in the patient presented herein using only the laparotomic approach. The gold standard in the treatment of ICLM is complete tumor excision. Excision of intracardiac tumors can be performed through controlled traction from the abdominal region.

Prognostic value of systemic inflammatory response markers in cervical cancer.

We investigated the association between preoperative ratios of inflammatory markers and the prognosis in patients with invasive cervical cancer (CC). In this single-centre study, we retrospectively enrolled 163 CC patients who underwent radical hysterectomy between February 2008 and October 2018. Among the evaluated ratios, a high neutrophil-to-lymphocyte ratio (N/L) was significantly associated with deep stromal invasion and tumour size larger than 2 cm, whereas a high M/L was significantly related to advanced-stage CC (IB3-IIIC2), lymphatic metastasis (total) and pelvic lymph node metastasis (p= .002, p= .046 and p= .046, respectively). The neutrophil count plus monocyte-to-lymphocyte ratio (NM/L) and platelet-to-lymphocyte ratio (P/L) were significantly higher in patients with deep stromal invasion, advanced stage and tumour size larger than 2 cm (p=.01, p=.044 and p=.007; p=.004, p=.005 and p=.003, respectively). In the multivariate analysis, high NM/L (>168) was associated with a statistically significant hazard ratio of 3.04 (95% CI: (1.38-6.72); p=.006) for recurrence and 9.05 (95% CI: (2.10-38.99); p=.003) for death. Both stage and NM/L are independent prognostic factors that are significantly associated with recurrence and overall survival in CC.Impact StatementWhat is already known on this subject? Previous studies suggested that there is a relationship between inflammation and the formation, development and progression of cancer. However, the relationship between cervical cancer (CC) and inflammatory blood parameters is incompletely understood.What do the results of this study add? This study investigated the relationship between systemic blood inflammatory ratios and clinicopathological patient characteristics and disease outcomes in CC.What are the implications of these findings for clinical practice and/or further research? According to this study, systemic blood inflammatory ratios may help predict the prognosis and survival of patients with CC.

Oncologic outcomes of patients with FIGO 2014 stage IB-IIA cervical adenocarcinoma who underwent radical surgery.

PURPOSE: To identify prognostic factors of early-stage cervical adenocarcinoma in patients with FIGO IB-IIA, who were treated with radical surgery. MATERIALS AND METHODS: Clinical data of 64 patients with stage IB-IIA cervical adenocarcinoma who underwent radical hysterectomy and lymphadenectomy with or without adjuvant therapy between 1993 and 2019 were retrospectively reviewed. The clinicopathologic factors that affect the oncological outcomes were evaluated. The Kaplan-Meier method was used for the assessment of survival outcomes. Survival curves were compared using the log-rank test. RESULTS: The 5-year recurrence-free survival and 5-year disease-specific survivals were 83% and 98%, respectively. Tumor size, stage of disease and uterine spread were significantly related prognostic factors for shorter recurrence-free survival. During the follow-up, nine (14.1%) patients recurred. Five of them were extrapelvic recurrence. No correlation was identified between histopathologic subtype and extrapelvic recurrence (p = 0.265). There was no difference between adjuvant only radiotherapy and concurrent chemoradiotherapy on recurrence-free survival in a univariate analysis adjusting for prognostic factors. CONCLUSION: It is important to determine the prognostic factors that predict disease outcome in surgically treated cervical adenocarcinoma for tailored adjuvant treatment. Tumor size, stage and uterine spread are determinant factors for recurrence. Risk stratifications, including uterine spread may especially be useful for patients with AC.

High Grade Serous Ovarian Carcinoma in a Liver Transplant Recipient Patient: A Case Report and Review of Literature.

According to GLOBOCAN 2020 data, the incidence of ovarian cancer is 1.6%. Ovarian cancer ranks 19th in incidence and 15th in mortality with a rate of 2.1%. High-grade serous ovarian cancer is the most common subtype of malignant ovarian tumors, and around 70% to 80% of all ovarian malignancies are included in this group. The incidence of gynecologic malignancies in liver transplant recipients is between 0% and 1.5%, and the duration of diagnosis for gynecologic cancer after transplantation is between 1 and 59 months. A 52-year-old patient was admitted to our hospital complaining of a periumbilical nodule. Her medical history revealed she had a cadaver liver transplantation in 2003 because of cirrhosis due to hepatitis B. On her physical examination, an erythematous nodular lesion was observed in the umbilical region. Ultrasonography demonstrated diffuse ascites and approximately 30 mm of a soft tissue density with lobulated contours located on the periumbilical skin. Both cytology and biopsy results were reported consistent with high-grade serous ovarian cancer. She underwent an operation, she had no problems during the postoperative follow-ups, and she was discharged on the eighth postoperative day. According to the 2018 International Federation of Gynecology and Obstetrics staging criteria for ovarian cancer, the patient's cancer was stage IVB. The patient received 6 cycles of adjuvant chemotherapy that included carboplatin (AUC = 6) and paclitaxel (175 mg/m2). The patient was evaluated as having a complete response according to Response Evaluation Criteria in Solid Tumors. The patient has been disease-free for 11 months after diagnosis.

Defining prognostic factors in older patients with endometrial cancer.

BACKGROUND: Endometrial cancer (EC) is most frequently seen in older and postmenopausal women. AIM: The aim of this study was to evaluate the rate of recurrence and survival and clinical, pathological, surgical, and treatment factors affecting recurrence and survival in older patients with EC. METHODS: Three hundred and six (21.7%) patients aged ≥ 65 out of a total of 1413 patients diagnosed with and treated for epithelial EC at the Division of Gynecologic Oncology between January 1993 and May 2013 were evaluated retrospectively. All patients were staged according to FIGO 2009 staging system. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were determined. Independent prognostic factors affecting recurrence and survival were evaluated by multivariate logistic regression analysis. RESULTS: The median age of the patients was 68 (65-92) years. Eighty-nine patients (29.1%) were diagnosed with stage III-IV disease. Tumor type was endometrioid in 226 (73.9%) patients, and 101 (33%) patients were diagnosed with FIGO grade 1 endometrioid endometrial cancer. One hundred fifty-three patients received adjuvant therapy after surgery. Five-year PFS, 5-year CSS, and 5-year OS were 73%, 85%, and 83%, respectively. Only the 2009 FIGO stage was independently associated with PFS (OR = 3.495, 95% CI 1.592-7.675; p = 0.002) and CSS (OR = 6.135, 95%CI 1.269-31.417; p = 0.024). CONCLUSION: In conclusion, 2009 FIGO stage was found to be the only independent prognostic factor associated with recurrence and death in older patients with endometrial cancer.

Evaluation of peripheral nodal recurrence in patients with endometrial cancer

OBJECTIVE: To evaluate the clinico-pathological patient features, prognostic factors, treatment options and outcomes of peripheral nodal recurrence (PNR) of endometrial cancer (EC). MATERIAL AND METHODS: The data of nine patients with PNR of EC from two institutions were reviewed. The electronic literature was reviewed from 1972 to May 2018 to identify articles about PNR in EC. Finally, 42 cases were evaluated. RESULTS: Nineteen (45.2%) patients were initially diagnosed with either stage I or II disease, whereas 20 (47.7%) patients had stage III or IV disease while the stages were not reported in three (7.1%). PNR developed as the first recurrence in 40 (95.2%) patients and as the second recurrence in 2 (4.8%) patients. Isolated PNR appeared in 35 (83.3%). Seven (16.7%) had PNR coexisting with multiple other sites of tumoral involvement. In the entire cohort, the 5-year and 10-year post-recurrence survival (PRS) were both 78%. Only the presence of distant hematogenous metastasis concurrent with PNR was significantly related to poor PRS (p=0.005). Among patients with isolated PNR, those who had surgery had 30% greater 5-year PRS than those treated without surgery, but this difference was not significant (80% vs 50%; p>0.05). CONCLUSION: A concurrent distant hematogenous metastasis was the only factor related to poor survival. A wide range of therapies exists for PNR but none of the therapies appear to be more advantageous than another. However, surgery as a component of treatment can render a survival advantage for patients who have isolated PNR.

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.

Prognostic factors determining survival after extrapelvic recurrence in endometrioid type endometrial cancer.

OBJECTIVE: To define the factors that determine survival after extrapelvic recurrence in patients with endometrioid type endometrial cancer (EC).objective MATERIALS AND METHODS: Clinicopathological and survival data of surgically treated endometrioid type EC patients who recurred outside pelvis were reviewed. Patients who had non-endometrioid tumor, sarcomatous component in the final pathology and synchronous tumor were excluded. The period from surgery to recurrence was defined as time to recurrence (TTR) and the period from recurrence to death or last visit was defined as post-recurrence survival (PRS). RESULTS: Sixty-six patients with extrapelvic recurrence were included in the study. No residual disease was achieved in all patients at initial surgery. Median TTR was 18 months (range, 2-84). Recurrence developed within 1 year in 24 (36.4%) patients and between 13 and 24 months in 22 (33.3%) patients. Fifty-three of 66 patients (80.3%) had extraabdominal recurrence. The 2-year PRS of the all cohort with extrapelvic recurrence was 56%. In the univariate analysis, advanced FIGO stage, lymph node metastasis, adnexal metastasis and short TTR were associated with diminished PRS (p < 0.05). The salvage chemotherapy for recurrence had a tendency to be associated with improved PRS in the univariate analysis. Two-year survival was 81% and 37% in the patients who received chemotherapy and radiotherapy, respectively (p = 0.057). CONCLUSION: Almost half of the patients with extrapelvic recurrence died of disease within 2 years. Chemotherapy seemed to be more effective than radiotherapy as the salvage therapy of extrapelvic recurrences.

The prognostic factors in 384 patients with FIGO 2014 stage IB cervical cancer: What is the role of tumor size on prognosis?

OBJECTIVE: To define the relationship of tumor size with surgico-pathological factors and oncological outcome in FIGO 2014 stage IB cervical cancer. METHODS: This study retrospectively evaluated 384 FIGO 2014 Stage IB cervical cancer patients who underwent radical hysterectomy and lymphadenectomy. Tumor size was stratified according to 2 cm (≤ 2cm, 2-≤4 cm, >4 cm) and 4 cm (≤4 cm, >4 cm), and the relationship with poor prognostic factors, and the effects on survival were examined. The distribution of prognostic factors was compared between three subgroups: ≤2 cm vs. 2-≤4 cm; 2-≤4 cm vs. > 4 cm and ≤ 2 cm vs. > 4 cm. Survival rate was evaluated using the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis was performed using Cox proportional-hazards regression. RESULTS: Stratification of tumor size according to 4 cm was found to better determine pelvic lymph node determination. Parametrial involvement, uterine involvement and deep cervical stromal invasion were correlated with increasing tumor size. Lymph node involvement and uterine involvement were an independent prognostic risk factor for recurrence and cancer-specific survival. Tumor size showed no association with prognosis. CONCLUSION: There is no meaningful cut-off value for tumor size determining all surgico-pathological factors. There was also seen to be no association between tumor size and recurrence or disease-related mortality.

Neoadjuvant chemotherapy for locally advanced stage (IB2-IIA2-IIB) cervical carcinoma: Experience of a tertiary center and comprehensive review of the literature

Objective: This study aimed to evaluate neoadjuvant chemotherapy (NACT) for locally advanced stage cervical carcinoma. Materials and Methods: Data of 43 patients with locally advanced cervical carcinoma who had NACT were reviewed. NACT protocols implemented included cisplatin/5-fluorauracil, cisplatin/UFT, and carboplatin/paclitaxel. After NACT, the patients were re-examined, and patients who had a tumor size ≤40 mm underwent Piver-Rutledge type III radical hysterectomy, while other patients received radiotherapy. Following NACT, clinical responses were assessed according to the criteria of the World Health Organization. Results: The mean age of the patients was 49.4 years, and the median follow-up duration was 48 (range, 5-228) months. The median tumor sizes were 50 and 30 mm before and after NACT, respectively. Complete clinical response was observed in 4 (9.3%) patients, partial clinical response in 8 (18.6%), and pathologic complete response in 3 (6.9%). Stable disease was noted in 30 (69.9%) patients and progression in 1 (2.3%) patient. After NACT, 31 patients have undergone radical surgical procedures. The 5-year disease-free survival rate was 72%, and the 5-year disease-specific survival rate was 91%. Age, International Federation of Gynaecology and Obstetrics 2009 stage, histopathologic type, NACT protocol, rate of decrease in tumor size after NACT, clinical response, number of courses, tumor size before NACT, tumor size after NACT, and lymph node metastasis were not associated with disease-free survival. Conclusion: Following NACT, a significant reduction in tumor dimension was observed, and the probability of radical surgery is increased. However, clinical response was not predictive of survival.

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.

Malignant struma ovarii: From case to analysis.

AIM: To evaluate the clinico-pathologic features, treatment options, prognostic factors, and survival outcomes of malignant struma ovarii based on a systematic literature review in association with our case study. METHODS: A systematic review of the medical literature was performed to identify articles about malignant struma ovarii from January 1983 until July 2020. We evaluated 178 cases. RESULTS: The 5-year progression-free survival (PFS) and overall survival (OS) of the entire cohort was 72.5% and 91%, respectively. In univariate analysis, younger age (<43 years), whole strumal cyst diameter >95 mm, presence of a histologic type other than papillary classic-type thyroid carcinoma within the tumor and lymphovascular space invasion were related to poor PFS. Patients who received radioactive iodine ablation (RIA) before the treatment failure had significantly higher PFS than those who did not receive RIA (94.9% vs. 64.8%, p = 0.041, respectively). In univariate analysis, PFS was significantly higher in patients who underwent gynecologic surgery followed by thyroidectomy and RIA compared with those who had surgical treatment only (94.5% vs. 64.3%, p = 0.05, respectively). However, this result could not be identified as an independent prognostic factor in multivariate analysis (p = 0.207). Younger age and absence of capsular involvement were related to significantly increased OS. Histologic type was the only independent prognostic factor for PFS (hazard ratio: 3.30, 95% confidence interval: 1.122-9.748; p = 0.030) CONCLUSION: The most common histologic subtype was the papillary classic type. The presence of a histologic type other than the classic papillary thyroid carcinoma within the tumor was an independent adverse prognostic factor.