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Are patients and physicians willing to accept less-radical procedures for cervical cancer?
Kemal Gungorduk,Roman Kocian,Derman Basaran,Taner Turan,Aykut Ozdemir,David Cibula 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.4
OBJECTIVE: To evaluate the opinions of women who underwent surgery for cervical cancer (CC) and physicians who treat CC about the acceptability of increased oncological risk after less-radical surgery. METHODS: One hundred eighty-two women who underwent surgery for CC and 101 physicians participated in a structured survey in 3 tertiary cancer centers in Czech Republic and Turkey. Patients and physicians were asked whether they would accept any additional oncological risks, which would be attributable to the omission of parametrectomy (radical hysterectomy/trachelectomy vs. simple hysterectomy/trachelectomy) or pelvic lymph node dissection (systematic resection vs. sentinel lymph node sampling). RESULTS: Although 52.2% of patients reported morbidity related to their previous treatment, the majority of patients would not accept less-radical surgical treatment if it was associated with any increased risk of recurrence (50%-55%, no risk; 17%-24%, risk <0.1%). Physicians tended to accept a significantly higher risk than patients in the Czech Republic, but not in Turkey. Patients with higher education levels, more advanced-stage of disease, or adverse events related to previous cancer treatment, and patients who received adjuvant therapy were significantly more likely to accept an increased oncological risk. CONCLUSION: Patients, even if they suffered from morbidity related to previous CC treatment, do not want to choose between oncological safety and a better quality of life. Physicians tend to accept the higher oncological risk associated with less-radical surgical procedures, but attitudes differ regionally. Professionals should be aware of this tendency when counselling the patients before less-radical surgery.
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Adjuvant Treatment Modalities, Prognostic Predictors and Outcomes of Uterine Carcinosarcomas
Kemal Gungorduk,Aykut Ozdemir,Ibrahim E. Ertas,Mehmet Gokcu,Elcin Telli,Tufan Oge,Ahmet Sahbaz,Sevil Sayhan,Muzaffer Sanci,Mehmet Harma,Sinan Ozalp 대한암학회 2015 Cancer Research and Treatment Vol.47 No.2
Purpose The purpose of this study is to evaluate the clinicopathological characteristics, treatment,and prognosis of uterine carcinosarcoma (UC). Materials and MethodsA retrospective review of three cancer registry databases in Turkey was conducted foridentification of patients diagnosed with UC between January 1, 1996, and December 31,2012. We collected clinicopathological data in order to evaluate factors important in disease-free survival (DFS) and overall survival (OS). ResultsA total of 66 patients with UC with a median age of 65.0 years were included in the analysis. The median survival time of all patients was 37.5 months and the 5-year OS rate was 59.1%. In early stage patients (I-II) who received adjuvant chemotherapy (CT) with radiation therapy(RT), the median DFS and OS was 44 months and 55 months, respectively, compared to34.5 months and 36 months, respectively, in patients who received adjuvant RT or CT alone(hazard ratio [HR], 1.4; 95% confidence interval [CI], 0.7 to 3.1 for DFS; p=0.23 and HR,2.2; 95% CI, 0.9 to 5.3 for OS; p=0.03). In advanced stage patients (III-IV), the median DFSand OS of patients receiving adjuvant RT with CT was 25 months and 38 months, respectively,compared to 23.5 months and 24.5 months, respectively, in patients receivingadjuvant RT or CT alone (HR, 3.1; 95% CI, 0.6 to 16.0 for DFS; p=0.03); (HR, 3.3; 95% CI,0.7 to 15.0 for OS; p=0.01). In multivariate analysis, advanced International Federation ofGynecology and Obstetrics (FIGO) stage and suboptimal surgery showed significant associationwith poor OS. ConclusionIn patients with early or advanced stage UC, adjuvant CT with RT is associated with improvedDFS and OS, as compared to CT or RT alone.
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Kemal Gungorduk,Ibrahim E. Ertas,Aykut Ozdemir,Emrah Akkaya,Elcin Telli,Salih Taskin,Mehmet Gokcu,Ahmet Baris Guzel,Tufan Oge,Levent Akman,Tayfun Toptas,Ulas Solmaz,Askın Dogan,Mustafa Cosan Terek,Muz 대한암학회 2015 Cancer Research and Treatment Vol.47 No.3
Purpose The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC). Materials and Methods Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected. Results In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 ! 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count ! 400,000 cells/mm3, staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002). Conclusion NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.
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