Impact of lymph node ratio on survival in stage III ovarian high-grade serous cancer: a Turkish Gynecologic Oncology Group study

Ali Ayhan,Nazlı Topfedaisi Ozkan,Mustafa Erkan Sarı,Husnu Celik,Murat Dede,Özgür Akbayır,Kemal Güngördük,Hanifi Şahin,Ali Haberal,Tayfun Güngör,Macit Arvas,Mehmet Mutlu Meydanlı 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.1

Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in patients with stage III ovarian high-grade serous carcinoma (HGSC). Methods: A multicenter, retrospective department database review was performed to identify patients with ovarian HGSC at 6 gynecologic oncology centers in Turkey. A total of 229 node-positive women with stage III ovarian HGSC who had undergone maximal or optimal cytoreductive surgery plus systematic lymphadenectomy followed by paclitaxel plus carboplatin combination chemotherapy were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 3 groups: LNR1 (<10%), LNR2 (10%≤LNR<50%), and LNR3 (≥50%). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results: Thirty-one women (13.6%) were classified as stage IIIA1, 15 (6.6%) as stage IIIB, and 183 (79.9%) as stage IIIC. The median age at diagnosis was 56 (range, 18–87), and the median duration of follow-up was 36 months (range, 1–120 months). For the entire cohort, the 5-year overall survival (OS) was 52.8%. An increased LNR was associated with a decrease in 5-year OS from 65.1% for LNR1, 42.5% for LNR2, and 25.6% for LNR3, respectively (p<0.001). In multivariate analysis, women with LNR≥0.50 were 2.7 times more likely to die of their tumors (hazard ratio [HR]=2.7; 95% confidence interval [CI]=1.42–5.18; p<0.001). Conclusion: LNR seems to be an independent prognostic factor for decreased OS in stage III ovarian HGSC patients.

Preparation, thermal properties and thermal reliability of eutectic mixtures of fatty acids/expanded vermiculite as novel form-stable composites for energy storage

Ali Karaipekli,Ahmet Sarı 한국공업화학회 2010 Journal of Industrial and Engineering Chemistry Vol.16 No.5

This paper deals with the preparation, characterization, thermal properties and thermal reliability of novel form-stable composite phase change materials (PCMs) composed of eutectic mixtures of fatty acids and expanded vermiculite for thermal energy storage. The form-stable composite PCMs were prepared by incorporation of eutectic mixtures of fatty acids (capric–lauric, capric–palmitic and capric–stearic acids) within the expanded vermiculite by vacuum impregnation method. The composite PCMs were characterized by SEM and FTIR techniques. Thermal properties of the composite PCMs were determined by differential scanning calorimeter (DSC) method. DSC results showed that the melting temperatures and latent heats of the prepared composite PCMs are in the range of 19.09–25.64 8C and 61.03–72.05 J/g, respectively. The thermal cycling test including 5000 heating and cooling process was conducted to determine the thermal reliability of the composite PCMs. The test results showed that the composite PCMs have good thermal reliability and chemical stability. Furthermore, thermal conductivities of the composite PCMs were increased by adding 10 wt% expanded graphite. Based on all results, the prepared form-stable composites can be considered as promising PCMs for low temperature thermal energy storage applications due to their satisfactory thermal properties, good thermal reliability, chemical stability and thermal conductivities. 2010 The Korean Society of Industrial and Engineering Chemistry. Published by Elsevier B.V. All rights reserved.

Prognostic factors and treatment outcomes in surgically­staged non­invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study

Mustafa Erkan Sarı,Mehmet Mutlu Meydanlı,Osman Türkmen,Günsü Kimyon Cömert,Ahmet Taner Turan,Alper Karalök,Hanifi Şahin,Ali Haberal,Eda Kocaman,Özgür Akbayır,Baki Erdem,Ceyhun Numanoğlu,Kemal Güngördü 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.4

Objective: To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. Methods: A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. Results: A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). Conclusion: Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.

Fragility Analysis of Atmospheric Storage Tanks by Observational and Analytical Data

Fırat Bezir,Sezer Öztürk,Ali Sarı,Kayahan Akgül 한국강구조학회 2022 International Journal of Steel Structures Vol.22 No.1

In this research, seismic fragility analysis of storage tanks is carried out with a large damage database from past earthquakes and analytical studies. At the fragility analysis, a new damage state has been defi ned. Peak ground acceleration is employed as an intensity measure. Epistemic and aleatory uncertainties are considered. At the observational fragility analysis, logit, probit and cumulative lognormal model and maximum likelihood method are utilized. In this research, Finite Element Analysis is also performed. As a result, new seismic fragility curves for storage tanks obtained and compared with the existing tank fragility curves in the literature.

Estimation of seismic effective energy based parameter

Ömer Faruk Nemutlu,Ali Sarı,Bilal Balun 국제구조공학회 2022 Structural Engineering and Mechanics, An Int'l Jou Vol.82 No.6

The effect of earthquakes in earthquake resistant structure design stages is influenced by the highest ground acceleration value, which is generally a strength-based approach in seismic codes. In this context, an energy-oriented approach can be suggested as an alternative to evaluate structure demands. Contrary to the strength-based approach, the strength and displacement demands of the structure cannot be evaluated separately, but can be evaluated together. In addition, in the energyoriented approach, not only the maximum effects of earthquakes are taken into account, but also the duration of the earthquake. In this respect, it can be said that the use of energy-oriented earthquake parameters is a more rational approach besides being an alternative. In this study, strength and energy-oriented approaches of earthquake parameters of 11 different periods of single degree of freedom systems were evaluated over 28 different earthquake situations. The energy spectra intended to be an alternative to the traditional acceleration spectra were created using the acceleration parameter equivalent to the input energy. Two new energy parameters, which take into account the effective duration of the earthquake, are proposed, and the relationship between the strength-oriented spectral acceleration parameters and the energy parameters used in the literature is examined by correlation study. According to the results obtained, it has been seen that energy oriented earthquake parameters, which give close values in similar period situations, will be a good alternative to strength oriented earthquake parameters. It was observed that the energy parameters were affected by the effective duration of the earthquake, unlike the strength-based parameters. It has been revealed that the newly proposed energy parameters considering the effective duration give good correlations. Finally, it was concluded that the energy parameters can be used in the design, and the newly proposed effective energy parameters can shorten the analysis durations.

Design Principles for Wind Turbine Earthquake and Wind Load Combinations

Elif Altunsu,Onur Gunes,Ali Sarı 한국강구조학회 2022 International Journal of Steel Structures Vol.22 No.3

With the ongoing changes in the modern world, the usage of renewable energy sources is increasing. The negative impact of fossil fuels on global warming has led to the search for clean energy sources. Wind energy, which is the most widely used of those sources, is discussed in this study. Numerous studies have been undertaken in this regard, but seismic eff ects are only newly being considered. In addition to having strong wind zones, Turkey is located in a geographical position through which active fault lines pass. The presence of high wind zones overlapping with these fault lines necessitates seismic analysis for turbines planned to be built in the country. Analysis of wind and seismic load simulation is diffi cult with traditional structural design programs. In this study, coeffi cients including wind loads are suggested for civil engineers who plan to analyze wind turbines with only seismic eff ects. For this purpose, a horizontal axis steel wind turbine with a 5 MW scale is analyzed in this work considering a series of wind and seismic loads in the area around Gelibolu. These environmental eff ects are evaluated under diff erent operating conditions of the turbine, including normal operation with no earthquake loads, park condition with earthquake loads, idling condition with wind loads, normal operation with earthquake loads, and idling condition with earthquake and wind loads. The full system model of the turbine is developed with the FAST fi nite element program employing a special code for wind turbines developed by the National Renewable Energy Laboratory. As a result of the analysis, it is concluded that seismic loads acting with the wind signifi cantly change the internal forces. Damping eff ects occur when seismic and wind loads act at the same time. For this reason, wind loads need to be reduced by a certain coeffi cient in some cases. Coeffi cients are proposed here for application in initial designs and load combinations for certain wind and earthquake conditions.

Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone

Nazli Topfedaisi Ozkan,Mehmet Mutlu Meydanlı,Mustafa Erkan Sarı,Fuat Demirkiran,Ilker Kahramanoglu,TUGAN BESE,Macit Arvas,Hanifi Şahin,Ali Haberal,Husnu Celik,Gonca Coban,Tufan Oge,Omer Tarik Yalcin,Ö 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.5

Objective: To determine factors influencing overall survival following recurrence (OSFR) inwomen with low-risk endometrial cancer (EC) treated with surgery alone. Methods: A multicenter, retrospective department database review was performed to identifypatients with recurrent “low-risk EC” (patients having less than 50% myometrial invasion[MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected. Results: We identified 67 patients who developed recurrence of their EC after initially beingdiagnosed and treated for low-risk EC. For the entire study cohort, the median time torecurrence (TTR) was 23 months (95% confidence interval [CI]=11.5–34.5; standard error[SE]=5.8) and the median OSFR was 59 months (95% CI=12.7–105.2; SE=23.5). We observed32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were locoregionalwhereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group(GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as highintermediaterisk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65–43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69–12.58; p=0.003) weresignificant predictors. Conclusion: Low-risk EC patients recurring earlier than 36 months and those carrying HIRcriteria seem more likely to succumb to their tumors after recurrence.

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus

Vakkas Korkmaz,Mehmet Mutlu Meydanli,Ibrahim Yalçın,Mustafa Erkan Sarı,Hanifi Sahin,Eda Kocaman,Ali Haberal,Polat Dursun,Tayfun Güngör,Ali Ayhan 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.6

Objective: To compare the clinical validity of the Gynecologic Oncology Group-99 (GOG-99), the Mayo-modified and the European Society for Medical Oncology (ESMO)-modified criteria for predicting lymph node (LN) involvement in women with endometrioid endometrial cancer (EC) clinically confined to the uterus. Methods: A total of 625 consecutive women who underwent comprehensive surgical staging for endometrioid EC clinically confined to the uterus were divided into low- and high-risk groups according to the GOG-99, the Mayo-modified, and the ESMO-modified criteria. Lymphovascular space invasion is the cornerstone of risk stratification according to the ESMO-modified criteria. These 3 risk stratification models were compared in terms of predicting LN positivity. Results: Systematic LN dissection was achieved in all patients included in the study. LN involvement was detected in 70 (11.2%) patients. LN involvement was correctly estimated in 51 of 70 LN-positive patients according to the GOG-99 criteria (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR−], 0.4), 64 of 70 LN-positive patients according to the ESMO-modified criteria (LR+, 2.5; LR−, 0.13) and 69 of the 70 LN-positive patients according to the Mayo-modified criteria (LR+, 2.2; LR−, 0.03). The area under curve of the Mayo-modified, the GOG-99 and the ESMO-modified criteria was 0.763, 0.753, and 0.780, respectively. Conclusion: The ESMO-modified classification seems to be the risk-stratification model that most accurately predicts LN involvement in endometrioid EC clinically confined to the uterus. However, the Mayo-modified classification may be an alternative model to achieve a precise balance between the desire to prevent over-treatment and the ability to diagnose LN involvement.