Gebelikte İlaç Maruziyetinin Prenatal ve Postnatal Sonuçları

Amaç: Hastanemize başvuran ve perinatoloji konseyimizde değerlendirdiğimiz gebelerden ilaç kullanım öyküsü olanların demografik özelliklerini ve maruz kalınan ilaçların Yapısal Tedavi Edici Kimyasallar Sınıflaması (ATC) sistemine göre dağılımlarını belirlemektir. Yöntem: Bu araştırma retrospektif kohort bir çalışma olarak tasarlanmıştır. Hastane veri tabanından elde edilen veriler, literatür ışığında değerlendirilmiştir. Gebeliğinde ilaç kullanımı tespit edilen gebelerin sıklıkla hangi ilaçları kullandıkları ATC sistemine göre kategorize edildi. Aynı zamanda gebelerin demografik verileri, eğitim durumları, gelir seviyeleri, alkol sigara kullanımları, obstetrik sonuçları incelendi. Bulgular: Çalışmamıza İzmir Tepecik Eğitim ve Araştırma Hastanesi, Perinatoloji Bölümü Konseyi’nde değerlendirilen 99 gebe dahil edildi. Gebelerde ortalama yaş 31,70 [18-47, standart sapma (SS)=5,880], ortalama gravida 2,81 (1-8, SS=1,452), ortalama parite 1,4 (0-5, SS=0,988) ve başvuru sırasındaki ortalama gebelik haftası 11,27 (5-30, SS=4,692) olarak hesaplandı. Ortalama ilaç kullanım süresinin ortalama 66,56 gün olduğu tespit edildi. Çalışmamızda %29,33 oranıyla en sık sinir sistemini ilgilendirilen ilaçların kullanıldığı bunu %15,03 oranıyla sindirim sistemini ilgilendiren ilaçların takip ettiği gözlendi. İlaca maruz kalan 100 gebenin sadece 5’inde doğumsal anomali gözlemlenmiştir. Sonuç: Gebelerin demografik verileri, maruz kaldıkları ilaçların dağılımları literatür ile benzer şekildedir. Ancak daha önceki çalışmalardan farklı olarak isteğe bağlı küretaj tercihi daha düşük orandadır. Bununla birlikte doğumsal anomali görülme durumu da beklenenden yüksek değildir

Risk factors for omental metastasis and the effect of omentectomy on survival in type 2 endometrial cancer patients

To investigate the risk factors for occult omental metastasis and the effect of omentectomy on the survival of type 2 endometrial cancer (EC) patients. This study enrolled patients who were diagnosed with high-risk (grade 3, serous, clear cell, undifferentiated, carcinosarcoma, or mixed type) EC between 2000 and 2021 and underwent surgery in our center. Data from 482 patients were analyzed retrospectively. Omentectomy was performed in 405 (84.0%) patients. Omental metastases were detected in 61 (12.7%) patients. Eighteen (29.5%) of these metastases were occult. Adnexal involvement, malignant cytology, and peritoneal spread were independent risk factors for omental metastasis. The 5-year overall survival (OS) rate was 59.5% in patients who underwent omentectomy and 64.7% in those who did not (P = 0.558). In patients with and without omental metastases, the overall 5-year OS rates were 34.9% and 63.5%, respectively (P < 0.001). The 5-year OS rates of patients with a normal omentum, gross tumors, and occult metastases were 63.5%, 26.9%, and 52.5%, respectively (P < 0.001). Omental metastases is not uncommon in type II endometrial cancer; approximately one third of patients have occult metastases. Factors - positive cytology, adnexal involvement, and peritoneal involvement are associated with higher probability of omental metastases

The clinical significance of lymphovascular space invasion in patients with low-risk endometrial cancer

OBJECTIVE: The aim of this study was to assess the effect of lymphovascular space invasion on recurrence and disease-free survival in patients with low-risk endometrial cancer. METHODS: The study included patients with stage 1A, grade 1-2 endometrioid endometrial cancer who underwent a total hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Independent prognostic predictors of endometrial cancer recurrence were assessed using the Cox regression model. Binary logistic regression analysis was used to identify the predictors of distant recurrence. Kaplan-Meier analysis was used to describe survival curves, and the log-rank test was used to compare the differences in survival curves. RESULTS: A total of 189 patients met the inclusion criteria, of whom 24 (12.7%) had lymphovascular space invasion. The median follow-up time was 60 (3-137) months. Distant recurrence was present in 11 of 22 patients who developed recurrence. Kaplan-Meier survival analysis showed that the 5-year disease-free survival rates of patients with lymphovascular space invasion(+) and lymphovascular space invasion(-) were 62.5 and 91.9%, respectively, which were significantly lower (p<0.001). In multivariate Cox regression analysis, the presence of lymphovascular space invasion (p<0.001) and age ≥60 years (p=0.017) remained as prognostic factors for reduced disease-free survival. In binary logistic regression analysis, only lymphovascular space invasion (adjusted OR=13, 95%CI=1.456-116.092, p=0.022) was a prognostic factor for distant recurrence. CONCLUSION: lymphovascular space invasion is a prognostic risk factor for recurrence and distant metastasis and also a predictor of poorer disease-free survival outcomes in low-risk endometrial cancer

The prognostic value of P53 index in predicting the recurrence of early low-risk endometrial cancer

Aim: We aimed to clarify the clinical value of P53 index in patients with early low-risk endometrial cancer (EC) and find an optimal cut-off value of P53 index for predicting the recurrence of these patients. Methods: The clinicopathological data of 157 patients with early low-risk EC (stage 1A with grade 1 or 2 endometrioid EC) were analyzed. The optimal cut-off value of the P53 index was calculated by the receiver operating characteristic curve analysis and Youden index. Cox regression model was used to evaluate the independent prognostic predictors of recurrence of EC. Then all patients were divided into two groups according to the optimal cut-off value of the P53 index. Differences of the clinicopathological parameters between the two groups were compared. Results: Multivariate analysis showed age PR (p = 0.020) and P53 (p = 0.001) were independent prognostic factors for the recurrence of EC. The value of P53 index was found to be the optimal cut-off point of 17.5% in estimating the recurrence of EC. The 5-year recurrence-free survival rates of patients in the low P53 index group (<17.5%) and the high P53 index group (≥17.5%) were 94.6% and 65.4% (p < 0.001). Conclusion: It has been revealed that the P53 index is a prognostic factor for recurrence in early low-risk EC. The optimal cut-off value of P53 index may contribute to the postoperative individualized treatment options for early low-risk EC patients