HPV Vaccines: Current Status

Abstract Cervical cancer is the fourth most common cancer in women worldwide, and the main cause is Human Papillomavirus (HPV) infection. HPV vaccines have had dramatic impacts on the prevalence of targeted HPV types (6,11,16 and 18), genital warts and precancerous cervical lesions. The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have confirmed the safety of HPV vaccines after >250 million doses were administered worldwide. WHO approved the two-dose-schedule of HPV vaccines in females younger than 15 years of age, with ≥6 month intervals. Extension of vaccination to men could further reduce the population prevalence of HPV and provide direct protection of men against genital warts and anal, penile and oropharyngeal cancers. The nine-valent HPV vaccine has demonstrated equivalent protection against the four types in the quadrivalent vaccine and high efficacy against the next five commonest causes of cervical cancer (HPV types 31,33,45,52 and 58). The Advisory Committee on Immunization Practices (ACIP) recommends the nine-valent vaccine and it has been approved by the FDA in 2014 for both genders between 11–12 years of age

Adenoid Basal Carcinoma of Uterine Cervix: A Case Report

Adenoid basal carcinoma of uterine cervix is a very rare entity that has been reported less than 100 cases in the literature. Although the origin of the carcinoma is controversial; the multipotential basal cell layer of cervix is the believed part for tumor growth. A 54 years-old white postmenopausal woman was referred to our clinic with the complaint of postmenopausal bleeding. Her pelvic examination revealed a tumor lesion of 1.5cm on the ectocervix. Her cervical and endometrial biopsies revealed an epithelial carcinoma and we performed a radical hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic-paraaortic lymph node dissection. The final pathology result revealed adenoid basal carcinoma. Distinction of adenoid basal carcinoma from adenoid cystic carcinoma and other aggressive basaloid pathologies of cervix is important for the clinical management of patients since adenoid basal carcinoma is benign in behaviour despite being a carcinoma

Uterine adenosarcomas: A dual-institution experience

There has been limited literature about treatment and follow-up strategies of uterine adenosarcomas because of their rare nature. For this study we retrospectively investigated the medical database of the two major womens’ health hospitals in Turkey. A total of 15 patients were identified from the hospital’s database. Median follow-up was 86.43 months for all patients. Seven out of 15 patients had recurrences during their follow-up. Among these 7 patients, 4 of them had stage IA disease. Median Disease Free Survival (DFS) and Overall Survival (OS) were calculated as 41.47 and 57.21 months, respectively. According to our study, polypoid tumours confined to the uterus with superficial myometrial invasion can be treated without comprehensive surgical staging. We believe that, publishing all the data in an organised manner even though they are small in size, gives us an opportunity to design meta-analysis for the development of more appropriate treatment strategies

Survival Analysis of Ovarian Carcinosarcomas Depending on Platinum or Doxorubicin Based Adjuvant Chemotherapy

OBJECTIVE: To analyse the survival outcomes of women with ovarian carcinosarcoma according to platinum or doxorubicin based adjuvant chemotherapy protocols. STUDY DESIGN: This retrospective study was performed at Etlik Zübeyde Hanım and Zekai Tahir Burak Women’s Health Education and Research Hospitals, which are tertiary centers in Turkey. A total of 31 women with ovarian carcinosarcoma between January 1999 and January 2013 were evaluated retrospectively. RESULTS: The mean age of patients was 53.84±10.13. Most of the patients were diagnosed with stage IIIC ovarian carcinosarcoma (n=21, 67.7%). Maximal debulking and optimal debulking was performed to 23 (74.2%) and 8 (25.8%) patients, respectively. Disease free survival was significantly shorter in stage IIIC patients when compared to stage IIIB patients (p=0.048). Disease free survival for one and three years according to the treatment protocol (platinum or doxorubicin based) was not significantly different (p=0.574). Additionally, three and five years overall survival was not significantly different (p=0.891) between the platinum and doxorubicin based chemotherapy protocols. DISCUSSION: We did not find a significant difference in terms of disease free survival and overall survival between platinum and doxorubicin based adjuvant chemotherapy protocols in women with ovarian carcinosarcoma

Effect of Adjuvant Therapy on Oncologic Outcomes of Surgically Confirmed Stage I Uterine Carcinosarcoma

Background: Uterine carcinosarcoma is rare neoplasm that mostly presents as metastatic disease. Stage is one of the most important prognostic factor, however, the management of the early stage uterine carcinosarcoma is still controversial. Aims: To evaluate prognostic factors, treatment options, and survival outcomes in patients with surgically approved stage I uterine carcinosarcoma. Study Design: Cross-sectional study. Methods: Data of 278 patients with uterine carcinosarcoma obtained from four gynecologic oncology centers were reviewed, and 70 patients with approved stage I uterine carcinosarcoma after comprehensive staging surgery were studied. Results: The median age of the entire cohort was 65 years (range; 39-82). All patients underwent both pelvic and paraaortic lymphadenectomy. Forty-one patients received adjuvant therapy. The median follow-up time was 24 months (range; 1-129). Nineteen (27.1%) patients had disease failure. The 3-year disease-free survival and cancer-specific survival of the entire cohort was 67% and 86%, respectively. In the univariate analysis, only age was significantly associated with disease-free survival (p=0.022). There was no statistical significance for disease-free survival between observation and receiving any type of adjuvant therapy following staging surgery. Advanced age (<75 vs ≥75 years) was the only independent prognostic factor for recurrence (hazard ratio: 3.8, 95% CI=1.10-13.14, p=0.035) in multivariate analysis. None of the factors were significantly associated with cancer-specific survival. Conclusion: Advanced age was the only independent factor for disease-free survival in stage I uterine carcinosarcoma. Performing any adjuvant therapy following comprehensive lymphadenectomy was not related to the improved survival of the stage I disease.PubMedWoSScopu

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

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 (= 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= 0.50 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

Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study

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