e17500 Background: Advanced-stage epithelial ovarian cancer (EOC) is characterized by biological heterogeneity and poor outcomes. Traditional survival statistics fail to capture the dynamic, time-dependent nature of prognosis. Conditional survival provides a framework for updating prognosis over time and offers clinically meaningful information for patient counseling and survivorship planning. In this two-decade real-world study, we applied conditional survival analysis to evaluate how prognosis evolves as patients live longer and remain progression-free. Methods: We retrospectively analyzed patients with FIGO stage III–IV epithelial ovarian cancer who underwent primary or interval cytoreductive surgery between 2004 and 2024. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Conditional overall survival (CS-OS) and conditional progression-free survival (CS-PFS) were calculated for additional 1- and 5-year intervals among patients who had survived or remained progression-free for 6 months, 1 year, 3 years, or 5 years after surgery. Results: A total of 808 patients with FIGO stage III–IV epithelial ovarian cancer were included. Median OS and PFS were 4.37 and 1.70 years, respectively, and approximately 11% survived beyond 10 years. Peritoneal dissemination and platinum resistance were independent predictors of poor survival. Conditional survival improved with increasing time survived. The 1-year CS-OS increased from 87% at 6 months to 95% at 5 years, while the 5-year CS-OS rose from 49% to 66%. Similarly, the 1-year CS-PFS increased from 89% to 95%, and the 5-year CS-PFS improved from 44% to 62%. In stage-stratified analyses, 5-year CS-OS increased from 43% to 58% in FIGO stage III disease and from 26% to 44% in FIGO stage IV disease. Conclusions: Conditional survival analysis provides time-updated prognostic information that complements traditional survival estimates and more accurately reflects long-term outcomes. Incorporating conditional survival into clinical practice may support more individualized patient counseling and inform survivorship planning, particularly for patients who remain alive and progression-free beyond the initial high-risk period. Conditional survival rates based on previous time survived (CS-OS) or on time without progression (CS-PFS) in patients with advanced epithelial ovarian cancer. Time already survived/progression-free CS-OS at 1 year (95% CI) CS-OS at 5 years (95% CI) CS-PFS at 1 year (95% CI) CS-PFS at 5 years (95% CI) 6 months 87 (84–90) 49 (45–53) 89 (86–92) 44 (40–48) 1 year 88 (85–91) 49 (45–53) 90 (87–93) 46 (42–50) 3 years 91 (88–94) 57 (52–62) 93 (89–96) 54 (50–58) 5 years 95 (92–98) 66 (61–71) 95 (91–98) 62 (57–67)

OBJECTIVES:Pregnancy after transplant still confers increased risks of various complications. This study analyzed obstetrical and perinatal outcomes of posttransplant pregnancy in kidney and liver transplant recipients. MATERIALS AND METHODS:We included kidney and liver transplant recipients with posttransplant pregnancy who were followed in our institution from 2011 to 2025. Patients were monitored simultaneously in the transplant outpatient clinic and obstetrics and gynecology clinics. We retrospectively analyzed the obstetrical complications, perinatal outcomes, and the effect of pregnancy on allograft function. RESULTS:We analyzed 18 kidney and 13 liver transplant recipients with posttransplant pregnancy. Mean mater-nal age of kidney transplant recipients was 31.1 years at the birth of the child. In the kidney transplant group, 7 patients (35 % ) delivered live birth at term, 7 patients (35 % ) experienced pregnancy complications of ges-tational hypertension or preeclampsia, and 1 patient experienced graft rejection during the postpartum period. In the liver transplant group, 8 patients (61.5 % ) delivered live birth at term. One patient had intrahepatic cholestasis of pregnancy, 1 patient had preterm premature rupture of membranes, 1 patient had preeclampsia, and 1 patient had gestational diabetes. There were no graft rejections in the liver transplant group. Mean maternal age and rate of nulliparity were higher in the kidney transplant versus the liver transplant group (P = . ⁰³² and P = . ⁰¹³, respectively ). No significant differences were shown for gestational age at delivery, preterm birth rate, birth weights of the newborns, and rates of neonatal intensive care unit hospitalizations. CONCLUSIONS:Pregnancy after solid -organ transplant is associated with potential risks for the mother, newborn, and the allograft. We observed higher rates of adverse obstetrical outcomes in the kidney transplant group versus the liver transplant group. We believe that a multidisciplinary approach during the antenatal and postpartum periods is essential to improve outcomes and minimize complications.

Leiomyosarcoma is characterized by its aggressive behavior, poor prognosis, resistance to chemotherapeutic drugs, and high recurrence rate. This study aimed to identify prognostic factors affecting the effectiveness of cytoreductive surgery (CRS) on overall survival (OS) in patients with recurrent leiomyosarcoma (LMS). A retrospective analysis was conducted at Başkent University Ankara Hospital from 2007 to 2016, involving 59 patients with uterine LMS who underwent surgery. We assessed demographic and clinical variables, disease recurrence intervals, and treatment outcomes. The median age of the patients was 50.0 (23–78) years, and the median follow-up time was 25.0 (2–87) months. Median disease-free survival (DFS) and OS were 15.0 and 37.0 months, respectively. Disease recurrence occurred in 44 patients (74.6

Advanced-stage epithelial ovarian cancer (EOC) is defined by biological heterogeneity and poor outcomes, and traditional survival metrics fail to reflect the evolving nature of prognosis as patients survive longer. This study aimed to evaluate conditional survival (CS) in advanced EOC using both overall survival (OS) and progression-free survival (PFS) metrics to provide a dynamic understanding of long-term outcomes. We retrospectively analyzed 808 patients with FIGO stage III-IV EOC who underwent surgery at Baskent University Ankara Hospital between 2004 and 2024. CS estimates were calculated for additional 1- and 5-year intervals among patients who had already survived 6 months, 1, 3, or 5 years after surgery. Median OS and PFS were 4.37 and 1.70 years, respectively. Peritoneal dissemination and platinum resistance were independent predictors of poor survival. Approximately 11% of patients achieved survival beyond ten years. The 1-year CS-OS increased from 87% at 6 months to 95% at 5 years, while the 5-year CS-OS rose from 49% to 66%; corresponding CS-PFS values increased from 89% to 95% and from 44% to 62%. Conditional survival analysis underscores that prognosis in advanced ovarian cancer is not static but continually improves with time survived and sustained disease control. These insights redefine long-term outcomes and provide a modern foundation for individualized patient counseling and survivorship planning.

OBJECTIVE:Brain metastases (BM) from epithelial ovarian cancer (EOC) are rare but clinically significant due to their poor prognosis. This study aimed to investigate prognostic factors influencing survival in EOC patients who developed BM and to evaluate treatment-related outcomes. METHODS:A retrospective review was conducted on 1123 patients with EOC treated between 2008 and 2021. Among them, 27 patients (2.4 %) developed BM. Demographic, clinical, and treatment-related data were collected. Overall survival after BM diagnosis was assessed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed on 21 patients who received active treatment (surgery and/or radiotherapy). RESULTS:The median time from ovarian cancer diagnosis to BM was 27 months, and the median post-BM survival was 12 months. Survival was significantly longer in platinum-sensitive patients (38 vs. 7 months, p = 0.04). Median survival was 30 months with combined therapy, 13 months with radiotherapy alone, and 1 month with palliative care (p = 0.01). Within the radiotherapy group, the median survival was 13 months in patients treated with stereotactic radiosurgery (SRS) and 6 months in those who received whole-brain radiotherapy (WBRT). Univariate analysis identified platinum sensitivity (p = 0.075), number of metastases (p = 0.017), and lesion localization (p = 0.021) as factors associated with survival. In multivariate analysis, platinum sensitivity remained the only independent predictor of improved survival (HR: 0.34; 95 % CI: 0.16-0.71; p = 0.04). CONCLUSION:Platinum sensitivity is a key prognostic determinant in ovarian cancer patients with BM. Early identification and tailored multimodal treatment strategies may contribute to prolonged survival in selected patients.

Objective:To evaluate the oncological and reproductive outcomes of patients with ovarian sex-cord stromal tumors (SCSTs) treated with fertility sparing surgery (FSS). Material and Methods:This retrospective study included patients diagnosed with malignant ovarian SCSTs between February 2007 and June 2020 at Başkent University Hospital, Ankara. All patients underwent FSS, which preserved at least one ovary and the uterus. Data on demographics, surgical and pathological features, adjuvant treatments, follow-up, recurrence, survival, and obstetric outcomes were collected. Follow-up continued until September 2025, with survival analyses performed using Kaplan-Meier and Cox regression methods. Results:The median age of the 35 included patients was 29.0 years, with a median follow-up of 141.0 months. Recurrence occurred in 17.1%, and disease-related mortality was 8.6%. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 85.7% and 97.1%, respectively. No significant factors influenced DFS, while adjuvant therapy impacted OS in univariate analysis. All patients maintained regular menstrual cycles post-treatment. Nine patients conceived (36.0%), resulting in 12 pregnancies and 6 live births (50.0%). Chemotherapy did not significantly affect fertility outcomes. Conclusion:FSS in patients with ovarian SCSTs demonstrated favorable oncologic and reproductive outcomes. Larger, prospective multicenter studies are necessary to optimize management strategies and establish definitive guidelines for fertility preservation in this patient population.

ABSTRACT Objective: This study aims to compare the clinicopathological characteristics and oncologic outcomes of patients with vanishing endometrial cancer (VEC) and superficial endometrial cancer (SEC). Materials and Methods: A retrospective analysis was conducted on 130 patients diagnosed with stage IA endometrial cancer who underwent surgery at Başkent University School of Medicine from 2007 to 2023. Data including age, body mass index (BMI), histopathological type, lymphovascular space invasion, and survival outcomes were collected. Statistical analyses were performed using IBM SPSS version 25.0. Results: Among the 130 patients, 40 (30.8%) had VEC and 90 (69.2%) had SEC. The median age was 55 years, and the median follow-up was 74.5 months. The 5-year DFS and OS rates were 99.2% and 97.5%, respectively, with no significant differences between the groups. Patients with VEC were younger and had a lower mean BMI compared to those with SEC. Rates of endometrial intraepithelial neoplasia and hyperplasia were similar across the groups. Conclusion: VEC is a rare entity that requires surgical intervention, as a significant proportion of patients exhibit hyperplasia or EIN in surgical specimens. The comparable survival outcomes for VEC and SEC suggest that current management strategies can yield favorable prognoses for both, emphasizing the need for careful monitoring to avoid undertreatment of VEC cases.

Objective The aim of this study was to investigate the impact of adjuvant treatments, factors influencing recurrence, and survival data in patients with 2023 International Federation of Gynecology and Obstetrics (FIGO) stage IIB endometrial cancer. Methods A retrospective analysis was conducted on patients with endometrial cancer who underwent surgery between 2005 and 2022 at seven different centers in Turkey. Demographic, clinicopathological, and survival data were collected and analyzed. Results Among 7323 patients, 565 (7.7%) were classified as 2023 FIGO stage IIB based on pathological results. Of 565 patients, 214 were followed without receiving adjuvant treatment, while 335 (95.4%) received adjuvant radiotherapy, and 16 (4.6%) received radiotherapy and chemotherapy. The locoregional recurrence rate was higher in patients with a tumor size >4 cm (p=0.038) and myometrial invasion >50% (p=0.045). In patients with distant metastasis, the recurrence rate was lower in those with myometrial invasion <50% compared with myometrial invasion ≥50% (p=0.031). The impact of adjuvant treatment on endometrial cancer patients revealed no significant differences for both disease free survival (p=0.85) and overall survival (p=0.54). Subgroup analyses showed that in patients with deep myometrial invasion, adjuvant treatment was associated with a significant increase in overall survival (p=0.044), but there was no effect on disease-free survival (p=0.12). Conclusions Patients with stage IIB endometrial cancer with myometrial invasion ≥50% were more likely to have locoregional and distant metastases. Adjuvant radiotherapy or chemoradiotherapy did not demonstrate an overall survival benefit in these patients.

OBJECTIVES:Clinical findings support the critical importance of cervical screening and the management of abnormal cervical cytology results in female organ transplant recipients. We evaluated the incidence and prognosis of atypical cervical lesions in women who are kidney and liver transplant recipients at our organ transplant center. MATERIALS AND METHODS:We performed a retrospective cohort study of patients at Başkent University, Ankara, Türkiye, from March 2003 to January 2023. We included women who underwent at least 1 cervical cytology after kidney or liver transplant. The Bethesda System was used to classify cervical cytology results. We analyzed follow-up data by using descriptive statistics. RESULTS:Our study included 124 patients, with 98 (79%) being kidney transplant recipients and 26 (21%) being liver transplant recipients. The median age was 37.5 years. Atypical cervical cytology was detected in 34 patients (27.4%). The distribution of cervical cytology results was 90 with normal cytology (72.6%), 10 with atypical squamous cells of undetermined significance (8.1%), 23 with low-grade squamous intraepithelial lesion (18.5%), and 1 with high-grade squamous intraepithelial lesion (0.8%). Among these, 42 patients (33.9%) underwent colposcopy, revealing abnormal results in 10 patients (23.8%), including 1 (2.38%) with cervical cancer. CONCLUSIONS:The findings underline the significant prevalence of atypical cervical lesions among solid-organ recipient patients, highlighting the need for proactive cervical screening and management strategies in this high-risk population.

Long-term immunosuppressive therapy increases the likelihood of renal transplant patients developing cervical cancer. We aimed to analyze the results of cervical cytology in renal transplant patients, compare these findings to those of the normal population, and determine the risk factors linked to the development of squamous intraepithelial lesions. Our analysis involved a retrospective study of hospital records from January 2000 to April 2018, encompassing 140 female renal transplant patients. A control group of 280 women with normal health status was selected and matched based on age and the cervical cytology procedure. The cervical cytology findings of the patients were re-evaluated using the Bethesda 2014 criteria. Of the total of 420 patients, 37 patients had epithelial cell abnormalities; including 32 (86.5%) patients in the renal transplant group and 5 (13.5%) control group (p ≤ 0.001). Sixty-two patients had infections; including 44 (71%) patients in the renal transplant group and 18 (29%) control group (p ≤ 0.001). We revealed that the development of squamous intraepithelial lesions was associated with factors such as having an immunologic disease as the primary renal disease, undergoing re-transplantation, and the presence of acute rejection (p ≤ 0.05). Cervical cytology screening plays a crucial role in detecting preinvasive lesions. The incidence of epithelial cell abnormalities is significantly higher in renal transplant patients compared to the normal population. Regular cervical cytology follow-up is vital for the early detection and prevention of cervical cancer progression in transplant recipients.

IntroductionThe aim of study was to compare the outcomes of stage III-IV ovarian cancer patients treated with NACT+İDS or PDS and to demonsrate the real life experience of a single centerMethodsThis retrospective case control study was carried out in Baskent University,Ankara,Turkey.Patients with high grade serous histology who diagnosed between 2007 and 2022 were evaluated .Patient ‘s characteristics and tumoral features like age,type of surgery,complications,OS,DFS were retrospectively documented.Results473 patienst included in PDS group and 143 patients included in NACT group.PDS group were slighly younger 57 y vs 59 y (p=006).Median follow up time was 44 months.PDS group were more subjected to extended surgery 46% vs 26% (p=0.001) ,however grade III-IV complications rates and RO resection rates were similar 6,8% vs 11,8% (p=0.18) and 78% vs 85% p=0.06 respectively . Median OS was 37 months (95% CI ;28,9–45,0) and 53 months (95% CI 48,2–57,2) for NACT and PDS group respectiveley ( p<0.00). Median DFS for NACT group was 12 months (95% CI ;10.2–13.7) and 15 months (95% CI 13.6–16.3) for PDS group ( p=0.002).İn the cox proportional hazard model NACT was associated with dimished DFS and OS (HR:1.3 ,95% CI:1.0–1.7; p=0.001) and (HR:1.6 ,95%CI:1.1–2.4; p=0.001 )Conclusion/Implicationsİn our retrospective cohort PDS seems to be more effective in the treatment of Stage III-IV ovarian cancer and patients who treated with PDS had better DFS and OS .

Introduction/Background In our clinical practice we began to plan paclitaxel rechallenge earlier (in thirdline) in patients with platine resistant recurrent high grade serous ovarian cancer (HG-SOC) and our aim is to evaluate the outcome of this approach with other prognostic factors. Methodology This retrospective study included 49 patients. Patient data including age, recurrence time, histopathological results, chemotherapy protocols, were obtained from the hospital database. Early paclitaxel rechallenge was defined as paclitaxel rechallenge in the thirdline after the secondline liposomal doxorubycin, late paclitaxel rechallenge was defined as treatment in further lines. Results The median age of the was 54 (range, 27–77). Median overall survival (OS) was 45 (range, 21–186) months. In survival analyses patients who underwent late rechallenge had worse overall survival (58.9 vs. 64.4 months, p:0.219) but this finding did not reach a statistical significance. In evaluation of challenges agent types patients who underwent single agent (only paclitaxel) had better OS when compared to two agents (paclitaxel + carboplatine); 67.6 vs 54.4 months (p:0.713) whereas this also did not reach a statistical significance. Conclusion Despite the later onset of approach and low number of patients the results of our study supports that early paclitaxel rechallenge may be promising in management of platine resistant recurrent high grade serous ovarian cancer. Also, single agent rechallenge may be a better option to avoid the chemotherapy related side effects with better overall survival results. Disclosures none

ObjectiveThis study aimed to assess the long-term oncologic and obstetric outcomes of women with epithelial ovarian cancer who underwent fertility-sparing surgery. MethodsA total of 68 patients observed between March 2007 and July 2021 were included in this retrospective study. Unilateral salpingo-oophorectomy and uterine preservation with staging surgery were the main procedures for fertility-sparing surgery. Disease-free, overall survival, and obstetric outcomes were measured as primary outcomes. ResultsThe median age of the patients was 30.5 years. The median follow-up time was 60.5 months. Disease recurrence occurred in 15 (22.1%) of the patients. Five-year disease-free survival and overall survival (OS) percentages were 75.6% and 83.3%, respectively, for all stages. The FIGO (International Federation of Gynecology & Obstetrics) stage was the only significant factor that affected OS (P = 0.001). Twenty-three patients tried to conceive, and 15 (65.2%) patients became pregnant. Twelve (80%) pregnancies reached term and resulted in 15 live births. Chemotherapy administration and surgical intervention (cystectomy or unilateral salpingo-oophorectomy) showed no difference in pregnancy results (P = 0.806 and P = 0.066, respectively). ConclusionFertility preservation is safe for invasive epithelial ovarian cancer at early stages for women in the reproductive era. Disease recurrence and OS results are similar to standard treatment at early stages with decent obstetric outcomes.

Uterine cervical sarcomas are extremely rare tumors. Patients may present with vaginal bleeding, mass protruding from vagina, and vaginal discharge. Surgical treatment as well as chemotherapy or radiotherapy can be utilized. Fertility-sparing surgery can be performed since most patients are in their reproductive age. Data of four patients with a mean age of 17.7 years are discussed. Fertility-sparing surgery was performed in all of these patients and adjuvant chemotheraphy was needed in two of them. Subtype of sarcomas were embryonal rhabdomyosarcoma in three patients, and alveolar soft part sarcoma in one patient. Three patients are being followed as disease-free, one case died.

INTRODUCTION:Although epithelioid ovarian cancer (EOC) is a radiosensitive tumor and radiotherapy (RT) played a significant role in adjuvant treatment management in the past, the role of RT has evolved with the advent of platinum-based chemotherapy regimens. Nonetheless, modern RT techniques may be useful in certain patients particularly those with recurrent disease.PRESENTATION OF CASE:After surgery and chemotherapy, two patients, aged 57 and 70, presented with recurrent lesions in the parailiac region. The recurrent lesions were treated with high field 1.5-Tesla MR-Linac treatment in 5 fractions at a dose of 30 Gy. The patients tolerated the treatment well and were disease free after 12 and 20 months of magnetic resonance guided radiotherapy (MRgRT), respectively.DISCUSSION:MRgRT is a novel and rapidly evolving technology that allows for the highly precise treatment of even mobile targets through direct visualization of the tumor. The majority of patients with EOC frequently present with abdominal-pelvic recurrences. It has been demonstrated that EOC requires high radiation doses for curative treatment. MR-Linac enables monitoring of organ motion during treatment, which is necessary for delivering higher doses to target volumes while sparing surrounding organs.CONCLUSION:To reduce radiation doses to nearby normal tissues, MRgRT allows for the delivery of hypofractionated RT with tight safety margins. Regardless of initial resistance or gradual development of intolerance to standard chemotherapy regimens, the role of RT in patients with persistent or recurrent EOC should be reconsidered.

A retrospective observational study was carried out in Baskent University School of Medicine, Ankara, Turkey. Recurrent ovarian cancer patients treated between 2007 and 2017 were divided into two groups according to their bevacizumab status. The primary endpoints were overall survival (OS) and safety. Three hundred and ninety-six patients enrolled in this study, 200 (50.5%) received bevacizumab while 196 (49.5%) patients never received bevacizumab. The median follow-up time was 48.2 and 47.6 months, respectively. The 5-year OS was 61% and 46%, respectively (p=.007). In multivariate analysis, only platinum-sensitivity (HR: 3.75, 95% CI: 3.0-5.32; p<.001) was identified as independent prognostic factors. In subgroup analyses according to platinum status, bevacizumab did not affect the 5 year OS in platinum sensitive patients (64% versus 68% p=.28) but increased survival in platinum resistant patients (36% versus 44%, p=.00). The rate of grade III-IV haematologic toxicities was 13.7% in the bevacizumab group and 11% in the other group (p=.6).Impact StatementWhat is already known on this subject? Bevacizumab increases the progression-free survival in platinum-sensitive and resistant recurrent ovarian cancer patients without changing overall survival.Whatdothe results of this study add? Bevacizumab did not affect OS in platinum sensitive recurrent ovarian cancer patients however improved OS in platinum resistant patients with mild toxicity.Whatarethe implicationsof these findingsfor clinical practice and/or further research? This study emphasised the crucial role of bevacizumab in the treatment of recurrent ovarian cancer patients.

Objective To evaluate the perioperative outcomes and complications of patients with peritoneal carcinomatosis who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). Methods This retrospective study included 100 patients operated on between 2016 and 2020. Patients' characteristics, including age, comorbidities, chemotherapy history, treatment failures, cancer type, histology, platinum sensitivity, and perioperative complications, were documented. Perioperative complications were classified according to the Clavien-Dindo classification. Results Median age was 58 years and median follow-up time was 16 months. Eighty-six (86%) patients had ovarian cancer; 11 (11%) experienced grade III-IV complications, and the only relevant factor was the presence of multiple metastasis (P = 0.031). Seven patients (7%) had surgical-site infection; in multivariant analyses, only ostomy formation was found as an independent risk factor for surgical-site infection (odds ratio [OR] 14.01; 95% confidence interval [CI] 1.36-143.52; P = 0.024). Fifteen (15%) patients experienced elevated serum creatinine after surgery and the median time to creatinine elevation was 5 days postoperatively (range 3-15 days). In multivariant analyses, only age of of 58 years or more was found as a significant factor for the elevation of serum creatinine (OR 6.96; 95% CI 1.42-32.81; P = 0.014). Conclusion Our results showed that the presence of multiple metastases increased the risk of grade III-IV complications and age of 58 years or more was the leading risk factor for renal complications. However, we could not find a relation between postoperative complications and oncologic outcomes. HIPEC seems to be a safe approach in experienced hands.