Zengel, Baha
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baha.zengel@ieu.edu.tr
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09.04. Surgical Sciences
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429
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11
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21
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2.20
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4.20
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| Journal | Count |
|---|---|
| Annals of Clinical and Analytical Medicine | 1 |
| Annals of Surgical Oncology | 1 |
| Cancers | 1 |
| Cyprus Journal of Medical Sciences | 1 |
| JAMA Surgery | 1 |
Current Page: 1 / 1
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Now showing 1 - 5 of 5
Article Citation - WoS: 9Citation - Scopus: 8Breast Cancer Recurrence in Initially Clinically Node-Positive Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in the Neosentiturk-Trials Mf18-02/18-03(Springer, 2025) Cabioglu, Neslihan; Karanlik, Hasan; Igci, Abdullah; Muslumanoglu, Mahmut; Gulcelik, Mehmet Ali; Uras, Cihan; Ozmen, Vahit; Zengel, BahaBackground. This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). MethodsThe retrospective multi-centre "MF18-02" and the prospective multi-centre cohort registry trial "MF18-03" (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/- axillary lymph node dissection (ALND) post-NAC. Results. A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0. Conclusions. The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.Article Citation - WoS: 2Citation - Scopus: 2A Comprehensive Analysis of Neoadjuvant Chemotherapy in Breast Cancer: Adverse Events, Clinical Response Rates, and Surgical and Pathological Outcomes-Bozyaka Experience(Mdpi, 2025) Yilmaz, Cengiz; Zengel, Baha; Ureyen, Orhan; Adibelli, Zehra Hilal; Tasli, Funda; Yilmaz, Hasan Taylan; Ilhan, EnverObjectives: To evaluate the neoadjuvant chemotherapy (NACTx) process in breast cancer (BC), its significant treatment-related adverse events (trAEs), tumor clinical response rates, and surgical and pathological outcomes, and to analyze factors influencing cavity shaving and axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB). Methods: A comprehensive retrospective study was conducted at a single center on patients who received NACTx for BC between 2015 and 2021. Results: Medical records of 242 patients were reviewed. Approximately one-fifth encountered grade >= 3 trAEs (21.5%), leading 3.3% to discontinue chemotherapy. Anthracycline cardiotoxicity (2.2%) caused one death (mortality rate = 0.4%). For clinical response and surgical and pathological outcomes, 229 patients were eligible. Clinical progression occurred in 3.9% of the patients (14% in triple-negative BC, p = 0.004). Breast-conserving surgery (BCS) was performed in 55% of the patients. There was no significant difference between the type of breast surgery (BCS vs. mastectomy) and molecular subtype, histology, tumor size, or tumor's pathological response degree. Cavity shaving was required in one-fifth of the patients who underwent BCS (n = 134) due to an invasive tumor at the surgical margin (SM). Tumor histology (invasive ductal vs. invasive lobular carcinoma; OR: 4.962, 95% CI 1.007-24.441, p = 0.049) and tumor SUVMax value (OR: 0.866, 95% CI 0.755-0.993, p = 0.039) had significant independent efficacy on SM positivity. Initially, 75% underwent SLNB, but nearly half of them needed ALND. ALND rates were significantly higher in the luminal A and LB-HER2(-) groups (87% vs. 69%) than in the HER2(+) and TN groups (43% to 50%) (p = 0.001). All luminal A patients and those with lobular histology required ALND after SLNB, but no patients in the HER2-enriched group required ALND. ER positivity and higher PR expression levels were associated with an increased need for ALND after SLNB, whereas HER2 positivity and higher SUVMax values of LN(s) were associated with a significantly reduced need for ALND. About 27% of the patients achieved overall pCR. No pCR was achieved in the LA group. Conclusions: The BC NACTx process requires close monitoring due to severe AEs and disease progression. NACTx decisions must be made on experienced multidisciplinary tumor boards, considering tumor characteristics and expected targets.Article Is There an MRI Characteristic Feature That Distinguishes a Phyllloid Tumor From a Fibroadenoma(Bayrakol Medical Publisher, 2025) Tuncez, Hulya Cetin; Unverdi, Basak; Adibelli, Zehra Hilal; Zengel, Baha; Tasli, FundaAim: Cellular fibroadenomas (CFAs) and phyllodes tumours (PTs) arise from the breast parenchyma and consist of both epithelial and stromal components. In our study, we aimed to investigate and compare magnetic resonance imaging (MRI) characteristics of these lesions to facilitate the process of differentiation and management. Materials and Methods: We retrospectively analysed the breast MRI data of patients pathologically diagnosed with PT and CFA. 25 patients with preoperative MRI who were diagnosed with PT in the last five years and 25 patients with preoperative MRI who were diagnosed with CFA in the last one year were randomly selected and included in the study. MRI findings were classified according to the Breast Imaging Reporting and Database System (BIRADS). Pearson Chi-Square and Fisher's Exact tests were used to calculate the statistical difference between MRI features of CFA and PT. Results: The mean age was calculated 32.68 +/- 7.73 for patients with CFA and 38.32 +/- 10.71 for patients with PT (p=0.038). In fat suppressed T2 weighed imaging (WI) both lesion groups showed similar characteristics; 24 of the CFAs and 19 of the PTs demonstrated an increase in signal intensity. Two CFAs and nine PTs had cystic components (p=0.017). Signal increase in the surrounding tissue in fat suppressed T2WI was seen in 11 (44%) of the PTs, but in only 1 (4%) of the CFAs (p=0.001). On delayed phase T1WI, 10 of the CFAs and 18 of the PTs sustained heterogeneous enhancement characteristics (p=0.023). Discussion: All in all, we found that PTs arise later in life compared to CFAs. Increased signal intensity in the surrounding tissue in fat suppressed T2WI and the presence of a cystic component is more suggestive of PT. In delayed phase T1WI, CFAs appear to be homogenously enhanced, whereas PTs maintain their heterogeneous enhancement.Article Citation - Scopus: 11De-Escalation of Nodal Surgery in Clinically Node-Positive Breast Cancer(American Medical Association, 2025) Cabioǧlu, N.; Koçer, H.B.; Karanlik, H.; Gülçelik, M.A.; Iǧci, A.; Müslümanoǧlu, M.; Özmen, V.; Zengel, BahaImportance: Increasing evidence supports the oncologic safety of de-escalating axillary surgery for patients with breast cancer after neoadjuvant chemotherapy (NAC). Objective: To evaluate the oncologic outcomes of de-escalating axillary surgery among patients with clinically node (cN)-positive breast cancer and patients whose disease became cN negative after NAC (ycN negative). Design, Setting, and Participants: In the NEOSENTITURK MF-1803 prospective cohort registry trial, patients from 37 centers with cT1-4N1-3M0 disease treated with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) alone or with ypN-negative or ypN-positive disease after NAC were recruited between February 15, 2019, and January 1, 2023, and evaluated. Exposure: Treatment with SLNB or TAD after NAC. Main Outcomes and Measures: The primary aim of the study was axillary, locoregional, or distant recurrence rates; disease-free survival; and disease-specific survival. Number of axillary lymph nodes removed was also evaluated. Results: A total of 976 patients (median age, 46 years [range, 21-80 years]) with cT1-4N1-3M0 disease underwent SLNB (n = 620) or TAD alone (n = 356). Most of the cohort had a mapping procedure with blue dye alone (645 [66.1%]) with (n = 177) or without (n = 468) TAD. Overall, no difference was found between patients treated with TAD and patients treated with SLNB in the median number of total lymph nodes removed (TAD, 4 [3-6] vs SLNB, 4 [3-6]; P =.09). Among patients with ypN-positive disease, those who underwent TAD were more likely to have a lower median lymph node ratio (TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]; P =.03). At a median follow-up of 39 months (IQR, 29-48 months), no significant difference was found in the rates of ipsilateral axillary recurrence (0.3% [1 of 356] vs 0.3% [2 of 620]; P ≥.99) or locoregional recurrence (0.6% [2 of 356] vs 1.1% [7 of 620]; P =.50) between the TAD and SLNB groups, with an overall locoregional recurrence rate of 0.9% (9 of 976). The initial clinical tumor stage, pathologic complete response, and use of blue dye alone as a mapping procedure were not associated with the outcome. Even though patients with TAD demonstrated an increased disease-free survival rate compared with the SLNB group, this difference did not reach statistical significance (94.9% vs 92.6%; P =.07). Factors associated with decreased 5-year disease-specific survival were cN2-3 axillary stage (cN1, 98.7% vs cN2-3, 96.8%; P =.03) and nonluminal type tumor pathologic characteristics (luminal, 98.9% vs nonluminal, 96.9%; P =.007). Conclusions and Relevance: The short-term results suggest very low rates of axillary and locoregional recurrence in a select group of patients with cN-negative disease after NAC treated with TAD alone or SLNB alone followed by regional nodal irradiation regardless of the SLNB technique or nodal pathology. Whether TAD might provide a clear survival advantage compared with SLNB remains to be proven in studies with longer follow-up. © 2025 American Medical Association. All rights reserved.Article New Lymph Node Parameters and a Comparison With the American Joint Committee on Cancer N-Stages in Breast Cancer(Galenos Publ House, 2023) Eliyatkin, Nuket Ozkavruk; Başkır, İnci; İşlek, Akif; Zengel, BahaBACKGROUND/AIMS: The N-stage of TNM systems considers only the number of metastatic lymph nodes (NMLN) in breast cancer (BC). However, new lymph node parameters refer to the number of harvested lymph nodes (NHLN) and negative lymph nodes (NNLN), which have had an increasing significance in the current literature. This study aimed to compare NHLN, NNLN, lymph node ratio (LNR), modified lymph node ratio (mLNR), and log odds of positive lymph nodes (LODDS) against the standard American Joint Committee on Cancer (AJCC) N-stage for the prognosis of BC patients. MATERIALS AND METHODS: This study was designed retrospectively. The socio-demographic data, clinical features, histopathological factors, treatment modalities, receptor status of BC, and lymph node related parameters (AJCC N, LNR, mLNR, LODDS) were identified. Then, lymph node related parameters were compared for cancer-related mortality (CRM), cancer recurrence, disease-free survival (DFS), and overall survival (OS). RESULTS: Eight hundred seven women who underwent surgery for BC were included in this study according to its eligibility criteria. The mean follow-up period was 113.34±74.85 (range: 6-378) months. The NHLN was 21.24±9.22, the NMLN was 4.85±7.38, the NNLN was 16.39±9.48, the LNR was 0.23±0.29, the mLNR was 5.38±7.38 and the LODDS was -0.74±0.80 on average. During the follow-up period, 42 (5.2%) patients had local recurrence, 188 (23.3%) had distant metastases, and 252 (31.2%) patients died due to BC. NMLN, LNR, mLNR, and LODDS were found to be significantly higher, and NNLN was significantly lower in those patients with cancer recurrence and CRM (p<0.001). AJCC N-stages, and also LNR, mLNR, and LODDS groups according to the calculated cut-off values, were significant for DFS and OS according to survival analysis. In Cox regression analysis, only LODDS was a significant independent risk factor for OS [p=0.014, heart rate (HR)=3.78, 95% confidence interval (CI) for HR: 1.30-10.94)]. CONCLUSION: The results indicated that LODDS was more successful compared to other lymph node staging systems, especially for OS. However, randomized prospective controlled studies with larger samples and homogeneous study groups are needed to create standard classification systems as alternatives to AJCC N.
