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Background: This study aims to identify prognostic factors and to develop a risk model predicting survival in patients undergoing secondary cytoreductive surgery (SCR) for recurrent epithelial ovarian cancer. Methods: Individual data of 1100 patients with recurrent ovarian cancer of a progression-free interval at least 6 months who underwent SCR were pooled analysed. A simplified scoring system for each independent prognostic factor was developed according to its coefficient. Internal validation was performed to assess the discrimination of the model. Results: Complete SCR was strongly associated with the improvement of survival, with a median survival of 57.7 months, when compared with 27.0 months in those with residual disease of 0.1–1 cm and 15.6 months in those with residual disease of >1 cm, respectively ( P <0.0001). Progression-free interval (⩽23.1 months vs >23.1 months, hazard ratio (HR): 1.72; score: 2), ascites at recurrence (present vs absent, HR: 1.27; score: 1), extent of recurrence (multiple vs localised disease, HR: 1.38; score: 1) as well as residual disease after SCR (R1 vs R0, HR: 1.90, score: 2; R2 vs R0, HR: 3.0, score: 4) entered into the risk model. Conclusion: This prognostic model may provide evidence to predict survival benefit from secondary cytoreduction in patients with recurrent ovarian cancer.

Introduction/BackgroundThe aim of the study was to evaluate site of splenic metastases and ıts affect on survival in advanced stage epithelial ovarian cancer.MethodologyThis retrospective study was done in Baskent University School of Medicine, Ankara, Turkey. We evaluated 182 patients who underwent splenectomy as a part of primary cytoreductive surgery between 2008–2018 Besides we invastegated 2,3 and 5 year overall survival rates.ResultsMedian age was 61 years (27–81),Median lenght of stay was 13 days (4–87 days). 40 (21,7%) patients had paranchimal and 144 (78,3%) had non paranchimal (Hilar or capsular) metastases,Median overal survival was 27 months and 31 months respectively(p=0,6).ConclusionSplenectomy in primary cytoreductive surgery is an effective intervention to achive R0 resection in advanced stage EOC However site of splenic metastases has no impact on short term and long term overall survival.DisclosureNothing to disclose.Abstract EP773 Table 1Median Overall Survival rates According to site of Splenic Metastases Site of Metastases Number Median Overall Survival (Months) 2 year OS 3 Year OS 5 year OS p value Paranhimal 40 27 62% 41% 23,5% 0,6 Non-Paranchimal 142 31 60% 44% 26%

Introduction/BackgroundRadical hysterectomy plus pelvic +- paraaortic lymhadenectomy is the first choice of treatment in early stage cervical cancer and adjuvant treatment is determined according to risk factors.High risk patients (positive surgical margine, positive parametrial invasion, lyph node invoılvement) recieve adjuvant chemoradiotherapy without a doubt.However adjuvant treatment in patients with intermadiate risk factors (tm size ≥4 cm,positive LVSİ and with deep stromal invasion) remains controversial. ESGO, ESTRO and ESP recomend adjuvant radiotheraphy to patients with these risk factors and also offer observation as an option especialy with an experienced team.MethodologyThis retrospective cohort study was carried out in Baskent University School of medicine Ankara, Turkey. All patietns underwent radical hysterectomy plus pelvic ±paraaortic lymhadenectomy, casese were included with negative lyph node, negative parametrial invasion and negative surgical margine. Patients with positive LVSİ and Deep stromal İnvasion or LVSİ and tm size ≥4 cm or DSİ and tm size ≥4 cm or only tm size ≥4 cm with minimum 24 months of follow up time were enrolled.Results The median age of patients were 50,4 years (23–80 y). 66 patients were treated only with surgery and 68 with adjuvant radiotheraphy after surgery. Total recurrence rates were 16,6% vs 23,5% respectively p=0,9. Besides each group had similar local recurrence rates.Five year DFS were 80,2% vs 78,2% in no adjuvant treatment and radiotheraphy group respectivelly p=0,25.Fİve year OS were 86% and 88% p=0,57. Having tumor size ≥4 cm was found to the only independent factor for recurrence HR 2,426 (1,123–5,239 with 95,0 Cİ).ConclusionNo further treatment after radical surgery for early stage cervical carcinoma with intermediate risk factors is a good option with same oncologic outcomes.DisclosureNothing to disclose.

Introduction/BackgroundThe goal of the study was to evaluate risk factors of lymph node metastases ın cervical cancer.MethodologyThis retrospective cohort study was done in Baskent University School l of medicine Ankara Turkey.352 cervical cancer patients operated in our clinic was evaluated,all patients underwent radical hysterectomy plus pelvic paraaortic lymhadenectomy.ResultsMedian age of entire cohort was 50 years (23–81).281 (78,1%) of cases were SCC,38 (10,8%) were adenocancer and and 33 (9,4%) were adenosquamous cancer. Median tumor size was 3,5 cm (1–10 cm) Of 352 patients 136 (% 37,8) patients had positive lymh node metastases.After univariant analayses,factors affecting lymh node involvement were subjected to multivariant cox - regression analyses and LVSİ,Parametrial invasion and tumor size were found to be ındependent risk factors.ConclusionLVSi,parametrial invasion and having Tumor size ≥4 cm are the independent factors affecting lymh node metastases in cervical cancer.DisclosureNothing to disclose.Abstract EP240 Table 1Multivariant cox-regression analyses of factors affecting lymh node involvement 95% CI P value Factor HR Lower Upper Parametrial involvement3,071,46,50,003Tumor size ≥4 cm1,271,011,40,039LVSİ37,78,81600,0001

Introduction/Background*The clinicopathologic characteristics, recurrence patterns, and survival of patients with grade III endometrial cancer (G3EC) and uterine carcinosarcoma (UCS) were compared.MethodologyThe medical records of patients treated for G3EC and UCS between January 1996 and December 2016 at X gynecologic oncology centers in Turkey and Germany were analyzed.Result(s)*UCS was diagnosed in 353 (48.2%) of the enrolled patients and G3EC in 380 (51.8%). The patients in each group were divided into three subgroups depending on the disease stage: early (stage IA), locally advanced (IB-II) and advanced (III-IV). For all stages, the recurrence rate was higher in patients with UCS than in those with G3EC. Adjuvant treatment type had no significant effect on disease-free survival (DFS) or overall survival (OS) in patients with early stage tumors. In patients with locally advanced disease, radiotherapy (RT) + chemotherapy (CT) was the most effective type of adjuvant therapy with respect to DFS and OS. In those with advanced disease, RT + CT was the most effective type of adjuvant therapy but only with respect to DFS.Conclusion*The recurrence rate was higher in UCS patients than in G3EC patients, regardless of disease stage. DFS was of shorter duration in UCS than in G3EC patients. OS did not significantly differ between UCS and G3EC patients with early or locally advanced disease. In patients with early stage UCS or G3EC, adjuvant therapy modalities had no effect on survival. However, in both groups of patients with locally advanced disease, adjuvant CT and RT resulted in a significant improvement in DFS and OS.

In this study, experimental and numerical results of compact tension shear (CTS) specimen and a new specimen type under in-plane mixed mode (Mode-I/II) loading conditions are compared with existing inplane mixed mode fracture criteria to investigate and understand the nature of fracture behavior properly. The material used in numerical and experimental analyses is Al 7075-T651 aluminum machined from rolled plates in the L-T rolling direction (crack plane is perpendicular to the rolling direction). In Part 1 of the study, results from numerical and experimental analyses are given. Having computed the mixed mode stress intensity factors from the numerical analyses, fracture loads are predicted and compared with different mixed mode-I/II fracture criteria. The experimental and numerical results show that many criteria are in good agreement with each other for predominately mode I to moderate mixed mode conditions. However, existing criteria increasingly differ from the experimental measurements for highly mode-II conditions. Using the computational and experimental results obtained, improved empirical mixed mode I/II fracture criteria for fracture condition and angle are also proposed.

Introduction/Background*The aim of this study was to evaluate sensitivity, negative predictive value (NPV) and false negative rate (FNR) of sentinel lymph node (SLN) mapping algorithm in high-risk endometrial cancer patients.MethodologyPatients with non-endometrioid histology, grade 3 endometrioid tumors and/or tumors with deep myometrial invasion were enrolled in this retrospective, multicenter study. After removal of SLNs, all patients underwent pelvic ± paraaortic lymphadenectomy. Operations were performed via laparotomy, laparoscopy or robotic surgery. Indocyanine green (ICG) and methylene blue (MB) were used as tracers. SLN detection rate, sensitivity, NPV and FNR were calculated.Result(s)*Two hundred forty-four patients were included. Surgeries were performed via open approach in 132 (54.1%) patients. While 92 (37.7%) patients underwent bilateral pelvic lymphadenectomy, 152 (62.3%) underwent both bilateral pelvic and paraaortic lymphadenectomy. ICG was used in 120 (49.2%) patients and MB in 124 (50.8%). At least 1 SLN was detected in 222 (91%) patients with a 65.6% bilateral detection rate. Fifty-five (22.5%) patients had lymphatic metastasis and 45 patients had at least 1 metastatic SLN: 28 macrometastasis, 6 micrometastasis and 11 isolated tumor cells. Lymphatic metastasis was detected by side-specific lymphadenectomy in 8 patients and 2 patients had isolated paraaortic metastasis. Overall sensitivity, NPV and FNR of SLN biopsy were 81.8%, 95% and 18.2%, respectively. By applying SLN algorithm steps, sensitivity and NPV improved to 96.4% and 98.9%, respectively. For grade 3 tumors, sensitivity, NPV and FNR of the SLN algorithm were 97.1%, 98.9% and 2.9%, respectively. Sensitivity, NPV and FNR of SLN algorithm were 95%, 98.9% and 5%, respectively in deep myoinvasive tumors.Abstract 750 Table 1Abstract 750 Table 2Conclusion*This study was performed in one of the largest high-risk endometrial cancer population. SLN algorithm was found to be safe and had high diagnostic accuracy also in high-risk endometrial cancer patients. Although it seems like SLN algorithm is a feasible option for staging, long term studies to determine impact of SLN biopsy alone on survival are needed before it becomes standard of care in high-risk endometrial cancer.

Introduction/Background*Diagnostic efficacy of sentinel lymph node (SLN) biopsy is proven in many studies in terms of the detection of lymphatic spread in endometrial cancer. However, there are limited data about the effect of SLN biopsy only on survival. The aim of this study was to investigate whether SLN biopsy only compromises oncologic outcomes compared to systematic lymphadenectomy in a large cohort.MethodologyIn this multicentric study, records of 564 endometrial cancer patients who underwent surgical staging with either sentinel lymph node biopsy alone or sentinel lymph node biopsy followed by systematic lymphadenectomy with at least 6 months of follow-up time were retrospectively reviewed. The impact of type of lymphadenectomy and histopathologic factors on recurrence, disease-free survival (DFS) and overall survival (OS) were assessed. DFS and OS rates were calculated using Kaplan-Meier method and log-rank test was used to calculate statistical significance between the groups. Cox univariate and multivariate analyses were used to identify prognostic factors for DFS and OS.Result(s)*Median follow up time was 28 months (range: 6-130) and 14 (2.5%) of the 21 (3.7%) deaths were due to the disease. 2- and 3-year OS were 98.2% and 97%, respectively. Median time to recurrence was 12.5 months (range: 3-30). Sites of the 42 (7.4%) recurrences were as follows: 12 (28.6%) locoregional, 19 (45.2%) distant, 3 (7.1%) nodal and 8 (19%) more than one site. 2- and 3-year DFS were 93.1% and 92.6%, respectively. While non-endometrioid subtypes (p=0.048), grade 3 histology (p<0.001) and presence of lymphovascular space invasion (LVSI) (p<0.001) were found as independent prognostic factors for decreased DFS, age (p=0.017) and tumor size (p=0.041) were independent factors for shorter OS. Type of lymphadenectomy was not a prognostic factor lymphatic recurrence, DFS and OS.Conclusion*Our study showed that removal of only SLNs was not associated with worse survival compared to systematic lymphadenectomy in endometrial cancer patients. Nodal recurrence rate was also similar between the groups.

Introduction/BackgroundThis dual-institutional, retrospective study aimed to determine the clinicopathological risk factors for para-aortic lymph node (LN) metastasis among women who underwent radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy for 2009 FIGO stage IB1-IIA2 cervical cancer.MethodologyInstitutional cervical cancer databases of two high-volume gynecologic cancer centers in Ankara, Turkey were retrospectively analyzed. Those featured in the study included women with 2009 FIGO stage IB1-IIA2 disease who underwent radical hysterectomy with pelvic and para-aortic lymphadenectomy between January 2006 and December 2018. We analyzed the patient data and investigated all potential predictive factors for para-aortic LN metastasis.ResultsA total of 522 women met the inclusion criteria. Pelvic LN metastasis was detected in 190 patients (36.4%); para-aortic LN metastasis in 48 patients (9.2%), isolated para-aortic LN metastasis in 4 (0.8%), and both pelvic and para-aortic LN metastasis in 44 (8.4%) women, respectively. The independent risk factors identified for para-aortic LN involvement included parametrial invasion (odds ratio [OR]: 3.57, 95% confidence interval [CI]: 1.65–7.72; p=0.001), metastasized pelvic LN size >1 cm (OR: 4.51, 95% CI: 1.75–11.64; p=0.002), multiple pelvic LN metastases (OR: 3.83, 95% CI: 1.46–10.01; p=0.006), and common iliac LN metastasis (OR: 2.97, 95% CI: 1.01–8.68; p=0.04). A total of 196 (37.5%) patients exhibited at least one risk factor for para-aortic nodal disease.ConclusionParametrial invasion, metastasized pelvic LN size >1 cm, multiple pelvic LN metastases, and common iliac LN metastasis seem to be independent predictors of para-aortic LN involvement.DisclosureNothing to disclose.

Introduction/BackgroundThe aim of this study was to determine the prognostic value of lymph node ratio (LNR) in women with 2018 FIGO stage IIIC cervical cancer.MethodologyIn this retrospective dual-institutional study, a total of 185 node-positive cervical cancer patients who had undergone radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy were included. All of the patients received adjuvant chemoradiation after surgery. LNR was defined as the ratio of positive lymph nodes to the total number of lymph nodes removed. The patients were categorized into two groups according to LNR; LNR <0.05 and LNR≥0.05. The prognostic value of LNR was evaluated with univariate log-rank tests and multivariate Cox regression models.ResultsA total of 139 patients (75.1%) had stage IIIC1 disease and 46 (24.9%) patients had stage IIIC2 disease. With a median follow-up period of 45.5 months (range 3–135 months), the 5-year disease free survival (DFS) rate was 62.5% whereas the 5-year overall survival (OS) rate was 70.4% for the entire study population. The 5-year DFS rates for LNR <0.05 and LNR ≥0.05 were 78.2%, and 48.4%, respectively (p<0.001). Additionally, the 5-year OS rates for LNR <0.05 and LNR ≥0.05 were 80.6%, and 61.2%, respectively (p=0.007). On multivariate analysis, LNR ≥0.05 was associated with a worse DFS (HR 2.13, 95% CI 1.21–3.72; p=0.008) and OS (HR 1.95, 95% CI 1.01–3.37; p=0.04) in women with stage IIIC cervical cancer.ConclusionLNR ≥0.05 seems to be an independent prognostic factor for decreased DFS and OS in stage IIIC cervical carcinoma.DisclosureNothing to disclose.