<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.4 20241031//EN"
        "https://jats.nlm.nih.gov/publishing/1.4/JATS-journalpublishing1-4.dtd">
<article  article-type="research-article"        dtd-version="1.4">
            <front>

                <journal-meta>
                                                                <journal-id>ktd</journal-id>
            <journal-title-group>
                                                                                    <journal-title>Kocatepe Tıp Dergisi</journal-title>
            </journal-title-group>
                                        <issn pub-type="epub">3061-9904</issn>
                                                                                            <publisher>
                    <publisher-name>Afyonkarahisar Sağlık Bilimleri Üniversitesi</publisher-name>
                </publisher>
                    </journal-meta>
                <article-meta>
                                        <article-id pub-id-type="doi">10.18229/kocatepetip.1310180</article-id>
                                                                <article-categories>
                                            <subj-group  xml:lang="en">
                                                            <subject>Gynecologic Oncology Surgery</subject>
                                                    </subj-group>
                                            <subj-group  xml:lang="tr">
                                                            <subject>Jinekolojik Onkoloji Cerrahisi</subject>
                                                    </subj-group>
                                    </article-categories>
                                                                                                                                                        <title-group>
                                                                                                                        <article-title>THE EFFECT OF TUMOR FREE DISTANCE ON THE PROGNOSTIC FACTORS OF ENDOMETRIAL CANCER</article-title>
                                                                                                                                                                                                <trans-title-group xml:lang="tr">
                                    <trans-title>ENDOMETRiYAL KANSERİN PROGNOSTiK FAKTÖRLERİ ÜZERİNDE TÜMÖRSÜZ MESAFENİN ETKİSİ</trans-title>
                                </trans-title-group>
                                                                                                    </title-group>
            
                                                    <contrib-group content-type="authors">
                                                                        <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0009-0007-1591-7822</contrib-id>
                                                                <name>
                                    <surname>Beyhekim</surname>
                                    <given-names>Hasan</given-names>
                                </name>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-9244-9168</contrib-id>
                                                                <name>
                                    <surname>Avcı</surname>
                                    <given-names>Fazıl</given-names>
                                </name>
                                                                    <aff>Selçuk üniversitesi tıp Fakültesi</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-2186-441X</contrib-id>
                                                                <name>
                                    <surname>İlhan</surname>
                                    <given-names>Tolgay Tuyan</given-names>
                                </name>
                                                                    <aff>MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-6888-0206</contrib-id>
                                                                <name>
                                    <surname>Uçar</surname>
                                    <given-names>Mustafa Gazi</given-names>
                                </name>
                                                                    <aff>SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-4188-2199</contrib-id>
                                                                <name>
                                    <surname>Kebapçılar</surname>
                                    <given-names>Ayşegül</given-names>
                                </name>
                                                                    <aff>SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-1106-6342</contrib-id>
                                                                <name>
                                    <surname>Yılmaz</surname>
                                    <given-names>Setenay</given-names>
                                </name>
                                                                    <aff>SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0003-2208-8712</contrib-id>
                                                                <name>
                                    <surname>Seçilmiş</surname>
                                    <given-names>Özlem</given-names>
                                </name>
                                                                    <aff>SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-6399-0166</contrib-id>
                                                                <name>
                                    <surname>Tazegul</surname>
                                    <given-names>Aybike</given-names>
                                </name>
                                                                    <aff>SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0009-0000-8371-4743</contrib-id>
                                                                <name>
                                    <surname>Beyhekim</surname>
                                    <given-names>Fatma</given-names>
                                </name>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0001-6165-5092</contrib-id>
                                                                <name>
                                    <surname>Celik</surname>
                                    <given-names>Cetin</given-names>
                                </name>
                                                                    <aff>SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ</aff>
                                                            </contrib>
                                                                                </contrib-group>
                        
                                        <pub-date pub-type="pub" iso-8601-date="20240718">
                    <day>07</day>
                    <month>18</month>
                    <year>2024</year>
                </pub-date>
                                        <volume>25</volume>
                                        <issue>3</issue>
                                        <fpage>289</fpage>
                                        <lpage>294</lpage>
                        
                        <history>
                                    <date date-type="received" iso-8601-date="20230606">
                        <day>06</day>
                        <month>06</month>
                        <year>2023</year>
                    </date>
                                                    <date date-type="accepted" iso-8601-date="20231025">
                        <day>10</day>
                        <month>25</month>
                        <year>2023</year>
                    </date>
                            </history>
                                        <permissions>
                    <copyright-statement>Copyright © 1999, Kocatepe Tıp Dergisi</copyright-statement>
                    <copyright-year>1999</copyright-year>
                    <copyright-holder>Kocatepe Tıp Dergisi</copyright-holder>
                </permissions>
            
                                                                                                <abstract><p>OBJECTIVE: We aimed to evaluate the importance of tumor-free distance (TFD) in prognostic factors of endometrial cancer (EC) and determine the best TFD cut-off value for predicting advanced EC.MATERIAL AND METHODS: This study included 153 patients diagnosed with EC. The depth of myometrial invasion (DOI) and TFD were measured, and the associations between prognostic factors for EC and DOI and TFD were evaluated.RESULTS: The mean ± standard deviation values of TFD and DOI were 12 ± 6 and 7 ± 6 mm, respectively. TFD and DOI were significantly related to lymph node (LN) metastasis, lymphovascular space invasion (LVSI) and cervical involvement. A shorter TFD was significantly associated with a higher tumor grade, positive cytology and LVSI. Shorter DOI was significantly associated with LN metastasis and cervical involvement. A receiver operating characteristics curve analysis demonstrated that the optimal TFD cut-off value was 48% for LN metastasis. A DOI of 47% had the best sensitivity and specificity for LN metastasis.CONCLUSIONS: TFD was superior for predicting LVSI as compared to DOI, whereas DOI showed good diagnostic performance for predicting LN metastasis. Further studies are needed to predict the effect of TFD and DOI on the prognostic factors of endometrial cancer.</p></abstract>
                                                                                                                                    <trans-abstract xml:lang="tr">
                            <p>AMAÇ: Endometrial kanserin (EK) prognostik faktörlerinde tümörsüz mesafenin (TFD) önemini değerlendirmeyi ve ileri evre EK&#039;ni öngörmek için en iyi TFD cut-off değerini belirlemeyi amaçladık.GEREÇ VE YÖNTEM: Bu çalışmaya EK tanısı alan 153 olgu dahil edildi. Myometriyal invazyonun derinliği (DOI) ve TFD ölçüldü ve EK için prognostik faktörler ile DOI ve TFD arasındaki ilişkiler değerlendirildi.BULGULAR: TFD ve DOI&#039;nin ortalama ± standart sapma değerleri sırasıyla 12 ± 6 ve 7 ± 6 mm olarak hesaplandı. TFD ve DOI, lenf nodu (LN) metastazı, lenfovasküler alan invazyonu (LVSI) ve servikal tutulum ile anlamlı şekilde ilişkiliydi. Daha kısa TFD, daha yüksek tümör grade, pozitif sitoloji ve LVSI ile anlamlı şekilde ilişkiliydi. Daha kısa DOI, LN metastazı ve servikal tutulum ile anlamlı şekilde ilişkiliydi. ROC eğrisi analizinde, LN metastazı için optimal TFD cut-off değerinin %48 olduğunu gösterildi ve %47&#039;lik DOI, LN metastazı için en iyi sensitivite ve spesifiteye sahipti.SONUÇ: TFD, DOI ile karşılaştırıldığında LVSI&#039;yi öngörmede daha üstün iken DOI, LN metastazını öngörmede iyi bir tanısal performans gösterdi. Endometriyal kanserin prognostik faktörleri üzerinde TFD ve DOI’nin etkisini öngörmede daha fazla çalışmalara ihtiyaç vardır.</p></trans-abstract>
                                                            
            
                                                            <kwd-group>
                                                    <kwd>Endometrial cancer</kwd>
                                                    <kwd>  Lymphatic metastasis</kwd>
                                                    <kwd>  Myometrium</kwd>
                                                    <kwd>  Prognosis.</kwd>
                                            </kwd-group>
                                                        
                                                                            <kwd-group xml:lang="tr">
                                                    <kwd>Endometrial kanser</kwd>
                                                    <kwd>  Lenfatik metastaz</kwd>
                                                    <kwd>  Miyometrium</kwd>
                                                    <kwd>  Prognoz</kwd>
                                            </kwd-group>
                                                                                                        <funding-group specific-use="FundRef">
                    <award-group>
                                                    <funding-source>
                                <named-content content-type="funder_name">None</named-content>
                            </funding-source>
                                                                    </award-group>
                </funding-group>
                                </article-meta>
    </front>
    <back>
                            <ref-list>
                                    <ref id="ref1">
                        <label>1</label>
                        <mixed-citation publication-type="journal">1. Siegel RL MK, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021 Jan;71(1):7-33.</mixed-citation>
                    </ref>
                                    <ref id="ref2">
                        <label>2</label>
                        <mixed-citation publication-type="journal">2. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and 
Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.</mixed-citation>
                    </ref>
                                    <ref id="ref3">
                        <label>3</label>
                        <mixed-citation publication-type="journal">3. Leslie KK TK, Goodheart MJ, De Geest K, Jia Y, Yang S. Endometrial cancer. Obstet Gynecol Clin North Am. 
2012;39(2):255-68.</mixed-citation>
                    </ref>
                                    <ref id="ref4">
                        <label>4</label>
                        <mixed-citation publication-type="journal">4. Crosbie EJ KS, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 
2022;9:399(10333):1412-28.</mixed-citation>
                    </ref>
                                    <ref id="ref5">
                        <label>5</label>
                        <mixed-citation publication-type="journal">5. Roguz S, Krowiranda KW, Michalski T, Bieńkiewicz A. Histological grading of endometrial carcinoma. Clinical 
and patomorphological analysis. Ginekol Pol. 2015;86(5):340-5.</mixed-citation>
                    </ref>
                                    <ref id="ref6">
                        <label>6</label>
                        <mixed-citation publication-type="journal">6. Solmaz U, Mat E, Dereli ML et al. Stage-III and -IV endometrial cancer: A single oncology centre review of 104 
cases. J Obstet Gynaecol. 2016;36(1):81-6.</mixed-citation>
                    </ref>
                                    <ref id="ref7">
                        <label>7</label>
                        <mixed-citation publication-type="journal">7. Amant F MP, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet. 2005;6-
12:366(9484):491-505.</mixed-citation>
                    </ref>
                                    <ref id="ref8">
                        <label>8</label>
                        <mixed-citation publication-type="journal">8. Hamilton CA, Pothuri B, Arend RC et al. Endometrial cancer: A society of gynecologic oncology evidence-
based review and recommendations. Gynecol Oncol. 2021;160(3):817-26.</mixed-citation>
                    </ref>
                                    <ref id="ref9">
                        <label>9</label>
                        <mixed-citation publication-type="journal">9. Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet. 
2009;105(2):109.</mixed-citation>
                    </ref>
                                    <ref id="ref10">
                        <label>10</label>
                        <mixed-citation publication-type="journal">10. Dowdy SC, Borah BJ, Bakkum-Gamez JN et al. Prospective assessment of survival, morbidity, and cost 
associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol. 2012;127(1):5-10.</mixed-citation>
                    </ref>
                                    <ref id="ref11">
                        <label>11</label>
                        <mixed-citation publication-type="journal">11. Cole AJ, Quick CM. Patterns of myoinvasion in endometrial adenocarcinoma: recognition and implications. 
Adv Anat Pathol. 2013;20(3):141-7.</mixed-citation>
                    </ref>
                                    <ref id="ref12">
                        <label>12</label>
                        <mixed-citation publication-type="journal">12. van der Putten LJ, van de Vijver K, Bartosch C et al. Reproducibility of measurement of myometrial invasion 
in endometrial carcinoma. Virchows Arch. 2017;470(1):63-8.</mixed-citation>
                    </ref>
                                    <ref id="ref13">
                        <label>13</label>
                        <mixed-citation publication-type="journal">13. Koskas M RR, Amant F. Staging for endometrial cancer: The controversy around lymphadenectomy - Can 
this be resolved? Best Pract Res Clin Obstet Gynaecol. 2015;29(6):845-57.</mixed-citation>
                    </ref>
                                    <ref id="ref14">
                        <label>14</label>
                        <mixed-citation publication-type="journal">14. Bilgi A GA, Kulhan M, Ateş MC , Keser Şahin HH, Celik, C. The effect of myometrial invasion and histological 
grade on lymph node metastasis in patient with early stage endometrium cancer . Journal of Health 
Sciences and Medicine. 2021; 4 (5): 552-6.</mixed-citation>
                    </ref>
                                    <ref id="ref15">
                        <label>15</label>
                        <mixed-citation publication-type="journal">15. Wang J, Xu P, Yang X et al. Association of Myometrial Invasion With Lymphovascular Space Invasion, 
Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 
Studies With 68,870 Patients. Front Oncol. 2021;11:762329.</mixed-citation>
                    </ref>
                                    <ref id="ref16">
                        <label>16</label>
                        <mixed-citation publication-type="journal">16. Morrison J, Balega J, Buckley L, et al. British Gynaecological Cancer Society (BGCS) Uterine Cancer 
Guidelines: Recommendations for Practice. Eur J Obstet Gynecol Reprod Biol. 2022;270:50–89.</mixed-citation>
                    </ref>
                                    <ref id="ref17">
                        <label>17</label>
                        <mixed-citation publication-type="journal">17. Creutzberg CL, Nout RA, Lybeert ML, et al. PORTEC Study Group. Fifteen-year radiotherapy outcomes of the 
randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011;15:81(4):631-8.</mixed-citation>
                    </ref>
                                    <ref id="ref18">
                        <label>18</label>
                        <mixed-citation publication-type="journal">18. Koskas M AF, Mirza MR, Creutzberg CL. Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet. 
2021;155:45-60.</mixed-citation>
                    </ref>
                                    <ref id="ref19">
                        <label>19</label>
                        <mixed-citation publication-type="journal">19. Kaku T, Tsuruchi N, Tsukamoto N, Hirakawa T, Kamura T, Nakanu H. Reassessment of myometrial invasion 
in endometrial carcinoma. Obstet Gynecol. 1994;84(6):979–82.</mixed-citation>
                    </ref>
                                    <ref id="ref20">
                        <label>20</label>
                        <mixed-citation publication-type="journal">20. Ali A, Black D, Soslow RA. Difficulties in assessing the depth of myometrial invasion in endometrial 
carcinoma. Int J Gynecol Pathol. 2007;26(2):115–23.</mixed-citation>
                    </ref>
                                    <ref id="ref21">
                        <label>21</label>
                        <mixed-citation publication-type="journal">21. Lindauer J, Fowler JM, Manolitsas TP et al. Is there a prognostic difference between depth of myometrial 
invasion and the tumor-free distance from the uterine serosa in endometrial cancer? Gynecol Oncol. 
2003;91(3):547-51.</mixed-citation>
                    </ref>
                                    <ref id="ref22">
                        <label>22</label>
                        <mixed-citation publication-type="journal">22. Chattopadhyay S GK, Patel A, Fisher A, Nayar A, Cross P, et al. Tumour-free distance from serosa is a 
better prognostic indicator than depth of invasion and percentage myometrial invasion in endometrioid 
endometrial cancer. BJOG. 2012;119(10):1162-70.</mixed-citation>
                    </ref>
                                    <ref id="ref23">
                        <label>23</label>
                        <mixed-citation publication-type="journal">23. Geels YP, Pijnenborg JM, van den Berg-van Erp SH, Snijders MP, Bulten J, Massuger LF. Absolute depth of 
myometrial invasion in endometrial cancer is superior to the currently used cut-off value of 50%. Gynecol 
Oncol. 2013;129(2):285-91.</mixed-citation>
                    </ref>
                                    <ref id="ref24">
                        <label>24</label>
                        <mixed-citation publication-type="journal">24. Ozbilen O, Sakarya DK, Bezircioglu I, Kasap B, Yetimalar H, Yigit S. Comparison of myometrial invasion and 
tumor free distance from uterine serosa in endometrial cancer. Asian Pac J Cancer Prev. 2015; 16(2):519-22.</mixed-citation>
                    </ref>
                                    <ref id="ref25">
                        <label>25</label>
                        <mixed-citation publication-type="journal">25. Lee KB, Ki KD, Lee JM, et al. The risk of lymph node metastasis based on myometrial invasion and tumor 
grade in endometrioid uterine cancers: a multicenter, retrospective Korean study. Ann Surg Oncol. 
2009;16(10):2882-7.</mixed-citation>
                    </ref>
                                    <ref id="ref26">
                        <label>26</label>
                        <mixed-citation publication-type="journal">26. Kondalsamy-Chennakesavan S, van Vugt S, Sanday K et al. Evaluation of tumor-free distance and depth 
of myometrial invasion as prognostic factors for lymph node metastases in endometrial cancer. Int J 
Gynecol Cancer. 2010;20(7):1217-21.</mixed-citation>
                    </ref>
                                    <ref id="ref27">
                        <label>27</label>
                        <mixed-citation publication-type="journal">27. Doghri R CS, Houcine Y, Charfi L, et al. Evaluation of tumor-free distance and depth of myometrial invasion 
as prognostic factors in endometrial cancer. Mol Clin Oncol. 2018;9(1):87-91.</mixed-citation>
                    </ref>
                                    <ref id="ref28">
                        <label>28</label>
                        <mixed-citation publication-type="journal">28. Schwab KV, O&#039;Malley DM, Fowler JM, Copeland LJ, Cohn DE. Prospective evaluation of prognostic 
significance of the tumor-free distance from uterine serosa in surgically staged endometrial 
adenocarcinoma. Gynecol Oncol. 2009;112(1):146-9.</mixed-citation>
                    </ref>
                                    <ref id="ref29">
                        <label>29</label>
                        <mixed-citation publication-type="journal">29. Oge T CD, Cakmak Y, Arık D. Is Tumor-Free Distance an Independent Prognostic Factor for Early-Stage 
Endometrioid Endometrial Cancer? J Oncol. 2020;14:2020:2934291.</mixed-citation>
                    </ref>
                                    <ref id="ref30">
                        <label>30</label>
                        <mixed-citation publication-type="journal">30. Pergialiotis V, Zachariou E, Vlachos DE, et al. Tumor free distance from serosa and survival rates of 
endometrial cancer patients: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2023;8:286:16-22.</mixed-citation>
                    </ref>
                            </ref-list>
                    </back>
    </article>
