Publications by authors named "Ahmet Taner Sumbul"

36 Publications

Concurrent versus sandwich treatment in adjuvant treatment in high risk operated gastric cancer: A single center experience.

J BUON 2020 Sep-Oct;25(5):2341-2349

Baskent University, Department of Medical Oncology, Adana, Turkey.

Purpose: In this study we compared postoperative early vs sandwich chemoradiotherapy in operated stage IIA-IIIC gastric cancer patients in terms of effectiveness and outcome.

Methods: The data of 201 gastric cancer patients treated in the same center between December 2006 and June 2017 were retrospectively evaluated. One hundred forty nine patients who were eligible for the study criteria were divided into two groups according to the postoperative treatment modality. The first group included 85 patients who were given chemoradiotherapy simultaneously (ETG) and the second group icluded 64 patients who received sandwich (chemotherapy-chemoradiotherapy-chemotherapy) (STG) treatment. Overall survival (OS) and disease-free survival (DFS) were evaluated as primary endpoints.

Results: The median follow-up time for all patient groups was 26.7 months (1.3 -136.5 months). Adjuvant chemotherapy and radiotherapy were initiated concurrently in patients receiving concomitant therapy. Half of the planned chemotherapy, then chemoradiotherapy and then the remaining chemotherapy treatments were given to the sandwich treatment group. A total of 50.4 Gy radiotherapy was given to the concurrent chemoradiotherapy group and a total of 45 Gy radiotherapy to the group receiving the sandwich treatment.. OS was 30.6 months (23.7-37.5) in all groups, 30.4 months (23.7-35.0) in concurrent therapy (ETG) and 35.6 months (26.3-45) in sandwich therapy (STG) (p=0.73). DFS was 26.6 months (21.3-32.0) in all groups and 24.5 months (18.1-31.0) in the group receiving ETG, 32.5 months (22.2-42.8) in STG. (p=0.46). The most common grade 3 and above toxicities were; acute upper gastrointestinal toxicity (19.1% in ETG vs. 9.0% in STG, p=0.01) and hematological toxicity (31.8% in ETG vs. 13.9% in STG; p=0.002). Early cessation of treatment was similar in both groups. In multivariate analysis, female gender (p=0.01), stage III disease, grade III disease were seen as negative predictive factors for overall survival. In DFS multivariate analysis, there was no difference between the groups in terms of gender, T stage, N stage, and AJCC stage.

Conclusion: In this study, superiority of sandwich treatment over concurrent treatment was observed in patients with operated stage IIB-IIIC gastric cancer, but the difference was not statistically significant. If this study is performed in larger patient series, the difference of sandwich treatment may become meaningful.
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December 2020

Atezolizumab in Patients with Metastatic Urothelial Carcinoma Who Have Progressed After First-line Chemotherapy: Results of Real-life Experiences.

Eur Urol Focus 2020 Sep 30. Epub 2020 Sep 30.

Medical Faculty, Ankara University, Ankara, Turkey.

Background: Atezolizumab (ATZ) has demonstrated antitumor activity and manageable safety in previous studies in patients with locally advanced or metastatic platinum-resistant urothelial carcinoma.

Objective: To compare the real-life experience and data of clinical trials on ATZ treatment in metastatic urothelial carcinoma.

Design, Setting, And Participants: Patients with urothelial cancer treated with ATZ after progression on first-line chemotherapy from an expanded access program were retrospectively studied. Data of patients were obtained from their files and hospital records. Safety was evaluated for patients treated with at least one cycle of ATZ.

Outcome Measurements And Statistical Analysis: The primary endpoint was objective response rate (ORR). The secondary endpoints are overall survival (OS), progression-free survival (PFS), duration of response, and safety profile of patients. Kaplan-Meier methods were used to calculate median follow-up and estimate PFS and OS.

Results And Limitations: Data of 115 enrolled patients were analyzed. Most of the patients (92.3%, n = 106) had received chemotherapy regimen only once prior to ATZ. The median follow-up duration was 23.5 mo. The complete response rate, partial response rate, and ORR were 8.7% (n = 10), 20.0% (n = 23), and 28.7% (n = 33), respectively. The median duration of response was 20.4 mo (95% confidence interval [CI], 6.47-28.8). Of the 33 patients who responded to treatment, 60% (n = 20) had an ongoing response at the time of the analysis. PFS and OS with ATZ were 3.8 mo (95% CI, 2.25-5.49) and 9.8 mo (95% CI, 6.7-12.9), respectively. All-cause and any-grade adverse events were observed in 113 (98%) patients. Of the patients, 64% experienced a treatment-related adverse event of any grade and 24 (21.2%) had a grade 3-4 treatment-related adverse event. Limitations of the study included its retrospective design, and determination of treatment response based on clinical notes and local radiographic studies.

Conclusions: In these real-life data, ATZ was effective and well tolerated in patients with metastatic urothelial carcinoma who have progressed with platinum-based first-line chemotherapy. ATZ is an effective and tolerable treatment for patients with locally advanced or metastatic platinum-resistant urothelial carcinoma in our study, similar to previously reported trials.

Patient Summary: Atezolizumab is effective and well-tolerated in patients with metastatic urothelial cancer who progressed with first-line chemotherapy, consistent with the outcomes of the previous clinical trials in this setting.
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http://dx.doi.org/10.1016/j.euf.2020.09.010DOI Listing
September 2020

The hematologic parameters in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate.

Future Oncol 2019 May 12;15(13):1469-1479. Epub 2019 Apr 12.

Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Currently, there are no predictive markers of response to abiraterone. We calculated neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) at baseline and at 4 and 12 weeks after initiation of abiraterone, and we evaluated prostate-specific antigen (PSA) response every 4 weeks in 102 metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone either pre- or postchemotherapy. With a median follow-up was 24.0 months (range: 0.3-54.9), median overall survival (OS) was 20.8 months. High-NLR patients who remained high or who returned to low NLR after 4 and 12 weeks showed significantly worse OS than patients with low baseline NLR. NLR and prostate-specific antigen response to abiraterone was a significant predictor of OS and progression-free survival (PFS) in metastatic castration-resistant prostate cancer patients treated with abiraterone delivered either pre- or postchemotherapy.
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http://dx.doi.org/10.2217/fon-2018-0635DOI Listing
May 2019

Outcome of loco-regional radiotherapy in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate.

Strahlenther Onkol 2019 Oct 30;195(10):872-881. Epub 2019 Jan 30.

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Purpose: To evaluate the potential benefit of curative radiotherapy (RT) to the primary tumor in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone.

Materials And Methods: The clinical parameters of 106 mCRPC patients treated with abiraterone were retrospectively evaluated. Patients were either oligometastatic (≤5 metastases) at diagnosis or became oligometastatic after the systemic treatment was analyzed. Local RT to the primary tumor and pelvic lymphatics was delivered in 44 patients (41%), and 62 patients (59%) did not have RT to the primary tumor. After propensity match analysis, a total of 92 patients were analyzed.

Resultsn: Median follow-up time was 14.2 months (range: 2.3-54.9 months). Median overall survival (OS) was higher in patients treated with local RT to the primary tumor than in those treated without local RT with borderline significance (24.1 vs. 21.4 months; p = 0.08). Local RT to the prostate and pelvic lymphatics significantly diminished the local recurrence rate (16 patients, 31% vs. 2 patients, 5%; p = 0.003). In multivariate analysis, the prostate specific antigen (PSA) response ≥50% of the baseline obtained 3 weeks after abiraterone therapy was the only significant prognostic factor for better OS and progression-free survival (PFS). Patients treated with primary RT to the prostate had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT.

Conclusions: Local prostate RT significantly improved OS and local control in mCRPC patients treated with abiraterone. The patients treated with primary RT had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT.
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http://dx.doi.org/10.1007/s00066-019-01429-6DOI Listing
October 2019

Does cyclin E and p57 expression have prognostic and survival value in colorectal adenocarcinoma?

Int J Clin Exp Pathol 2018 1;11(8):3867-3875. Epub 2018 Aug 1.

Department of Medical Laboratory Techniques, Vocational School of Health Sciences, Harran University Şanlıurfa, Turkey.

Introduction: Colorectal cancer is still one of the main causes of cancer death in the world. There is a continous need for novel biomarkers for diagnose, treatment modalities and follow-up. Cyclin E and p57 as the positive and negative regulators of cell cycle seem to be an important target for investigations.

Materials And Methods: In a retrospective setting, primary colorectal adenocarcinoma cases examined in Mustafa Kemal University, School of Medicine, Pathology Department between 2008-2015 were reviewed. Immunohistochemical expressions of cyclin E and p57 in 80 pairs of colorectal carcinoma and adjacent normal mucosal tissues were evaluated and the findings were compared with clinicopathological parameters and survival time.

Results: There were no statistically significant difference between two groups both in cyclin E and p57 stained tissues (P>0.05). There were 40 (50%) patients in high-expression group and 40 (50%) patients in low-expression group for cyclin E. p57 was negative in 55 (68.75%) patients and positive in 25 (31.75%) patients. There were no statistically significant relation between p57 and cyclin E expressions with clinicopathologic parameters defined as age, gender, lymphovascular invasion, perineural invasion, depth of invasion, nodal involvement, emergency in operation, perforation before operation and overall survival except that there was significant relation between p57 expression and histological grade (P=0.012).

Conclusions: Immunohistochemical studies of cyclin E and p57 should be performed with larger series of patients supported by more detailed technical research methods to be candidates as predictive markers for treatment modalities and prognostic factors.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962821PMC
August 2018

Genetic polymorphisms in human telomerase reverse transcriptase (hTERT) gene polymorphisms do not associated with breast cancer in patients in a turkish population: hospital-based case-control study.

Cell Mol Biol (Noisy-le-grand) 2018 Feb 28;64(3):108-115. Epub 2018 Feb 28.

Department of Nursing, Adiyaman School of Health, Adiyaman University, Adiyaman, Turkey.

Breast cancer (BC) is encountered most frequently in developed or developing countries. It is the most common cancer in humans following lung cancer, and it is the most common cancer type resulting in mortality in women. Genetic polymorphisms are among the genetic factors that play an important role in the development of the breast cancer. The purpose of this study was to investigate the effect of five functional single nucleotide polymorphisms (SNPs) of hTERT (rs2736109 G>A, rs2735940 T>C, rs2853669 A>G, rs2736098 G>A, and rs2736100 T>G) on susceptibility to BC in Turkish population. The genotype frequency of hTERT rs2736109 G>A, rs2735940 T>C, rs2853669 A>G, rs2736098 G>A, and rs2736100 T>G polymorphisms were determined by using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and TaqMan methods in 123 subjects with GC and 122 healthy control subjects. The mean age value of the BC patients was 51.58±11.28 (among them 8 subjects ≤35 and 115 subjects >35). In this study, it was found that there was no statistical difference between hTERT rs2736109 G>A, rs2735940 T>C, rs2853669 A>G, rs2736098 G>A, and rs2736100 T>G polymorphisms that can be associated with risk of BC.
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http://dx.doi.org/10.14715/cmb/2018.64.1.3DOI Listing
February 2018

Prognostic value of procalcitonin in infection-related mortality of cancer patients.

J BUON 2016 May-Jun;21(3):740-4

Department of Medical Oncology, Baskent University, Adana, Turkey.

Purpose: Infectious diseases are a major cause of morbidity and mortality in cancer patients. Tumor-induced inflammatory responses may increase the value of classical inflammatory markers in blood, so these markers may not be as useful in cancer patients as in non-cancer patients. Serum procalcitonin (PCT) is a sensitive and specific biomarker for severe infection, and has been shown to be unaffected by tumor-induced inflammatory response. In this study we aimed to evaluate the possible role of PCT in mortality in cancer patients with infection.

Methods: In total, 104 consecutive adult cancer patients who presented with fever (body temperature ≥ 38.3° C or ≥ 38° C on two consecutive measurements) during follow-up and needing hospitalization for infection were enrolled in this study.

Results: The majority (72%) of the patients were male. The most common diagnosis and type of infection were lung cancer (40.4%) and pneumonia (56.7%), respectively. The overall mortality rate was 17%. Statistical analysis showed a significant relationship between PCT levels and mortality (p=0.001), but not between classical inflammatory markers and mortality (p>0.05). The mortality rate of patients with a PCT value > 2 ng/mL was 34.3%, compared with 9.6% in patients with a PCT below this value (p=0.005). Furthermore, PCT predicted in-ward cancer patient mortality with a sensitivity of 66% and a specificity of 76%.

Conclusion: PCT is a unique serum biomarker significantly related to infection-related mortality and predicts mortality with a relatively high sensitivity and specificity.
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December 2016

An old enemy not to be forgotten during PET CT scanning of cancer patients: tuberculosis.

Contemp Oncol (Pozn) 2016 8;20(2):188-91. Epub 2014 Jul 8.

Department of Medical Oncology, Medical Faculty, Baskent University, Ankara, Turkey.

Aim Of The Study: Positron emission tomography-computed tomography (PET CT) scan is commonly used in current medical oncology practice as an imaging method. In this study we present data from cancer patients who were followed at our clinic and suspected of having tuberculosis during PET CT scanning. After the biopsy, they were diagnosed with concomitant tuberculosis.

Material And Methods: In this study, 14 patients who applied to our clinic and followed up due to cancer, and had PET CT scanning for the preliminary staging or further evaluation, were included. The patients were diagnosed with metastatic or recurrent disease, and their biopsy results revealed tuberculosis.

Results: The mean age was 57.8 years with SD (standard deviation) 13.1 years and gender distribution of 78.6% (n = 11) females and 21.4% (n = 3) males. None of the patients had tuberculosis in their personal history (0%). Among the patients, 5 (35.7%) were diagnosed with tuberculosis during the preliminary staging, whereas 9 (64.3%) were diagnosed during the follow-up after the treatment. The median time to tuberculosis diagnosis was 11 months (min-max: 3-24 months) after the treatment. The most commonly involved lymph nodes during PET CT scanning were mediastinal in 8 (64.3%), axillary in 3 (21.4%) and para-aortic in 3 (21.4%) patients. The mean SUVmax (maximum standardised uptake value) of lymph node involved by PET CT scanning was defined as 8.5 (SD 2.6).

Conclusions: Despite all improvements in modern medicine, tuberculosis is still a serious public health problem. It should always be considered in differential diagnosis while evaluating PET CT scanning results of cancer patients, because it may cause false positive results.
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http://dx.doi.org/10.5114/wo.2014.43985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925724PMC
June 2016

Polymorphisms in human telomerase reverse transcriptase (hTERT) gene and susceptibility to gastric cancer in a Turkish population: Hospital-based case-control study.

Gene 2016 Jul 23;585(1):84-92. Epub 2016 Mar 23.

Adıyaman Univesity, Faculty of Medicine, Department of Thoracic Surgery, 02040 Adıyaman, Turkey.

Erosion of telomeres, tandem nucleotide repeats (TTAGGG)n that cap the end of eukaryotic chromosomes, has been related with carcinogenesis. The human telomerase reverse transcriptase (hTERT) gene is encoded the rate-limiting catalytic subunit of the telomerase complexes, which is essential for the protection of telomeric DNA length and chromosomal stability. The purpose of this study was to examine the effect of four functional single nucleotide polymorphisms (SNPs) of hTERT (rs2736109 G>A, rs2735940 T>C, rs2853669 A>G and rs2736100 T>G) on susceptibility to gastric cancer (GC) in Turkish population. The genotype frequency of hTERT rs2736109 G>A, rs2735940 T>C, rs2853669 A>G and rs2736100 T>G polymorphisms were determined by using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and TaqMan methods in 104 subjects with GC and 209 healthy control subjects. We found that hTERT rs2736109 G>A (AA+AG vs. GG OR=1.68 95% CI=1.01-2.81, P=0.04), rs2735940 T>C (CC vs. CT+TT: OR=2.53 95% CI=1.01-6.13, P=0.03), and rs2736100 T>G (TT vs. TG+GG: OR=2.27 95% CI=1.23-4.17, P=0.006) polymorphisms were associated with risk of GC. In the haplotype analysis, hTERT Grs2736109/Trs2735940/Ars2853669/Grs2736100 haplotype was also related with an increased risk of GC (OR=1.75; 95% CI: 1.05-2.93, P=0.03). Because this is the first study regarding the hTERT rs2736109 G>A, rs2735940 T>C, rs2853669 A>G and rs2736100 T>G polymorphisms and the risk of GC susceptibility in the literature, further independent studies are needed to verify our results in a larger sample sizes, as well as in patients of different populations.
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http://dx.doi.org/10.1016/j.gene.2016.03.030DOI Listing
July 2016

Risk factors for brain metastasis as a first site of disease recurrence in patients with HER2 positive early stage breast cancer treated with adjuvant trastuzumab.

Breast 2016 Feb 20;25:22-6. Epub 2015 Dec 20.

Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.

Purpose: The aim of this study was to determine risk factors for brain metastasis as the first site of disease recurrence in patients with HER2-positive early-stage breast cancer (EBC) who received adjuvant trastuzumab.

Methods: Medical records of 588 female patients who received 52-week adjuvant trastuzumab from 14 centers were evaluated. Cumulative incidence functions for brain metastasis as the first site of disease recurrence and the effect of covariates on brain metastasis were evaluated in a competing risk analysis and competing risks regression, respectively.

Results: Median follow-up time was 36 months. Cumulative incidence of brain metastasis at 12 months and 24 months was 0.6% and 2%, respectively. HER2-enriched subtype (ER- and PR-) tumor (p = 0.001, RR: 3.4, 95% CI: 1.33-8.71) and stage 3 disease (p = 0.0032, RR: 9.39, 95% CI: 1.33-8.71) were significant risk factors for development of brain metastasis as the first site of recurrence.

Conclusions: In patients with HER2 positive EBC who received adjuvant trastuzumab, HER2-enriched subtype (ER- and PR-) tumor and stage 3 disease were associated with increased risk of brain metastasis as the first site of disease recurrence.
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http://dx.doi.org/10.1016/j.breast.2015.11.006DOI Listing
February 2016

A functional HOTAIR rs12826786 C>T polymorphism is associated with breast cancer susceptibility and poor clinicopathological characteristics in a Turkish population: a hospital-based case-control study.

Tumour Biol 2016 Apr 14;37(4):5577-84. Epub 2015 Nov 14.

Department of Thoracic Surgery, Faculty of Medicine, Adıyaman University, 02040, Adıyaman, Turkey.

Hox transcript antisense intergenic RNA (HOTAIR), a long non-coding RNA (lncRNA), is pervasively overexpressed and correlated with tumor invasion, progression, metastasis, and poor prognosis in various human cancers including breast cancer (BC) that plays a role as an oncogenic molecule. A common functional single-nucleotide polymorphism (SNP) (rs12826786 C>T) at the HOTAIR promoter has been reported to influence HOTAIR expression and gastric adenocarcinoma susceptibility, but relation of HOTAIR rs12826786 C>T polymorphism with BC susceptibility and clinicopathological characteristics has yet to be reported. To explore the association of the HOTAIR rs12826786 C>T polymorphism with the risk of BC in a Turkish population, a hospital-based case-control study was carried out consisting of 123 BC patients and 122 age-matched healthy controls. HOTAIR rs12826786 C>T polymorphism was determined by real-time polymerase chain reaction (PCR) using TaqMan assay. We found that women carrying TT genotype of HOTAIR rs12826786 C>T polymorphism had an increased risk of developing BC in both codominant (odds ratio (OR) = 2.24, 95 % confidence interval (CI) 1.05-4.81, P = 0.02) and recessive (OR = 2.49, 95 % CI 1.25-4.97, P = 0.008) inheritance models. Moreover, TT genotype of HOTAIR rs12826786 C>T polymorphism was significantly related with multiple clinicopathological characteristics concerned with worse BC progression such as advanced TNM stage (III and IV), larger tumor size (T3 and T4), and distant metastasis (M1), as well as poor histological grade (III) (P < 0.05). Because of our results put forward for the first time that TT genotype of HOTAIR rs12826786 C>T polymorphism might play crucial roles in genetic susceptibility and poor prognosis for BC in Turkish population, further independent studies are needed to confirm our results in a larger series, as well as in patients of distinct populations.
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http://dx.doi.org/10.1007/s13277-015-4430-yDOI Listing
April 2016

MicroRNA 211 expression is upregulated and associated with poor prognosis in colorectal cancer: a case-control study.

Tumour Biol 2015 Dec 8;36(12):9703-9. Epub 2015 Jul 8.

Department of Biology and Genetics, Gaziantep University, Gaziantep, Turkey.

Increasingly more evidence support the role of the microRNAs (miRNA) in tumorigenesis. The role of up/downregulation microRNA-211 (miR-211) during human tumorigenesis is still contentious and may exhibit tissue-specific regulatory manner, but the exhaustive mechanisms underlying its pro/anti-oncogenic effects remain to be unknown. Sixty-six patients that were diagnosed and operated with colorectal cancer (CRC) and sixty-five healthy cases that were age and sex compatible with them were included in our study. miRNA was isolated from the formalin-fixed paraffin-embedded (FFPE) tissues of all cases. The expression level of miR-211 in matched normal and tumor tissues of CRC group and healthy group was evaluated using a quantitative real-time RT-PCR (qRT-PCR). Based on the average miR-211 levels, two groups of low or high expression were formed in CRC group. Correlation of the patients' clinicopathological factors and survival was also analyzed. No statistically significant differences were found in miR-211 levels among tumorous and normal tissues of CRC patient group (P = 0.59). Also, no statistically significant correlation was determined between clinicopathological factors and miR-211 expression level in CRC group. However, miR-211 expression levels between the CRC group and the healthy group were determined to be of statistical significance (P < 0.0001). There were 33 (50 %) CRC patients that expressed low levels of miR-211 and 33 (50 %) CRC patients that expressed high levels of miR-211. A median survival between low levels of miR-211 group and high levels of miR-211 group was evaluated via Kaplan-Meier, and the difference was of statistical significance (P = 0.035). The univariate analysis of the factors that may affect survival indicated invasion depth (P = 0.063), lymphovascular invasion (P = 0.011), perineural invasion (P = 0.009), and miR-211 expression level (P = 0.041) presence to be effective. In the multivariate analysis of these factors with overall survival, only miR-211 expression level (P = 0.01) was effective on overall survival. Our results suggest for the first time that miR-211 expressed more in CRC patients than in healthy group could be a new prognostic biomarker in order to predict survival. Independent studies are needed to validate our findings in a larger series, as well as in cancer of different tissues.
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http://dx.doi.org/10.1007/s13277-015-3708-4DOI Listing
December 2015

A functional HOTAIR rs920778 polymorphism does not contributes to gastric cancer in a Turkish population: a case-control study.

Fam Cancer 2015 Dec;14(4):561-7

Department of Biology, Faculty of Science and Letters, Adıyaman University, 02040, Adıyaman, Turkey.

An aberrant up-regulation of HOX transcript antisense intergenic RNA (HOTAIR), a long non-coding RNA (lncRNA), is associated with human cancers including gastric cancer (GC) and worse clinicopathological features. A naturally occurring functional single nucleotide polymorphism (SNP) rs920,778 (C→T) in the intronic enhancer of HOTAIR gene has been demonstrated to affect HOTAIR expression and cancer susceptibility. To investigate the association of the HOTAIR rs920778 polymorphism on the risk of GC susceptibility in Turkish population, a hospital-based case-control study was carried out consisting of 104 GC and 209 healthy control subjects matched on age and gender. The genotype frequency of HOTAIR rs920778 polymorphism was determined by using TaqMan Real-Time Polymerase Chain Reaction. No statistically significant differences were found in the allele or genotype distributions of the HOTAIR rs920778 polymorphism among GC and healthy control subjects (P > 0.05). Our results demonstrate that the HOTAIR rs920778 polymorphism has not been in any major role in genetic susceptibility to gastric carcinogenesis, at least in the population studied here. Independent studies are needed to validate our findings in a larger series, as well as in patients of different ethnic origins.
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http://dx.doi.org/10.1007/s10689-015-9813-0DOI Listing
December 2015

Concurrent chemoradiotherapy with vinorelbine plus split-dose cisplatin may be an option in inoperable stage III non-small cell lung cancer: a single-center experience.

Med Sci Monit 2015 Mar 3;21:661-6. Epub 2015 Mar 3.

Department of Medical Oncology, Başkent University Medical Faculty, Adana, Turkey.

Background: Concurrent chemoradiotherapy is the current standard treatment for inoperable stage III non-small cell lung cancer (NSCLC). In this study we aimed to investigate the efficacy and toxicity of CCRT with split dose of cisplatin (30 mg/m2) and vinorelbine (20 mg/m2) in patients with inoperable stage III NSCLC followed in our oncology clinic.

Material And Methods: Medical records of 97 patients with inoperable stage III NSCLC treated with concurrent chemoradiotherapy with cisplatin-vinorelbine were retrospectively analyzed. Cisplatin (30 mg/m2) and vinorelbine (20 mg/m2) were administered on days 1, 8, 22, and 29 during radiotherapy. Two cycles of consolidation chemotherapy were given. All patient data, including pathological, clinical, radiological, biochemical, and hematological data, were assessed retrospectively using our database system.

Results: Our study included 97 unresectable stage III NSCLC patients who were treated with CCRT. Median age was 58 years old (range 39-75) and 87 (89.7%) of the patients were men. ECOG performance score was 0-1 in 93 patients (95.9%). Squamous histology, the most common histology, was diagnosed in 46 patients (47.4%). Median follow-up time was 23.8 months. Median progression-free survival (PFS) and median overall survival time (OS) were 10.3 months and 17.8 months, respectively. Objective response rate and clinical benefit rate were 75.3% and 83.5%, respectively. Distant and local relapse rate were 57.1% and 42.9%, respectively. Hematological and non-hematological grade 3-4 toxicities were seen in 13 (13.4%) and 16 (16.5%) patients, respectively. Six (6.1%) patients died due to toxicity.

Conclusions: The results of this study suggest that split-dose cisplatin may offer fewer grade III-IV toxicities without sacrificing efficacy and could be an option in patients with inoperable stage III NSCLC during CCRT. Similar to past studies, despite high response rate during CCRT, distant relapse is the major parameter that influences patient survival in long-term in NSCLC.
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http://dx.doi.org/10.12659/MSM.892730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356262PMC
March 2015

Gemcitabine + platinum combination chemotherapy in patients with metastatic cancer who suffer from severe and irreversible hepatic impairment: a single center experience.

Hepatogastroenterology 2014 Oct;61(135):1895-900

There is limited information on chemotherapeutic agent doses suitable for patients with metastatic cancer who suffer from and irreversible hepatic impairment and who could potentially benefit from chemotherapy and on their results. In this retrospective study, we aimed to share our center’s experience of Gemcitabine + Platinum Combination chemotherapy in these patients. Data of 13 patients matching the criteria were analyzed. In our study the patients were treated with a dose of Gemcitabine + Platinum Combination, 50% of the original dose and the dose was increased gradually on the following days. Thirteen of one patient was given Gemcitabine & Carboplatin protocol and the others were given Gemcitabine & Cisplatin . In 42 chemotherapy cycles in total grade 3-4 thrombocytopenia occurred after 7 cycles, grade 3-4 neutropenia was not observed. While liver functions in 8 patients improved slightly, no change was observed in 2 patients and in 3 patients they deteriorated. Total survival period was calculated as 3.78 (95CI% : 0,17-7.54) months. As a consequence, Gemcitabine + Platinum Combination chemotherapy in patients with metastatic cancer who suffer from severe and irreversible hepatic impairment can be implemented when clinical benefits are expected.
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October 2014

Effect of HOTAIR rs920778 polymorphism on breast cancer susceptibility and clinicopathologic features in a Turkish population.

Tumour Biol 2015 May 14;36(5):3863-70. Epub 2015 Jan 14.

Department of Nursing, Adıyaman School of Health, Adıyaman University, 02040, Adıyaman, Turkey,

Overexpression of Hox transcript antisense intergenic RNA (HOTAIR), a long non-coding RNA (lncRNA), is associated with cancer cell proliferation, invasion, progression, and metastasis as well as poor survival in a variety of human cancers including breast cancer (BC). A common functional single nucleotide polymorphism (SNP) rs920778 (T → C) in the intronic enhancer of the HOTAIR has been reported to influence HOTAIR expression and cancer predisposition, but the association of HOTAIR rs920778 polymorphism with BC susceptibility and clinicopathological features has yet to be investigated. We genotyped HOTAIR rs920778 polymorphism in 245 Turkish women including 123 BC patients and 122 age-matched healthy controls by a real-time polymerase chain reaction (PCR) with the TaqMan assay. We found that the CC genotype of HOTAIR rs920778 polymorphism significantly increased the risk of BC in both codominant (odds ratio (OR) = 2.12, 95 % confidence interval (CI) 1.00-4.51, P = 0.05) and recessive (OR = 2.40, 95 % CI 1.22-4.73, P = 0.01) inheritance genetic models. Our research also indicated an association between the CC genotype of HOTAIR rs920778 polymorphism and clinicopathologic features of tumor, including advanced tumor-node-metastasis (TNM) stage, larger tumor size, distant metastasis, and poor histological grade (P < 0.05). Because our findings suggest for the first time that the CC genotype of HOTAIR rs920778 polymorphism might play important roles in genetic susceptibility to BC development and aggressiveness in a Turkish population, further independent studies are required to validate our findings in a larger series, as well as in patients of different populations.
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http://dx.doi.org/10.1007/s13277-014-3028-0DOI Listing
May 2015

Patients with distal intestinal gastric cancer have superior outcome with addition of taxanes to combination chemotherapy, while proximal intestinal and diffuse gastric cancers do not: does biology and location predict chemotherapy benefit?

Med Oncol 2015 Feb 9;32(2):476. Epub 2015 Jan 9.

Department of Medical Oncology, Medical Faculty, Baskent University, Adana, Turkey.

Gastric cancer, with one million new cases observed annually, and its dismal prognosis, is one of the leading causes of cancer-related mortalities. Systemic chemotherapy is the main treatment modality in advanced gastric cancer patients. We aim to evaluate the predictive role of tumor localization and histopathology on choosing three or two-drug combination regimens. Consecutive 110 metastatic gastric adenocarcinoma patients who were admitted to the Baskent University Department of Medical Oncology and the Van Research and Training Hospital were included in the study. Data of patients were analyzed retrospectively. Median age of patients was 58 years (range 30-80). Proximal intestinal, distal intestinal, and diffuse gastric cancers were found in 35 (32 %), 64 (58 %), and 11 (10 %) patients, respectively. 5-fluoracil and platinum (PF) and PFtax were administered to 47 (43 %) and 63 (57 %) patients, respectively. Median progression-free survival (PFS) was 4.0 (95 % CI 2.5-5.6) and 7.4 months (95 % CI 6.0-8.7) for PF and PFtax groups, (p = 0.034). When we used tumor localization as strata in the PFS survival curve, PFtax produced significantly higher PFS rates only in distal intestinal-type gastric cancer, compared with PF (p = 0.03). Median overall survival (OS) was 9.0 (95 % CI 5.2-12.3) and 17.3 months (95 % CI 7.8-27) for PF and PFtax groups, (p = 0.010). When we used tumor localization as strata in the OS survival curve, PFtax produced significantly higher OS rates only in distal intestinal-type gastric cancer compared with PF (p = 0.015). Pathology and tumor location in gastric cancers may affect the outcome, the addition of taxanes as a third drug may significantly increase PFS and OS rate purely in distal intestinal-type gastric cancer but not in patients with proximal and diffuse-type gastric cancers.
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http://dx.doi.org/10.1007/s12032-014-0476-8DOI Listing
February 2015

A case of rectal adenocarcinoma presented with palatine tonsil metastasis.

J Oncol Pharm Pract 2016 Apr 23;22(2):341-3. Epub 2014 Dec 23.

Department of Gastroenterology, Hatay Antakya State Hospital, Hatay, Turkey.

The most common metastatic sites of colorectal cancer are liver, lung, peritoneum and lymph nodes. Metastasis of colorectal carcinoma to palatine tonsil is rarely seen. To our knowledge, only 11 patients were documented in English literature. Atypical metastases can sometimes lead to misdiagnosis. Precise diagnosis of atypical metastases requires a careful physical examination, good imaging method and comprehensive pathological evaluation. Here, we report a case of rectal adenocarcinoma presented with palatine tonsil metastasis.
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http://dx.doi.org/10.1177/1078155214565124DOI Listing
April 2016

Continuous distress in an oncology clinic in Turkey: should we make use of the distress thermometer mandatory as a precautionary measure for physicians?

J BUON 2014 Jul-Sep;19(3):807-11

Mustafa Kemal University, Medical Faculty, Department of Medical Oncology, Hatay, Turkey.

Purpose: To study the data on the distress scale points (DSP) of patients in oncology clinics in relation to age, the reasons for admission to the hospital, the educational status and the family support.

Methods: Six hundred and fifty three patients diagnosed with malignancies were enrolled. All of the patients were asked to fill in a questionnaire that included data about their demographic characteristics, diagnoses, the cause of hospital admission and the educational status. The family support of each patient was observed and noted by clinicians and other healthcare providers during the clinical visits.

Results: The mean patient age was 54.8 years (± SD 13.7). Of the patients 314 (48.1%) were male and 339 (51.9%) female. The median DSP for the group that included patients <35 years of age was 3; this was 5 for the 36-49 age group, 4 for the 50-69 age group and 4.5 for the >70 age group. A statistically significant difference in DSP between these groups was noticed (p=0.035). The DSP for patients <35 years of age was lower than that of the other age groups. The median DSP for the patients presenting to the outpatient clinic for adjuvant therapy was 5; this was 5 for patients presenting for palliative therapy, and 3 in the active surveillance group, and a statistically significant relationship was determined between the DSP and the reason for admission to the outpatient clinic (p<0.001). The patients that had presented to the outpatient clinic for active surveillance had statistically significantly lower DSP compared to the other groups (p<0.05).

Conclusions: Distress in oncology clinics seems to be continuous; thus, the use of distress thermometer as a precautionary measure for distress development in patients with malignancies should be mandatory to help medical oncologists understand the psychosocial needs of their patients and start to treat them as a human beings.
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November 2014

miR-204-5p expression in colorectal cancer: an autophagy-associated gene.

Tumour Biol 2014 Dec 11;35(12):12713-9. Epub 2014 Sep 11.

Department of Medical Oncology, Medical Faculty, Mustafa Kemal University, Hatay, Turkey,

MicroRNAs (miRNAs) are important factors during tumorigenesis by affecting posttranscriptional gene expression. miRNA 204 (miR-204) is a miRNA frequently investigated in different types of cancers. According to literature, autophagy has dual roles in cancer, acting as both a tumor suppressor and cell survival agent. Also, the current data suggests that autophagy is activated in human colorectal cancer cells and enhances the aggressiveness of human colorectal cancer cells. So, our aim is to investigate potential effect of miR-204-5p on colorectal cancer by associating its expression with autophagy-related targets of miR-204-5p. This is the first miRNA study conducted on patients with colorectal cancer and healthy subjects and also to search the relation of miR-204-5p with clinicopathological factors and survival. Sixty-six patients with colorectal cancer and healthy subjects without any known chronic disease were enrolled into our study. Total miRNA was isolated from paraffin-embedded tissues of all patients' cancerous and normal tissues, and healthy subjects. cDNAs were obtained from this miRNAs by reverse transcriptase method, and miR-204-5p relative expression levels were detected by qRT-PCR method. Patients were divided into two groups according to median relative expression levels of miR-204-5p, as low- and high-expression group. Relation of miR-204-5p with clinicopathological factors and overall survival was also investigated. Medians of miR-204-5p relative expression levels in cancerous and normal tissues of patients were found as 0.00235 and 0.00376, respectively. The difference between two groups was not statistically significant (p = 0.11). Nonetheless, median of miR-204-5p relative expression levels in healthy subjects were found as 0.00135, and the difference between patient with cancer and healthy subjects and between normal tissues of patients and healthy subjects were statistically significant (p = 0.021 and p = 0.0005, respectively). There were 32 patients (48.5 %) showing high expression and 34 patients (51.5 %) showing low expression according to miR-204-5p relative expression levels. There were no statistically significant relation between clinicopathologic features and miR-204-5p relative expression levels. We also investigated the relation between miR-204-5p relative expression levels and overall survival, and no statistically significant relation was found between them (p = 0.462). The absence of any significant difference between tumor and non-tumor samples, low sample size, and performance at just one center are the limitations of our study. In opposition to literature, miR-204-5p is overexpressed in colorectal cancer patients as compared with healthy subjects and this situation is not associated with clinicopathological factors and overall survival. This may be explained by the fact that miR-204-5p increases in colorectal cancer cases in order to inhibit increased activity of LC3B-II in autophagy and Bcl2 against apoptosis posttranscriptionally and to take role as tumor suppressor.
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http://dx.doi.org/10.1007/s13277-014-2596-3DOI Listing
December 2014

Being a medical oncologist near the war area.

J BUON 2014 Apr-Jun;19(2):580

Mustafa Kemal University School of Medicine, Department of Medical Oncology, Hatay, Turkey.

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September 2014

Evaluation of mean platelet volume in patients with type 2 diabetes mellitus and blood glucose regulation: a marker for atherosclerosis?

Int J Clin Exp Med 2014 15;7(4):955-61. Epub 2014 Apr 15.

Department of Endocrinology and Metabolism, Mustafa Kemal University Hatay, Turkey.

Objective: Platelets have an important role in atherosclerosis and arterial thrombosis. Cardiovascular complication prevalence of type 2 diabetes mellitus (type 2 DM) may be associated with glycosylated hemoglobin (HbA1c) and mean platelet volume (MPV). The aim of the study was to investigate if platelets were activated in diabetes and its associated vascular complications by measuring the MPV in the diabetics compared to the non-diabetics, and to determine the correlation of MPV with fasting serum glucose (FSG), HbA1c and duration of diabetes in the diabetic patients, respectively.

Materials And Methods: The study carried out in 65 patients with type 2 DM and 40 non-diabetic subjects. In addition to non-diabetic patients, all diabetic patients were divided into two groups according to their HbA1c levels: group A consisted of patients with HbA1c levels ≤7% and group B consisted of patients with HbA1c levels >7%.

Results: MPV was significantly higher in Group B as compared to both non-diabetics and Group A. MPV had a high positive correlation with HbA1c and FSG, as with diabetes duration. It is found that MPV was increased in type 2 DM.

Conclusion: Our findings suggested an association between MPV and HbA1c. Therefore, MPV would be a beneficial prognostic marker of cardio-vascular complications in patients with type 2 DM.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057846PMC
June 2014

Malignant pleural mesothelioma: a single-center experience in Turkey.

Med Sci Monit 2014 May 20;20:825-32. Epub 2014 May 20.

Department of Medical Oncology, Başkent University, Medical Faculty, Adana, Turkey.

Background: Malignant pleural mesothelioma is a rare lethal malignancy caused by asbestos exposure. It is more frequently seen in certain regions in Turkey. In this retrospective study, we aimed to analyse demographic, clinical, and pathological data and treatment-related features in 54 patients.

Material And Methods: The study included 54 patients diagnosed with malignant mesothelioma that were followed and treated.

Result: Of the 54 patients, 34 (55.6%) were male. The median age in men and women were 60.3 (38.2-77.2) and 65.8 (37.7-77.5) years, respectively. In 35 (64.8%), exposure to asbestosis was present. Epithelial type was found in 27 (50.0%), followed by mixed type in 7 (13.0%) patients, and in 20 (37.0%) patients the subtype could not be determined. The disease was staged as IV in 37 (68.5%) patients. In 28 patients (51.9%), it was right-sided and in 1 (1.9%) it was bilateral. The most frequent metastatic sites (in decreasing order) were lungs, mediastinum, diaphragm, liver, and thoracal wall. Of the 54 patients, 36 (66.6%) received 1st-line chemotherapy and 20 (37%) 2nd-line chemotherapy. Eighteen patients (33.3%) received radiotherapy; 11 (20.3%) with palliative intention and 7 (12.9%) with curative intention. Median overall survival (OS) was 12.03 months (95% CI 7.2-16.8). OS was not affected by sex (p=0.32), smoking history (p=0.51), alcohol consumption (p=0.36), family history (p=0.67), pleural effusion presence (p=0.80), operation (p=0.14), clinical stage (p=0.072), symptom at presentation (p=0.66), having mixed type histology (p=0.079), asbestos exposure (p=0.06), and type of 1st-line chemotherapy (p=0.161). On the contrary, it may be positively affected by good ECOG PS (0-1) (p<0.01), age below 65 (p=0.03), left-sided disease (p=0.01), receiving chemotherapy (p<0.01), having unilateral pleural effusion (p=0.018), and type of 2nd-line chemotherapy (p=0.025).

Conclusions: OS of our patients was better than that found in the literature, seeming to be positively affected by early stages, better ECOG PS, age below 65 years, left side involvement, and having second-line chemotherapy with cisplatin-gemcitabine or 3M. Overall treatment success seems to be comparable to what is currently expected.
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http://dx.doi.org/10.12659/MSM.890020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038637PMC
May 2014

Can low molecular weight heparins circumvent the problem of coumadine and chemotherapy interaction in cancer patients with prosthetic heart valves?

Asian Pac J Cancer Prev 2014 ;15(4):1889-90

Department of Medical Oncology, Baskent University School of Medicine, Turkey E-mail : drtanersu@ yahoo.com.

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http://dx.doi.org/10.7314/apjcp.2014.15.4.1889DOI Listing
November 2014

Can serial monitoring of serum Vascular Endothelial Growth Factor (VEGF), Nitric Oxide (NO), and Angiotensin II (ANGII) levels have predictive role during Bevacizumab treatment?

Med Sci Monit 2014 Mar 15;20:428-33. Epub 2014 Mar 15.

Depertment of Medical Oncology, Başkent University Medical Faculty, Adana, Turkey.

Background: Standard treatment of colorectal cancer includes both cytostatic chemotherapy and targeted therapies. Bevacizumab, targeting the VEGF receptor, is one of the primary targeted therapies that achieve better response rate and survival rate as compared to combination chemotherapy. To the best of our knowledge, there is no established single marker that can be used as a predictive marker in bevacizumab therapy.

Material And Methods: We enrolled 24 patients with the diagnosis of metastatic colorectal cancer in our study. During the study, 2 blood samples were drawn from patients before the first cycle and after the sixth cycle of bevacizumab therapy. Serum levels of VEGF, ANG II, and NO were recorded.

Results: While the change across VEGF levels was found to be a statistically significant decreasing trend (p=0.009), this decrease was not found to be correlated with treatment response and hypertension development. Additionally, no statistically significant difference was found in terms of NO and ANG II levels.

Conclusions: This study showed a significant decrease in serum VEGF, but failed to show a significant change in NO and ANG II levels during bevacizumab treatment. Although no significant correlation was found between the presence of hypertension and markers, most patients (83%) had an increase in their blood pressure. Our results suggest that dynamic monitoring of NO and ANG II, along with VEGF, may not be useful as predictive markers for bevacizumab treatment in colorectal cancer.
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http://dx.doi.org/10.12659/MSM.889945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962326PMC
March 2014

Is it rational to continue anti-neoplastics with minimal toxicity even after progression in patients with no other options? Possibly yes.

Asian Pac J Cancer Prev 2014 ;15(2):1061-2

Oncology Clinic, Mustafa Kemal University Medical Faculty Antakya Hatay Turkey E-mail :

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http://dx.doi.org/10.7314/apjcp.2014.15.2.1061DOI Listing
November 2014

Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus.

J Int Med Res 2014 Apr 24;42(2):581-8. Epub 2014 Feb 24.

Department of Medical Physiology, Medical Faculty, Mustafa Kemal University, Hatay, Turkey.

Objective: Leukocytosis is thought to be directly associated with the pathogenesis of atherosclerosis and metabolic syndrome. Increased white blood cell (WBC) count is related to cardiovascular disease in patients with type 2 diabetes mellitus; raised neutrophil lymphocyte ratio (NLR) is associated with metabolic syndrome. There is little information, however, concerning a correlation between glycosylated haemoglobin (HbA1c) and NLR. The aim of the present study was to investigate the relationship between NLR and blood glucose regulation.

Methods: This retrospective study was conducted in patients with type 2 diabetes mellitus, divided into two groups according to HbA1c levels: group 1, HbA1c levels ≤ 7%; group 2, HbA1c levels > 7%. Venous WBC, neutrophil and lymphocyte counts were determined.

Results: Of 71 patients included, fasting serum glucose, neutrophil and WBC counts were significantly higher in group 2 compared with group 1. NLR had a positive correlation with HbA1c.

Conclusion: There may be a significant relationship between NLR and blood glucose regulation. The authors propose that increased NLR may be associated with elevated HbA1c in patients with type 2 diabetes mellitus.
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http://dx.doi.org/10.1177/0300060513516944DOI Listing
April 2014

Neutrophil-to-lymphocyte ratio predicts PSA response, but not outcomes in patients with castration-resistant prostate cancer treated with docetaxel.

Int Urol Nephrol 2014 Aug 13;46(8):1531-5. Epub 2014 Feb 13.

Tıp FakültesiTıbbiOnkoloji BD, Mustafa Kemal Üniversitesi, Hatay, Turkey,

Purpose: The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammatory response and evidences for the relationship between NLR and the response to treatment gradually increases in cancer patients. In this study, we aimed to investigate the effect of the pretreatment NLR and other factors related to the patient on predicting the outcome of docetaxel + prednisone chemotherapy in prostate cancer patients who become castration resistant.

Materials And Methods: Thirty-three metastatic castration-resistant prostate cancer patients those who were treated between 2009 and 2013 were included in our study. All data of the patients, including pathological, clinical, radiological, biochemical and hematological data, were assessed retrospectively using our database system.

Results: The median progression-free survival (PFS) was determined as 23.9 months (range 0.36-118.7) with androgen suppression therapy and 9.5 months (range 1.7-39.4) with docetaxel + prednisone therapy. NLR was found to be correlated with only posttreatment psa levels. In the NLR ≤3 group, the PSA levels were statistically significantly lower than the other group (r = 0.002). Furthermore, the relationships between the clinical response and PFS and the other pretreatment parameters of the patients were evaluated in order to predict which group would respond better to docetaxel + prednisone therapy after becoming androgen resistant. No relationship was found between any of the parameters and the response to therapy.

Conclusion: Although NLR was found effective in predicting the PSA response in docetaxel + prednisone therapy, neither NLR nor any other clinical parameter was found effective in predicting the outcome and the role of NLR in the future of CRPC is questionable.
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http://dx.doi.org/10.1007/s11255-014-0664-7DOI Listing
August 2014

Low serum levels of vitamin D in metastatic cancer patients: a case-control study.

Med Oncol 2014 Mar 4;31(3):861. Epub 2014 Feb 4.

Division of Medical Oncology, Faculty of Medicine, Mustafa Kemal University, 31000, Antakya, Hatay, Turkey,

Accompanying comorbidities observed during the cancer treatment usually affect the course and outcome of the therapy. Hypovitaminosis D, which is one of these conditions, is a resolvable problem, if recognized. In this study, we investigated whether the serum 25(OH)D levels of the patients who were presented to our outpatient clinic were different from the serum levels of the healthy population living in the same area. Our study included 90 patients who were presented to the Medical Oncology outpatient clinic and 90 age, gender, body mass index and ethnic origin matched controls without a known disease, who were presented to the outpatient clinics of the Departments of Internal Diseases and Family Medicine for routine controls. Blood count tests, detailed biochemistry tests (including serum levels of Cr, Ca and P), measurement of serum 25(OH)D levels and C-reactive protein were performed in serum samples of all of the patients and controls. Mean serum levels of 25(OH)D were 13.5 ng/ml (SD 5.1) in all cancer patients, 13.1 ng/ml (SD 4.2) in the patients who were presented for adjuvant therapy, 13.8 ng/ml (SD 5.5) in the patients who were presented at metastatic stage and 18.4 ng/ml (SD 12.5) in the controls. Mean serum CRP levels were 5.4 mg/dl (SD 1.2) in the control group, 8.4 mg/dl (SD 4.3) in the adjuvant therapy group and 20.3 (SD 16.8) in the patients with metastatic disease. Generally, all cancer patients (p 0.003) and the patients with metastatic cancer (p 0.004) had lower serum 25(OH)D levels compared to controls, and there was an inverse correlation between serum 25(OH)D and CRP levels in patients with metastatic cancer (p 0.036). In metastatic cancer patients, hypovitaminosis D may be a comorbidity and it is recommended to consider during initial evaluation and follow-up. Because it might improve these patients quality of life and chemotherapy adherence.
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http://dx.doi.org/10.1007/s12032-014-0861-3DOI Listing
March 2014

Which patients with advanced cancer and biliary obstruction benefit from biliary stenting most? An analysis of prognostic factors.

Support Care Cancer 2013 Apr 8;21(4):1131-5. Epub 2012 Nov 8.

Department of Internal Medicine, Division of Medical Oncology, Başkent University School of Medicine, Adana, Turkey.

Background: Patients with advanced cancer may present with obstructive jaundice. Biliary stenting is the treatment of choice. However, which patients benefit most is not well-defined, yet. Our aim was to delineate the clinical factors affecting prognosis.

Material And Methods: Charts of 140 patients with advanced cancer who underwent biliary stenting were retrospectively analyzed. Their median age was 63.5 years. Of these patients, 73 (52.1 %) were male, 32 (22.9 %) had ECOG PS 1 and 81 (57.9 %) had PS 2. The most frequent cancer types were cholangiocellular cancer (64, 45.7 %) and pancreatic cancer (36, 25.7 %).

Results: Median overall survival (OS) was 141 (95 % CI, 100.7-185.3) days. Female patients lived longer (161.0 vs. 124.0 days) (p = 0.036). Those patients with colorectal cancer lived the longest (667.0 days), followed by cholangiocellular (211.0 days), and gastric cancers (106.0 days) (p = 0.004). The distribution of primary diagnosis differed significantly between sexes: cholangiocellular cancer was present in 22 (30.1 %) out of 73 men and 42(62.7 %) out of 67 women (chi-square p < 0.001). There was a trend for longer overall survival if ALT (p = 0.08) and AST (p = 0.06) were normalized after stent insertion. Of the 137 patients, 63 (45.5 %) did not experience any complication. In 74 patients with complications, there were 39 (28.5 %) episodes of cholangitic infections and 35 (25.5 %) biliary obstructions. In three patients, we could not find data on infections.

Conclusion: Underlying malignancy, hence the natural biology and the therapeutic expectations are probably the most important factors which must be considered during decision-making.
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http://dx.doi.org/10.1007/s00520-012-1636-zDOI Listing
April 2013