Publications by authors named "Nuriye Ozdemir"

156 Publications

Attitudes of physicians towards COVID-19 vaccines and reasons of vaccine hesitancy in Turkey.

Int J Clin Pract 2021 May 26:e14399. Epub 2021 May 26.

Ankara City Hospital, Ankara, Turkey.

Aim: The development of safe and effective vaccines against SARS-CoV-2 and successful implementation of a global vaccination programme are prerequisites for a return to normal living conditions. Despite these intensive research efforts, vaccine hesitancy and misinformation in many countries present substantial obstacles to achieving sufficient coverage and community immunity. Here, we report the findings of a survey regarding the likelihood of COVID-19 vaccine acceptance in a sample of physicians in Turkey.

Materials And Methods: An anonymous web-based survey was prepared and sent to medical doctors randomly selected from seven parts of Turkey via a text message sent to their mobile phones. Demographic data were collected, including sex (male or female), medical specialty, age, professional experience, COVID-19 history, knowledge of COVID-19 vaccines and behaviours related to vaccines against COVID-19 and other diseases. The survey was conducted over a 1-week period in December 2020.

Results: A total of 1,557 medical doctors responded to the survey. A total of 1,065 (68.4%) respondents were considering COVID-19 vaccination, 374 (24%) were undecided and 118 (7.6%) did not want to be vaccinated. As a result of multivariate analysis, the male gender, absence of history of COVID-19 infection, and having sufficient information about the vaccine were determined as predictive factors for willingness to vaccination.

Conclusion: Although trials tend to focus on the efficacy of vaccines, the results of this study indicated that the most important factor affecting the preference for a given vaccine among Turkish physicians is safety.
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http://dx.doi.org/10.1111/ijcp.14399DOI Listing
May 2021

A Phase II Study of the Combination of Oxaliplatin, Capecitabine, and Trastuzumab and Chemoradiotherapy in the Adjuvant Setting in Operated Patients With HER2-positive Gastric or Gastroesophageal Junction Cancer (TOXAG Study): A Turkish Oncology Group Study.

Am J Clin Oncol 2021 May 12. Epub 2021 May 12.

Department of Medical Oncology, Acibadem Adana Hospital Departments of Radiation Medical Oncology, Baskent University, Adana Department of Medical Oncology, Hacettepe University Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital Department of Medical Oncology, Gazi University Department of Medical Oncology, Medical Park Ankara Hospital Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara Department of Medical Oncology, Marmara University Department of Medical Oncology, Ethica Incirli Hospital Roche Pharmaceuticals Department of Medical Pharmacology, Bahcesehir University School of Medicine Department of Biostatistics and Medical Informatics, Koc University/MedStats Consulting, Istanbul Department of Medical Oncology, Necmettin Erbakan University Meram School of Medicine, Konya Department of Medical Oncology, Ege University, Izmir, Turkey.

Background: Trastuzumab prolonged the overall survival in patients with advanced gastric cancer with human epidermal growth factor receptor 2 (HER2) overexpression in combination with chemotherapy. In this phase II open-label prospective study, the tolerability and safety of trastuzumab with chemotherapy, and chemoradiotherapy for curatively resected patients with HER2-positive gastric carcinoma was investigated.

Methods: The patients with HER2-positive gastric, or gastroesophageal junction adenocarcinoma, after gastrectomy plus D2 dissection, were included. They received 3 cycles of oxaliplatin (100 mg/m2 intravenously day 1) plus capecitabine (850 mg/m2 orally days 1 to 14), trastuzumab (8 mg/kg intravenously day 1 in cycle 1, 6 mg/kg thereafter) every 21 days, followed by chemoradiotherapy. Trastuzumab was given for 1 year.

Results: Of the 212 patients screened, 35 were eligible, and 34 were treated. The median age was 56 years (minimum to maximum: 35 to 75 y), male patients constituted 73.5% (n=25), and 33 (97.1%) had gastric adenocarcinoma. R0 resection was performed in 30 (88.2%). The majority (26, 61.7%) were in stage III disease. Most of the adverse events were grade I/II, the most frequent grade III side effects were nausea (3, 8.8%), vomiting (3, 8.8%), diarrhea (2, 5.9%), and weight loss (n=2, 5.9%). Two patients died during the first 3 cycles of chemotherapy and chemoradiotherapy; 1 secondary to pulmonary thromboembolism, and the other due to cerebral ischemia. After excluding 2 with early progression and 1 consent withdrawal, of the remaining 31 patients, 28 (90.3%) were able to complete the chemotherapy and chemoradiotherapy part of the trial. After the 25 months follow-up period, 21 patients (61.8%) were alive. Overall survival at 12 and 24 months was 75.0% and 58.0%, while disease-free survival at 12 and 24 months was 65.7% and 55.0%, respectively.

Conclusions: Trastuzumab in combination with capecitabine, oxaliplatin following chemoradiotherapy as the adjuvant therapy for gastric or gastroesophageal junction adenocarcinoma was considered as safe and tolerable. The frequency of HER2 overexpression in curatively resected patients is comparable to that in patients with metastatic disease (trial registration: clinicaltrials.gov the identifier: NCT01748773, December 13, 2012, https://clinicaltrials.gov/ct2/show/NCT01748773).
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http://dx.doi.org/10.1097/COC.0000000000000825DOI Listing
May 2021

The role of serum albumin/globulin ratio in combination with prognostic risk indexes of febrile neutropenia.

Int J Clin Pract 2021 Mar 30:e14185. Epub 2021 Mar 30.

Department of Medical Oncology, Gazi University, Ankara, Turkey.

Objectives: The aim of this study was to evaluate the effect of the serum albumin/globulin ratio (AGR) on the 30-day mortality of febrile neutropenia (FEN). The second aim of the study was to evaluate the effect of the combination of the AGR with the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) risk indexes on 30-day mortality of FEN.

Methods: A retrospective study evaluating the effect of serum AGR, MASCC and CISNE scores on 30-day FEN mortality.

Results: A total of 137 FEN episodes in 120 patients were included in this study. Nineteen patients (14%) died within the first 30 days of FEN episodes. The 30-day mortality rate was calculated as 4% in patients with high AGR and 23% in patients with low AGR (P = .002). According to the MASCC and CISNE risk scores, the mortality rates in low-risk patients were 8% and 6%, respectively, and in the high-risk group 22% and 29%, respectively (P = .024 vs P < .001). In the group of patients with MASCC <21 and CISNE ≥3, the 30-day mortality rate was 7%, when the AGR was >1.13, and in those with AGR ≤1.13 mortality rate increased to 50% (P = .012).

Conclusion: A low AGR in a patient with FEN was found to be associated with an increased risk of 30-day mortality. Combining the AGR with MASCC and CISNE risk indexes might increase the predictive value of these scoring systems on 30-day mortality.
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http://dx.doi.org/10.1111/ijcp.14185DOI Listing
March 2021

Clinicopathological Evaluation of Gastric Signet Ring Cell Carcinoma: Our Experience.

Euroasian J Hepatogastroenterol 2020 Jul-Dec;10(2):76-84

Oncolocy Department, Gazi University, Ankara, Turkey.

Aim: Gastric cancer is one of the most common cancers worldwide. In Turkey, stomach cancer is ranked 5th among men and 8th among women in all cancers and is located in the forefront in cancer-related deaths. Signet ring cell adenocarcinoma, which is the histopathological subtype of gastric cancer, has a poor prognosis. The incidence of signet ring cell adenocarcinoma is rising. In the present study, we aimed to describe the clinicopathologic features of signet ring cell adenocarcinoma.

Materials And Methods: A total of 79 patients with 30 being female (38%) and 49 male (62%) who were diagnosed with gastric signet ring cell adenocarcinoma in the Medical Oncology Department of Ankara Numune Training and Research Hospital between January 2004 and October 2015 were retrospectively evaluated.

Results: The baseline demographic characteristics of the patients, such as tumor localization, tumor stage, preoperative serum tumor markers, and treatment type (surgery and chemotherapy regimen), and the effects of these variables on survival and mortality were evaluated. Total surgery, stage III disease, moderate to poor grade, preoperative serum CA 19-9 and CEA levels were found as independent predictors of progression risk ( < 0.05). Each 1 ng/mL increase in preoperative serum CEA level was found to increase the risk of progression by 1.20 folds. Again, each 1 U/mL in preoperative serum CA 19-9 level was found to increase the risk of progression and mortality by 1.06 folds.

Conclusion: The clinicopathologic features of signet ring cell stomach cancer were described. Tumor localization and disease, CA 19-9 and CEA levels, and treatment type (surgery and chemotherapy regimen) were effective on survival and mortality. However, further studies with larger patient groups are needed on this issue.

How To Cite This Article: Altay SB, Akkurt G, Yılmaz N, Clinicopathological Evaluation of Gastric Signet Ring Cell Carcinoma: Our Experience. Euroasian J Hepato-Gastroenterol 2020;10(2):76-84.
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http://dx.doi.org/10.5005/jp-journals-10018-1325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801891PMC
January 2021

Long-term follow-up results of surgically treated patients with foraminal and far lateral disc herniations.

Br J Neurosurg 2021 Jan 27:1-8. Epub 2021 Jan 27.

Department of Neurosurgery, Istanbul Education and Research Hospital, Istanbul, Turkey.

Purpose: Foraminal and far lateral disc herniations are rarer cause of nerve root compression. There are reports regarding the outcome, however long-term follow-up results of surgically treated patients are few. The purpose of this retrospective study is to analyze the clinical characteristics and long-term surgical outcomes of the foraminal and far lateral disc herniations.

Materials And Methods: The 114 patients who underwent an operation for foraminal and far lateral disc herniaitions were reviewed. Visual analogue scale of back and leg pain, the ocurrence of motor deficit and sensory dysesthesia before and after operations were used to compare the results of early and long-term outcome.

Results: A total of 114 telephone interviews were conducted. The mean follow up was 134 months. Complete relief of symptoms were reported by 77 patients (67.1%). The average VAS of radicular leg pain was 7.5 Post-operatively the average VAS of radicular pain decreased to 2.2. Preoperatively, 9 patients (7.6%) had motor deficit and 17 (14.4%) patients had sensory dysesthesia. Post-operatively 9 (100%) of the patients showed motor, and 12 (70.6%) of the patients showed sensory improvement. In 17 patients with hypoesthesia the complaints continued during 2 weeks to 6 months. They were given gabapentin as medical treatment, however 5 of these patients still have sensory dysesthesia. The outcome was: 67.1% excellent (77 patients), 26.3% good (30 patients), 6.1% fair (7 patients).

Conclusion: The far lateral approach is a minimally invasive and safe procedure with low complication rates.
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http://dx.doi.org/10.1080/02688697.2021.1874293DOI Listing
January 2021

PD-L1 expression in immune cells is a favorable prognostic factor for nasopharyngeal carcinoma.

Indian J Cancer 2020 Dec 10. Epub 2020 Dec 10.

Department of Oncology, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Background: Programmed death-ligand 1 (PD-L1) has been determined as a reliable prognostic factor for various malignancies. In this study, we aimed to determine the prognostic effect of PD-L1 expression in tumor-infiltrating immune cells (TIICs) of nasopharyngeal carcinoma (NPC) patients.

Methods: Seventy patients diagnosed with non-metastatic NPC were included in the study. PD-L1 expression on immune cells was analyzed by immunohistochemical method. Patients were categorized into two groups according to the PD-L1 expression level in TIICs (level of PD-L1 staining ≥5% positive vs <5% negative).

Results: Median follow-up period was 34 months (range = 1 - 188). 1 and 2 years survival rate were found as 75% and 63% in PD-L1 negative TIICs group (47%), and 85% and 83% in PD-L1 positive TIICs group (53%), respectively. PD-L1 positivity in immune cells (ICs) was detected in 53% of the patients. The survival rate was found better in the PD- L1 positive group compared to the negative group (P = 0.049).

Discussion: In conclusion, the survival rate was found significantly better in the PD-L1 positive TIICs group, compared to the negative group.
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http://dx.doi.org/10.4103/ijc.IJC_459_19DOI Listing
December 2020

Good prognostic factor in patients with nonmetastatic nasopharyngeal carcinoma: Programmed death ligand-1 expression in tumor cells.

J Cancer Res Ther 2020 Dec;16(Supplement):S43-S47

Department of Oncology, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Purpose: Programmed death ligand-1 (PD-L1) is the main ligand for programmed death-1 (PD-1), and is one of the major targets for cancer immunotherapy. Only a few studies are available for the clinical significance of PD-1/PD-L1 in nasopharyngeal carcinoma (NPC). There is a controversial association between PD-L1 expression and survival in NPC. This study aimed at defining any potential association between PD-L1 expression in tumor cells (TCs) and prognosis in NPC.

Patients And Methods: A total of seventy NPC patients treated between January 2008 and December 2016 were included in the study. PD-L1 expression was assessed by immunohistochemistry (IHC) in tumor specimens. The IHC assay was considered positive if ≥5% of TCs are stained. Clinicopathological variables were documented. Variables included in the analysis were PD-L1 expression, clinicopathological characteristics, and prognosis.

Results: The estimated 5-year overall survival (OS) rate was 62%. Nearly 55.7% (n = 39) of the TCs tested positive for PD-L1 expression. No associations were found between the level of PD-L1 in TCs and clinicopathological characteristics. Comparisons between patients with PD-L1-positive tumors and PD-L1-negative tumors revealed that OS was statistically significantly longer in patients with PD-L1-positive tumors as assessed by the univariate Cox regression analysis (hazard ratio [HR], 0.378; 95% confidence interval, 0.158-0.905; P = 0.029) and Kaplan-Meier curves (P = 0.023).

Conclusion: PD-L1 expression is an important prognostic factor in NPC. PD-L1 expression positively correlates with survival.
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http://dx.doi.org/10.4103/jcrt.JCRT_759_19DOI Listing
December 2020

Harmful consequences of COVID-19 fear in patients with cancer.

BMJ Support Palliat Care 2020 Dec 21. Epub 2020 Dec 21.

Medical Oncology, Gazi University, Ankara, Turkey.

The rapid spread of COVID-19 infection and its negative effects on human health caused a great change in oncology practice. Although oncologists respond quickly to this change, anxiety caused by pandemics in some patients prevented cancer treatment. Although patients know that delaying cancer treatment can be life-threatening, they are concerned about contacting the hospital because they are afraid of becoming infected with COVID-19. Here, we would like to present three patients with delayed admission to the hospital to draw attention to the harmful consequences of COVID-19 fear in the community. These patients with cancer-related anxiety may exaggerate protective attitudes during the pandemic process, leading to delayed oncological treatment and poor prognosis of the patient.
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http://dx.doi.org/10.1136/bmjspcare-2020-002628DOI Listing
December 2020

A Rare Entity: Idiopathic Spinal Cord Herniation.

Neurol India 2020 Nov-Dec;68(6):1472-1474

Department of Neurosurgery, Istanbul Education and Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.4103/0028-3886.304129DOI Listing
December 2020

Clinical features and outcomes of COVID-19 in patients with solid tumors: Turkish National Registry Data.

Int J Cancer 2020 Dec 7. Epub 2020 Dec 7.

Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

We present demographic, clinical, laboratory characteristics and outcomes of the patients with solid malignancies and novel coronavirus disease (COVID-19) collected from the National COVID-19 Registry of Turkey. A total of 1523 patients with a current or past diagnosis of solid tumors and diagnosed with COVID-19 (confirmed with PCR) between 11 March and 20 May 2020 were included. The primary outcome was 30-day mortality. Median age was 61 (range: 18-94), and 752 (49%) were male. The most common types of cancers were breast (19.8%), prostate (10.9%) and colorectal cancer (10.8%). 65% of the patients had at least one comorbidity. At least one COVID-19-directed therapy was given in 73% of the patients.. Hospitalization rate of the patients was 56.6% and intensive care unit admission rate was 11.4%. Seventy-seven (5.1%) patients died within 30 days of diagnosis. The first multivariate model which included only the demographic and clinical characteristics showed older age, male gender and presence of diabetes and receipt of cytotoxic therapy to be associated with increased 30-day mortality, while breast and prostate cancer diagnoses were associated with lower 30-day mortality. In the second set, we further included laboratory parameters. The presence of leukocytosis (OR 6.7, 95% CI 3.3-13.7, P < .001), lymphocytopenia (OR 3,1, 95% CI 1,6-6,1, P = .001) and thrombocytopenia (OR 3,4 95% CI 1,5-8,1, P = .005) were found to be associated with increased 30-day mortality. Relatively lower mortality compared to Western countries and China mainly results from differences in baseline risk factors but may also implicate the importance of intensive supportive care.
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http://dx.doi.org/10.1002/ijc.33426DOI Listing
December 2020

Prognostic and Predictive Value of NAR Score in Gastric Cancer.

J Gastrointest Cancer 2020 Oct 16. Epub 2020 Oct 16.

Medical Oncology, Medicine Faculty of Gazi University, Ankara, Turkey.

Introduction: Neoadjuvant treatment is a widely accepted approach for locally advanced rectum cancer. Efforts to explore a surrogate endpoint for clinical trials revealed a new prognostic scoring system which is named as neoadjuvant rectal score (NAR) in patients who received neoadjuvant treatment for rectal cancer.

Material And Methods: 88 patients who met inclusion criteria were included in the study. The optimal cutoff value of the NAR score was 17.6 with 71% sensitivity and 63% specificity. Patients with NAR score > 17.6 (n: 48, 54%) were defined as the high-risk group and those with NAR score ≤ 17.6 (n: 40, 56%) as the low-risk group.

Result: Survival analysis according to the NAR score group (low-risk vs high-risk) revealed that there was a statistically significant difference between groups regarding OS and DFS. The median OS for high-risk patients was 27.3 months (95% CI, 15.0-39.6); it was 76.6 months (47.3-106.0) for low-risk patients (p < 0.0001). The median DFS was 15.1 months (11.8-18.4) for high-risk patients; it was 44.3 months (95% CI, 4.1-84.6) in the low-risk group (p = 0.002).

Discussion: As a result, we interpreted our findings as supporting data about the utility of NAR score not only as a surrogate endpoint for the clinical trial of rectal cancer but also as a prognostic marker in patients with gastric cancer who received neoadjuvant treatment.
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http://dx.doi.org/10.1007/s12029-020-00537-2DOI Listing
October 2020

A rare case of cervical metastatis of glioblastoma after cranial tumor resection: case report and review of literature.

Br J Neurosurg 2021 Jun 1;35(3):341-347. Epub 2020 Sep 1.

Department of Neurosugery, Istanbul Education and Research Hospital, Istanbul, Turkey.

Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults. GBM extraneural metastases occur in only approximately 0.2-0.4% of patients. We present a case of a cervical metastasis of glioblastoma after cranial tumor resection. In concord with case presentation, we reviewed the metastatic location and metastasis time of the gliablastomas seen in the literature.
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http://dx.doi.org/10.1080/02688697.2020.1814994DOI Listing
June 2021

Herpes zoster infection of the breast.

Breast J 2020 11 31;26(11):2267-2268. Epub 2020 Aug 31.

Department of Medical Oncology, Gazi University School of Medicine, Besevler/Ankara, Turkey.

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http://dx.doi.org/10.1111/tbj.14000DOI Listing
November 2020

Effect of serum uric acid level and Multinational Association for Supportive Care in Cancer risk score on febrile neutropenia mortality.

Support Care Cancer 2021 Feb 25;29(2):1047-1053. Epub 2020 Jun 25.

Department of Medical Oncology, Gazi University, Ankara, Turkey.

Purpose: The study was aimed to evaluate the effect of uric acid (UA) on the 30-day mortality of patients admitted to the tertiary referral hospital with a complaint of febrile neutropenia (FEN). The secondary aim was to evaluate the use of combining serum UA levels with the Multinational Association for Supportive Care in Cancer (MASCC) risk score.

Methods: A retrospective study in which the MASCC score and serum UA levels were used to evaluate the mortality risk within 30 days among patients with FEN.

Results: A total of 118 FEN episodes were included in the study and 17 (14%) of these patients died. While this rate is 23% in the high-risk group according to the MASCC score, it is 7% in the low-risk group (p = 0.011). In multivariate analysis of the parameters that significantly affect the 30-day FEN mortality, MASCC risk score (OR, 4.28; CI 95% 1.19-15.39, p = 0.013) and having a level of serum UA > 7 mg/dL (OR, 4.46; CI 95% 1.19-15.38, p = 0.032) was significantly increased the risk of in 30-day mortality of FEN. The rate of 30-day mortality of FEN was 0% in patients with a low MASCC risk score and UA level compared with 50% in the high MASCC risk score and high UA level group, and the difference was statistically significant (p < 0.001).

Conclusion: Increased level of UA at the time of FEN diagnosis was independently associated with an increased rate of 30-day mortality of FEN. The combination of the MASCC risk score and serum UA level might thoroughly predict the 30-day mortality of FEN.
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http://dx.doi.org/10.1007/s00520-020-05587-7DOI Listing
February 2021

Prediction of Peritoneal Recurrence in Patients with Gastric Cancer: a Multicenter Study.

J Gastrointest Cancer 2021 Jun;52(2):634-642

Faculty of Medicine, Department of Medical Oncology, Yıldırım Beyazıt University, Ankara, Turkey.

Purpose: The peritoneum is the common recurrence site of gastric cancer (GC) presenting with worse survival. Although some predictive clinicopathological factors have been identified, there is no comprehensive assessment of peritoneal recurrence risk prediction for patients treated with adjuvant chemotherapy (CR) or chemoradiotherapy (CRT) after surgery. We aimed to predict peritoneal recurrence and develop a new scoring model in GC.

Methods: This retrospective study included 274 GC patients who presented with recurrence after curative gastrectomy followed by adjuvant chemotherapy (CT) or chemoradiotherapy (CRT). Risk factors for peritoneal recurrence were analyzed using the following parameters: age, gender, tumor location and characteristics, and differences between treatment modalities. All parameters were assessed by binary logistic regression analysis to compare the patients with and without peritoneal recurrence. Then, a new risk scoring model was developed.

Results: Peritoneal recurrence was observed in 115 (44.1%) patients. Peritoneal recurrence was higher in female gender (odds ratio (OR), 1.93; 1.07-3.49, P = 0.030, 1 point), T4a-b stage (OR, 2.47; 1.14-5.36, P = 0.022, 1 point), poor/undifferentiated (OR, 2.04; 1.31-4.06, P = 0.004, 1 point), and signet cell carcinoma (OR, 2.04; 1.04-4.02, P = 0.038, 1 point) after adjusted for resection and dissection types. The risk scoring model was developed using the related parameters: Peritoneal recurrence rates were 24.6%, 42.6%, and 71.4% for group 1 (0 point), group 2 (1-2 points), and group 3 (3-4 points), respectively.

Conclusion: Female gender, T4 tumor stage, undifferentiated histopathology, and signet cell type had a tendency to peritoneal recurrence after adjusted for treatment modalities. Patients with 3 or 4 risk factors had an 8.8-fold increased risk for the development of peritoneal recurrence.
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http://dx.doi.org/10.1007/s12029-020-00419-7DOI Listing
June 2021

Correlation between peripheral blood inflammatory indicators and pathologic complete response to neoadjuvant chemotherapy in locally advanced breast cancer patients.

Medicine (Baltimore) 2020 May;99(22):e20346

Gazi University, Department of Medical Oncology, Ankara, Turkey.

The immune system plays a fundamental role in the response to neoadjuvant chemotherapy (NAC) of locally advanced breast cancer (LABC) patients. Patients with pathological complete response (pCR) after NAC have a higher survival rate. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are peripheral blood indicators of inflammatory response. This investigates the correlation between NLR, PLR, LMR, and other clinicopathological features of breast cancer patients before receiving NAC and pCR.Data of LABC patients who underwent NAC between 2009 and 2018 were retrospectively reviewed. Each patient's peripheral complete blood count was recorded before starting NAC. The cut-off values for neutrophils, lymphocytes, monocytes, and platelets in the peripheral blood and NLR, PLR, and LMR were determined by receiver operating characteristic curve analyses.The records of 131 patients were analyzed and divided into two groups, pCR (+ve) and pCR (-ve), and their clinicopathological features and laboratory findings were compared. pCR was achieved in 23.6% of patients. The cut-off values of neutrophils, lymphocytes, monocytes, and platelets at the time of diagnosis and NLR, PLR, and LMR were, respectively, 4150 μL, 2000 μL, 635 μL, 271 × 10 μL, 1.95, 119, and 3.35. The pCR rate was higher in patients with low neutrophil count, low NLR, and high lymphocyte count (P = .002, <.001, and .040, respectively).As per the findings of multivariate logistic regression analysis, the independent predictive factors of pCR were clinical tumor size T1 and T2, grade 3, ER negativity, and low NLR (P = .015, .001, .020, .022, and .001, respectively).While NLR was found to be an independent predictive factor of pCR in LABC patients receiving NAC, a similar result was not observed for PLR and LMR. NLR can be a useful biomarker for predicting the response of patients receiving NAC.
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http://dx.doi.org/10.1097/MD.0000000000020346DOI Listing
May 2020

Quality of life study of patients with unresectable locally advanced or metastatic pancreatic adenocarcinoma treated with gemcitabine+nab-paclitaxel versus gemcitabine alone: AX-PANC-SY001, a randomized phase-2 study.

BMC Cancer 2020 Mar 30;20(1):259. Epub 2020 Mar 30.

Hacettepe University Cancer Institute, Ankara, Turkey.

Background: Combination of gemcitabine and nab-paclitaxel has superior clinical efficacy than gemcitabine alone. Nevertheless, health-related quality of life. (QoL) associated with this combination therapy when administered at first-line in advanced pancreatic adenocarcinoma is unknown.

Methods: A total of 125 patients were randomized to combination therapy (1000 mg/m2 gemcitabine + 125 mg/m2 nab-paclitaxel) and single-agent gemcitabine (1000 mg/m2) arms to take treatment weekly for 7 of 8 weeks, and following 3 of 4 weeks, until progression or severe toxicity. Primary endpoints were three-months of definitive deterioration free percent of patients, and QoL.

Results: Overall QoL analyses showed that 34 and 58.3% of cases in gemcitabine and gemcitabine+nab-P arms had no deterioration in 3rd month QoL scores (p = 0.018). These proportions were 27.3 and 36.6% in 6 month assessments, respectively (p = 0.357). Median overall survivals in combination and single-agent arms were 9.92 months and 5.95 months, respectively (HR: 0.64, 95% CI: 0.42-0.86, p = 0.038). Median progression free survivals in these treatment arms were 6.28 and 3.22 months, respectively (HR: 0.58, 95% CI: 0.39-0.87, p = 0.008). Median time-to-deterioration were 5.36 vs 3.68 months, and objective response rates were 37.1% vs 23.7% (p = 0.009), respectively in combination and single-agent arms.

Conclusions: Combination therapy with gemcitabine + nab-paclitaxel had better overall and progression-free survival than gemcitabine alone. Also, combination therapy showed increased response rate without toxicity or deteriorated QoL. Combination treatment with gemcitabine and nab-paclitaxel may provide significant benefit for advanced pancreatic cancer.

Trial Registration: This study has been registered in ClinicalTrials.gov as NCT03807999 on January 8, 2019 (retrospectively registered).
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http://dx.doi.org/10.1186/s12885-020-06758-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106641PMC
March 2020

Clinicopathologic and Prognostic Differences between Three Different Age Groups (Child/Adolescent, Young Adults, and Adults) of Colorectal Cancer Patients: A Multicentre Study.

Oncol Res Treat 2019 22;42(10):516-522. Epub 2019 Aug 22.

Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakir, Turkey.

Background: Colorectal cancer (CRC) is a rare disease amongst children and adolescents. Previous studies have reported a number of differences between children/adolescents, young adults, and adult patients with CRC. However, none of these studies compared these age groups according to their clinicopathologic and prognostic characteristics. In the current study, we compare these three age groups.

Methods: A total of 173 (1.1% of 15,654 patients) young CRC patients (≤25 years) were included in the study. As a control group, 237 adult CRC patients (>25 years) were also included. Patients were divided into three age groups: child/adolescent (10-19 years), young adult (20-25 years), and adult (>25 years).

Results: Statistical differences amongst the three groups in terms of gender (p = 0.446), family history (p = 0.578), symptoms of presentation (p = 0.306), and interval between initiation of symptoms and diagnosis (p = 0.710) could not be demonstrated. Whilst abdominal pain (p < 0.001) and vomiting (p = 0.002) were less common in young adults than in other groups, rectal bleeding and changes in bowel habits were relatively less common in adolescents than in other groups. Rectal localisation (p = 0.035), mucinous adenocarcinoma (p < 0.001), and a poorly differentiated histologic subtype (p < 0.001) were less common in the adult group than in other groups. The percentage of patients with metastasis and sites of metastasis (e.g., peritoneum and lung) differed between groups. The median overall survival was 32.6 months in the adolescent group, 57.8 months in the young adult group and was not reached in the adult group (p = 0.022). The median event-free survival of the adolescent, young adult, and adult groups was 29.0, 29.9, and 61.6 months, respectively (p = 0.003).

Conclusions: CRC patients of different age groups present different clinicopathologic and prognostic characteristics. Clinicians should be aware of and manage the disease according to these differences.
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http://dx.doi.org/10.1159/000502120DOI Listing
February 2020

Re: Combination of radiotherapy and immunotherapy? Do timing and dose matter?

J Oncol Pharm Pract 2019 12 21;25(8):2062-2063. Epub 2019 Jun 21.

Medical Oncology, Adana Acıbadem Hospital, Adana, Turkey.

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http://dx.doi.org/10.1177/1078155219858176DOI Listing
December 2019

A rare case: Branch retinal vein occlusion associated with the use of tamoxifen.

J Cancer Res Ther 2019 Jul-Sep;15(3):722-724

Department of Medical Oncology, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Tamoxifen-induced ocular complications including cataracts, keratopathies, retinopathy, impaired visual acuity, ocular irritation, optical neuritis, and retinal vein occlusion are uncommonly reported in the literature. Herein, we report on a premenopausal patient with right-side breast carcinoma who received adjuvant tamoxifen therapy (20 mg/day) for 1.5 years and developed sudden visual loss. Fundal examination revealed an obstruction in the branch of the retinal vein. The diagnosis was confirmed by fluorescein angiography and optical coherence tomography. Thus, tamoxifen was switched to an aromatase inhibitor. Tamoxifen-induced ocular complications should be kept in mind when visual symptoms are seen in patients undergoing tamoxifen therapy. In such cases, a complete ocular examination should be performed.
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http://dx.doi.org/10.4103/0973-1482.204888DOI Listing
November 2019

Prognostic factors for survival in patients with mucosal and ocular melanoma treated with ipilimumab: Turkish Oncology Group study.

J Oncol Pharm Pract 2020 Mar 29;26(2):267-272. Epub 2019 Mar 29.

Medical Oncology, Ankara University School of Medicine, Ankara, Turkey.

Objective: To evaluate prognostic factors associated with the use of ipilimumab in patients with mucosal and uveal melanoma.

Methods: In this multicenter, retrospective study, 31 patients with uveal and mucosal melanoma diagnosed between 2010 and 2017 were enrolled. Patients' characteristics, metastatic disease sites, treatment before ipilimumab therapy, performance status, hemoglobin, lactate dehydrogenase levels, B-RAF and c-kit mutation status, toxicity, and survival data were assessed for patients with mucosal and uveal melanoma. SPSS version 17 was used for statistical analysis. Kaplan-Meier method was used for survival analysis. The log-rank test was used for univariate analyses. The Cox regression analysis was used to test the association between multivariate variables and survival. The p-value of less than 0.05 was considered statistically significant.

Results: Twenty patients had uveal and eleven patients had mucosal melanoma. The median overall survival was seven months (95% confidence interval: 1.1-12.7). In univariate analysis, while bone metastasis, anemia, high lactate dehydrogenase level, and more metastatic sites were associated with lower overall survival, better treatment response and administration of ipilimumab in first or second lines were associated with favorable overall survival. In multivariate analysis, only treatment response status and administration of ipilimumab in first or second lines were found to be significant as independent prognostic factors for survival.

Conclusion: Ipilimumab therapy may be associated with increased survival, but this retrospective small N study makes that hard to definitely conclude.
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http://dx.doi.org/10.1177/1078155219840796DOI Listing
March 2020

Comparison of Gemcitabine monotherapy with Gemcitabine and Cisplatin combination in metastatic pancreatic cancer: a retrospective analysis.

J BUON 2018 12;23(7):116-121

Ankara Numune Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey.

Purpose: Gemcitabine is among the standard first-line agents for the treatment of metastatic pancreatic cancer. However, as the median survival with gemcitabine monotherapy is 6 months, different combinations are being studied for better, prolonged survival. In this multicenter study, we aimed to compare the results of gemcitabine monotherapy with those of gemcitabine and cisplatin combination therapy as first-line treatments for metastatic pancreatic cancer.

Methods: Data of 664 patients diagnosed with metastatic pancreatic cancer between January 2007 and December 2016 from seven oncology centers in Turkey were retrospectively evaluated, and 319 patients with gemcitabine alone (n=138) or gemcitabine and cisplatin combination (n=181) as first-line treatment were included.

Results: The median patient age was 62 years (range 42-79), being 60 years (42-75) in the gemcitabine/cisplatin arm and 67 years (52-79) in gemcitabine alone arm. no complete response was observed in either arm, whereas partial response rates were 30.1% in gemcitabine/cisplatin arm and 15.3% in gemcitabine alone arm (p=0.001). median overall survival was 8 months (95% CI:7.7-10.2) and was significantly longer in the gemcitabine/cisplatin arm than in the gemcitabine alone arm (10 vs. 6 months, p=0.004).

Conclusion: The cemcitabine and cisplatin combination therapy as first-line treatment of metastatic pancreatic cancer yields significantly prolonged survival over gemcitabine monotherapy. In patients with favorable performance conditions, the combination therapy should be preferred.
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December 2018

Molecular subtypes are prognostic for N3 breast cancer patients in the modern therapeutic era.

Mol Clin Oncol 2019 Jan 19;10(1):180-184. Epub 2018 Nov 19.

Department of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydin 09010, Turkey.

Nodal (N) status and molecular subtypes are well-known prognostic factors for breast cancer patients. The aim of the present study was to evaluate whether there was a prognostic role of molecular subtypes for pN3a breast cancer patients in the modern therapeutic era. The present study retrospectively evaluated a total of 521 breast cancer patients who had 10 or more metastatic lymph nodes and received adjuvant systemic therapy at the Oncology Department of four different centers in Turkey between 2000-2015. Patients were divided into four molecular subtypes by immunohistochemical staining. There were no significant differences in relapse rates according to the molecular subtypes (P=0.07). The five year disease free survival rate was 62% for the whole study population, 67% for Luminal A tumors, 53% for Luminal B tumors, 64% for human epidermal growth factor receptor 2-positive tumors and 56% for triple negative tumors. Luminal A patients had a better progression free survival when compared with Luminal B (P=0.026) and triple negative (P=0.07) patients. pT stage (P<0.001), and breast cancer subtype (P<0.001), remained significant independent factors for disease free survival. Therefore, breast cancer subtypes are still prognostic for patients with pN3 breast cancer.
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http://dx.doi.org/10.3892/mco.2018.1771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313943PMC
January 2019

The frequency and predictors of persistent amenorrhea in premenopausal women with colorectal cancer who received adjuvant chemotherapy.

Anticancer Drugs 2019 03;30(3):289-294

Medical Oncology, Hacettepe University Cancer Institute.

The purpose of this study was to identify the frequency of chemotherapy-induced amenorrhea and associated factors thereof in premenopausal female patients diagnosed with colon cancer. Premenopausal female patients under the age of 50 years who were diagnosed with stages I, II, and III colon cancer were included. A questionnaire surveying personal history including menarche, comorbidities, drugs, other clinical features, and menstrual history during and after completion of chemotherapy was filled by the patients during outpatient visits. Patients who received pelvic radiotherapy were excluded from the study. A total of 60 patients were included in the study. Eleven patients had been treated with surgery alone, and 49 patients had received adjuvant chemotherapy with either fluorouracil (5-FU) alone (n=22) or 5-FU+oxaliplatin (n=27). The frequency of persistent amenorrhea 1 year after receiving chemotherapy was 20% in the whole group, 18% in patients who had received adjuvant chemotherapy with 5-FU alone, and 22% in patients who had received chemotherapy with 5-FU+oxaliplatin. Frequency of persistent amenorrhea was 3.5% in patients under the age of 44 years and 42.8% in patients aged 44 years and older. Multivariate analysis showed that age of 44 years and older (hazard ratio: 29.3; 95% confidence interval: 2.8-309.2, P=0.005) and menarche age of 14 years and older (hazard ratio: 7.6; 95% confidence interval: 1.2-49, P=0.076) were significantly associated with increased risk of persistent amenorrhea. In this study, we found that the frequency of persistent amenorrhea was 20% in patients who received 5-FU monotherapy or oxaliplatin-based adjuvant chemotherapy protocols in colon cancer treatment. Older age and later menarche were the factors that increased the risk of persistent amenorrhea 1 year after chemotherapy.
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http://dx.doi.org/10.1097/CAD.0000000000000728DOI Listing
March 2019

Mortality risk analysis of asymptomatic and symptomatic venous thromboembolism in patients with metastatic colorectal cancer.

J Cancer Res Ther 2018 Oct-Dec;14(6):1330-1335

Department of Medical Oncology, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Background: The current study aimed to compare the clinicopathological characteristics and survival data of the patients with metastatic colorectal cancer who had symptomatic or asymptomatic venous thromboembolism (VTE) and non-VTE.

Patients And Methods: The files of the patients diagnosed with 521 metastatic colorectal cancer in our hospital between April 2001 and January 2015 were analyzed retrospectively. VTE was divided into four groups in relation with their locations as extremity, port, visceral, and nonvisceral VTE. VTE was also categorized as symptomatic or asymptomatic in relation with the presence of thrombus-related symptoms. The median overall survival was considered as the period from the diagnosis of metastasis to death or last control.

Results: A total of 424 patients were included in the study. The median age was 62 (range 24-95) years. Seventy-two (16.9%) patients developed VTE. Among all, 8.9% of the patients had asymptomatic VTE, 8% of them had symptomatic VTE, and remaining 83.1% of them were in the non-VTE group. Visceral thrombosis located in pulmonary and the thrombosis located in extremities and port location was usually symptomatic while nonvisceral thrombosis and nonpulmonary visceral thrombosis were frequently asymptomatic and found incidentally on radiological imaging obtained for tumor. Anticoagulant treatment was administered to all patients with symptomatic thrombosis. None of the patients with asymptomatic thrombosis was given anticoagulants. The median survival was 16.3 months (95% confidence interval [CI]: 13.8-18.9) in symptomatic, 22.5 months (95% CI: 18.6-26.4) in asymptomatic, and 21 months (95% CI: 20.5-21.5) in the non-VTE groups (P = 0.03).

Conclusions: Symptomatic VTE is a predictor of poor survival in patients with metastatic colorectal cancer. The presence of an asymptomatic thrombus does not have any effect on prognosis, and follow-up without anticoagulant treatment may be appropriate in those patients.
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http://dx.doi.org/10.4103/0973-1482.188441DOI Listing
February 2019

Prognostic factors for survival in patients with metastatic malign melanoma treated with ipilimumab: Turkish Oncology Group study.

J Oncol Pharm Pract 2019 Oct 6;25(7):1658-1664. Epub 2018 Nov 6.

10 Medical Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey.

Purpose: Studies in the last decade show survival improvement with checkpoint blocker therapy in patients with metastatic malign melanoma. Our purpose was to define the efficacy of ipilimumab according to the patient's baseline characteristics including absolute lymphocytes count.

Methods: We collected the data of 97 patients with advanced malign melanoma treated with ipilimumab (3 mg/kg, q3w) retrospectively. Log-rank test was used to analyze the univariate effects of patient's characteristics (age, gender, metastatic sites, ECOG PS, type of melanoma, lactic dehydrogenase levels, anemia, lymphocytes (L), neutrophils (N), N/L ratio), c-kit and BRAF status. Survival analyses were estimated with Kaplan-Meier method. Cox regression analysis was used to assess the possible factors identified with log-rank test.

Results: The median age was 58, and 58% were male and 90% of patients had at least one prior systemic therapy. The median survival was 9.7 months for all patients; and the 12- and 24-month survival rates were 43% and 19%, respectively. Absolute lymphocytes count, lactic dehydrogenase level, bone metastasis, the number of metastatic sites, and RECIST response were significantly related to survival. After Cox regression analysis, RECIST response (complete or partial response), absolute lymphocytes count (more than 1500/mm) and the number of metastatic sites (less than three sites) remained as significant independent prognostic factors for longer survival.

Conclusion: Ipilimumab improved survival of patients with metastatic malign melanoma. However, patients with fewer metastatic sites and higher absolute lymphocytes count have a significantly better benefit. To determine if these markers could be used to direct patient therapy, further validation analysis is needed.
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http://dx.doi.org/10.1177/1078155218805539DOI Listing
October 2019

Advanced signet-ring cell carcinoma of the stomach: Clinicopathological characteristics of patients and efficacy of the modified docetaxel, cisplatin, and fluorouracil regimen.

J Cancer Res Ther 2018 Sep;14(Supplement):S742-S747

Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey.

Background: The aim of this retrospective study was to investigate the clinicopathological characteristics of patients with signet-ring cell carcinoma (SRCC) of the stomach, and the efficacy of the modified docetaxel, cisplatin, and fluorouracil (mDCF) chemotherapy regimen.

Patients And Methods: Sixty-five patients diagnosed with metastatic or recurrent SRCC and treated with at least one course of mDCF regimen as the first-line treatment at our hospital July 2007 and January 2015, were included in this study. The mDCF protocol comprised docetaxel at 60 mg/m/day (day 1), cisplatin at 60 mg/m/day (day 1), and 5-fluorouracil at 600 mg/m/day (days 1-5) for every 3 weeks.

Results: The median age was 53 years (range, 25-69 years). The most frequent sites of metastasis were the peritoneum (50.8%) and liver (21.5%). The median number of chemotherapy courses was six. In assessing 61 patients for response evaluation, one patient (1.6%) achieved a complete response, and 36 (59.0%) achieved a partial response. Fifteen patients (24.6%) had stable disease and nine (14.8%) had progressive disease. Grades 3-4 hematological toxicity revealed anemia in three (4.6%) patients, thrombocytopenia in two (3.1%), and neutropenia in five (7.7%). Grades 3-4 nonhematological side effects revealed nausea and vomiting in four (6.1%) patients and mucositis in one (1.5%). The overall survival (OS) and progression-free survival (PFS) were 10.4 months (95% confidence interval [95% CI], 8.9-12.0) and 6.1 months (95% CI, 5.1-7.0), respectively. Multivariate analysis showed that Eastern Cooperative Oncology Group (ECOG) performance score of 2 and a high pretreatment carcinoembryonic antigen level were statistically significant.

Conclusions: mDCF is an effective regimen in patients with SRCC of the stomach who have ECOG performance score of 0-1 when the PFS, OS, and tumor response rate are considered. Further prospective studies including more patients should be conducted on this subject.
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http://dx.doi.org/10.4103/0973-1482.184514DOI Listing
September 2018

Spinal paragangliomas: Surgical treatment and follow-up outcomes in eight cases.

Medicine (Baltimore) 2018 Sep;97(38):e12468

Department of Neurosurgery, İstanbul Training and Research Hospital, Istanbul Department of Neurosurgery, Sakarya Training and Research Hospital, Sakarya Department of Pathology, İstanbul university Cerrahpasa Medicine Faculty, Istanbul, Turkey.

Paragangliomas are neuro-endocrine tumors originating from the adrenal gland. They are usually benign and nonfunctioning, rarely seen in central nervous system. More than 90% of central nervous system paragangliomas are manifested as carotid and glomus jugulare tumors. Spinal paragangliomas are quite rare.The study was conducted through retrospective analysis of the files of the patients who had undergone surgery with pre-diagnosis of spinal intradural tumor between 2011 and 2017 and diagnosed with paraganglioma.A total of 8 patients (4 females and 4 males) were included in the study. Mean age of the patients was 51.1 years (28-64). Time to admission was mean 6.5 months (3 weeks-24 months). Recurrence was not observed in 7 patients, 1 patient is being followed up due to residual tumor.Treatment may be achieved through recognizing malignant transformation in patients who were not diagnosed histopathologically. We consider that quality of life of the patients may be improved through this way.
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http://dx.doi.org/10.1097/MD.0000000000012468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160075PMC
September 2018

Retrospective evaluation of patients diagnosed solid pseudopapillary neoplasms of the pancreas.

Curr Probl Cancer 2019 02 19;43(1):27-32. Epub 2018 Jul 19.

Department of Medical Oncology, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey.

Purpose: Solid pseudopapillary neoplasm (SPN) is a rare, low-grade neoplasm with excellent prognosis. In this study, we evaluated clinicopathological characteristics of patients diagnosed with SPN retrospectively.

Methods: This is a retrospective study intended to characterize patients with the diagnosis of SPN between 2005 and 2015. Clinicopathological features, recurrence rate, and overall survival of 28 patients were recorded. Malignant SPN criteria were defined as the presence of distant metastasis (developed at diagnosis or during follow up) or lymph node involvement.

Results: The mean age at diagnosis was 42 (range: 17-41). Among patients, 82% (n = 23) were female and 17.9% (n = 5) were male. The mean size of tumor was 5.81 cm (range: 2-15). The mean follow up period was 55.6 months, 1-year survival was 96.5% and 5-year survival rate was 88%. A total of 25 patients were alive at the end of follow-up period and 3 of the patients became exitus due to disease. Two patients had a metastatic presentation in livers at the diagnosis and metastasis developed in 3 patients during follow-up (liver of 1 patient, peritoneum in 1 patient and liver and peritoneum in 1 patient). The reason of admission was headache in 68% patients. The type of operation was frequently subtotal pancreatectomy (n = 11, 39.3%) and distal pancreatectomy (n = 10, 35.7%). Tumors were located frequently in body and tail regions (n = 18, 64.3%) and the number of patients with malignant criteria was 6 (21.4%). Although the mean age of malignant patients was significantly higher than benign patients (P = 0.046), there was no significant difference between 2 groups in terms of gender, tumor size, capsule invasion, perineural invasion, vascular invasion, and margin status.

Conclusion: SPN is a rarely seen tumor with low malignity potential. Surgical resection provides long-term survival rate even in local invasion or metastasis conditions.
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http://dx.doi.org/10.1016/j.currproblcancer.2018.06.014DOI Listing
February 2019

Prognostic importance of the albumin to globulin ratio in metastatic gastric cancer patients.

Curr Med Res Opin 2019 02 20;35(2):275-282. Epub 2018 Jun 20.

a Department of Medical Oncology , SBÜ Ankara Numune Education and Research Hospital , Ankara , Turkey.

Aim: The aim of this study was to evaluate the prognostic importance of the albumin to globulin ratio (AGR) in terms of overall survival (OS) and progression free survival (PFS) in metastatic gastric cancer patients.

Methods: The patients diagnosed with metastatic gastric cancer between 2009 and April 2016 at the hospital have been studied retrospectively. The clinicopathological characteristics, laboratory, and treatment parameters have been assessed. AGR value has been calculated using the following formula (AGR = serum albumin/total protein - serum albumin).

Results: In total, 251 patients were included in the study population. The median value of AGR was 1.206 (range = 0.460-3.130), and the cut-off value was set as 1.20. Based on the cut-off value, 126 patients were categorized in the low AGR group, while the remaining 125 patients were categorized in the high AGR group. ECOG (Eastern Cooperative Oncology Group) performance scores, CEA levels, CA19-9 levels, hemoglobin levels, lactate dehydrogenase levels, and liver metastasis ratios varied significantly between the low and high AGR groups (p < .05). The Kaplan-Meier curve has shown that, compared to the low AGR group, the high AGR group has better OS (12.2 vs 9.3 months, p = .002) and better PFS (8.0 vs 5.7 months, p < .001) rates. The univariate and multivariate analyses also proved that low AGR is an independent bad risk factor in metastatic gastric cancer patients, both in terms of OS (p = .019, Hazard Ratio (HR) = 1.380, 95% Confidence Interval (CI) = 1.055-1.805) and PFS (p = .002, HR = 1.514, 95% CI = 1.164-1.968).

Conclusion: In metastatic gastric cancer patients, AGR is an independent prognostic factor for OS and PFS. Thus, in this patient group, the low cost albumin and globulin which can be measured with routine clinical practice may be used as an appropriate prognostic tool.
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http://dx.doi.org/10.1080/03007995.2018.1479683DOI Listing
February 2019