Browsing by Author "Cihan, Sener"

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Adrenocortical Carcinoma: Single Center Experience
(2020) Seçmeler, Şaban; Can, Orcun; Yasar, Nurgul; Geredeli, Caglayan; Demir, Cumhur; Sakin, Abdullah; Cihan, Sener
Objective: The prevalence of adrenocortical carcinoma (ACC) is approximately 0.02% of all cancers, and the annual incidence is approximately 1-2 per million population. ACC is more aggressive, and the prognosis of ACC is poorer in adults than that in pediatric patients. We aimed to investigate the clinicopathological characteristics and factors affecting overall survival (OS) in patients with ACC who were followed-up and treated in our hospital.Methods: The patients, who were treated and followed up in the oncology clinic between 2006 and 2018, were included in the study. The patients who were diagnosed with ACC in the pathologic evaluation were included.Results: A total of 10 patients, five men (50%) and five women (50%), were included in the study. The mean age was 42.4 years (range=18-67). Six patients (60%) were stage 3, and four patients (40%) were stage 4. Eight patients (80%) underwent surgery. The release of glucocorticoid and/or androgen was detected in six patients (60%). Recurrence developed in six patients (100%), and seven patients (70%) died during the follow-up. The median OS was 13 months in patients with stage 3 disease, and the median OS was eight months in patients with stage IV disease (Log-rank p=0.177). The eastern cooperative oncology group performance status (ECOG PS) and performing of surgery were detected as the most significant factors affecting OS (Log-rank p=0.01, Log-rank p=0.02).Conclusion: The significant factors for OS were found to be surgery and ECOG PS in our study.
Assessment of Pretreatment Albumin-Bilirubin Grade in Pancreatic Cancer Patients With Liver Metastasis
(Imprimatur Publications, 2020) Sakin, Aysegul; Sahin, Suleyman; Sakin, Abdullah; Atci, Muhammed Mustafa; Yasar, Nurgul; Arici, Serdar; Cihan, Sener
Purpose: This study aimed to assess the effect of pretreat- ment albumin-bilirubin (ALBI) score on treatment outcomes in pancreatic cancer (PC) patients with liver metastasis at the time of diagnosis treated with chemotherapy (CT) in the first-line setting. Methods: This was a retrospective study of 273 PC patients >= 18 years of age who had liver metastasis at the time of diagnosis and received CT in the first-line. ALBI score was calculated through the following formula; [(log10 bilirubin (mu mol/L)x0.66)+[albumin(g/l)x-0.0852]. Patients were strati- fied into 3 categories based on the ALBI score as follows; grade I:ALBI <=-2.60, grade II:-2.60-1.39. Results: A total of 273 patients, [180 (65.9%) men and 93 (34.1%) women], were evaluated. The median age was 60 years. ALBI grade was I in 45 (16.4%) patients, II in 156 (57.1%) patients, and III in 72 (26.5%) patients. Based on the ALBI grade, median progression-free survival (mPFS) was 9 months in grade I patients, 6 months in grade II patients, and 4 months in grade III patients (p=0.002), with median overall survival (mOS) durations of 12 months vs. 8 months vs. 5 months, respectively (p<0.001). Multivariate analysis showed that ALBI grade II (HR,1.543) or III (HR,2.260) negatively affected survival. Conclusion: A higher pretreatment ALBI grade is related to worse OS and PFS in PC patients with liver metastasis treated with a first-line CT, and therefore it can help predict the treatment outcomes in these patients.
The Clinical Importance of Androgen Receptor Status in Response To Neoadjuvant Chemotherapy in Turkish Patients With Local and Locally Advanced Breast Cancer
(Karger, 2020) Arici, Serdar; Sengiz Erhan, Selma; Geredeli, Caglayan; Cekin, Ruhper; Sakin, Abdullah; Cihan, Sener
Purpose:To investigate whether androgen receptor (AR) status affects neoadjuvant chemotherapy (NACT) in stage II and III Turkish breast cancer patients.Methods:The histological response for breast and axilla was assessed according to the Miller-Payne grading system. In light microscopy, nuclear staining in tumor cells was evaluated, and nuclear staining above 1% was accepted as positive for AR expression. The patients were divided into 3 groups according to the intensity of AR staining: low, moderate, and high.Results:In total, 71 women with breast cancer were included in the study. In univariate analysis, age, menopause status, tumor diameter, stage, histological grade, Ki-67, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER-2) status were tested to determine which of these factors were associated with >90% responsiveness. AR negativity was found to be the only statistically significant factor. In multivariate analysis, AR positivity at each intensity was found to be the single important factor affecting decreasing pathologic response in patients receiving NACT for breast cancer.Conclusion:Our results show that AR positivity is associated with poor response to NACT in Turkish breast cancer patients and that AR positivity is independent of stage, hormone receptor status, HER-2 status, and disease stage.
Does the Waiting Period for Genetic Tests Affect the Prognosis in Chemotherapy-Treated De Novo Metastatic Non-Small Cell Lung Cancer Patients Without a Driver Mutation
(Karger, 2021) Arici, Serdar; Sakin, Abdullah; Cekin, Ruhper; Secmeler, Saban; Yasar, Nurgul; Cihan, Sener
Introduction: The length of the necessary waiting period to test driver mutations may generate anxiety in patients and clinicians. For this reason, an investigation was conducted to determine whether the duration between diagnosis and the start of first-line chemotherapy (DDC) in non-small cell lung cancer (NSCLC) patients without driver mutations has an impact on prognosis. Methods: The study included 303 de novo metastatic NSCLC patients without a driver mutation and patients were divided into 2 groups according to DDC: <= 30 days (group A) or >30 days (group B). The determinant factors for progression-free survival (PFS) and overall survival (OS) were examined by Cox regression analysis. Results: The mean DDC was calculated as 38.2 +/- 54.5 days. The number of patients in group A and B were 183 and 120, respectively. The median PFS in groups A and B was 5.0 and 6.0 months (p = 0.268) and the median OS was 10.0 and 11 months, respectively (p = 0.341). Univariate and multivariate analyses revealed that DDC was not a factor associated with PFS and OS. Conclusion: Our results show that a higher DDC was not associated with a worse prognosis in metastatic NSCLC patients without driver mutations. In this context, it is safer for patients and their physicians to wait for test results before starting chemotherapy.
The Effect of Body Mass Index on Location of Recurrence and Survival in Early-Stage Colorectal Cancer
(Wolters Kluwer Medknow Publications, 2020) Sakin, Abdullah; Samanci, Nilay Sengul; Secmeler, Saban; Arici, Serdar; Can, Orcun; Yasar, Nurgul; Cihan, Sener
Introduction: Obesity has become one of the major public health problems in many countries. Controversial results were reported in publications on the relationship between obesity and mortality in patients diagnosed with colorectal cancer (CRC) and that receive curative treatment. In this study, we evaluated the effects of body mass index (BMI) on the location of recurrence and disease-free survival (DFS) in patients with early-stage CRC. Materials and Methods: Patients that were followed up and treated in the Department of Medical Oncology between 1999 and 2016 were retrospectively included in the study. Patients with operated Stage I, II, and III CRC were included in the study. Patients were divided into three groups based on their BMI (kg/m2) of below 25, between 25 and 30, and above 30. Results: A total of 950 patients, of which 527 (55.5%) were male and 423 (44.5%) were female, were included in the study. The median age of the patients was 56 years. Of the patients, 408 (42.4%) had BMI of <25, 370 (38.9%) had BMI between 25 and 30, and 172 (18.2%) had BMI of 30. Local recurrence rate was significantly higher in the group with BMI >= 30 compared to the other groups (P <0.01). When compared with DFS, there was a statistically significant difference between groups with BMI of <25 and >= 30 (P = 0.02) and that difference was more evidently observed in Stage III (P = 0.02). There was no statistically significant difference of overall survival in the BMI groups (P = 0.87). In multivariate analysis, the BMI >= 30 (hazard ratio [HR], 1.49, 95% confidence interval [CI], 1.02-2.17), rectal tumor (HR, 1.70, 95% CI, 1.15-2.51), Stage III (HR, 3.91, 95% CI, 1.86-8.25), number of positive lymph nodes (HR, 1.05, 95% CI, 1.03-1.07), and R1 resection (HR, 3.47, 95% CI, 1.71-7.05) were identified as independent risk factors negatively affecting DFS. Conclusion: In this study, we observed that the high BMI increased the risk of recurrence, especially in Stage III CRC patients, and that the recurrence frequently occurred locally.
The Effect of Body Mass Index on Treatment Outcomes in Patients With Metastatic Non-Small Cell Lung Cancer Treated With Platinum-Based Therapy
(Routledge Journals, Taylor & Francis Ltd, 2021) Sakin, Aysegul; Sahin, Suleyman; Mustafa Atci, Muhammed; Yasar, Nurgul; Demir, Cumhur; Geredeli, Caglayan; Cihan, Sener
To investigate the effect of body mass index(BMI) on treatment outcomes and side-effect profile in metastatic non-small cell lung cancer(NSCLC) patients receiving platinum-based chemotherapy(ChT) in the first-line setting. This was a retrospective analysis of 233 NSCLC patients who were treated and followed up from 2008 through 2018. NSCLC patients who had metastatic disease at the time of diagnosis and were treated with platinum-based ChT in the first-line setting were included. The patients were divided into 2 groups based on the BMI as follows; BMI < 25 kg/m(2)and BMI >= 25 kg/m(2). This retrospective analysis enrolled 233 patients, 35 (15.0%) of whom were female. The BMI in 132 patients (56.2%) was < 25 kg/m(2). The median age was 58 years (range, 21-90). Median progression-free survival(PFS) was 7 mo, in the patients with BMI >= 25 kg/m(2)compared to 5.0 mo, in those with BMI < 25 kg/m(2)(p = 0.032), with corresponding median overall survival(OS) durations of 12 vs. 9 mo, (p = 0.003). In multivariate analysis, ECOG PS 2, grade III histology, and brain or bone metastasis negatively affected OS, whereas BMI >= 25 kg/m(2)positively affected OS. A high BMI prior to therapy in patients with NSCLC treated with platinum-based ChT in the first-line setting was associated with more favorable PFS and OS.
The Effects of Diabetes and Fasting Plasma Glucose on Treatment of Breast Cancer With Neoadjuvant Chemotherapy
(Mosby-elsevier, 2020) Arici, Serdar; Geredeli, Caglayan; Secmeler, Saban; Cekin, Ruhper; Sakin, Abdullah; Cihan, Sener
Purpose: To determine the effects of diabetes and fasting plasma glucose (FPG) level on the pathologic response in patients with breast cancer who received neoadjuvant chemotherapy. Methods: One hundred and thirty-five patients files who received neoadjuvant chemotherapy between 2013 and 2017 years, were scanned. Pathologic responses, diabetes, and FPG dates of patients were reached from archive files. Patients were grouped as diabetic and nondiabetic. Results: Patients with higher than 90% pathologically response according to Miller-Payne grading system, constituted 11 (44%) and 61 (55.5%) of patients: patients with equally or lower than 90% pathologically response were 14 (56%) and 49 (44.5%) and the number of patients with nonpathologic response 5 (20%) and 2 (1.8%) in diabetic and nondiabetic group, respectively. This difference between diabetic and nondiabetic groups was statistically significant (P=0.005). In Miller-Payne groups, the median FPG levels were 135 mg/dl (165.6 +/- 86.5), 96 mg/dl (110.0 +/- 30.6), 97 mg/dl (101.9 +/- 23.9). 91.5 mg/dl (102.5 +/- 44.3) and 93.5 mg/dl (112.0 +/- 61.2) respectively 0%, 1%-30%, 31%-90%, 91%-99%, and 100%. Patients with lower 91% pathologic response had statistically significant higher FPG levels compared with patients with higher patholocig response (P= 0.008). The cut-of FPG value to determine nonpathologic response was calculated 105 mg/dl (sensitivity 85.7% specificity 74.2%). The FPG, diabetes, lymph node positivity, and disease stage were statistically significant in the multivariate analysis for affecting non-pathologic response (P= 0.013, P=0.016, P= 0.036, and P=0.035 respectively). Conclusion: Diabetes and high FPG level may be predictive to the non-response of neoadjuvant chemotherapy in patients with breast cancer. (C) 2019 Elsevier Inc. All rights reserved.
The Effects of Fulvestrant Treatment on Hormone Receptor-Positive Metastatic Breast Cancer
(2020) Geredeli, Çağlayan; Cihan, Sener; Arıcı, Serdar; Seçmeler, Şaban; Yasar, Nurgul; Sakin, Abdullah; Can, Orcun
Objectives: To determine fulvestrant efficacy and tolerability in Turkish patients with hormone receptor-positive metastatic breast cancer.Methods: Patients who developed metastasis while taking tamoxifen or aromatase inhibitors in the adjuvantperiod or metastatic disease at the diagnosis. Fulvestrant 500 mg was administered intramuscularly every 28days. Progression-free survival (PFS) and overall survival (OS) durations were calculated.Results: In this particular research, totally 137 patients were participated. Median PFS was 9 months (95%CI, 5.7-10.3). The 12-month PFS rate was calculated as 42%, and the 36-month PFS rate was 17%. The medianPFS was not reached in the first line use of fulvestrant in the metastatic period but 9 months and 7 months inthe second and subsequent lines respectively. Results indicated that this difference was statistically significant(p = 0.002). It was shown that patients with liver and brain metastasis had lower PFS compared patients withno liver and no brain metastasis. The estimated median OS was 38 months after fulvestrant started. The 12-month OS rate was calculated as 82.4%, and the 36-month OS rate was 50%.Conclusions: Fulvestrant contributes both PFS and OS in patients with hormone receptor-positive metastaticbreast cancer and this effect is more clear in using fulvestrant as first-line treatment.
Efficacy and Tolerability of Adjuvant Therapy in ≥70-Year Patients With T3n0m0 Colorectal Cancer: an Observational Study
(Sage Publications Ltd, 2020) Sakin, Abdullah; Yasar, Nurgul; Sahin, Suleyman; Arici, Serdar; Secmeler, Saban; Can, Orcun; Cihan, Sener
Background:This study aimed to retrospectively investigate the efficacy and tolerability of adjuvant chemotherapy in >= 70-year-old patients with stage IIA (T3N0M0) colorectal cancer. Methods Lymphovascular invasion, perineural invasion, margin positivity, dissected lymph node count of <12, and presence of perforation/obstruction were accepted as risk factors. Those patients with at least one risk factor were regarded as having high risk.Results:The study included 168 patients, among which 95 (56.5%) were male and 73 (43.5%) were female. The median age of patients was 73 years (range: 70-94). One hundred one (60.1%) patients were identified to have high risk. Eighty-one (87%) patients received 5-flourouracil+leucovorin and 12 (13%) patients received capecitabine regimens as adjuvant chemotherapy. The patients receiving capecitabine regimen had significantly higher rates of dose reduction at initiation and during the treatment. Among low-risk group, there was no statistically significant difference between patients with and without adjuvant chemotherapy in terms of disease-free survival or overall survival (p = 0.528 and p = 0.217, respectively). In high-risk group, patients receiving adjuvant chemotherapy significantly differed from those not receiving adjuvant chemotherapy in terms of median disease-free survival and overall survival (p = 0.009 and p < 0.001, respectively). While the grade, lymph node status, and adjuvant chemotherapy were identified as the most significant independent factors for disease-free survival, the most significant factors for overall survival were the age, Eastern Cooperative Oncology Group performance status, adjuvant chemotherapy, and recurrence.Conclusion:The findings of our study showed improved disease-free survival and overall survival in high-risk >= 70-year-old patients who received adjuvant chemotherapy due to T3N0M0 colorectal cancer. We believe that 5-flourouracil+leucovorin or capecitabine regimens should be recommended for these older high-risk patients who could receive adjuvant chemotherapy regardless of age.
Factors Affecting Disease-Free Survival in Operated Nonmetastatic Gastrointestinal Stromal Tumors
(Academic Press inc Elsevier Science, 2019) Sakin, Abdullah; Can, Orcun; Arici, Serdar; Yasar, Nurgul; Geredeli, Caglayan; Demir, Cumhur; Cihan, Sener
Background: Possibly originating from interstitial Cajal cells, gastrointestinal stromal tumors (GISTS) have variable biological behaviors. In this study, we aimed to examine the factors affecting the disease-free survival (DFS) in patients with GIST who underwent operation. Material and methods: The study included the patients who were followed up and treated for GIST in our oncology clinic between 2002 and 2017. The Armed Forces Institute of Pathology criteria (Miettinen risk score) were used for risk stratification of patients. Results: Seventy-four patients were included to the study, where female patients constituted 52.7%, and the median age was 56 (range: 24-83) y. Most common primary tumor location was the stomach (51.4%), followed by the small intestine (33.8%), colorectum (10.8%), and retroperitoneum (4.1%). Miettinen risk score showed 12 patients (16.7%) at very low risk, 15 patients (20.8%) at low risk, 18 patients (25%) at intermediate risk, and 27 patients (37.5%) at high risk. DFS was significantly lower in patients with small intestine involvement than in cases with stomach involvement (P = 0.004). DFS was significantly lower in patients at high risk than in patients with no high risk (P = 0.034). Small intestine localization (hazard ratio [HR], 8.98; 95% confidence interval [CI], 1.14-8.18), high-risk score (HR, 5.16; 95% CI, 1.42-12.75), c-kit positivity (HR, 0.24; 95% CI, 0.13-0.69), and adjuvant therapy (HR, 0.37; 95% CI, 0.20-0.92) were found to be the most significant factors affecting DFS. Conclusions: Our study showed negative effects of small intestine localization and high-risk category and positive effects of c-kit positivity and adjuvant therapy on DFS in patients with GIST who underwent operation. When a decision will be made in favor of adjuvant therapy, tumor localization and c-kit mutation should also be considered in addition to risk score. (C) 2019 Elsevier Inc. All rights reserved.
Factors Affecting Survival and Treatment Efficacy in Breast Cancer Patients With Bone Marrow Metastasis
(Wiley-hindawi, 2020) Sakin, Abdullah; Sakalar, Teoman; Sahin, Suleyman; Yasar, Nurgul; Demir, Cumhur; Geredeli, Caglayan; Cihan, Sener
Factors Affecting Survival in Esophageal Squamous Cell Carcinoma: Single-Center Experience
(Kare Publ, 2020) Sakin, Abdullah; Urun, Yonca Yilmaz; Sahin, Suleyman; Atici, Muhammed Mustafa; Arici, Serdar; Geredeli, Caglayan; Cihan, Sener
OBJECTIVE: Squamous cell esophageal cancer (ESCC) is a highly fatal malignancy. This study aims to investigate the factors affecting survival in patients with metastatic and non-metastatic ESCC. METHODS: Between 2008 and 2016, 107 patients with ESCC who were followed up in an oncology clinic were included in the analysis. Patients were grouped based on the stage of disease as clinical-stage II to IV. RESULTS: Of the 107 patients, 55 (55.1%) of them were male and 52 (48.6%) of them were female. The mean age was 60.8 years. Based on the clinical-stage, 28 (26.2%) patients had stage II disease, 33 (30.8%) had stage III disease, and 46 (43.0%) had stage IV disease. Twenty-nine (27.1%) patients with the non-metastatic disease underwent surgery following neoadjuvant chemoradiotherapy (CRT), while 29 (27.1%) patients received definitive CRT. Twenty-six (56.5%) patients with metastatic disease received chemotherapy (CT). While median overall survival (mOS) could not be reached in patients who underwent surgery following neoadjuvant CRT, mOS for patients receiving definitive CRT versus patients treated with surgery alone-was 22.0 months and 24.0 months, respectively (p=0.008). In the metastatic stage, mOS was 8.0 months for the patients treated with a first-line CT and 3.0 months for patients receiving best supportive care (p<0.001). In multivariate analysis, factors predicting survival in patients with the non-metastatic disease were ECOG PS 3-4 (Hazard ratio [HR], 6.13), undergoing surgery (HR, 0.22), clinical-stage III disease (HR, 3.19), and presence of recurrence (HR, 24.12). For patients with metastatic disease, ECOG PS 3-4 (HR, 3.31), grade-III histology (HR, 3.39), liver metastasis (HR, 2.53), and receiving CT (HR, 0.15) were the factors associated with survival in multivariate analysis. CONCLUSION: In our study, surgery and early clinical-stage increased survival, whereas experiencing recurrence adversely affected survival in non-metastatic ESCC. In the metastatic stage, ECOG PS 3-4, grade-3 histology and liver metastasis adversely affected survival, while receiving CT significantly improved survival.
Factors Affecting Survival in Operated Pancreatic Cancer: Does Tumor Localization Have a Significant Effect on Treatment Outcomes
(Kare Publ, 2020) Sakin, Abdullah; Sahin, Suleyman; Sakin, Aysegtil; Atci, Muhammed Mustafa; Arici, Serdar; Yasar, Nurgul; Cihan, Sener
OBJECTIVE: This study aims to investigate the factors affecting survival in operated pancreatic ductal adenocarcinoma (PDAC) and the possible prognostic effect of primary tumor localization on treatment outcomes. METHODS: In this study, 98 patients with curatively-operated PDAC, who were followed up and treated for the years 2008 through 2018, were enrolled. Metastatic and locally advanced stages and patients under 18 years of age were excluded from this study. Patients were divided into two groups based on the primary tumor localization as *head or *body/tail. RESULTS: Sixty-seven (68.3%) patients were male and 31 (31.7%) were female, with a median age of 62 years (range, 35-82 years). The numbers of patients with a primary tumor located in *head vs.*body/tail were 74 (75.4%) vs. 24 (24.6%), respectively. Patients with a primary tumor located in *head vs.*body/tail; median disease-free survival was 16.0 months vs. 13 months (p=0.972), respectively, with corresponding median overall survival was 25 months vs. 33 months (p=0.698). The level of carcinoembryonic antigen(CEA) at diagnosis (Hazard ratio[HR], 1.09 95%CI, 1.01-1.18), stage III disease (HR, 2.09 95%CI, 1.16-4.35), and receiving adjuvant treatment (HR, 0.20 95%CI, 0.09-4.34) were the independent predictors of survival. CONCLUSION: Our study revealed that high levels of CEA at diagnosis and stage III disease adversely affected the survival in non-metastatic PDAC patients, while receiving adjuvant therapy had a positive effect on survival. The findings suggest that primary tumor localization did not affect survival in operated PC patients. The results on this issue are still inconsistent and under debate in the literature.
Factors Affecting Survival in Patients With Isolated Liver-Metastatic Colorectal Cancer Treated With Local Ablative or Surgical Treatments for Liver Metastasis
(Imprimatur Publications, 2019) Sakin, Abdullah; Sahin, Suleyman; Atci, Muhammed Mustafa; Yasar, Nurgul; Geredeli, Caglayan; Aribal, Serkan; Cihan, Sener
Purpose: Local treatments for isolated synchronous or metachronous liver metastases in colorectal cancer (CRC) have been shown to improve overall survival (OS). The aim of this study was to investigate the factors affecting OS in CRC patients with isolated liver metastasis in whom the primary tumor and corresponding liver metastasis were treated with curative intent using local ablative or surgical methods. Methods: A total of 47 CRC patients presenting with an initial or subsequent isolated liver metastasis, who were treated with local surgical or ablative treatment for liver metastasis with curative intent, were enrolled in this study between 2007 and 2017. The possible factors affecting OS were analyzed. Results: Out of the 47 patients, 35 (74.5%) were male. The median age was 61 (25-80) years. Thirty-four (72.3%) patients underwent liver metastasectomy, while 13 (27.7%) patients were treated with non-surgical local ablative therapies (NSLAT) for liver metastasis. Median OS (mOS) could not be reached in patients who underwent metastasectomy at the time of diagnosis compared to 55 months in those undergoing metastasectomy following a chemotherapy period (p=0.03). Patients treated with NSLAT had a mOS of 60 months compared to "not reached'' in those who underwent liver metastasectomy (p=0.45). mOS was higher in patients with pT4 stage vs.
The Impact of Tumor Regression Grade on Long-Term Survival in Locally Advanced Rectal Cancer Treated With Preoperative Chemoradiotherapy
(Sage Publications Ltd, 2020) Sakin, Abdullah; Sahin, Suleyman; Sengul Samanci, Nilay; Yasar, Nurgul; Demir, Cumhur; Geredeli, Caglayan; Cihan, Sener
Purpose The aim of this study is to investigate the prognostic effect of tumor regression grade (TRG) on long-term survival in locally advanced rectal cancer treated with preoperative chemoradiotherapy. Methods Medical records of 182 patients with locally advanced rectal cancer, who were treated with preoperative chemoradiotherapy followed by surgery between 2002 and 2016, were retrospectively reviewed. TRG was classified into five categories based on the pathological response as follows - TRG1: no viable cancer cell, TRG2: single cancer cell or small groups of cancer cells, TRG3: residual tumor outgrown by fibrosis, TRG4: residual tumor outgrowing fibrosis, TRG5: diffuse residual tumor without regression. TRG1, (TRG2+TRG3), and (TRG4+TRG5) were grouped as complete response, intermediate response, and no response, respectively. Results Of the 182 patients with locally advanced rectal cancer, 112 (61.5%) were male. The mean age was 54.4 (range, 25-87) years. The total number of patients in complete response, intermediate response, and no response group was 24 (13.2%), 105 (57.7%), and 53 (29.1%), respectively. The corresponding five-year relapse-free survival and overall survival rates were 79.8%-92.3%, 74.7%-79.4%, and 55.7%-55.8%, respectively (p < 0.05 for relapse-free survival, p < 0.05 for overall survival). According to ypTNM stage, there was no significant difference in relapse-free survival among TRG groups in ypStage I and II patients (p > 0.05). In ypStage III patients, relapse-free survival was 62 months in no response group vs. not reached in intermediate response group (p < 0.05). According to the ypTNM, there was no significant difference in overall survival among TRG groups in ypStage I, II, and III patients (p > 0.05). In the multivariate analysis, pathological complete response was found to be an independent variable for relapse-free survival and overall survival (hazard ratio (95% confidence interval), 0.34 (0.17-6.77), 0.39 (0.18-0.83), respectively). Conclusion This study showed that patients with pathological complete response to preoperative chemoradiotherapy had longer relapse-free survival and overall survival rates than those with residual disease.
Mean Platelet Volume and Platelet Distribution Width Correlates With Prognosis of Early Colon Cancer
(Imprimatur Publications, 2020) Sakin, Aysegul; Sahin, Suleyman; Sakin, Abdullah; Karatas, Fatih; Samanci, Nilay Sengul; Yasar, Nurgul; Cihan, Sener
Purpose: Several platelet indices have been linked to prognosis of various cancers, including metastatic colorectal cancer. The aim of this study was to investigate the prognostic effect of mean platelet volume (MPV) and platelet distribution width (PDW) in early colon cancer (CC) patients. Methods: This retrospective study included early CC patients who were followed up and treated between 2005 and 2017. Relapse free survival (RFS) and overall survival (OS) were determined with respect to several demographic and clinical characteristics of patients, including MPV and PDW. The cut-off value was determined as >8.5 fL for MPV (sensitivity: 67.1%, specificity 54.5%) and <= 16% for PDW (sensitivity: 66.7%, specificity: 60.0%). Results: The study included 394 patients, 53.3% of which were male. Stage I, II, and III patients constituted 8.9%, 46.4%, and 44.7% of the study population, respectively. Among all patients, RFS and OS were significantly longer in patients with MPV <= 8.5 fL and PDW>16 fL (p <0.001 and p=0.011 for MPV, respectively; and p<0.001 and p=0.026 for PDW, respectively). In patients with stage III disease, those with MPV <= 8.5 fL had significantly longer RFS and OS compared to those with MPV >8.5 fL (p<0.001 and p=0.001, respectively). On the other hand, those with PDW>16% had significantly longer RFS than that in those with PDW <= 16 fL, among stage III patients (p<0.001). In multivariate analysis, stage, perineural invasion, lymphovascular invasion, adjuvant treatment, CEA, CA19-9, PDW, and MPV were found the most significant factors affecting RFS. Conclusion: Our study suggests that elevated MPV and decreased PDW appear to be unfavorable prognostic factors in early CC, especially in patients with stage III disease. Considering the wide availability and accessibility of these indices, it is reasonable to designate further larger prospective studies to clarify and verify their potential roles in early CC.
The Predictive Role of Metabolic Tumor Volume on No Response To Neoadjuvant Chemotherapy in Patients With Breast Cancer
(Sage Publications Ltd, 2020) Arici, Serdar; Karyagar, Sevda S.; Karyagar, Savas; Geredeli, Caglayan; Cekin, Ruhper; Secmeler, Saban; Cihan, Sener
Introduction To evaluate the predictive significance of pretreatment metabolic tumor volume on pathologic response in patients who received neoadjuvant chemotherapy for breast cancer. Methods Seventy patients who received neoadjuvant chemotherapy between 2013 and 2017 years were enrolled in the study. Pathologic responses and 18-fluorodeoxyglucose positron emission tomography/computed tomography metabolic dates of patients were obtained from archive files. Results Forty-six (65.7%) patients were in stage II and 24 (34.3%) patients were in stage III; 25 (35.7%) patients were human epidermal growth factor receptor 2 positive, 46 (65.7%) patients were estrogen receptor-positive, 26 (37.1%) patients were progesterone receptor-positive. According to the Miller-Payne grading system, 24 (34.3%) patients constituted 100% pathological response; patients with 91-99% pathological response were 12 (17.1%), the number of patients with non-pathologic response was 6 (8.6%). Median metabolic tumor volume was 7.3 cm(3) (7.1 +/- 3.5), 8.8 (11.4 +/- 9.4), 7.7 (8.3 +/- 4.6) and 22 cm(3) (19.8 +/- 11.0) in patients with stages IIA, IIB, IIIA, and IIIB, respectively (p = 0.032). In Miller-Payne grading, the median metabolic tumor volume value was higher in patients with no pathologic response group than 100% response group (p = 0.003). The cut-off metabolic tumor volume value determining no pathologic response was calculated as higher than 13.62 cm(3) (sensitivity 83.3% and specificity 82.8%). Conclusions Our study results suggest that higher pretreatment metabolic tumor volume values are predictive on no pathologic response in patients treated with neoadjuvant chemotherapy for breast cancer.
The Predictive Value of Baseline Volumetric Pet/Ct Parameters on Treatment Response and Prognosis in Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiotherapy
(Springer, 2022) Sakin, Abdullah; Sahin, Suleyman; Karyagar, Sevda Saglampinar; Karyagar, Savas; Atci, Mustafa; Akboru, Mustafa Halil; Cihan, Sener
Purpose To investigate the prognostic effects of baseline volumetric PET/CT parameters including the maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG) on treatment response and prognosis in locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (NACRT). Methods Between 2015 and 2018, 51 patients with LARC treated with NACRT followed by surgery were included in this retrospective study. Patients were divided into 2 groups by tumor regression grade (TRG) as follows: group I = TRG 1 (no detectable cancer cells) + TRG 2 (single cells and/or small groups of cancer cells) and group II = TRG3 (residual tumor outgrown by fibrosis) + TRG 4 (remarkable fibrosis outgrown by tumor cells) + TRG 5 (no fibrosis with extensive residual cancer). Results Of the 51 patients, 34 (66.7%) were male. The median age was 55 (range, 37-78) years. According to TRG status, 14 (27.4%) patients were in group I and 37 (72.6%) patients were in group II. The area under the curve (95% CI) was 0.749 (0.593-0.905) in the ROC curve plotted for MTV. The cut-off value for MTV was 12, with 70% sensitivity and 65% specificity. MTV was >= 12 in 32 (62.8%) patients. MTV and TLG values were significantly different between groups I and II, whereas there was no significant difference between the groups in terms of SUVmax values (p = 0.006, p = 0.033, and p = 0.673, respectively). The disease-free survival was not reached in patients with MTV < 12 vs. 20 months in those with MTV >= 12 (p = 0.323). In multivariate analysis, MTV (OR, 95% Cl, 5.00 [1.17-21.383]) was found to be the factor that affected pathological complete response. Conclusion In LARC treated with NACRT, MTV prior to treatment can help predict the response to treatment.
Prognostic Impact of Blood Transfusion in Patients With Metastatic Non-Small Cell Lung Cancer Receiving Chemotherapy
(Elsevier Ireland Ltd, 2019) Sakin, Abdullah; Sahin, Suleyman; Yasar, Nurgul; Demir, Cumhur; Arici, Serdar; Geredeli, Caglayan; Cihan, Sener
Purpose: To investigate the prognostic effects of Allogeneic Blood Transfusion (ABT) in patients with metastatic Non-Small Cell Lung Cancer (NSCLC) receiving Chemotherapy (CT) in the first-line treatment, comparing untransfused patients to those receiving blood transfusion during treatment period or before treatment period. Methods: This was a retrospective study of 433 patients with metastatic NSCLC receiving CT in the first-line treatment. Patients were categorized into 3 groups according to the transfusion strategy as follows; group-U (Untransfused patients, n = 303), group-B(patients receiving transfusion Before treatment period, n = 43), and group-D(patients receiving transfusion During treatment period, n = 87). Results: There were 433 patients in the analysis, consisting of 388 (89.6%) males, with a median age of 60 years (range, 21-92). The median Overall Survival(mOS) according to the ABT was 14 months for group-U, 9 months for group-B, and 7 months for group-D (p < 0.001). In subgroup analysis, patients with squamous cell carcinoma subtype, mOS was 11 months for group-U, 12 months for group-B, and 9 month for group-D (p = 0.074) The corresponding mOS durations for adenocarcinoma subtype were 21 months, 7 months, and 6 months (p < 0.001). Performing ABT during treatment period was found to be a negative independent factor related to OS (HR 1.50 for progression-free survival, 95% CI 1.15-1.97, HR 1.36 for OS, 95% CI 1.04-1.80). Conclusion: Our results demonstrated that ABT was significantly associated with earlier progression and shorter survival in patients with metastatic NSCLC, especially in adenocarcinoma histology, hence suggesting that transfusion strategy in this group should remain limited, and its benefit should outweigh the risk of progression.
The Prognostic Importance of Microsatellite Instability Status in Turkish Stage Ii and Iii Gastric Cancer Patients Who Received Adjuvant Chemotherapy
(Akad Doktorlar Yayinevi, 2021) Arici, Serdar; Erhan, Selma Sengiz; Geredeli, Caglayan; Atci, Muhammed Mustafa; Secmeler, Saban; Cekin, Ruhper; Cihan, Sener
Some retrospective studies in different populations have evaluated the prognostic value of microsatellite instability status (MSI) in patients with gastric cancer (GC). A small number of studies have focused on the effect of MSI status on the outcome of GC patients who have received adjuvant chemotherapy (CT). Medical records of 318 patients with stage II or III GC who had been treated with adjuvant CT after D2 gastrectomy between 2016 and 2019 were scanned. Eligible patients were divided into two groups: MSI-H and microsatellite stable (MSS). The determinant factors were examined using Cox regression analysis. A statistical significance level of alpha was accepted as p < 0.05. The study included 207 GC patients and 21 (10.1%) MS-high patients. A median disease-free survival was not reached (95% CI NR) in MSI-H patients, whereas a median disease-free survival was 30 months in MSS patients (95% CI 24.3-35.6) (p= 0.046). A median overall survival (OS) was not reached in MSI-H patients, whereas a median overall survival of 46 months (95% CI: 28.8 - 60.1) was reached in MSS patients (p= 0.032). In the multivariate Cox regression analysis for OS, female gender and MSI-H status were positive predictors of OS, whereas stage III disease negatively affected OS (p= 0.009, p= 0.030, and p= 0.009, respectively). Microsatellite instability status may be a prognostic factor in stage II and III Turkish GC patients who have received adjuvant oxaliplatin-based CT.