Browsing by Author "Demir, Cumhur"

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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.
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 Evaluation of Efficacy and Tolerability of Gemcitabine Vs. Capecitabine Therapy in the Second-Line Setting for Metastatic Pancreatic Cancer Patients With Poor Performance Status
(2019) Yasar, Nurgul; Sakin, Abdullah; Cihan, Şener; Geredeli, Caglayan; Atcı, Muhammed Mustafa; Sahin, Suleyman; Demir, Cumhur
Aim: The aim of this study was to evaluate the efficacy and tolerability of single-agent gemcitabine vs.capecitabine therapy in the second-line setting for metastatic Pancreatic Cancer (mPC) patients withpoor performance status.Material and methods: A total of 48 patients with mPC, who were followed and treated in oncologycenter between 2012 and 2017, were included. After a failure of first-line therapy, patients with an ECOGPS 2 treated with capecitabine or gemcitabine monotherapy in the secondline setting were retrospectively analyzed.Results: Of the 48 patients, 26(54.2%) were males and 22(45.8%) were females. The median age of thepatients was 62 years(range, 31-82). Treatment regimens in the first-line setting were as follows;gemcitabine+cisplatin in 24(50%) patients, gemcitabine+nub-paclitaxel in 4(8.3%) patients, FOLFIRINOXin 8(16.7%) patients, FOLFOX in 8(16.7%) patients, and gemcitabine+oxaliplatine in 4(8.3%) patients. Afterprogression on first-line therapy, 29(60.5%) patients were treated with capecitabine in the second-linesetting, while 19(39.5%) patients were given gemcitabine. Median progression-free survival was found tobe 4 months(95% CI,1.9-6.0) in patients receiving capecitabine compared to 2 months(95% CI, 0.5-3.4) inthose treated with gemcitabine (p¼0.271). Median overall survival was 6.0 months(95% CI, 2.0-9.9) inpatients receiving capecitabine therapy versus 5.0 months (95% CI, 1.0-8.9) in those treated with gemcitabine monotherapy (p¼0.353).Conclusions: Optimal second-line treatment for mPC has not yet been established. In the present study,capecitabine monotherapy was compared to gemcitabine and it was found that they both had similarefficacy in the second-line treatment for mPC patients who were not eligible for combination chemotherapy regimen.
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
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.
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 Relation Between Hemogram Parameters and Survival in Extensive-Stage Small Cell Lung Cancer
(Karger, 2019) Sakin, Abdullah; Sahin, Suleyman; Yasar, Nurgul; Demir, Cumhur; Arici, Serdar; Geredeli, Caglayan; Cihan, Sener
Purpose: To determine whether hemogram parameters have prognostic effects on survival in patients with extensive-stage small cell lung cancer (ED-SCLC). Methods: This retrospective analysis included 113ED-SCLC patients, who were followed in an oncology clinic. The data regarding the baseline patient demographic characteristics, complete blood count (white blood cell, red blood cell, hemoglobin, hematocrit, mean platelet volume, platelet, total neutrophil, total lymphocyte, total monocyte, neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], and monocyte-to-lymphocyte ratio [MLR]), and survival were analyzed. According to the ROC curve drawn for overall survival (OS) analysis, the cutoff values were determined as follows: NLR >= 3, with 71.4% sensitivity and 63.6% specificity; PLR >= 0.150, with 68.1% sensitivity and 52.4% specificity; and MLR >= 0.367, with 64.4% sensitivity and 71.4% specificity. Results: Of the 113 patients with ED-SCLC, 92 (81.4%) were men and 21 (18.6%) were women. The median age was 65 years (range, 35-81 years). NLR was <3 in 40 (65.4%) patients. Patients with NLR <3 had significantly higher OS than those with NLR >= 3 (15 vs. 5 months, respectively, p < 0.001). Patients with PLR <150 had significantly higher median OS than those with PLR >= 150 (14 vs. 6 months, respectively, p = 0.014). The median OS was significantly greater in patients with MLR <0.367 compared to that in patients with MLR >= 0.367 (11 vs. 6 months, respectively, p = 0.016). In multivariate analysis, NLR was the only factor associated with OS (HR = 2.26, 95% Cl 1.24-4.10). Conclusion: NLR was determined as an independent negative prognostic factor for OS in ED-SCLC patients at diagnosis, thus may help determine disease prognosis as a useful prognostic marker.