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    C-Reactive Protein to Albumin Ratio is an Indicator of Poor Prognosis for Patients with Biliary Tract Cancer
    (Kare Publ, 2020) Demir, Tarik; Kostek, Osman; Araz, Murat; Sakin, Abdullah; Aliyev, Altay; Besiroglu, Mehmet; Turk, Haci Mehmet
    Objectives: This retrospective study evaluated the prognostic significance of the ratio of C-reactive protein (CRP) to albumin (Alb) in patients with biliary tract cancer (BTC). Methods: A total of 178 patients with newly diagnosed BTC, who had been treated in our departments between January 2013 and September 2018, were enrolled in the study. All medical records were reviewed retrospectively. Patients who showed clinical evidence of infection or other inflammatory conditions were excluded. We investigated the correlation between the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), CRP to Alb ratio (CAR) and the overall survival (OS) rates for BTC patients. Both univariate and multivariate analyses were performed to identify clinicopathological variables associated with OS. Results: The optimal cutoff level for the CAR was 0.66. An elevated CAR was associated with low OS (p<0.001). In the multivariate analysis CAR, was independently associated with OS (HR 3.44, 95% CI: 2.05-5.79, p<0.001). Median OS for CAR <= 0.66 and CAR >0.66 were 22.0 months and 6.0 months, respectively. By contrast, NLR (p=0.12) and PLR (p=0.85) were not independently associated with OS. Conclusion: The CAR might be an independent prognostic marker for patients with BTC, and might have value comparable with other established inflammation-based prognostic scores. The prognostic value of this novel inflammation-based prognostic score needs to be verified in patients with other types of cancer.
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    Is lymph node dissection necessary for staging while undergoing nephrectomy in patients with renal cell carcinoma?
    (Mosby-Elsevier, 2021) Demir, Tarik; Aliyev, Altay; Besiroglu, Mehmet; Araz, Murat; Kostek, Osman; Sakin, Abdullah; Shbair, Abdallah T. M.
    Objective: The essential treatment for patients with renal cell carcinoma is nephrectomy. As no lymph node dissection (LND) could be performed in the majority of these patients, healthy staging could not be carried out. In this study, we investigated the impact of LND during nephrectomy on patient survival. Methods: A total of 181 patients-58 (32%) were female and 123 (68%) were male-were included in the study. Median follow-up period was 48 months. The patients were separated into 4 groups according to their stage during diagnosis; group 1 (T1-3N0M0), group 2 (T1-3NXM0), group 3 (T1-3N1M0), and group 4 (T14N0/XM1). The disease-free survival of nonmetastatic patients and the overall survival of all groups were calculated. Results: Mean age was 58.4 +/- 12.0 years. Median survival for Group 1 could not be reached. Median survival was 89 months in Group 2, 50 months in Group 3, and 39 months in Group 4 (P <0.001). There was no statistically significant difference between the N1 and M1 groups (P = 0.297). For the NX patient group without LND, median survival was 89 months, which is worse than the N0 group and better than the N1 group (P = 0.002). Conclusions: Our study presumes that the patients without LND are not staged sufficiently, NX patients have worse survival rates when compared with N0 patients, node-positive patients have poor survival rates as do the metastatic patients, and it should be defined as TNM stage4. (c) 2020 Elsevier Inc. All rights reserved.