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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.
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    The prognostic value of lymph node ratio in patients with curatively resected pancreatic adenocarcinoma.
    (Amer Soc Clinical Oncology, 2015) Turan, Nedim; Araz, Murat; Algin, Efnan; Unal, Olcun Umit; Benekli, Mustafa; Tastekin, Didem; Dane, Faysal
    [Abstract Not Available]
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    Regorafenib or rechallenge chemotherapy: which is more effective in the third-line treatment of metastatic colorectal cancer?
    (Springer, 2019) Kostek, Osman; Hacioglu, Muhammet Bekir; Sakin, Abdullah; Demir, Tarik; Sari, Murat; Ozkul, Ozlem; Araz, Murat
    PurposeTo assess the efficacy and safety of regorafenib versus rechallenge chemotherapy in previously treated mCRC patients in third-line setting.Materials and methodsThe data of 104 patients diagnosed with mCRC enrolledfrom2010to2017 in six oncology centers were analyzed. Tumor treatment options were obtained from follow-up and treatment files. Rechallenge chemotherapy was identified as the re-use of the regimen which was previously administered to patients in one of the therapy lines and obtained disease control, these were the patients whose disease did not progress within 3months.ResultsA total of 104 patients had received previously two lines of chemotherapy regimens for mCRC. Of these, 73 patients with mCRC who received regorafenib and 31 those who received rechallenge chemotherapy in third-line therapy were analyzed. Overall survival was better with rechallenge than it was with regorafenib (HR 0.29 95% CI 0.16-0.54, p<0.001). Median OS was 12.0months (95% CI 8.1-15.9) in rechallenge versus 6.6months (95% CI 6.0-7.3) in regorafenib group (p<0.001). Progression-free survival in the rechallenge group showed a higher median value of 9.16months (95% CI 7.15-11.18) versus with that recorded in the regorafenib group of 3.41months (95% CI 3.01-3.82), in favor of rechallenge chemotherapy. The most common adverse events of regorafenib was liver function test abnormality and hand-foot syndrome. Although grade 3 or 4 adverse events were similar, non-hematologic toxicities were more common than those of rechallenge.ConclusionsRechallenge is still a valuable option against regorafenib in patients who achieved disease control in one of the first two lines of therapy. Even though mCRC patients treated with regorafenib benefited clinically from this treatment, we revealed that chemotherapy rechallenge compared to regorafenib was more effective in the third-line treatment for mCRC patients.