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Öğe Comparison of real-life data from patients with NGS panel negative and KRAS mutation positive metastatic lung adenocarcinoma(Sage Publications Ltd, 2022) Gokyer, Ali; Kucukarda, Ahmet; Kostek, Osman; Gokmen, Ivo; Ozcan, Erkan; Sayin, Sezin; Tastekin, EbruObjective: To evaluate clinical and demographic characteristics and the results of cytotoxic treatments of KRAS(G12C), KRAS(other), and next-generation sequencing (NGS) panel negative patients. Methods: NGS data of 1264 patients with non-small cell lung cancer were retrospectively evaluated. Among these patients, the mutation distributions of 1081 patients with metastatic lung adenocarcinoma were analyzed. A total of 150 patients with negative NGS panel or mutant KRAS followed up in our clinic were included. Clinical features, overall survival, first-line chemotherapy responses, and progression-free survival of NGS panel negative, KRAS(G12C), and KRAS(other) groups were compared. Results: In 1081 patients who underwent NGS from tumor tissue with the diagnosis of metastatic lung adenocarcinoma, 296 (27%) NGS panel negative and 276 (26%) KRAS mutant patients were detected. Among these patients, 150 patients whose data were available were 71 (47.3%) NGS panel negative, 54 (36%) KRAS(other), and 25 (16.7%) KRAS(G12C). Clinical features, brain metastasis, and first-line chemotherapy response were similar among groups. Bone metastases were detected more often in the NGS panel negative group (p = 0.03). The median follow-up was 8.4 months. Overall, 107 deaths had occurred at the time of analysis. There was no difference in overall survival (p = 0.56) or progression-free survival (p = 0.71) among NGS panel negative, KRAS(other), and KRAS(G12C) patients. Conclusion: There is no difference in overall survival, first-line chemotherapy response, or progression-free survival among patients with NGS panel negative, KRAS(G12C), or KRAS(other) metastatic lung adenocarcinoma. Bone metastases were observed more frequently in the NGS panel negative group.Öğe Comparison of skeletal muscle mass loss in patients with metastatic colorectal cancer treated with regorafenib or TAS-102(Imprimatur Publications, 2019) Hacioglu, Muhammet Bekir; Kostek, Osman; Kurt, Nazmi; Kucukarda, Ahmet; Gokyer, Ali; Ustabasioglu, Fethi Emre; Karatas, FatihPurpose: To assess whether regorafenib and TAS-102 treatments are associated with a change in Skeletal Muscle Area (SMA) as well as to compare Skeletal Muscle Mass (SMM) loss levels between regorafenib and TAS-102 treatments and prognostic significance in the patients with metastatic colorectal cancer (mCRC). Methods: A total of 36 mCRC patients, who received regorafenib or TAS-102 in the third-line and subsequent settings were assessed in the analysis. SMM changes were assessed with CT scans findings, and they were categorized into two groups as SMM-loss (SMM decrease >= 2%) and SMM-stable (SMM change <2%). Results: The SMM change after regorafenib therapy was significantly worse compared with TAS-102 therapy (p=0.001). The median overall survival (OS) was longer in SMM-stable group than in SMM-loss group (12.8 months; 95%CI:9.8-15.7) vs. 6.4 months; 95%CI:5.2-7.7, respectively;p=0.04). Cox regression analysis showed that SMM loss was independent prognostic indicator for OS (HR, 2.87; 95%CI: 1.07-7.42, p=0.03). Conclusion: Although patients who received regorafenib had more SMM loss than those who received TAS-102, there was no difference in OS between drugs.Öğe Contrast nephropathy in cancer patients receiving anti-VEGF therapy: a prospective study(Springer Japan Kk, 2020) Gokyer, Ali; Kucukarda, Ahmet; Kostek, Osman; Hacioglu, Muhammet Bekir; Uzunoglu, Sernaz; Kula, Osman; Kurt, NazmiObjectives Contrast nephropathy risk has been increasing in cancer patients. Nephrotoxic side effects of anti-vascular endothelial growth factor/receptor (anti-VEGF/R) drugs used in oncologic treatment are also prominent. The purpose of this study was to identify the possible association among anti-VEGF/R drugs use and development of the contrast-induced nephropathy (CIN) in patients with cancers. Methods A total of 92 patients were included in this prospective cross-sectional study. Patients whose glomerular filtration rate (GFR) of < 50 ml/min, hemoglobin of < 10 g/dl, and eastern cooperative oncology group (ECOG) score of >= 2 and had received nephrotoxic drugs were not included in the study. Blood samples were collected baseline at pre computed tomography (CT) and day 2, day 3 and day 7 later CT imaging. CIN was defined as either an increased serum creatinine value of 0.5 mg/dl or increased 25% to baseline. CIN frequency between groups receivingand not receiving anti-VEGF/R was compared using the chi-squared test. CIN frequency between bevacizumab and other anti-VEGF/R was also analyzed. Results There were 39 patients in the anti-VEGF/R (+) group and 53 patients in the anti-VEGF/R (-) group. Eleven patients (28%) in the anti-VEGF/R (+) group and 3 patients (5.6%) in the anti-VEGF/R (-) group had CIN (p = 0.006). In the anti-VEGF/R (+) group, 23 patients received bevacizumab (combined with FOLFOX/FOLFIRI), while 16 patients received other anti-VEGF/R (sunitinib, axitinib, regorafenib, aflibercept) effective treatments. CIN ratio in patients who received bevacizumab or other anti-VEGFR therapy was similar (p = 0 = 50). Of the patients, one patient had acute kidney injury leading to death. Conclusion CIN was significantly more frequent in cancer patients who receiving anti-VEGF/R drugs than those not receiving anti-VEGF/R drugs.Öğe Does primary tumor localization has prognostic importance in seminoma patients?: Turkish Oncology Group Study(Imprimatur Publications, 2020) Yildiz, Birol; Kucukarda, Ahmet; Gokyer, Ali; Demiray, Atike Gokcen; Paydas, Semra; Aral, Ipek Pinar; Gumusay, OzgePurpose: The purpose of this study was to determine whether primary tumor localization may be a risk factor for relapse and survival in seminomatous germ cell tumors (GCT) patients. Methods: In our study, 612 seminomatous GCT patients diagnosed in 22 centers between 01.01.1989 and 03.02.2019 were retrospectively evaluated. Patient interview information, patient files and electronic system data were used for the study. Results: The primary tumor was localized in the right testis in 305 (49.9%) patients and in 307 (50.1%) in the left testis. Mean age of the patients was 36 years (range 16-85 +/- 10.4). The median follow-up period was 47 months (1-298). Recurrence was observed in 78 (127%) patients and 29 (4.7%) died during the follow-up period. Four-year overall survival (OS) was 95.4% and 4-year progression-free survival (PFS) was 84.5%. The relationship between localization and relapse was significant in 197 patients with stage 2 and stage 3 (p=0.003). In this patient group, 41 (20.8%) relapses were observed. Thirty (73.2%) of the relapses were in the right testis and 11 (26.8%) in the left testis. Four-year OS was 92.1% in patients with right tumor; and 98.7% in patients with left tumor (p=0.007). When 612 patients were evaluated with a mean follow-up of 4 years, there was a 6.6% survival advantage in patients with left testicular tumor and this difference was significant (p=0.007). Conclusion: Survival rates of patients with primary right testicular localization were worse compared with left testicular localization, and relapse rates were higher in stage 2 and 3 patients with right testicular localization.Öğe Efficacy and safety of trastuzumab emtansine in older patients with HER2-positive advanced breast cancer: a real-world study(Sage Publications Ltd, 2022) Cil, Ibrahim; Kucukarda, Ahmet; Atci, Muhammed Mustafa; Secmeler, Saban; Paksoy, Nail; Ferhatoglu, Ferhat; Ak, NaziyeIntroduction: Ado-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate and its survival advantage has been shown in advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, clinical trials underrepresent patients > 65 years of age, leading to a lack of information in this population. We analyzed the real-world outcomes of older women who were treated with T-DM1 therapy. Methods: We performed a multicenter, observational, retrospective analysis of patients aged > 65 years treated with T-DM1. A total of 93 patients from 10 cancer centers were involved in the study. Our goal was to determine the survival, response rates, and toxicity profile in T-DM1-treated patients, as well as the factors that influence survival. Results: Median follow-up was 12.2 months. Objective response rate was 29%. Median progression-free survival (PFS) and overall survival (OS) were 8.47 and 15.0 months, respectively. In multivariate analysis, Eastern Cooperative Oncology Group Performance Score 2 was found to be an independent prognostic factor for worse PFS (hazard ratio [HR] 1.81, p = 0.032) and OS (HR 2.33, p = 0.006). Any adverse event (AE) was seen in 92.5% of patients; grade 3 or 4 AEs were seen in 30.1%. Dose reduction or treatment discontinuation rates were 11.8% and 6.5%, respectively. Conclusion: The efficacy of T-DM1 was acceptable and it was generally well-tolerated among older patients with advanced HER2-positive breast cancer.Öğe An experimental study: the effect of S. boulardii on abemaciclib-induced diarrhea(Tubitak Scientific & Technological Research Council Turkey, 2023) Cakcak, Ibrahim Ethem; Aytin, Yusuf Emre; Sayin, Sezin; Kucukarda, Ahmet; Gokyer, Ali; Gokmen, Ivo; Ozcan, ErkanBackground/aim: In our study, we aimed to investigate the protective effects of Saccharomyces boulardii on abemaciclib-induced diarrhea model, which is a commonly used drug in breast cancer. Materials and methods: Thirty rats were divided into 3 groups as control (Group 1), abemaciclib (Group 2), and abemaciclib + Saccharomyces boulardii (Group 3) groups. The clinical status, body weight, and defecation status were monitored daily. At the end of the 15-day experiment period, the rats were killed with high-dose anesthesia and the resected small intestine segments were evaluated histopathologically. Lesions were classified according to thickening of the villus, inflammation and edema of mucosa and intraepithelial leukocyte accumulation. Then, mean values of both crypt depths and villi thicknesses were calculated for each rat. Normal distribution assumption was controlled with the Shapiro-Wilk test. One-way analysis of variance for normally distributed variables in the comparisons of more than two independent groups and Kruskal-Wallis test for nonnormally distributed variables were used. The significance value was accepted as 0.05. Results: There was one death in Group 3, but none in the others. There were no findings of mucositis in Group I. There was mild diarrhea and weight loss in only one rat in Group 1. For the comparison of the severity of diarrhea (72.5%/39%) and weight loss (72.5%/45%), a decrease was found in Group 3 according to Group 2 (p < 0.01). Histopathological findings such as edema, inflammation, and intraepithelial leukocyte accumulation also showed a decrease in Group 3 compared to Group 2 (p < 0.01). Conclusion: Saccharomyces boulardii should be considered as a treatment option in abaemaciclib (chemotherapy)-induced diarrhea. Further comparative studies and in vivo human randomized controlled studies can be conducted in the future.Öğe The frequency and prognostic significance of ABO/Rh blood groups in male breast cancer patients: A multicenter study(Lippincott Williams & Wilkins, 2022) Dogan, Izzet; Ayhan, Murat; Gurbuz, Mustafa; Kucukarda, Ahmet; Aydin, Esra; Urun, Yuksel; Cicin, IrfanThe study evaluated the distributions and prognostic significance of ABO and rhesus (D) groups in male breast cancer (MBC) patients. The data of 137 patients were retrospectively reviewed. Clinical, histopathological data and ABO/Rh blood groups of the patients were recorded. The ABO/Rh blood group distributions were compared to the healthy men control group (n = 120,160) by the chi-square test. Overall distributions of ABO blood groups were different between the patients (17.5% AB, 38% A, 19% B, and 25.5% O) and control group (7.88% AB, 42.06% A, 15.22% B, and 34.84% O) (P < .001). There were significant differences between the patients and control group with respect to AB vs non-AB blood group distributions (P < .001, odds ratio: 2.43, 95% CI) and O vs non-O blood group distributions (P = .016, odds ratio: 0.62, 95% CI). However, A vs non-A and B vs non-B blood group distributions were not significantly different. The distribution of the Rh factor was similar between patients and the control group (P = .93). In univariate analysis, ABO/Rh blood groups were not a prognostic factor on OS (P = .29). The frequency of the AB blood group in MBC patients is increased than in the healthy control group. AB blood group may be a risk factor for MBC, whereas O blood group may be a protective factor.Öğe Iatrogenic Cushing's Syndrome After Topical Steroid Therapy for Psoriasis(Medknow Publications & Media Pvt Ltd, 2016) Sahip, Birsen; Celik, Mehmet; Ayturk, Semra; Kucukarda, Ahmet; Mert, Onur; Dincer, Nejla; Guldiken, SibelGlucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing's syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing's syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with iatrogenic Cushing's syndrome related to long-term clobetasol propionate treatment for psoriasis. In the context of such treatment, the glucocorticoid withdrawal problem has to be overcome. At present there is no consensus on steroid withdrawal. Patients on long-term glucocorticoid treatment must be evaluated for potential adverse effects and withdrawal symptoms by their physician and their endocrinologist.Öğe Immunotherapy in Elderly Cancer Patients(Ortadogu Reklam Tanitim & Yayincilik, 2020) Gokyer, Ali; Kucukarda, Ahmet; Cicin, IrfanTwo-thirds of all new cancer diagnoses are made in persons over the age of 65 years. It is unclear if age affects patient respons to immunotherapy, which is increasingly becoming first-line therapy in advanced stages of different tumor types. As a result of data obtained from different immunotherapy studies, it was seen that advanced age did not change safety and response. In these studies, it was found that drugs were generally in low toxicity profile and well tolerated in elderly and young patient subgroups. However, there are drug-specific differences for immune check-point inhibition in comparison of young patients and overall survival and progression-free survival rates in elderly individuals. Further studies should be conducted on patients who respond to and do not give medication to optimize the use of immunotherapy in elderly patients.Öğe Investigation of the Effect of Tumor Location in Patients with Stage III Colon Cancer Receiving Adjuvant Oxaliplatine-Based Adjuvant Chemotherapy(Akad Doktorlar Yayinevi, 2021) Urvay, Semiha; Demir, Hacer; Gokyer, Ali; Hacibekiroglu, Ilhan; Kucukarda, Ahmet; Cakir, Emre; Beypinar, IsmailLeft-sided (LCC) and right-sided (RCC) colon cancers have different prognostic and predictive features in metastatic colon cancers, however there is insufficent data about tumor location in stage III disease. The aim of this study is to investigate the effect of tumor location on prognosis in patients with stage III colon cancer. From 2006 to 2012, medical records of 215 patients who underwent primary surgery and received adjuvant oxaliplatin based chemotherapy at 5 referral centers were collected, retrospectively. Disease-free survival (DFS) and overall survival were analysed using Kaplan-Meier and log-rank tests, and prognostic facrtors were identified by Cox regression methods. Clinicopathological characteristics of patients were similar between patients with right-and left-sided colon cancers. The 3-year DFS rate was similar (88% vs 78%, p= 0.07) but the RCC was significantly associated with a shorter 3-year OS than LCC (76% vs 87%, p= 0.03). The 3-year median OS was 125.8 months for all patients groups, 92.2 (+/- 5.81) months for the RCCs and 132.2 (+/- 5.52) months for the LCCs (p= 0.037). Multivariate analysis showed that stage (HR:0.32, p= 0.042 for OS) and venous invasion (HR: 0.28, p= 0.002 for OS) were the independent prognostic factors. Although there was no DFS difference between RCCs and LCCs, poorer survival of RCC indicated that the prognosis of RCC worsened after transitioning to the metastatic stage. Tumor location may be a prognostic factor in metastatic colon cancer but not in stage III disase.Öğe Merkel cell carcinoma in Turkey: A multicentric study(Wolters Kluwer Medknow Publications, 2021) Yildiz, Fatih; Demirci, Umut; Kucukarda, Ahmet; Buyuksimsek, Mahmut; Sakalar, Teoman; Topcu, Turkan Ozturk; Aslan, FeritBackground: Merkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine carcinoma of the skin. In this study, we aimed to evaluate the clinicopathologic characteristics, treatment outcomes, and survival of MCC cases in Turkey. Materials and Methods: The patients diagnosed with MCC between 1999 and 2018 at twenty different centers in Turkey were included in the study. Patient and tumor characteristics and adjuvant and metastatis treatment outcomes were analyzed retrospectively. Results: The median age of totally 89 patients was 70 (26-93). The most common primary location was lower limbs (n = 29, 32.5%). Immunohistochemically, CK20 positivity was present in 59 patients (66.3%). Only two patients had secondary malignancy. The majority of the patients (n = 76, 85.4%) were diagnosed at the localized stage. Surgery was performed for all patients in the early stage, and adjuvant radiotherapy or/and chemotherapy was applied to 52.6% (n = 40) of nonmetastatic patients. The median follow-up was 29 months. Recurrence developed in 21 (27.6%) of the 76 patients who presented with local or regional disease. Two-year disease-free survival (DFS) was 68.1% and 5-year DFS was 62.0% for localized stage. The 5-year DFS was similar for patients receiving adjuvant treatment (chemotherapy, radiotherapy, or sequential chemoradiotherapy) and without adjuvant therapy (P > 0.05). Two-year overall survival in patients who presented with localized disease was 71.3% and 18.5% in metastatic patients (P < 0.001). In the metastatic stage, platinum/etoposide combination was the most preferred combination regimen. Median progression-free survival (PFS) in first-line chemotherapy was 7 months (95% confidence interval: 3.5-10.5 months; standart error: 1.78). Conclusions: Although MCC is rare in Turkey, the incidence is increasing. Gender, CK20 status, tumor size, lymph node involvement, and adjuvant treatment were not associated with recurrence.Öğe Nasal hemangiopericytoma presenting with oncogenic osteomalasia: A case report and literature review(Mosby-Elsevier, 2021) Gokyer, Ali; Sayin, Sezin; Kucukarda, Ahmet; Celik, Mehmet; Guldiken, Sibel; Cicin, IrfanSinonasal type hemangiopericytoma is a rare soft tissue tumor. Oncogenic osteomalacia (tumor-induced osteomalacia) is a rare syndrome that develops especially due to benign mesenchymal tumors. Nonspecific general bone pain and weakness delay the diagnosis and treatment of oncogenic osteomalacia, and it is difficult to determine the localization of the primary tumor causing oncogenic osteomalacia. A 43-year-old male patient with nasal hemangiopericytoma with symptoms of oncogenic osteomalacia is presented. The patient had musculoskeletal complaints at first and was diagnosed with lumbar disc herniation and surgery was performed. When his complaints recurred 1 year later, he was re-evaluated and diagnosed with hypophosphatemic osteomalacia. Despite the various treatments he received, his complaints did not decrease but increased, so a detailed examination was decided. When the positive PHEX mutation and very high fibroblast growth factor 23 level were detected, PET-CT imaging was performed with a pre diagnosis of possible oncogenic osteomalacia, but no finding was found. Then he was evaluated with Ga68 DOTATATE, and the soft tissue mass filling the right ethmoidal sinus was detected. Due to the relation of the mass with surrounding structures, it was considered unsuitable for total excision and incomplete surgical excision was performed. Pathologic evaluation revealed sinonasal type hemangiopericytoma (glomangiopericytoma). A significant remission in the patient's complaints was observed after the operation. Young patients with osteomalacia with unknown causes should be evaluated for malignancy, and screening and further examinations should be performed. (c) 2020 Elsevier Inc. All rights reserved.Öğe Prognostic Factors for Survival in Transverse Colon Cancers(Springer, 2022) Kucukarda, Ahmet; Gokyer, Ali; Sayin, Sezin; Gokmen, Ivo; Ozcan, Erkan; Kostek, Osman; Hacioglu, Muhammet BekirBackground Transverse colon cancer (TCC) is a rare condition that accounts for 10% of all colon cancers. TCC was accepted more likely right-sided colon cancers. We aimed to investigate whether TCC differs from other colon tumors by using clinical, pathological, and molecular prognostic factors known to be important in colon cancer and if it differs in its own anatomical structure. Patients and Methods We evaluated local and locally advanced TCC patients between 2007 and 2020 years for demographics data, symptoms, treatment status, and histopathological and molecular features. Results Overall, 107 TCC patients were included in this study. According to the molecular data analysis of 44, 35, and 23 patients for MSI, RAS, and BRAF status, respectively, 7 (15.9%) were MSI-H, 13 (37.1%) were RAS mutant, and 11 (47.8%) had BRAF V600E mutation. The median follow-up time was 31.5 months. Median disease-free survival (DFS) was 5.19 months, and median OS was 88.3 months for the whole study population. The tumor stage was the most significant prognostic factor for DFS and OS. Although BRAF mutation was not a significant marker for DFS, it was an independent prognostic marker for OS (HR 3.90 95% CI 1.42-10.7). There were no statistically significant differences between proximal two-thirds and distal one-third tumor location. Conclusion TCC has molecular features and prognostic factors more likely RCC and no differences between proximal and distal sub-parts. BRAF V600E mutation status is an independent predictor of survival even in the early stages of TCC.Öğe Prognostic nutritional index and its dynamics after curative treatment are independent prognostic factors on survival in non-metastatic nasopharyngeal carcinoma(Springer, 2022) Kucukarda, Ahmet; Erdogan, Bulent; Gokyer, Ali; Sayin, Sezin; Gokmen, Ivo; Ozcan, Erkan; Hacioglu, Muhammet BekirPurpose We aimed to identify the prognostic and predictive values of post-treatment prognostic nutritional index (PNI) and PNI dynamics in nasopharyngeal cancer patients (NPC) in this study. Methods One hundred seven non-metastatic NPC patients were included. PNI was calculated by using the following formula: [10 x serum albumin value (gr/dL)] + [0.005 x total lymphocyte count (per mm3)]. ROC analysis was used for determining prognostic PNI values and univariate and multivariate statistical analyses for prognostic characterization of PNI. Results The statistically significant cut-off values for pre- and post-treatment PNI were 50.65 and 44.75, respectively. Of the pre-treatment PNI analysis, PNI <= 50.65 group had shorter loco-regional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Furthermore, for post-treatment PNI analysis, PNI <= 44.75 group had shorter LRRFS and OS. In univariate analysis, only pre-treatment PNI was associated with LRRFS and DMFS, while pre- and post-treatment PNI were both associated with OS. In multivariate analysis, both PNI were independent prognostic markers for OS. In the combined analysis, pre- and post-treatment PNI, differences between the groups were statistically significant, and the PNI dynamics was an independent prognostic indicator for OS. Conclusion PNI is a useful, independent prognostic marker for non-metastatic NPC patients. It is used for either pre- or post-treatment patients. Furthermore, changes in pre-treatment PNI value after curative treatment is a significant indicator for OS.Öğe Recurrent delayed immune-related pneumonitis after immune-checkpoint inhibitor therapy for advanced osteosarcoma(Future Medicine Ltd, 2022) Kucukarda, Ahmet; Gokmen, Ivo; Ozcan, Erkan; Peker, Pinar; Akgul, Fahri; Cicin, IrfanIntroduction: The case of a patient who developed recurrent delayed immune-related pneumonitis (checkpoint inhibitor pneumonitis [CIP]) after immune checkpoint inhibitor (ICI) therapy for advanced osteosarcoma treatment is presented. Case summary: A 25-year-old female patient with metastatic osteosarcoma was treated with atezolizumab. Grade 2 pneumonitis developed three times in the first two years. Treatment was discontinued after recovery from the last episode of pneumonitis, which was complicated with secondary spontaneous pneumothorax. 2 years after discontinuation of immunotherapy, the patient again developed CIP. Pneumonitis symptoms were regressed with oral steroid therapy during follow-up and a stable disease response continued. Conclusion: Immunotherapy can cause recurrent CIP at any time during the treatment period or after discontinuation of treatment. Plain language summary Immune checkpoint inhibitors have been used in many types of cancer because they cause prolonged tumor responses. However, new side effects associated with these drugs have been identified. Pneumonia of the lung tissue may occur and recur during the use of these drugs or after their discontinuation. Patients with newly developing pulmonary symptoms during follow-up should be carefully monitored for this side effect.Öğe The relation between tissue galectin-3 level and platinum resistance in neoadjuvant bladder cancer treatment(Imprimatur Publications, 2021) Gokyer, Ali; Kucukarda, Ahmet; Kostek, Osman; Saying, Sezin; Can, Nuray; Hacioglu, Bekir; Erdogan, BulentPurpose: This study aimed to reveal the relationship between the level of galectin-3 expression and the depth of response to neoadjuvant therapy in bladder tumor tissue with muscle invasion revealed by transurethral biopsy. Methods: The percentage of galectin-3 staining in transurethral biopsy tissue with muscle invasion was determined by immunohistochemistry. The patients were divided into two groups: the down-staging (+) group consisting of patients with pathological complete response or non-invasive bladder cancer, and the down-staging (-) group consisting of patients with stage 2 and above. Results: There were 11 patients in the down-staging (+) group and 12 patients in the down-staging (-) group. There was no significant difference between the two groups in terms of median age, gender, smoking, clinical stage at the time of diagnosis, distribution of carboplatin or cisplatin used as a platinum agent. Galectin-3 was positive in 2 patients (18.2%) in the group where down-staging was achieved with neoadjuvant therapy, while it was positive in 9 patients (75%) in the other group (p = 0.01). The median follow-up period of the patients was 31.6 months (95% CI 25.1-39.3). Overall survival was 43.4 months in the down-staging (+) group (95% CI 25.1-61.6) and 31.6 months in the down staging (-) group (95% CI 12.7-50.6). Although there was a numerical difference, it did not reach statistical significance (p=0.37). Conclusion: The rate of down-staging after platinum-based neoadjuvant chemotherapy is significantly higher in patients with low galectin-3 staining in transurethral bladder biopsy tissue.Öğe Relationship between prognostic nutritional index and neutrophil lymphocyte ratio with overall survival in patients with metastatic colorectal cancer receiving regorafenib(Wolters Kluwer Medknow Publications, 2023) Erdogan, Bulent; Ozcan, Erkan; Gokmen, Ivo; Gokyer, Ali; Kucukarda, Ahmet; Kostek, Osman; Hacioglu, Muhammet BekirAim: In this study, we aimed to analyze the effect of prognostic nutritional index and neutrophile lymphocyte ratio on the overall survival (OS) in patients treated with regorafenib. Materials and Methods: Metastatic colorectal cancer (CRC) patients who treated with regorafenib between 2016 and 2020 in a single center were evaluated retrospectively. ROC analysis was used for neutrophile lymphocyte ratio (NLR's) and prognostic nutritional index (PNI's) optimum cut-off value. The relationship between OS with PNI and NLR was investigated. Results: Fifty-two patient's data were analyzed. The median age was 57 years, 22 (41.5%) of the patients were female. The optimal cut-off value of PNI for OS was 45.7 according to ROC curve analysis. The median NLR value was accepted as 2.7. Median OS was 8.3 months. Patients who have high PNI value than 45.7 had longer OS (12.09 months vs. 6.31 months hazard ratio [HR]: 0.37 95% confidence interval [CI]: 0.19-0.73 P = 0.003) and there was a tendency for longer OS with low NLR value then median (12.05 months vs. 6.14 months HR: 0.54 95% CI: 0.29-1.23 P = 0.057). Primary tumor resected patients had longer OS than nonresected patients (12.05 months vs. 6.30 months HR: 0.34 95% CI: 0.17-0.66 P = 0.001). In multivariate analysis, high PNI value more than 45.7 (HR: 0.40 95% CI: 0.18-0.88 P = 0.02) and resection of the primary tumor (HR: 0.40 95% CI: 0.21-0.80 P = 0.01) were the only independent factors for longer OS. Conclusion: Metastatic CRC patients with high pretreatment PNI and primary tumor resected are more likely to have longer OS with regorafenib. PNI is more reliable index than NLR to predict OS in metastatic CRC patients treated with regorafenib.Öğe Secondary pneumothorax during immunotherapy in two patients with metastatic solid tumors; a new entity(Future Medicine Ltd, 2021) Kucukarda, Ahmet; Sayin, Sezin; Gokyer, Ali; Aykan, Musa Baris; Karadurmus, Nuri; Cicin, IrfanLay abstract Immune checkpoint inhibitors are used with increasing frequency in cancer therapy. New side effects associated with these drugs have been identified. Air accumulation between the pleural membranes, which envelop the lungs and protect them in the ventilation function, without trauma may occur after using these drugs. We present here two cases that were treated with these drugs and developed this side effect. Patients with newly developed shortness of breath during this treatment should be careful about side effects such as this. Background: We present two cases of secondary pneumothorax after immunotherapy in two different clinics. Case summary: A 25-year old female patient with metastatic osteosarcoma, treated with atezolizumab. Grade 2 pneumonitis developed twice in the first year. Treatment was continued after recovery and areas of pneumonitis and pneumothorax were observed on computed tomography. No other reason could be found to cause pneumothorax. Pneumothorax resorbed spontaneously during follow-up. A 36-year old female patient treated with nivolumab for metastatic renal cell carcinoma (RCC), areas of pneumonitis and pneumothorax were only found as the cause of dyspnea. After treatment, remission was achieved on computed tomography findings. Pneumothorax was detected for the second time during continued therapy, and immunotherapy stopped permanently. Conclusion: These cases, indicate that immunotherapy can cause secondary immune-related pneumothorax based on immune pneumonitis.Öğe Skeletal muscle loss during anti-epidermal growth factor receptor therapy is an independent prognostic factor on non-small cell lung cancer patients survival(Imprimatur Publications, 2021) Kucukarda, Ahmet; Gokyer, Ali; Gokmen, Ivo; Hacioglu, Muhammed Bekir; Kostek, Osman; Kurt, Nazmi; Karabulut, DeryaPurpose: We aimed to assess whether skeletal muscle loss during EGFR thyrosine kinase inhibitor therapy of advance non-small cell lung cancer patients is an independent prognostic factor for progression-free survival (PFS) and overal survival (OS). Methods: A total of 45 patients who had computed tomography images were retrospectively evaluated at the diagnosis and during the treatment period before progression occurs. Results: During treatment 19 patients (42.2%) had skeletal muscle loss. Objective response rates in muscle loss group and muscle stable group were 36.8% and 73.0%, respectively (p<0.01). Median follow-up time was 18.9 months (14.832.1). Median PFS was 14.7 months (95% CI 12.1-17.3) in muscle stable group and 7.6 months (95% CI 6.7-8.5) in muscle loss group (p<0.01). Median OS was 18.3 months (95% CI 16.5-20.2) in muscle loss group while it was 30.1 months (95% CI 22.1-38.2) in muscle stable group (p<0.01). In multivariate analysis for both PFS and OS, skeletal muscle loss was an independent prognostic factor. Hazard ratios (HR) for PFS and OS were 12.2 (95% CI 4.3-34.4) and 3.51 (95% CI 1.41-8.73) respectively. Conclusion: On CT imaging skeletal muscle loss before progression is an independent prognostic factor for both PFS and OS in advance non-small cell lung cancer patients who received EGFR tyrosine kinase inhibitor therapy.Öğe Stage I colon cancer that spreads into a colovesical fistula-mediated bladder due to crohn's disease: A case report(Elsevier, 2020) Gokyer, Ali; Kucukarda, Ahmet; Sayin, Sezin; Keskin, Fatma Elif Usturali; Cicin, IrfanIntroduction: Colovesical fistulas are one of the most frequent complications in fistulizing Crohn's disease. Fistulizing Crohn's disease and tumor coexistence may lead to tumor spread through the fistula. Case report: In this study, a 62-year-old male patient with colon cancer spreading to bladder mucosa through the colovesical fistula due to Crohn's disease is presented. He was treated and followed up for Crohn's disease and in the routine follow-up colonoscopy, a mass was observed in sigmoid colon. Computed tomography demonstrated the mass as a local disease. The patient underwent both left hemicolectomy and due to intraoperative colovesical fistula, subsequently, fistulectomy. Pathologic evaluation revealed stage 1 adenocarcinoma of the colon. Transurethral resection was performed for postoperative evaluation and a mass was detected and resected in the bladder. Pathologic findings of resected specimens were consistent with metastasis of adenocarcinoma of the colon. The clinical features, diagnosis and treatment data were analyzed retrospectively and it was thought that the existing tumor spreads to the bladder through the colovesical fistula due to no invasion into the muscularis propria layer of the bladder. Management and outcome: Since muscle invasion was not detected in the bladder after TUR-T, cystectomy was not planned. 8 cycles of systemic adjuvant chemotherapy (Oxaliplatin and Capecitabine) were planned for 6 months. Gastroenterology consultation was requested for Crohn's disease treatment. It was recommended to discontinue azathioprine and continue with adalimumab therapy. Discussion: Colovesical fistula may develop in Crohn's disease that is not in remission and the fistulae can lead the metastasis of tumors.
