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Öğe Adrenocortical Cancer in the Real World: A Comprehensive Analysis of Clinical Features and Management from the Turkish Oncology Group (TOG)(Cig Media Group, Lp, 2024) Yasar, Hatime Arzu; Aktas, Burak Yasin; Ucar, Gokhan; Goksu, Sema Sezgin; Bilgetekin, Irem; Cakar, Burcu; Sakin, AbdullahAdrenocortical cancer is a rare and poor prognostic malignant tumor. The definitions of prognostic factors in localized and metastatic diseases are important. In this paper, we defined the clinical features, management, and prognostic factors related to survival in patients with metastatic and nonmetastatic ACC. Cox regression analysis showed that age, Ki67 value, ECOG PS, and hormonal activity were significantly associated with survival in patients with nonmetastatic disease. Only patients who underwent surgery had significantly better OS compared with patients without surgery in univariate analyses of metastatic disease. Introduction: Adrenocortical carcinoma (ACC) is a rare yet highly malignant tumor associated with significant morbidity and mortality. This study aims to delineate the clinical features, survival patterns, and treatment modalities of ACC, providing insights into the disease's prognosis. Materials and Methods: A retrospective analysis of 157 ACC patients was performed to assess treatment methodologies, demographic patterns, pathological and clinical attributes, and laboratory results. The data were extracted from the hospital's database. Survival analyses were conducted using the Kaplan-Meier method, with univariate and multivariate analyses being performed through the log -rank test and Cox regression analyses. Results: The median age was 45, and 89.4% had symptoms at the time of diagnosis. The median tumor size was 12 cm. A total of 117 (79.6%) patients underwent surgery. A positive surgical border was detected in 26 (24.1%) patients. Adjuvant therapy was administered to 44.4% of patients. The median overall survival for the entire cohort was 44.3 months. Median OS was found to be 87.3 months (95% confidence interval [CI] 74.4-100.2) in stage 2, 25.8 (95% CI 6.5-45.1) months in stage 3, and 13.3 (95% CI 7.0-19.6) months in stage 4 disease. Cox regression analysis identified age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as significant factors associated with survival in patients with nonmetastatic disease. In metastatic disease, only patients who underwent surgery exhibited significantly improved overall survival in univariate analyses. Conclusion: ACC is an uncommon tumor with a generally poor prognosis. Understanding the defining prognostic factors in both localized and metastatic diseases is vital. This study underscores age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as key prognostic determinants for localized disease, offer ing cr itical insights into the complexities of ACC management and potential avenues for targeted therapeutic interventions.Öğe Assessing the Clinical Impact of Lutetium-177 DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) on Metastatic Neuroendocrine Tumors: A Multicenter Real-World Data from Türkiye(Kare Publ, 2023) Unal, Caglar; Selcuk, Nalan Alan; Biricik, Fatih Selcuk; Alan, Ozkan; Ordu, Cetin; Selvi, Oguzhan; Sakin, AbdullahObjectives: This study aimed to evaluate the clinical outcomes, including progression-free survival (PFS), overall sur-vival (OS), Objective Response Rate (ORR), and Disease Control Rate (DCR), in patients received Lutetium-177 (Lu-177) DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) for metastatic neuroendocrine tumors. This study further stratified outcomes based on tumor grade, Ki-67 status, primary tumor localization, number of treatment cycles, and associated adverse effects.Methods: We conducted a multicenter retrospective study analyzing the data of 73 patients with metastatic NETs across 17 different hospitals in various regions of Turkiye. A total of 73 metastatic NET patients underwent Lu-177 DOT-ATATE PRRT between December 2013 and March 2023. Results: Over a median follow-up of 52.7 months, patients showed a median PFS of 13.7 months and OS of 51.2 months. The ORR was 29.6%, and the DCR was 66.2%. Grade 1 and 2 tumor patients had superior outcomes (PFS: 16.9 months, OS: 55.5 months) compared to grade 3 tumor patients (PFS: 8.5 months, OS: 29.5 months). Based on their Ki-67 status, those <= 20% had prolonged PFS (16.9 months) and OS (55.5 months) than those between 21 and 55% (PFS: 5.9 months, OS: 41.3 months). Regarding primary tumor localization, the PFS values were 13.1, 15.3, 13.7, and 8.6 months for pancreatic, GIS, lung, and unknown origin tumors, respectively. The OS across tumor types fluctuated between 41.1 and 54.1 months. Patients who received more than four cycles demonstrated significantly improved median PFS (22.4 months) and OS (90.3 months) compared to those who received <= 4 cycles (median PFS: 9.3 months; median OS: 41.8 months). Grade 3-4 adverse effects were observed in 21.9% of patients.Conclusion: Our findings affirm that PRRT is a potent and well-tolerated treatment for metastatic NETs. Notably, pa-tients who received more than 4 cycles of PRRT experienced a markedly improved median PFS and OS compared to their counterparts who received <= 4 cycles.Öğe 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 MehmetObjectives: 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.Öğe Characteristic features and prognostic factors in gastric cancer patients with bone metastases: multicenter experience(Taylor & Francis Ltd, 2024) Hamdard, Jamshid; Bilici, Ahmet; Sakin, Abdullah; Kahraman, Seda; Yasin, Ayse Irem; Kalaci, Ender; Gokmen, IvoWe evaluated the incidence, clinicopathological features, prognostic factors, progression-free survival (PFS) and overall survival (OS) of patients with gastric cancer and bone metastases. The medical records of 110 patients with bone metastases were retrospectively analyzed. In our study, the incidence of bone metastases was 3.2%. The median patient age was 60 years. A total of 68 (61.8%) patients exhibited synchronous metastases, and 42 (38.2%) patients developed metachronous metastases. Alkaline phosphatase (ALP) levels were high in 54 (49%) patients. At the median follow-up time of 9.8 months, median PFS and OS times were 4.7 and 6.3 months, respectively. The median interval from the diagnosis to bone metastases was 9.3 months. Univariate analysis showed that Eastern Cooperative Oncology Group Performance Status (ECOG PS) >= 2, stage at diagnosis, time of metastases, number of metastases, presence of extraskeletal metastases, use of zoledronic acid treatment, palliative chemotherapy post-bone metastases and radiotherapy to bone metastases were significant prognostic indicators for PFS. Additionally, ECOG PS >= 2, stage at diagnosis, time of metastases, number of metastases, presence of extraskeletal metastases, zoledronic acid treatment, palliative chemotherapy post-bone metastases, and radiotherapy to bone metastases significantly influenced OS. Moreover, in multivariate analysis, ECOG PS, time of metastases, presence of extra-bone metastases, and the use of palliative chemotherapy after bone metastases were found to be independent prognostic factors for PFS. Moreover, ECOG PS, time of metastases, and use of palliative chemotherapy after bone metastases were significantly independent prognostic indicators for OS. Our findings show that the presence of synchronous metastases, use of palliative chemotherapy, use of zoledronic acid after bone metastases, and ALP level within the normal range were significantly associated with prolonged OS in gastric cancer patients with bone metastases.Öğe Clinical outcomes of patients with pure small cell carcinoma of the urinary bladder(Springer London Ltd, 2020) Erdem, Gokmen Umut; Dogan, Mutlu; Aytekin, Aydin; Sahin, Suleyman; Cinkir, Havva Yesil; Sakin, Abdullah; Ozcelik, MelikeObjectives There is not yet a standardized approach to treat patients with small cell carcinoma of the bladder (SmCCB). This study aims to investigate the clinical features, treatment, and survival outcomes of patients with pure SmCCB. Materials and methods Patients diagnosed with SmCCB between January 2006 and September 2015 were retrospectively evaluated. Results A total of 34 patients with a median age of 63.0 years were included in the study, with a male to female ratio of 4.6:1.0. At the time of diagnosis, 22 patients (64.7%) had stage IV disease. At a median follow-up time of 12.7 months, 67.6% of patients died of bladder carcinoma, with an overall survival (OS) of 15.7 months for all patients. In the patients with stages I-III, nodal involvement, and distant metastases, the median OS was 31.8, 15.7, and 8.4 months, respectively (P = 0.005). Considering the survival rates of the patients (stages I-III) treated with surgery vs. local therapy, there was not a statistically significant difference (26.6 months and 31.8 months, P = 0.97, respectively). A multivariate analysis revealed that stage IV disease and poor ECOG performance status were associated with OS. Conclusion The optimal treatment of SmCCB has been under debate. For the patients with advanced stage of disease (T4b, N+, M+), platinum containing chemotherapeutic agents should be preferred. Stage IV disease and poor ECOG performance status were associated with shorter OS.Öğe 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.Öğe Is the prognostic nutritional index a prognostic and predictive factor in metastatic non-small cell lung cancer patients treated with first-line chemotherapy?(Springer, 2020) Bozkaya, Yakup; Kostek, Osman; Sakin, Abdullah; Ozyukseler, Deniz Tataroglu; Sakalar, Teoman; Cil, IbrahimPurpose We aimed to assess the prognostic and predictive significance of pretreatment Onodera's prognostic nutritional index (OPNI) in metastatic non-small cell lung cancer patients (NSCLC) treated with first-line chemotherapy. Materials and methods Patients with metastatic NSCLC who attended five different medical oncology clinics between December 2008 and January 2018 were retrospectively analyzed. The optimal cut-off point for OPNI was performed by a receiver operating characteristic (ROC) curve analysis. Patients were assigned to either the low OPNI group or high OPNI group. Results A total of 333 patients were included in the study. Significant differences between the low and high OPNI groups were found regarding the rates of response to chemotherapy, sex, and hemoglobin level (p < 0.05). The patients in high OPNI group had a longer overall survival (OS) (15.3 vs. 10.6 months, p < 0.001) and progression-free survival (PFS) (6.7 vs. 5.3 months, p < 0.001) compared to the patients in low OPNI group. A multivariate analysis using Cox regression model revealed that a high OPNI score was an independent prognostic factor of OS (HR = 1.535, p = 0.002) and PFS (HR = 1.336, p = 0.014), but failed to demonstrate a statistical significance of pretreatment OPNI scores in predicting treatment response (p = 0.56). Conclusions Pretreatment OPNI is an independent prognostic factor for OS and PFS in metastatic NSCLC patients treated with first-line chemotherapy. Thus, it may be used as easily calculated and low-cost prognostic tool in the routine clinical practice in this patient group.Öğe 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, MuratPurposeTo 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.
