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Eda Caliskan Yildirim,1 Yusuf Acikgoz,2 Yakup Ergun,2 Efnan Algin,2 Oznur Bal2 1Dokuz Eylul University, Department of Internal Medicine, Division of Medical Oncology, Izmir, Turkey; 2Health Sciences University Ankara City Hospital, Department of Medical Oncology, Ankara, TurkeyCorrespondence: Eda Caliskan Yildirim, Dokuz Eylul University, Department of Internal Medicine, Division of Medical Oncology, Izmir, 35340, Turkey, Tel +905545070442, Email caliskan_eda@yahoo.comPurpose: N3 gastric cancer is characterized by a fairly high lymph node metastasis burden and poor outcome despite optimal therapy. Given the limitations of TNM classification, a comprehensive evaluation tool is necessary to predict the prognosis of patients with N3 gastric cancer who underwent curative surgery. This study aims to explore the outcomes and clinicopathologic prognostic factors affecting the overall survival (OS) of patients with N3 gastric cancer after surgery.Methods: Data on patients with N3 gastric cancer who underwent (sub)total gastrectomy and regional lymph node dissection between November 2005 and September 2018 (n = 169) were analyzed by Cox regression to determine the independent prognostic factors for OS.Results: The multivariable analysis established that gender, patient performance status, metastatic lymph node ratio (MLNR), tumor grade, and adjuvant chemotherapy are significantly associated with OS. The five-year OS of the study population was 15%. Adjuvant chemoradiotherapy was applied to 72% of the patients, which resulted in an improvement in recurrence-free survival but not OS. Recurrence occurred in 103 (75%) patients, in which the most frequent recurrence site was distant metastasis.Conclusion: Male gender, poor performance status, grade 3 tumor, MLNR > 0.37, and not receiving adjuvant chemotherapy are predictors of poor prognosis in N3 gastric cancer after curative resection. Considering the high recurrence rates of this group, prospective studies are needed to optimize treatment strategies.Keywords: gastric cancer, prognosis, N3, lymph node ratio, recurrence pattern

3D Modelling of gravity data is generally performed as a multi-objective optimisation, trying to minimise observed-calculated data misfit while providing models with certain properties, such as smooth or sharp boundaries. We demonstrated that controlling the model properties in global optimisation schemes is possible through basic image processing filters, and developed a Particle Swarm Optimisation (PSO) algorithm that benefits from Gaussian and Percentile filters to avoid ambiguous boundaries that are generally seen in 3D smooth inversions of gravity data. The effectiveness of the algorithm is shown on a synthetic model consisting of two dipping structures with anomalous density contrasts. Thereafter, the algorithm is implemented to recover subsurface density distribution from a field data set. The field data is collected at the south-western part of the Sinanpaşa graben, Turkey. Due to the lack of previous geophysical studies in the area, 3D Euler decomposition, tilt angle, and 3D smooth inversion methods are also implemented to help interpretation and to compare to the model recovered using the PSO algorithm. The developed approach is observed to be resulted with a model, which is more compatible with the known geology of the region. [ABSTRACT FROM AUTHOR]

The article considers the problem of improving safety indicators on the railways of Ukraine, in particular, with regard to the temperature-stressed jointless track, which makes up more than 75% of the total length of the main tracks. During the operation of this structure, there is a risk of dangerous failures, such as “track ejection” and “rail and sleeper grid displacement”, which can lead to a rolling stock derailment. The article considers various aspects of this problem and analyses the stress state of the jointless track in the context of loss of longitudinal stability, investigating the factors that affect this risk. The purpose of the article is to propose comprehensive solutions to reduce the risk of loss of longitudinal stability of the continuous track and improve safety on Ukrainian railways. The study is based on the analysis of actual cases of rolling stock derailments due to loss of rail and sleeper grid stability. The article also examines the regulatory approach to determining the conditions of longitudinal stability of continuous track in Ukraine and the European Union and compares their approaches. Finally, the authors of the article offer proposals for improving the safety performance of railways, including the introduction of: the European approach to authorization of the subsystem “infrastructure”; modern systems for diagnostics and monitoring of the state of infrastructure; and an approach to work planning based on the assessment of the probability of the risk of loss of rail and sleeper stability. The general context of the article is to improve traffic safety on Ukrainian railways and to avoid transportation accidents associated with the loss of longitudinal stability of the rail and sleeper grid of a jointless track.

Copyright of Eastern-European Journal of Enterprise Technologies is the property of PC TECHNOLOGY CENTER and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Eastern-European Journal of Enterprise Technologies is the property of PC TECHNOLOGY CENTER and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Thymic epithelial tumors represent the most common cause of anterior mediastinal masses in adults. Among these tumors, thymomas constitute the majority, whereas thymic carcinomas are less prevalent and associated with a poorer prognosis. This study seeks to investigate the clinical and prognostic factors of these rare entities, thymoma, and thymic carcinomas., Materials and Methods: We conducted a retrospective analysis on a cohort of 60 patients diagnosed with thymoma and thymic carcinoma, who were under follow-up at our clinic between January 1998 and February 2023. The clinical characteristics and prognostic factors of these patients were analyzed separately., Results: Thymomas accounted for 75% of the cases. The median age at diagnosis was 46 years in both patient groups. Masaoka stage 4 was observed in 28.9% of thymoma patients and 66.7% of thymic carcinoma patients. The median overall survival (mOS) for thymoma patients was 261.4 months, while it was 9.23 months for patients with thymic carcinoma. Curative surgery emerged as a prognostic factor significantly influencing overall survival in both thymoma and thymic carcinoma patients., Conclusion: Our study highlights the significance of Eastern Cooperative Oncology Group (ECOG) performance status and curative surgery as prognostic factors affecting overall survival in thymoma patients. In thymic carcinoma, only curative surgery was found as a prognostic factor. These findings may enhance patient care and guide personalized treatment strategies. Further investigations and prospective studies are warranted to corroborate and expand upon these results., Competing Interests: Conflict of interestIn our study, we did not receive any financial support or sponsorship. The authors declare that there is no conflict of interest among them. All the research and analysis were conducted independently without any external influence or funding. The study was solely driven by the scientific curiosity and dedication of the authors to contribute to the field of thymic epithelial tumors. The absence of any financial or personal conflicts of interest ensures the objectivity and integrity of our research findings., (© Indian Association of Cardiovascular-Thoracic Surgeons 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Letrozole is an aromatase inhibitor (AI), which suppresses plasma estrogen levels by inhibiting the aromatase enzyme, that causes the conversion of androgens to estrogen in peripheral tissues. There is very few information in the literature regarding the development of acute heart failure after AI use. We would like to report a case of a patient who was started letrozole for hormonal treatment and developed acute heart failure due to this., Case Report: Fifty-seven-year-old woman with hormone positive breast cancer was operated after neoadjuvant chemotherapy and received radiotherapy. Letrozole treatment was initiated after radiotherapy and the patient presented to the emergency department after two weeks with cough and dyspnea. Ejection fraction decreased to 20% and acute heart failure developed., Management and Outcome: Letrozole treatment was stopped. Afterwards, improvement in the patient's cardiac functions was observed. Letrozole-induced heart failure was thought to be reversible., Discussion: Letrozole is one of the most commonly used HT in the treatment of hormone positive breast cancer. It may rarely cause cardiac side effects. It is very important to make patients aware of these issues and to be consulted by cardiology in case of possible cardiac symptoms., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The only phase 3 study on the effectiveness of CDK 4-6 inhibitors in first-line treatment in premenopausal patients with hormone receptor (HR) positive, HER2 negative metastatic breast cancer is the MONALEESA-7 study, and data on the effectiveness of palbociclib is limited. Data are also limited regarding the effectiveness of CDK 4-6 inhibitors in patients whose dose was reduced due to neutropenia, the most common side effect of CDK 4-6 inhibitors. In our study, we aimed to evaluate the effectiveness of palbociclib and ribociclib in first-line treatment in patients with premenopausal metastatic breast cancer and the effect of dose reduction due to neutropenia on progression-free survival. Our study is a multicenter, retrospective study, and factors affecting progression-free survival (PFS) were examined in patients diagnosed with metastatic premenopausal breast cancer from 29 different centers and receiving combination therapy containing palbociclib or ribociclib in the metastatic stage. 319 patients were included in the study. The mPFS for patients treated with palbociclib was 26.83 months, and for those receiving ribociclib, the mPFS was 29.86 months ( p  = 0.924). mPFS was 32.00 months in patients who received a reduced dose, and mPFS was 25.96 months in patients who could take the initial dose, and there was no statistical difference ( p  = 0.238). Liver metastasis, using a fulvestrant together with a CDK 4-6 inhibitor, ECOG PS 1 was found to be a negative prognostic factor. No new adverse events were observed. In our study, we found PFS over 27 months in patients diagnosed with premenopausal breast cancer with CDK 4-6 inhibitors used in first-line treatment, similar to post-menopausal patients. We did not detect any difference between the effectiveness of the two CDK 4-6 inhibitors, and we showed that there was no decrease in the effectiveness of the CDK 4-6 inhibitor in patients whose dose was reduced due to neutropenia.

Objective: We represent Sprouty 2 (Spry2) expression analysis and its association with key driver mutations and clinical features of patients with non-small cell lung cancer as the largest ex vivo data., Methods: The strength of Spry2 expression was evaluated using the immunoreactivity score (IRS), which was calculated using the following formula: IRS=(staining intensity score) SI×(percentage of positively stained cells) PP. The median IRS score was defined as the cutoff value. Patients were grouped as "weak immunoreactivity score" (IRS: 0 to 4) or "strong immunoreactivity score" (IRS: ≥4) with respect to the IRS score., Results: The intensity and percentage of Spry2 staining were significantly lower in tumor tissues than in normal lung tissues ( P <0.0001). Patients' characteristics were similar for both groups, except for smoking status and, brain and lymph node metastasis. Overall survival of patients with a strong immunoreactivity score was significantly lower than those with a weak immunoreactivity score among metastatic patients (6.9 mo vs. 13.6, P =0.023) and adenocarcinoma histology (7.0 mo vs. not reached, P =0.003)., Conclusion: Spry2 expression was lower in tumor tissues than in normal lung parenchyma. Increased expression of Spry2 is associated with poor prognosis. There were no significant associations between epidermal growth factor receptor, anaplastic lymphoma kinase, or c-ros oncogene 1 rearrangement and Spry2 expression. Despite the absence of KRAS mutational analysis, the clinical and epidemiological features of patients suggested that KRAS mutation might be an underlying determinant factor of the functional role of Spry2 in non-small cell lung cancer., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Aims and Background: In general, neoadjuvant treatment is the standard for clinical stage II/III esophageal cancer (EC), whereas the effect of adjuvant treatment on survival still remains controversial. The aim of this study was to investigate the efficacy of adjuvant treatment modalities on the survival of EC patients., Patients and Methods: A total of 63 patients with stage II-IVA EC who had undergone curative surgery between the years 2002 and 2020 were included in the study. Patients' data were retrospectively collected from oncologic follow-up files. Various treatment regimens were administered during this period, including chemotherapy and chemoradiotherapy., Results: The median age was 56 years (24-73), and the number of males was slightly higher than females (male/female: 33/30). While 32 (51%) patients received postoperative adjuvant treatment, the remaining 31 (49%) patients underwent surgery alone. The median overall survival (OS) was 45.9 months (95% confidence interval [CI]: 25.1-66.8) in patients receiving adjuvant therapy and 37.6 months (95% CI: 20.9-54.4) in patients not receiving adjuvant therapy. The 8.3-month survival difference was statistically insignificant (P = 0.54). The 1-, 3-, and 5-year OS rates were 87.5% versus 77.4%, 58.4% versus 51.6%, and 40.8% versus 27.6% for patients with and without adjuvant therapy, respectively. Pathological stage (P = 0.028) and lymph node status (P = 0.044) were significant prognostic factors for survival., Conclusions: This study did not support the benefit of adjuvant treatment compared with surgery alone in completely resected EC patients. The reason for this result may be related to the small sample size and different treatment regimens due to the change in treatment options over time., (Copyright © 2023 Copyright: © 2023 Journal of Cancer Research and Therapeutics.)

Background: Inflammation markers are the new point of view in cancer due to increasing data on the interaction of immune system with tumor cells and their prognostic and predictive importance were found in many different types of solid tumors. Therefore, we aimed to evaluate the prognostic value of neutrophil-lymphocyte ratio (NLR), neutrophil-platelet score (NPS), and systemic inflammation index (SII) in Ewing sarcoma patients in which risk groups are still not clearly defined., Methods and Results: A total of 64 patients were evaluated retrospectively. Receiver operating characteristic analysis was performed to find cut-off values for NLR and SII. Survival analysis was calculated by using Kaplan-Meier method. Cox regression analysis was performed to determine prognostic factors such as age, stage, and neoadjuvant chemotherapy were statistically significant prognostic factors for OS in multivariate analysis. While patients with low NLR and SII had longer OS (P = 0.003 and P = 0.018), patients with high NPS score had shorter OS (67.7 vs 21.7 months, P = 0.001)., Conclusion: Patients with lower NLR, NPS, and SII score have a better prognosis compared with those with higher NLR, NPS, and SII score and these simple parameters may be monitoring tools of the tumor microenvironment.

Purpose: COVID-19 will continue to disrupt the diagnosis-treatment process of cancer patients. Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital has been considered as a 'non-pandemic' center ('clean') in Ankara, the capital city of Turkey. The other state hospitals that also take care of cancer patients in Ankara were defined as 'pandemic' centers. This study aimed to evaluate hospital admission changes and the precautionary measures in clean and pandemic centers during the pandemic. The effect of these measures and changes on COVID-19 spreading among cancer patients was also evaluated., Methods: The patients admitted to the medical oncology follow-up, new diagnosis, or chemotherapy (CT) outpatient clinics during the first quarter of pandemic period (March 15-June 1, 2020) of each center were determined and compared with the admissions of the same frame of previous year (March 15-June 1, 2019). COVID-19 PCR test results in clean and pandemic centers were compared with each other. Telemedicine was preffered in the clean hospital to keep on follow-up of the cancer patients as 'noninfected'., Results: In the clean hospital, COVID-19-infected patients that needed to be hospitalized were referred to pandemic hospitals. COVID-19 test positivity rate was eight-fold higher for outpatient clinic admissions in pandemic hospitals (p < 0.001). The number of patients admitted new diagnosis outpatient clinics in both clean and pandemic hospitals decreased significantly during the pandemic compared with the previous year., Conclusion: We consider that local strategic modifications and defining 'clean' hospital model during infectious pandemic may contribute to protect and treat cancer patients during pandemic.

Introduction: Fluoropyrimidine and platinum-based chemotherapy regimens are widely accepted for metastatic gastric cancer (GC). Because of drug toxicity, a combined two-drug cytotoxic drug regimen is recommended for first-line therapy, while three-drug cytotoxic regimens are recommended for patients with medically fit and better performance status. In this study, it was aimed to compare modified FOLFOX-6 (mFOLFOX-6) and modified DCF (mDCF) regimens in terms of survival and side effects in first-line treatment in metastatic GC., Methods:  We retrospectively reviewed the clinical record of patients with metastatic gastric or gastro-esophageal junction cancer who had received mDCF or mFOLFOX-6 as the first-line treatment, and followed up in our center between February 2013 and December 2020. The data were collected from the patients' registration database of the hospital and oncologic follow-up files of our center. In the mDCF arm, docetaxel 60 mg/m 2 and cisplatin 60 mg/m 2 on day 1 intravenous (i.v.) infusion, and 600 mg/m 2 5-fluorouracil (FU) as a continuous infusion for five days were administrated every three weeks for up to six cycles. In the mFOLFOX-6 arm, 85 mg/m 2 oxaliplatin and 400 mg/m 2 LV as an i.v. infusion over two hours and a 5-FU bolus of 400 mg/m 2 as a 10-minute infusion, followed by 2.400 mg/m 2 5-FU as a 46-hour continuous infusion were administrated every two weeks for up to six cycles. Univariate and multivariate analyses for overall survival (OS) were performed by Cox proportional hazards regression model. Survival analysis was performed by the Kaplan-Meier method with the Long-rank test. P-value <0.05 was considered statistically significant., Results: A total of 70 patients included into the study. Of those, 40 (57%) patients had received mDCF and 30 (43%) had received FOLFOX-6 regimens as first-line treatment. There were no complete responses in both groups. The partial response rate was 28% and 27% for mDCF and mFOLFOX-6, respectively. There was no statistically significant difference regarding treatment response for both groups (p=0.787). The median OS was 13.9 months (95% CI: 7.5-20.4) in the mDCF arm, and 10.4 months (95% CI: 6.4-14.4) in the mFOLFOX-6 arm (p=0.409). The median progression-free survival (PFS) was 5.2 months (95% CI: 3.6-6.9) in the mDCF arm, and 6.4 months (3.2-9.6) in the FOLFOX-6 arm (p=0.126). The ratio of dose reduction, treatment delay, and neutropenic fever were not statistically different between treatment arms., Conclusion: The present study demonstrated that proper patient selection for metastatic GC may give rise to comparable survival rates without increased toxicity. mFOLFOX-6 and mDCF had similar response rates, OS, PFS, and side effect profiles., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Acikgoz et al.)

BACKGROUND : We aim to explore the predictive role of clinical and hematological parameters for cetuximab-induced skin toxicity (CI-ST) and survival outcomes in patients according to risk categories. RESEARCH DESIGN AND METHODS : The optimal cut-off values for hematological parameters were assessed by the Receiver Operating Characteristic (ROC) analysis. Patients were classified as High risk, Intermediate risk and Low risk subgroups with respect to platelet to lymphocyte ratio (PLR) and red blood cell count (RBC) values. Kaplan-Meier test was used for survival analysis, and outcomes were analyzed by Log-rank test. P-value <0.05 considered as statistically significant. RESULTS : Among hematological parameters, only PLR and RBC were statistically significant prognostic factors.Optimal cut-off value for PLR was 196.2 (82.9% sensitivity and 61.1% specificity), and 4.610x106/µL for RBC count (65.9% sensitivity and 81.1% specificity). Patients in high risk group had increased risk with an OR:69.34 (p<0.0001), and in the intermediate risk group had an OR:28.73 (p=0.002) for CI-ST. De novo metastatic patients had 9.11-fold increased risk for CI-ST compared to recurrent metastatic patients (p=0.028). CONCLUSION : Our study indicates that risk categories based on PLR and RBC can predict CI-ST and de novo metastatic patients had higher risk for CI-ST.

Background: Growing teratoma syndrome (GTS) is a very uncommon phenomena. Given its lower prevalence, there is little data about clinichopathological features and management of GTS. Literature about disease mostly composed of case reports. In this study, we aimed to report patients characteristics and treatment modalities in our center within a relatively large cohort., Patients and Methods: We retrospectively reviewed the clinical records 21 patients who fulfilled criteria of GTS. Survival analysis was performed by using the Kaplan-Meier method with the Long-rank test. p<0.05 was considered statistically significant., Results: The median age at diagnosis was 25 (range 17-51). A total of 12 patients could have undergone surgery. Of patients who underwent surgery, 5 patients remained fully disease free, and 7 patients had experienced disease recurrences. Nine patients had unresectable disease, and treated with either platin-based chemotherapy or interferone α2b. Of those, 5 patients eventually had undergone autologous stem cell transplantation (ASCT) with surprisingly promising response rates. One patient had complete response and three patients had partial response. One patient died soon after ASCT due to infectious complication., Conclusion: GTS is an unique entity with regard to its clinicopathological features and available treatment options as we mentioned in the text. Despite various agents reported to have efficacy in case reports, surgery remains as the mainstay of treatment. According to result of our study, ASCT and platin-based chemotherapy regimens may be feasible options for patients with unresectable disease., Competing Interests: None

Objective: To compare the clinicopathological characteristics, treatment responses, survival analysis of osseous Ewing sarcoma (OES) and extraosseous ES (EES)., Study Design: Observational study., Place and Duration of Study: Ankara City Hospital and Ankara Numune Training Research Hospital Medical Oncology Clinics from January 2005 to February 2020., Methodology: Clinicopathological characteristics of histologically confirmed ES/PNET and followed up, and treatment modalities were recorded from patients' registration data-base of the hospital. Lactate dehydrogenase (LDH), alkaline phosphatase (ALP), hemoglobin were measured before chemotherapy or surgery. The patients with a second cancer, gall bladder/biliary tract diseases, viral hepatitis and other bone diseases were excluded., Results: Sixty seven patients evaluated retrospectively. Out of the total patients, 56.7% consisted of OES, and 43.3% consisted of EES. The median age of the EES group (26 years) was significantly higher than that of the OES group (22 years, p = 0.008). The most common metastasis region was lung in both the groups. Age, LDH levels and stage of the disease were found to be statistically significant prognostic factors in univariate and multivariate analysis. The median OS of patients who started with local treatment (surgical, surgical ± radiotherapy) and followed up with chemotherapy was 82.6 months (95% CI, 55.2-110.1), while the median OS of patients who received local treatment between or after chemotherapy was 43.4 months (95% CI, 13.2-73.6, p = 0.042)., Conclusion: Patients with extrosseus ES were significantly older. Age, LDH levels, stage of disease, local treatment followed by systemic therapy are important associated factors. Key Words: Osseous ewing sarcoma, Extraosseous ewing sarcoma, Chemotherapy, Local treatment.

Objectives: Neuroendocrine tumors (NETs) are very heterogeneous tumors. This study aimed to evaluate prognostic value of an albumin-to-alkaline phosphatase (ALP) ratio (AAPR) in well-differentiated NETs., Methods: A total of 110 patients were included in this study. Albumin-to-alkaline phosphatase ratio was calculated by dividing albumin concentration (g/dL) to ALP level (U/L). Cutoff value for AAPR was determined by receiver operating characteristic analysis. Survival analysis was performed by Kaplan-Meier method with the log-rank test. A P value of less than 0.05 was considered statistically significant., Results: The optimum cutoff value for AAPR was 0.028. Patients were divided into 2 groups as patients with AAPR of 0.028 or less (n = 22, 20%) and with AAPR of greater than 0.028 (n = 88, 80%). Patients with AAPR of greater than 0.028 had statistically longer overall survival compared with patients with 0.028 or less (not reached vs 96.8 months, P = 0.001). In addition, AAPR has been shown to be an independent prognostic factor for overall survival in multivariate analysis (hazard ratio, 3.99; 95% confidence interval, 1.26-12.61, P = 0.018)., Conclusions: Patients with higher AAPR had more favorable prognosis compared with patients with lower AAPR. We demonstrated that AAPR can be of prognostic value in well-differentiated NETs., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Stage III non-small cell lung cancer (NSCLC) is a highly heterogeneous subtype of lung cancer. There are still no widely accepted prognostic parameters for stage III NSCLC. In this study, we evaluated the prognostic value of the standardized uptake value (SUV) max ratio of primary tumor to lymph node (T/N SUV max) and its correlation with various hematological parameters.Patient data were reviewed from the hospital database retrospectively. The T/N SUV max ratio was calculated by dividing the SUV max of the primary tumor by the maximal SUV max of the lymph node. The cut-off value for T/N SUV max ratio was determined by receiver operating characteristic analysis. Survival analysis was performed by Kaplan-Meier method with the Long-rank test. P value < .05 was considered statistically significant.A total of 52 patients were included in this study. The optimal cut-off value for T/N SUV max was 1.96 (area under the curve: 0.74; 72.7% sensitivity and 73.7% specificity). Patients with T/N SUV max ≤1.96 were defined as high risk patients and those with >1.96 were defined as low risk patients. The median event (recurrence or progression) free survival was 24.3 months (95% confidence interval: 12.0-36.6) for low risk patients, and 9.2 months (95% confidence interval: 6.1-12.4) for high risk patients (P = .0015). There was an inverse correlation between T/N SUV max and hemoglobin concentration and mean corpuscular volume (rho: -0.349, P = .011; rho: -0.312, P = .025, respectively).Low risk patients had a more favorable prognosis compared to high risk patients. We demonstrated that T/N SUV max can be of prognostic value in stage III NSCLC. T/N SUV max correlated only with hemoglobin and mean corpuscular volume.

Introduction Treatment options for metastatic renal cell carcinoma disease have been improved in recent years. However, there is still no optimal treatment sequence or combination for metastatic disease. We aimed to investigate whether patients differed in terms of disease outcomes regarding pre-nivolumab tyrosine kinase inhibitors (TKIs). Material and methods The analysis of patients was performed after all cohorts were sub-grouped into two groups according to pre-nivolumab TKIs as following the sunitinib arm and the pazopanib arm. Result A total of 75 patients were included in this study. The median follow-up time was eight months for all cohorts. The objective response rate was statistically significantly higher in the pazopanib arm as compared to the sunitinib arm (56% vs 30%, p=0.02). Progression-free survival was significantly higher in pazopanib than sunitinib (10.3 months vs 5.3 months, p=0.02). Multivariate analysis revealed that pazopanib treatment was associated with better progression-free survival (HR: 0.44, 95 CI; 0.22-0.91, p=0.02). While the median overall survival for patients who had received sunitinib was 11.0 months, it has not been reached the median in the pazopanib arm (11.0 months vs NR, p=0.051). Discussion We demonstrated significantly better progression-free survival and a higher objective response rate with nivolumab treatment in patients who had received pazopanib as compared with patients who received sunitinib in the pre-nivolumab period., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Ucar et al.)

Background: Bisphosphonates are the mainstay therapeutic options for prevention of skeletal-related events and generally used for up to 2 years in bone metastatic cancer patients., Aim: We aimed to evaluate the long-term outcomes of prolonged (> 2 years) bisphosphonate usage in bone metastatic breast cancer (BMBC) patients., Methods: Ninety-nine BMBC patients who had prolonged bisphosphonates were evaluated retrospectively for long-term outcomes and survival rates., Results: Median duration of bisphosphonate therapy was 46.8 (24-198) months. Seven patients had bisphosphonate-related adverse events (osteonecrosis of the jaw (ONJ) (n = 6), ONJ and renal failure (n = 1)). Bisphosphonate was switched to another one because of bone metastasis progression in more than one-third of the patients (n = 36, 36.3%). The patients who had bisphosphonate switch therapy had statistically significant longer overall survival (p < 0.01). Neither duration nor type of bisphosphonates had effect on frequency of bisphosphonate-related adverse events., Conclusion: Bisphosphonates might be prolonged for more than 2 years in BMBC patients with an acceptable toxicity profile. In addition, bisphosphonates switch therapy should be preferred in those with progressive bone metastasis since it might contribute to better survival despite bisphosphonates could not have been shown to have survival benefit in previous studies.

Background: We aimed to evaluate the correlation between MKK4 expression and clinicopathological features, KRAS/NRAS mutation in colorectal cancer., Methods: MKK4 expression was assessed by immunoreactivity score (IRS). Staining intensity(SI) and percentage of positively stained cells (PP) were used for IRS (IRS = SI×PP). Cutoffs were explored with ROC analysis. Patients were grouped as WIR ('weak immunoreactive'; IRS:0-2) and SIR ('strong immunoreactive'; IRS: >3)., Results: We enrolled 95 patients. 63.2% had metastasis. Median follow-up was 31.4 months. KRAS/NRAS mutation rate was 45.2%. Median values for OS, DFS, and PFS were as 31.6, 17.2, and 10.3 months. WIR group had longer OS ( p = 0.03). Recurrence rate was 36.8%. Median DFS was longer for recurrent patients in WIR group ( p = 0.055). KRAS or NRAS wild-type patients and those with left-sided tumors in WIR group had longer OS ( p = 0.029, p = 0.024, p = 0.03). There was no PFS difference ( p : 0.15). In correlation analysis, there was a negative correlation between MKK4 expression and KRAS mutation, NRAS mutation, OS, PFS, DFS ( r : -0,06; r : -0,02; r : -0,10; r : -0,06; r : -0,34). Only the correlation for MKK4 expression and DFS was significant ( p = 0.04)., Conclusion: MKK4 expression inversely correlates with survival outcomes. Patients with KRAS/NRAS wild-type, left-sided tumors with WIR had longer OS.

Background: Primary tumor resection (PTR) in metastatic colorectal cancer (mCRC) has not been suggested by guidelines, since new systemic chemotherapy options have improved overall survival. However, the effect of PTR is still controversial in mCRC. In this study, we aimed to evaluate the effect of PTR on survival in unresectable mCRC., Materials and Methods: Two hundred and fifty-two patients with unresectable mCRC were screened retrospectively between January 2007 and December 2017 and a total of 147 patients who met inclusion criteria were included. The patients with emergency or elective PTR and the patients without surgery were compared for baseline features and overall survival., Results: The median follow-up time was 15.6 months (range; 1.2-78.9) in whole patients. There were 91 patients in nonsurgical (NS) group and 56 patients in PTR group. The median overall survival was significantly longer in PTR group compared NS group (21.8 vs. 17.0 months, P = 0.01), but it was not associated to better overall survival in multivariate Cox analysis (hazard ratio: 0.65, 95% confidence interval: 0.41-1.02, P = 0.06). There was no significant difference in overall survival between emergency and elective surgery subgroups (22.9 vs. 16.1 months, respectively, P = 0.9)., Conclusion: PTR did not offer an overall survival benefit in this study. Although it is debated, we think that it is better to start treatment with chemotherapy and biological agent combinations in patients with asymptomatic mCRC. Thus, the patients can be protected from the morbidity and mortality of the surgery., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Research in Medical Sciences.)

Background : In this study, we aimed to investigate the frequency, prognostic effect of codon, and amino acid-specific KRAS mutations in patients with metastatic colorectal cancer (mCRC) and their predictive effect on irinotecan and oxaliplatin during first-line treatment. Methods : The data of 304 mCRC patients were retrospectively evaluated between 2010 and 2018. Patients were categorized according to the most prominent codon and amino acid mutation and their prognostic features were analyzed. Results : In total, 274 patients were included in the study and 128 patients (47%) revealed KRAS mutation. Median follow-up time was 19.8 months (range; 1.6-96). The median overall survival rates for patients with codons 12 and 13 mutations were 25.4 and 22.2 months, respectively ( p = 0.4). Moreover, the median overall survival for the codon 12 mutant patients who received irinotecan-based chemotherapy in the first-line treatment was 42.7 months, whereas for the codon 13 mutant and KRAS wild-type patients, it was 18.3 and 23.9 months, respectively (codon 12 vs. codon 13; HR: 0.31, p = 0.03, codon 12 vs. wild-type; HR: 0.45, p = 0.03). Conclusion : The significant survival advantage was observed in patients with codon 12 mutations who received irinotecan-based chemotherapy as a first-line treatment.

Purpose: The optimal treatment regimens after second line chemotherapy in metastatic colorectal cancer (mCRC) remains unclear. This study aimed to compare the real-life data of regorafenib versus capecitabine plus temozolamide (CapTem) regimen as third-line setting in mCRC., Methods: Between January 2013 and March 2018, data of 358 mCRC patients were retrospectively evaluated. Forty-two mCRC patients who received regorafenib (n:27) or CapTem (n:15) as third-line setting were included., Results: Median follow-up was 6 months (range: 2.2-29.7). No complete remission was achieved. Disease control rate was 22% and 20% for the regorafenib and CapTem arms, respectively. There was no statistically significant difference for either median overall survival (OS) or progression-free survival (PFS) between the two groups. Median OS was 7 months in the regorafenib group and 6.5 months in the CapTem group (hazard ratio [HR] for death, 0.60; 95% confidence interval [CI] 0.28-1.27; p=0.18), and median PFS was 3.3 months for the patients in the regorafenib group and 3.2 months for those in the CapTem group (HR for disease progression or death, 0.68; 95% CI 0.34-1.33; p= 0.25)., Conclusion: The present study showed that CapTem regimen and regoafenib as third-line setting had similar activity in mCRC. We consider that CapTem regimen might be an alternative treatment option to regorafenib after two lines of chemotherapy in mCRC. However, prospective randomized trials with large number of patients are needed in this issue.