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The aim of this study is to make a differential diagnosis and prognosis of the ampullary adenocarcinoma subtypes. We also investigated the role of prognostic markers PD-1 and PD-L1, and epidermal growth factor receptor (EGFR).Local or locally advanced stage ampullary adenocarcinoma patients who had undergone pancreaticoduodenectomy at the time of diagnosis were included. MUC1,MUC2, MUC5AC, CDX2, CK7, CK20, PD-1, and PDL-1 were analysed immunohistochemically, and EGFR was analysed by real-time polymerase chain reaction.According to histopathological and immunohistochemical evaluation, we found27 patients as pancreatobiliary type and 56 patients as intestinal type adenocarcinoma. The median survival of patients with intestinal and pancreatobiliary typeadenocarcinoma was 23 months and 76 months (p = 0.201), respectively.When the survival of PD1-positive (n = 23) and PD-L1-positive (n = 18) patientswere compared with the patients with negative staining (n = 60, n = 65), no significant difference was found. Epidermal growth factor receptor mutation was detected in a total of 6 patients, and 5 of these 6 mutations were shown in intestinaltype tumours and one in a pancreatobiliary type tumour. A significant differencewas determined in terms of overall survival for the patients with EGFR mutationscompared to those without (p = 0.008). In conclusion, we could reveal the prognostic significance of EGFR mutation, which is also a target molecule.

In patients with coronavirus disease 2019, the gastrointestinal symptoms have been reported increasingly in addition to the respiratory system symptoms. The studies show that the prevalence of gastrointestinal system symptoms and how the gastrointestinal system contributes to the severity and prognosis of the disease is still not clear. This study aims to find the prevalence of gastrointestinal symptoms and the correlation between the gastrointestinal symptoms and the clinical results in hospitalized patients diagnosed with coronavirus disease 2019.This study retrospectively analyzes patients diagnosed with coronavirus disease 2019 and hospitalized in the pandemic unit between March 2020 and August 2020 and compares their demographic and clinical characteristics, laboratory and radiologic findings, coronavirus disease 2019 treatments received, the clinical course of the disease, and the gastrointestinal symptoms.In our study, we included 322 patients diagnosed with coronavirus disease 2019 and hospitalized; 39 patients (12.1%) were admitted to the hospital with at least one gastrointestinal symptom (nausea and vomiting, diarrhea, abdominal pain, and the loss of taste). Nausea and vomiting are the most common gastrointestinal symptoms with a prevalence of 7.1%, followed by diarrhea with 2.8%, the loss of taste with 2.2%, and abdominal pain with 1.5%. The mean age and D-dimer levels of the patients showing gastrointestinal symptoms were lower than those who did not have any gastrointestinal symptoms. We did not find a significant correlation between the presence of the gastrointestinal symptoms and the severity of the disease, treatment received, risk of acute respiratory distress syndrome and septic shock, admission to the intensive care unit, the need for mechanical ventilation, the mortality rate or the length of hospitalization in the medical floor or the intensive care unit.In this study, we observed that 12.1% of coronavirus disease 2019 patients apply to the hospital due to gastrointestinal symptoms. Furthermore, the gastrointestinal symptoms do not seem to affect the severity and the course of the disease, it is important to identify coronavirus disease 2019 patients showing unusual symptoms such as the gastrointestinal symptoms at an early stage to protect healthcare professionals from infection risk.

Objectives: Thymoquinone a bioactive component extracted from the seeds of Nigella sativa, has been proved to have antiinflammatory, antioxidantproperties anti antitumor efficiency against breast, prostate, bladder, and renal cell cancer. We aimed to investigate the synergistic cytotoxic and apoptoticeffects of thymoquinone in combination with nivolumab, an immuno-control inhibitor, and its mechanism in renal cell cancer models.Materials and Methods: In vitro studies: Caki-1 and Renca renal cancer cell lines with mononuclear cells were cocultured and thymoquinone andnivolumab effect were analyzed by MTT and Annexin V + PI. In vivo studies: Renal cell cancer model was provided by subcutaneous injection of RENCAcells to C57BL/6, male, 8 weeks old mice in four groups. Control group, thymoquinone (1,4,7,14days,20mg/kgIP), nivolumab administered (1,6,13days10mg/kgIP), thymoquinone and nivolumab. Seven animals was randomized in each experimental group. Apoptosis, necrosis, CD4,CD8,C20,CD34,CD31,VEGF-A byimmunohistochemistry, FGFR-1,PDGFRbeta,VEGFR-2,c-kit,RET,c-Met,AXL,Flt-3,TIE2, ICAM-1,VCAM-1 and E-selectin mRNA levels by quantitative real-time-PCR were evaluated on tumor tissue. Liver, kidney, brain, lung and heart tissues was evaluated for side effects. Plasma biochemistry tests were performed.Statistical analysis was be performed with Mann-Whitney U test with p Results: Thymoquinone showed antitumor effect in vitro and in vivo. It also showed increase in immune cell death of nivolumab. Tumor tissue showedprominent necrosis or complete response to therapy in combination group.Conclusions: We conclude that thymoquinone has antitumor effect on renal cell carcinoma and increases the effect of nivolumab immune, cell deatheffects. Besides, it does not have side effect on other organs whether alone or in combination.Keywords: Renal Cell Cancer, Thymoquinone, Immune Check Point Inhibitors

SS101-Does Microscopic Epidermal Ulseration Present Effect The Breast Cancer Stage?Merih Güray Durak1, Sümeyye Ekmekçi2, Zümre Arıcan Alıcıkuş3, Volkan Semiz3, Işıl Somali4, Ali İbrahim Sevinç5,İlknur Bilkay Görken31Department of Pathology, Dokuz Eylul University School of Medicine, İzmir, Turkey2Department of Pathology, İzmir University ofHealth Sciences, Tepecik Training and Research Hospital, İzmir, Turkey3Department of Radiation Oncology, Dokuz Eylül University School of Medicine, İzmir, Turkey4Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey5Department of General Surgery, Dokuz Eylül University School of Medicine, İzmir, TurkeyObjective: Invasive breast carcinoma is the most common cancer in women. Accurate staging after diagnosis is very important in predictingprognosis and evaluating treatment response. According to the TNM classification of breast cancer, tumors that show direct extension to thechest wall and/or skin regardless of size are considered pT4. However, to diagnose pT4 breast cancer, skin invasion must be accompanied byulceration or macroscopically defined skin nodules. Only the presence of dermal invasion is not sufficient for the pT4 stage. In this study, weaimed to evaluate the effect of epidermal ulceration on prognosis in breast cancer patients with microscopic dermal invasion.Materials and Methods: The study included 193 patients diagnosed with breast cancer in our hospital between 2002 and 2016 who hadmicroscopic dermal invasion. Preparations were re-evaluated for tumor type, histological grade, tumor size, lymphovascular invasion, receptorand HER2 status as well as the presence of epidermal ulceration. Local recurrence and overall survival data of the patients whose treatment wascontinued in our hospital after diagnosis and followed up were obtained and statistical analysis was performed using SPSS 15.0.Results: 184 patients were female and their ages ranged between 26-91 (mean 59.5). Microscopic epidermal ulceration was detected in 17.6%of the patients. The most common tumor type was invasive ductal carcinoma (45.8%) and most of the patients (62.4%) were grade 2. Thepresence of microscopic epidermal ulceration was significantly associated with blood vessel invasion (p=0.035). Distant metastasis was detectedin 76.2% of the patients who had epidermal ulceration in pathology specimens (p=0.006). In patients with a mean follow-up of 76.7 months,distant metastasis was significantly associated with survival (p

Amaç: Bu çalışma kemoterapi alan meme kanserli hastaların sorunları ve gereksinimleri doğrultusunda, evde uygulanan hemşirelik girişimlerinin hastaların semptom kontrolü ve yaşam kalitesinin etkisini belirlemek amacıyla yapılmıştır. Yöntem: Araştırma iki aşamada gerçekleştirilmiştir. İlk aşama, kemoterapi alan meme kanserli hastaların evde bakım gereksinimlerini açıklamak için yapılan kalitatif çalışmadır. Bunun için 24 derinlemesine bireysel görüşme yapılmıştır. İkinci aşama, yarı deneysel çalışma olarak 35 deney ve 35 kontrol grubu olmak üzere toplam 70 hasta çalışmaya alınmıştır. Verilerin değerlendirmesinde Hasta Bilgi Formu, Edmonton Semptom Tanılama Ölçeği, EORTC QLQ-C30 Yaşam Kalitesi Ölçeği ve QLQ-BR23 Modülü kullanılmıştır. Verilerin analizinde varyans analizi ve t testi yapılmıştır. Bulgular: Kemoterapi alan meme kanserli hastalara yönelik derinlemesine bireysel görüşmelerden elde edilen evde bakım gereksinimleri, yaşadıkları sorunlar ve Hasta gereksinimleri teması olarak belirlenmiştir. Evde uygulanan hemşirelik girişimleri sonrası deney grubundaki kemoterapi alan meme kanserli hastaların kontrol grubuna göre bazı alt boyutlarının puan ortalamalarında değişim olmazken bir çok alt boyut puan ortalamalarında düşüş saptanmıştır. EORTC QLQ-C30 Yaşam Kalitesi Ölçeği Fonksiyonel Alt Boyutu puan ortalamalarında deney grubunda zaman ilerledikçe yükselme saptanmıştır. EORTC QLQ-C30 Yaşam Kalitesi Ölçeği Semptom Alt Boyutu puan ortalamalarında deney grubunda zaman ilerledikçe düşüş olduğu saptanmıştır. EORTC QLQ-C30 Yaşam Kalitesi Ölçeği Genel Sağlık Durumu Alt Boyutu puan ortalamalarında deney grubunda zaman ilerledikçe artış olduğu saptanmıştır. EORTC QLQ-BR23 Ölçeği Fonksiyonel Skor Alt Boyutu puan ortalamaları deney grubunda girişim süresince değişim göstermezken, kontrol grubunda fonksiyonel skor puan ortalamalarının azaldığı saptanmıştır. EORTC QLQ-BR23 Ölçeği Semptom Skor Alt Boyutunun Küçük Alt Boyutlarının puan ortalamaları deney grubunda zaman ilerledikçe artış olduğu fakat bu artış kontrol grubunda fazla olduğu saptanmıştır. Deney ve kontrol gruplar arasında tüm zaman dilimlerinde istatistiksel olarak anlamlı bir fark olduğu saptanmıştır. Sonuç: Kemoterapi alan meme kanserli hastaların gereksinimleri ve sorunlarının giderilmesi doğrultusunda uygulanan hemşirelik girişimleri sonucunda hastaların semptom kontrolünde iyileşme ve yaşam kalitesinde yükselme oluştuğu saptanmıştır. Bu nedenle kemoterapi gören kanser hastalarına evde bakım hizmetinin sunulması önem kazanmıştır. Bu hastaların durumunu iyileştirmek için evde bakım hizmetlerinin birincil basamakta çalışan hemşire ve hekimlerin katılımını sağlayan kapsamlı ve multidisipliner araştırmalar da önerilmektedir.Anahtar Kelimeler: Meme kanseri, kemoterapi, evde bakım, hemşirelik Objective: The aim of this study was to determine the effect of home nursing interventions on symptom control and quality of life in line with the problems and needs of breast cancer patients receiving chemotherapy. Methods: The research was carried out in two stages. The first step is a qualitative study to determine the home care needs of breast cancer patients receiving chemotherapy. For this, 24 in-depth individual interviews were conducted. The data were collected by a semi-structured interview form and analyzed by the content analysis method. The second stage is a quasi-experimental study on 70 patients with breast cancer, 35 of which are experimental and 35 are control groups. Data were collected using the Patient Information Form, Edmonton Symptom Assessment Scale, EORTC QLQ-C30 Quality of Life Scale, and QLQ-BR23 Module. Analysis of variance and t-test were used for data analysis. Results: Data obtained from in-depth individual interviews about home care needs of breast cancer patients receiving chemotherapy, problems they experienced, and patient needs. In the second stage of the study; After the nursing interventions performed at home, it was found that the mean scores of Edmonton Symptom Assessment Scale, EORTC QLQ-C30 Quality of Life Scale functional subscale scores increased, the mean scores of the Symptom Sub-Dimension scores increased and the general health subscale scores increased compared to the control group. While the mean scores of the EORTC QLQ-BR23 Scale Functional Scale Sub-Dimension did not change in the experimental group, it was found that functional score scores decreased in the control group. EORTC QLQ-BR23 Scale Symptom Score Subdimension The mean scores of the small subscales were increased in time in the experimental group but this increase was higher in the control group. There was a statistically significant difference between the experimental and control groups in all time periods. Conclusion: As a result of nursing interventions applied to eliminate the needs and problems of breast cancer patients receiving chemotherapy, it was determined that patients improved their symptom control and improved their quality of life. For this reason, it is important to provide home care services to cancer patients receiving chemotherapy. To improve the condition of these patients, comprehensive and multidisciplinary researches enabling the participation of nurses and physicians working in primary care at primary care is also recommended.Keywords: Breast cancer, chemotherapy, home care, nursing. 1944

Kolorektal kanser (KRK), yetişkinlerde gastrointestinal sistemin en sık görülen kanseri olup tüm dünyada kansere bağlı ölümler arasında akciğer kanserinden sonra ikinci sırada yer almaktadır. Bu çalışmada nötrofil/lenfosit oranı (NLR), trombosit/lenfosit oranı (PLR), ortalama trombosit hacmi (MPV)'nin KRK tanısı alan hastalarda erken tanıda ve postoperatif nüks izleminde biyomarker olarak kullanılabilirliğinin araştırılması amaçlandı.Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi Tıbbi Onkoloji kliniğinde 2005-2015 yılları arasında KRK tanısı alan 1020 hastanın hasta dosyaları tarandı. Verilerine ulaşılabilen çalışma için uygun koşulları sağlayan, erken evredeki 188 hastanın demografik, laboratuar ve histopatolojik verileri kaydedildi.Çalışmaya dahil edilen hasta grubumuzun tümör rezeksiyonu öncesi değerlendirmede NLR ort:3.15±2.6, PLR:163.05±84.07, MPV ort:8.19±1.17 fl ölçüldü. Çalışmada hastalar nüks pozitif ve nüks negatif olarak 2 gruba ayrıldı. Hastaların 25'inde (%13,3) izlemde nüks görüldü. Nüks pozitif grupta nüks negatif gruba göre tümör rezeksiyonu öncesi dönemde NLR daha yüksek izlendi. Nüks negatif grupta tümör rezeksiyonu sonrasında MPV'de anlamlı azalma izlenirken; nüks pozitif hastalarda tümör rezeksiyonu sonrası NLR, PLR veya MPV'de anlamlı azalma görülmedi. Nüks izlenen hastalarda, primer tümör rezeksiyonu sonrası takipte nüks anında NLR, PLR ve MPV'de anlamlı artış olmadı. Hastalık evrelerine göre değerlendirmede, evre 3 hastalarda evre 2 ye göre MPV değerinin yüksek olması istatistiksel olarak anlamlı bulundu. Sonuç olarak bu çalışma, NLR, MPV ve PLR nin KRK taramasında ve tümör rezeksiyonu sonrası takipte prognostik faktör olarak kullanılabileceğini gösterdi. Anahtar kelimeler: kolorektal kanser, ortalama trombosit hacmi, trombosit/lenfosit oranı, nötrofil/lenfosit oranı, biyomarker Colorectal carsinoma (CRC) is the most common cancer diagnosed in the gastrointestinal system and it's second among all deaths due to cancer in the world after lung cancer.In this study, we are aim to investigate the availability of neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV) of the CRC early diagnosis and postoperative recurrence monitoring in patients with diagnosed CRC as biomarkers. 1020 patients with diagnosed CRC files between 2005-2015 in Dokuz Eylül University Faculty of Medicine were screened. 188 patients of in the early stages with Providing appropriate conditions for study and accessible data; demographic, laboratory and histological data were recorded.Before tumor resection in our group of patients included in the study assessment NLR mean 3.15 ± 2.6, PL: 163.05 ± 84.07, MPV mean: 8.19 ± 1.17 fl were measured.In this study, patients were divided into 2 groups recurrent positive and recurrent negative. In 25 patients (13.3%) recurrence was observed. Before the tumor resection NLR was higher in recurrent positive group than recurrent negative group. In recurrent negative group were observed in a significant decrease in MPV after tumor resection and in recurrent positive group NLR, PLR or MPV didn't significantly reduce after tumor resection. In recurrent positive group; NLR, PLR and MPV didn't significantly increase on time recurrence when resection of the primary tumor follow-up. According to the assessment disease stage, the higher MPV values in stage 3 than stage 2 were statistically significant.As a result this study shows NLR, PLR MPV could be used as a prognostic factor for screening and follow up prognostic tumor resection in CRC.Key words: colorectal cancer, mean platelet volume, platelet / lymphocyte ratio, neutrophil / lymphocyte ratio, biomarker 58

Giriş ve Amaç: Bu çalışmada,Dokuz Eylül Üniversitesi Tibbi Onkoloji Bilim Dalı Polikliniğinde Ocak 1996-Aralık 2011 tarihleri arasında takip ve tedavi edilen Malign Melanom tanılı hastaların Klinikopatolojik özellikleri, primer yerleşim yerleri,metastaz yerleri,primer yerleşim yerlerine göre sağ kalım oranlarına bakmayı amaçladık.Malign Melanom çevre şartlarından etkilenen bir hastalıktır.Güneş ışığına maruziyet bir risk faktörüdür.Fakültemiz bulunduğu konum itibariyle daha çok Ege bölgesi hastalarına hitap etmektedir.Ege bölgesi ülkemizde görece güneş ışığının fazla olduğu bir bölgedir.Dolayısıyla İzmir ve çevresindeki Malign Melanom hastalarını klinikopatolojik olarak değerlendirme imkanımız olacaktır.Ayrıca Türkiye'de malign melanom hastalarının özelliklerinin belirlenmesine yönelik çalışmaların sayısı oldukça azdır.Bu çalışmanın diğer bir amacı da Türkiye veri tabanına katkıda bulunmaktır.Hastalar ve Yöntem: Bu çalışmada Dokuz Eylül Üniversitesi Hastanesi Tıbbi Onkoloji bölümünde 1991-2011 Yılları arasında takip edilen malign melanom tanılı 166 hasta retrospektif olarak değerlendirilmiştir.Öncelikle hastane otomasyon sistemine malign melanom ICD kodu girilerek 334 malign melanomlu hastanın bilgisine ulaşılmıştır.Daha sonra bu hastalar Tibbi Onkolojinin kendi arşivi taranarak 240 tane hasta dosyası bulunmuştur.84 hasta dışlama kriterleri içinde olduğu için çalışmaya dahil edilmemiştir. Çalışmaya dahil edilen tüm hastaların demografik ve klinik verileri olan tanıda yaş, cinsiyet, metastaz, tümörün yeri, breslow kalınlığı, son kontrol tarihi, ilk metastaz tarihi, exitus tarihi Tibbi Onkoloji dosyalarındaki veriler ve hastane otomasyon sistemi baz alınarak kaydedildi. Tümörün ortalama görülme yaşına bakıldı.Ayrıca cinsiyete,yaşa,breslow kalınlığına,genel sağ kalıma ve lokalizasyona göre ortalama sağ kalıma bakıldı.Yine lokalizasyona göre breslow kalınlığında anlamlı bir fark olup olmadığına bakılarak analiz edildi.Sonuçlar: Hastalardan 87'si erkek, 79'u kadındır. Tüm hastaların ortanca yaşı 52,66 (21-81) dır. En sık extremite bölgesinde malign melanom görülürken daha az sıklıkta baş boyun ve gövdede gözlenmiştir. Primer tümör bölgesi ile breslow kalınlığı arasında istatistiksel bir anlamlılık saptanmamıştır(p=0.109). Ancak breslow kalınlığı ile sağ kalım arasında istatistiksel bir fark bulunmuştur. Breslow kalınlığı 0-2 mm arasında olanların ortalama sağkalımı 125,6 ay(99-151), 2-4 mm arasında olanların ortalama sağkalımı 121,2 ay(92-151), 4 mm ve üstünde olanların ortalama sağkalımı 89 ay(68-111) olarak saptanmıştır ve aradaki fark istatistiksel olarak anlamlı saptanmıştır(p=0,012). Tüm hastaların 1 yıllık sağkalım oranı %96, iki yıllık sağkalım oranı %92.1 ve 5 yıllık sağkalım oranı %82.7 saptanırken; ortalama sağkalım süresi 89,74±6,9 ay olarak saptanmıştır. Kadın cinsiyette ortalama sağkalım 108.8 ay, erkeklerde ortalama sağkalım 72.7 ay saptanmış olup aradaki fark istatistiksel olarak anlamlı bulunmuştur(P=0,001). Melanomun primer yerleşim yerine göre sağkalımları sırasıyla baş-boyun yerleşiminde 69.6 ay, gövde 114.1 ay, extremite yerleşiminde 82.0 ay olup aradaki fark istatistiksel olarak anlamlı saptanmamıştır(P=0,32).Tartışma: Malign melanom en kötü seyirli deri tümörü olup prognozu etkileyen faktörler birden fazladır. Bu çalışmada en önemli prognostik faktörler breslow kalınlığı, primer tümör yerleşim bölgesi ve cinsiyet olarak saptanmıştır. Ülkemizde malign melanomun prognozu ve kliniği ile ilgili yapılmış nadir çalışmalardan biridir. Introduction and Objective: Our aim in this study is to analyse clinicopathological features, primary locations, metastasis locations and survival rates due to primary locations in malign melanoma patients that followed by Dokuz Eylul University Hospital Medical Oncology Clinic in years between 1999 and 2011. Malign melanoma is depended on environmental factors. Sunlight exposure is a risk factor. We mostly administer patients from Aegean Region that gets more sunlight relatively. Consequently, we would have opportunity to evaluate malign melanoma patients around Izmir clinicopathologically. Furthermore the descriptive studies about malign melanoma are few in Turkey. Contribution to Turkish data would be our other objective.Patients and Method: In this study, 166 malign melanoma patients that followed by Dokuz Eylul University Hospital Medical Oncology Clinic in years between 1991 and 2011 were evaluated retrospectively. Initially, malign melanoma ICD code was entered to hospital computer system, we achieved 334 malign melanoma patient data. We found complete data of 240 patients in Oncology records. 84 patients were excluded from the study. The demographic and clinical datas of all patients were included in the study such as age, sex, metastasis, tumor location, breslow thickness, last follow-up date, first metastasis date, exitus date and datas in oncology charts which are recorded by hospital otomation system. Average age of tumor occurence and average time of survival were detected due to sex, breslow thickness, general time of survival and location. Significance of difference between location and breslow thickness was also analysed.Results: 87 of patients is male, 79 is female. The median age is 52,66 (21-81). The most common site for malign melanoma is extremity; head, neck and body are less commonly involved. There is no statistically significant difference between primary tumor site and breslow thickness (p=0.109). Breslow thickness and survival are related statistically significant. Average survival time for Breslow thickness between 0 and 2mm is 125,6 months (99-151), 2 and 4 mm is 121,2 months (92-151) and over 4mm is 89 months (68-111) and difference between groups are statistically significant (p=0,012). 1 year survival rate for all patients is 96%, 2 year survival rate is 92.1% and 5 year survival rate is 82.7%. Average survival time is detected as 89,74±6,9 months. Mean survival time for female patients is 108.8 months, 72.9 months for male patients which is statistically significant (P=0,001 The mean survival time for head-neck malign melanoma is 69.6 months, 114.1 months for body involvement and 82.0 months for extremity involvement. ). There is no significant difference in survival due to melanom primary site (P=0,32) .Discussion: Malign melanoma has the worst progress in all skin cancers and there are several factors affecting the prognosis. The most important prognostic factors detected in this study are breslow thickness, primary tumor site and sex. This study is one the few studies designed to investigate malign melanoma prognosis and clinic in our country. 51