A Modified H-index Calculated Using the Duration of Professional Experience and the Author's Significant Contribution to Publications.

Recently, the h-index (HI) has been accepted as a globally valid indicator that measures the professional achievement of scientists. Although it has been criticized in some respects, it is the most frequently used parameter as a criterion that generally measures the number and quality of publications combined. In the evaluation of the scientific publication, apart from these, the duration (years) of professional experience of the scientist and the impact/significance of the author's contribution to publications should also be used; however, HI does not take these into account. In this article, we present our recommendations for a modified HI considering these two important parameters.

Prognostic significance of body mass index and serum albumin as the indicators of nutritional status in small cell lung cancer.

BACKGROUND: Body mass index (BMI) and serum albumin (ALB) level are long-established markers that reflect the nutritional status and eventually the prognosis of cancer patients. The objective of the study was to determine the clinical significance of these factors and specify their roles in outcomes compared with performance status (PS) and weight loss (WL), which are considered the most significant patient-related prognostic factors in small cell lung cancer (SCLC) treated with platinum-etoposide-based chemotherapy. METHODS: A total of 378 patients with SCLC were enrolled in the study and analyzed retrospectively. RESULTS: BMI values were similar by clinical stage, whereas the percentages of the patients with WL, low serum ALB, and particularly poor (≥2) PS were significantly higher in patients with extended disease SCLC (ED-SCLC) compared to those with limited disease SCLC (LD-SCLC). In LD-SCLC, patients with poor PS lived for a significantly shorter time than patients with good PS (HR: 7.791, p = 0.0001); however, BMI (HR: 1.035, p = 0.8), WL (HR: 0.857, p = 0.5), and ALB (HR: 0.743, p = 0.3) had no significant effect on the outcome. In ED-SCLC, PS (HR: 4.257, p = 0.0001), WL (HR: 1.677, p = 0.001), and ALB (HR: 0.680, p = 0.007) had an impact on survival, but BMI did not (HR: 0.791, p = 0.08). In LD-SCLC, the univariate analysis showed that only poor PS was correlated with increased mortality (HR: 7.791, p = 0.0001); yet it lost significance in multivariate analysis. In ED-SCLC, poor PS (HR: 4.257, p = 0.0001), WL (HR: 1.667, p = 0.001), and a low ALB level (HR: 0.680, p = 0.007) were shown to be factors for poor prognosis in the univariate analysis; yet only PS remained significant in multivariate analysis (HR: 2.286, p = 0.001). CONCLUSION: Even though BMI and serum albumin showed no prognostic value in SCLC patients treated with chemotherapy, PS was found to be the most significant prognostic factor in both LD- and ED-SCLC stages.

Comorbidity in Small Cell Lung Cancer: Prognostic Impacts of Hypertension/Coronary Artery Disease, Diabetes Mellitus, and Chronic Obstructive Pulmonary Disease.

Comorbidity, the most important components of which are hypertension/coronary artery disease (HTN/CAD), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD), is frequently encountered in small cell lung cancer (SCLC) patients. We aimed to assess the possible impacts of these major comorbidities on the prognoses of SCLC patients. A total of 378 SCLC patients were analyzed retrospectively. We did not ascertain the effect of comorbidity on survival in SCLC patients in general; and similarly, the presence of HTN/CAD and COPD did not adversely affect the outcome. However, lower survival rates were observed in patients with SCLC coexisting with DM.

Timing of chemotherapy after diagnosis of small cell lung cancer.

Systemic chemotherapy is the backbone of therapeutic management in small cell lung cancer (SCLC) and delay of treatment may lead to adverse patient outcomes. This study was conducted to determine the time elapsed between pathological diagnosis and initiation of chemotherapy in SCLC patients and to evaluate its clinical significance. A total of 323 pathologically confirmed SCLC patients were enrolled in the study and analyzed retrospectively. The median value of the patients' time to treatment was used as the cut-off value in distinguishing between early and late chemotherapy. The median (range) of the time interval between the pathological diagnosis and the initiation of chemotherapy was 18 days (1-257). Compared with other clinical variables, only the performance status of patients was significantly associated with the time from diagnosis to initiation of chemotherapy; patients with poor prognostic factors received chemotherapy earlier than other patients (32.9 vs 18.9%, p = 0.004, and 14.5 vs 19 days, p = 0.006). Although patients who received early treatment were found to live less, there was no statistically significant difference in overall survival in patients according to the timing of chemotherapy administration (p = 0.08). In conclusion, there are controversial results about the timing of chemotherapy administration to SCLC patients. More standardized definitions and guides for calculation of the time interval between diagnosis and treatment are needed to better understand the delays in the treatment of patients with clinically rapidly disseminating SCLC.

Primary tumor SUVmax and ratio of SUVmax to primary tumor size on pretreatment 18F-FDG-PET/CT scan in small cell lung cancer : Which is superior for the prognosis?

BACKGROUND: The prognostic impact of tumor SUVmax (t-SUVmax) in small cell lung cancer (SCLC) has been questioned with controversial results, and the significance of the ratio of tumor SUVmax to primary tumor size (SUVmax/t-size) in SCLC has yet to be clarified as well. In this study, a retrospective analysis was carried out to figure out the prognostic and predictive powers of pretreatment primary t­SUVmax and t­SUVmax/t-size ratio in patients with SCLC. METHODS: A total of 349 SCLC patients who underwent pretreatment staging with PET/CT scan were enrolled in the study and analyzed retrospectively. RESULTS: In limited disease SCLC (LD-SCLC), tumor size was significantly associated with both t­SUVmax (p = 0.02) and t­SUVmax/t-size (p = 0.0001). Furthermore, performance status, tumor size (p = 0.001), and liver metastasis were significantly associated with t­SUVmax in extended disease SCLC (ED-SCLC). Moreover, tumor size (p = 0.0001), performance status, cigarette smoking history, and pulmonary/pleural metastasis were found to be correlated with t­SUVmax/t-size. No associations were found between clinical stages and either t­SUVmax or t­SUVmax/t-size (p = 0.9 for both), and t­SUVmax and t­SUVmax/t-size values were found to have similar survival rates in both LD-SCLC and ED-SCLC patients. In univariate and multivariate analyses, both t­SUVmax and t­SUVmax/t-size were found not to be associated with overall survival (p > 0.05) CONCLUSION: This study does not advocate the use of either t­SUVmax or t­SUVmax/t-size on pretreatment 18F­FDG-PET/CT scan as prognostic and predictive tools for both LD-SCLC and ED-SCLC patients. Likewise, we did not find that t­SUVmax/t-size was superior to t­SUVmax in that respect.

Breast cancer patients are diagnosed at younger ages in Turkey: a comparative study.

BACKGROUND: The incidence of breast cancer (BC) has been on the rise over the last decades in the USA, and it is most frequently diagnosed among women aged 65-74 years. AIMS: The aim of this study was to demonstrate the median age of BC at diagnosis and the age-specific incidence ratios of Turkish BC patients over the last 10 years. METHODS: A total of 6009 Turkish BC patients who had been admitted to the Institute of Oncology, a tertiary referral center, from January 2011 to December 2020 were included in the study. RESULTS: The median age at diagnosis was 49 years. This was 14 years younger than that of the US patients according to SEER data from 2014 to 2018 showing that the median age at diagnosis was 63 years. The distribution curve of the age-specific incidence ratios significantly shifted to the left compared to the American data. CONCLUSIONS: Turkish BC patients are diagnosed at younger ages than BC patients in developed countries, and this portends a significant health problem. Therefore, it is important and vital that society be educated about the disease without any further delay and screening programs should be instated effectively and extensively from the age of forties.

Neither the presence nor the severity of hyponatremia affected the outcome of the patients with small cell lung cancer.

BACKGROUND: Hyponatremia is the most common electrolyte disorder in lung cancer, and it particularly occurs in small cell lung cancer (SCLC) patients. The prognostic significance of hyponatremia has been reported in several studies with controversial results. AIMS: We aimed in this study to investigate hyponatremia and evaluate its prognostic value in SCLC patients. METHODS: The data of 373 SCLC patients were analyzed retrospectively. Serum sodium concentrations were measured from blood samples taken from all patients before treatment. Hyponatremia was defined as a serum sodium concentration below 135 mmol/L and then assigned into two groups: mild (130 to 134 mmol/L) and severe (below ≤ 129 mmol/L) hyponatremia. RESULTS: Hyponatremia was detected in 85 (22.8%) patients (mild hyponatremia in 51 (13.7%) and severe hyponatremia in 34 (9.1%) patients). Furthermore, 26% (63 of 242) of ED-SCLC patients and 16.8% (22 of 131) of LD-SCLC patients had hyponatremia. While no clinical parameter was statistically associated with serum sodium concentrations in LD-SCLC patients, hyponatremic ED-SCLC patients were more frequently associated with weight loss (p = 0.04) and liver metastasis (p = 0.04). In LD-SCLC, the overall survival (OS) rates of patients with hyponatremia were similar to those with normonatremia (p = 0.6). Likewise, hyponatremic and normonatremic ED-SCLC patients had similar life expectancies (p = 0.1). Moreover, the severity of hyponatremia did not affect OS in either LD-SCLC (p = 0.3) or ED-SCLC (p = 0.1). CONCLUSION: Serum sodium concentration did not have an impact on survival in SCLC patients; thus, we concluded that neither the presence nor the severity of hyponatremia affected the outcome of these patients.

Diagnosing lung cancer at a younger age and with male dominance: Comparison of Turkish patients with United States patients.

BACKGROUND: The risk of lung cancer (LC) increases with an older age and is most frequently diagnosed among patients aged 65-74 years with an increasing women ratio over the years in the United States (US). AIM: This study aimed to demonstrate the age and gender distribution of Turkish LC patients at diagnosis over the past 10 years. MATERIAL AND METHODS: A total of 5,201 LC patients who had been admitted to the Institute of Oncology, a tertiary referral center, from January 2011 to December 2020 were included in the study. RESULTS: The median age at diagnosis was 62 years. This was 9 years younger than that of the US patients according to surveillance, epidemiology, and end results program data from 2015 to 2019, showing that the median age at diagnosis was 71 years. The distribution curve of the age-specific incidence ratios significantly shifted to the left compared to the American data. The majority of the patients were men (79.2%); women were 20.8%. These values were quite different from the US patients; the distribution of gender was nearly identical, with 51.8% for men and 48.2% for women according to American Cancer Society data from 2011 to 2020. The changes in the ratios of Turkish and US LC patients by sex were identical over the years; although the proportion of men has been in a downtrend, the proportion of women has been in an uptrend in both countries. CONCLUSION: Turkish LC patients are diagnosed at younger ages and male-dominant compared to LC patients from the US, and this portends a significant health problem. Therefore, efforts to quit smoking must be increased.

Online public interest in smoking and lung cancer: A comparative study in Google Trends.

BACKGROUND: Lung cancer is the leading cause of cancer death globally. There is a causal relationship between smoking and lung cancer; nearly 90% of cases are caused by cigarette smoking. AIM: To investigate the public interest in the relationship between lung cancer and tobacco smoking through an analysis of searches in Google Trends over the past 16 years. MATERIAL AND METHODS: We conducted a systematic search through Google Trends using the search terms "lung cancer" and "smoking" to identify the numbers of lung cancer and tobacco smoking searches in populations from Turkey, the United States, and the whole world between January 1, 2004 and December 31, 2019. RESULTS: Online searches that reflect public awareness are nearly identical for both lung cancer and smoking; however, there is an inverse correlation between population interest and incidences of lung cancer and smoking. Furthermore, the numbers of searches on lung cancer and smoking decrease gradually in Turkey, in the world, and in the United States over the years, displaying a slight seasonal pattern. CONCLUSION: Informative and educational campaigns covering the whole year are required to raise awareness of the relationship between lung cancer and smoking and keep people argus-eyed.

Melanoma publications do not increase as much as the incidence of melanoma in the last two decades.

ABSTRACT: In recent years, the incidence of melanoma has increased more dramatically than any other malignancy. We compared the number of publications between melanoma and other cancers in the last two decades. We performed a systematic search on PubMed using the search terms "melanoma" and "cancer" to determine the number of publications on melanoma and other cancers. The numbers and lifetime risk ratios of both melanoma and other cancer patients by year were obtained from the "Cancer Statistics" articles published annually by the American Cancer Society. The number of both melanoma and cancer publications increased at the same rate (3.01-fold), and the ratio of melanoma publications to all cancer publications did not change over the years: nearly, 3.4% on average. Melanoma rates increased faster than other cancers; 2.02 and 1.44 times, respectively. Similarly, the incidence of melanoma increased from 3.91% to 5.47%. In conclusion, the increase in the number of publications related to melanoma could not meet the dramatic increase in the number of melanoma patients.

Ulceration vs. Mitosis in Cutaneous Melanoma: Which Is Superior for Predicting Prognosis Across Clinical Stages?

Ulceration and high mitosis are considered among the major unfavorable prognostic factors in the survival of cutaneous melanoma patients. The aim of this study was to investigate the clinical significance of these parameters and to compare them to see which one is superior to predicting prognosis across all clinical stages of melanoma. A total of 1,074 melanomas were analyzed retrospectively. Tumor ulceration was found to be limited to the local stage for predicting survival, whereas, mitosis maintained its prognostic strength for predicting survival across all clinical stages. Furthermore, no survival differences were observed between ulceration and mitosis across clinical stages.

Major Histotypes in Skin Melanoma: Nodular and Acral Lentiginous Melanomas Are Poor Prognostic Factors for Relapse and Survival.

ABSTRACT: The histological subtype is not considered one of the major prognostic factors in melanoma, yet it is known to have an impact on survival. The aim of this study was to investigate the clinical significance of histological subtypes and the possible impacts of clinicopathological factors on the course of melanoma patients of all stages. A total of 1017 cutaneous melanoma patients were analyzed retrospectively. Four major melanoma histotypes that were studied in this study were as follows: (1) superficial spreading melanoma (SSM), (2) nodular melanoma (NM), (3) acral lentiginous melanoma (ALM), and (4) lentigo maligna melanoma (LMM). Unlike SSMs and LMMs, there were statistically significant correlations between NMs and ALMs and most aggressive histopathological prognostic indicators, such as higher Clark level ( P = 0.0001), thick Breslow depth ( P = 0.0001), presence of ulceration ( P = 0.0001), and lymphovascular invasion ( P = 0.0001). Furthermore, NMs and ALMs were also associated with advanced clinical stages, that is, node involvement and metastasis. Relapse rates for nonmetastatic melanomas were higher in NMs (39.6%) and ALMs (35.3%) than in SSMs (24.3%) and LMMs (10.3%) ( P = 0.0001). Additionally, 5-year relapse-free survival rates were 90.5%, 70.5%, 55.7%, and 50.5% in LMMs, SSMs, ALMs, and NMs, respectively ( P = 0.0001). Moreover, 5-year overall survival rates plummeted from 84.3% in LMMs to 74.8%, 64.3%, and 46% in SSMs, ALMs, and NMs, respectively ( P = 0.0001). In conclusion, we observed that the histologic subtype was an independent predictor for relapse and outcome for cutaneous melanoma patients. Both NM and ALM had unfavorable prognoses, and they were associated with known poor pathological and clinical indicators.

Trunk melanomas: no survival differences between lesion sites.

OBJECTIVES: The anatomic site of primary melanoma is significantly associated with patient survival, e.g. trunk melanomas have poorer prognosis than limb melanomas. The aim of this study was to evaluate the clinicopathological factors and survival outcomes of trunk melanoma patients and to identify the differences between anatomical areas of the trunk. METHODS: A total of 491 trunk melanomas were analyzed retrospectively. RESULTS: The median age was 49 years. The 5-year relapse-free survival rate was 58.3% for all patients, which was 60%, 53.1%, 56.5%, 60.1%, and 66.1% for chest, abdominal, dorsal, lumbar, and gluteal melanoma patients, respectively (p = 0.8). The 5-year overall survival rate was 61.1% for all patients, which was 62.6%, 57.4%, 59.1%, 66.9%, and 72.1% for chest, abdominal, dorsal, lumbar, and gluteal melanoma patients, respectively (p = 0.3). The unfavorable pathological and clinical prognostic factors, such as sex (p = 0.0001), histology (p = 0.0001), Clark level (p = 0.0001), Breslow depth (p = 0.0001), mitotic rate (p = 0.002), ulceration (0.0001), lymphovascular invasion (p = 0.01), BRAF mutation (p = 0.01), lymph node positivity (p = 0.0001), metastasis (p = 0.0001), and relapse (p = 0.0001), were found to be associated with overall survival. CONCLUSION: Trunk melanomas may be associated with aggressive pathological and poor clinical features, such as thickness, mitotic rate, ulceration, and advanced clinical stages; therefore, they predict unfavorable survival rates regardless of anatomical sites.

Successful Treatment of a 92-Year-Old Classic Kaposi's Sarcoma Man With Ultra-Low Dose Oral Etoposide.

INTRODUCTION: Because classic Kaposi's sarcoma (CKS) is currently regarded as a low-grade vascular malignancy, it has been usually known as indolent clinical course. The slow-growing neoplasms are usually asymptomatic and rarely systematically progressive. Although CKS is a chronic disease which is rarely life-threatening, systemic therapy may be necessary in some patients with symptomatic skin or visceral involvement. CASE REPORT: In this report, we presented a 92-year-old CKS man with widespread and symptomatic skin lesions. MANAGEMENT AND OUTCOME: Patient was treated successfully with ultra-low dose oral etoposide; 50 mg/day for 7 days. Cycles were repeated in every 21 days. There was a dramatic regression in all lesions at the end of treatment; only skin colorations were persisted instead of palpable nodular lesions. Moreover, no serious hematological and non-hematological adverse events were observed. DISCUSSION: Fragile advanced CKS patients with advanced age and/or comorbitidies need to be considered to optimize outcomes. Treatment with single-agent oral chemotherapy, oral ultra-low dose etoposide, may be one of the effective treatment styles.

Complementary and alternative medicine (CAM) in Turkish cutaneous melanoma patients: A prospective study from tertiary cancer center.

BACKGROUND: Only a few studies assessed the prevalence and the predictors of complementary and alternative medicine (CAM) use specifically in melanoma patients. The aim of this study was to assess the extent of CAM use in Turkish melanoma patients. OBJECTIVE: To assess the extent of CAM use and to compare sociodemographic and clinical characteristics between users and non-users in melanoma patients. METHODS: One hundred melanoma patients who were seen in outpatient clinics were included in a survey using questionnaire on CAM use. RESULTS: Twenty-seven patients used at least one type of CAM, the majority of which were herbs (73%). Turmeric (curcumin) was the most popular herb that was used alone or in conjunction with various other herbs (41%). Living in rural areas was significantly associated with CAM use (p = 0.02). The most common reason for CAM use was intent to cure of the disease (52%). The primary source of information about CAM was a close friend or a family contact (44%). CAMs were generally used together with conventional anticancer treatment modalities (64%) and they were ingested on a regular base (72%). CAMs could easily be acquired at regular herbal stores (88%). The patients experienced almost no adverse effects with CAM use; and most cases (71%) had confidence in CAM. About half of the patients consulted with their physicians about CAM use. CONCLUSION: Minority, nearly one fourth of the melanoma cases used at least one type of CAM, the majority of which were herbs and turmeric (curcumin) was the most popular agent.

Different mitotic rates are associated with different prognostic factors, relapses, and survival rates in melanoma.

BACKGROUND: Mitotic rate is one of the major prognostic factors in melanoma. OBJECTIVE: To investigate the significance of mitotic rate and possible impacts of clinicopathological factors on the course of all staged melanoma patients. METHODS: A total number of 970 melanoma patients were analyzed. Mitotic rates were grouped for analysis as follows: 0-1, 1.1-4.9, 5-9.9, and ≥10 mitoses/mm2 . RESULTS: Melanomas with higher mitotic rates were more likely to be associated with nodular histology (P = 0.0001), higher Clark level (P = 0.0001), thick Breslow depth (P = 0.0001), ulceration (P = 0.0001), vertical growth pattern (P = 0.0001), neurotropism (P = 0.04), lymphovascular invasion (P = 0.01), de novo melanoma (P = 0.0001), absence of tumor infiltrating lymphocytes (P = 0.02), advanced stage (P = 0.0001), and relapse (P = 0.0001). The 5-year overall survival (OS) rate of all patients was 68.7%, and it decreased significantly from 87% in melanomas with 0-1 mitoses/mm2 to 65.2%, 56.6%, and 50.4% in melanomas with 1.1-4.9, 5-9.9, and ≥10 mitoses/mm2 , respectively (P = 0.0001). Age (P = 0.04), gender (P = 0.03), histology (P = 0.0001), Clark level (P = 0.001), T-stage (P = 0.003), ulceration (0.006), node involvement (P = 0.0001), metastasis (P = 0.005), and relapse (P = 0.0001) were correlated with OS in 0-1 mitoses/mm2 melanomas, whereas lymphovascular invasion (P = 0.0001), BRAF mutation (P = 0.01), metastasis (P = 0.0001), relapse (P = 0.0001), and relapse pattern (P = 0.005) were found significant for ≥10 mitoses/mm2 melanomas. CONCLUSION: Higher tumor mitotic rates associated with known histopathological and clinical poor prognostic factors were found to be significantly independent predictors of early relapse and unfavorable survival for cutaneous melanoma patients. Moreover, different prognostic variables were found to be affecting survivals in melanoma patients with lower and higher mitosis.

Limb melanomas: acral melanomas have worse survival.

BACKGROUND: The anatomic site of primary melanoma is significantly correlated with survival, and extremity melanomas have better prognosis than trunk or head and neck melanomas. AIM: The aim of this study was to review and evaluate the prognostic factors and survival outcomes associated with both upper and lower extremity melanomas. METHODS: A total of 524 limb-located melanomas were analyzed retrospectively. RESULTS: Lower extremity melanomas were predominant in number and feet/toes melanomas were more frequently found in the elderly. Acral lentiginous melanomas were found to affect more frequently lower limbs and showed mainly distal distributions for both limbs. However, acral melanomas were more often ulcerated and they were more frequently BRAF wild-type melanomas associated with significant lymphovascular invasion. Foot and toe melanomas relapsed more frequently than leg melanomas. The 5-year overall survival rates for upper and lower limbs were the same, 62%. The finger (p = .0001) and toe (p = .005) melanomas had worse overall survivals than arm and leg melanomas, respectively. Both overall and disease-free survivals of acral melanoma patients were found worse than those of nonacral melanoma patients, p = .0001 and p = .001 respectively. Despite not having adjusted by Breslow, ulceration and nodal involvement status, acral location per se could be associated with poorer outcome in our retrospective study. CONCLUSION: Even though they were not found to be correlated with major predictors of poor prognosis, acral melanomas significantly predict poor survival.

Digit melanomas are associated with poor prognostic factors and unfavorable survivals.

BACKGROUND: The anatomic location of primary melanoma is significantly associated with outcome. OBJECTIVE: To evaluate the prognostic factors and survival outcomes associated with melanomas on hand and foot digits. METHODS: The data of 106 patients with digit melanomas were analyzed retrospectively. RESULTS: Median age of patients was 55 years, and male-to-female ratio was one. Majority of the patients had skin melanomas (74.5%); and 25.5% of them had ungual melanomas. The lesions slightly more frequently affected toes (53.8%) and thumbs (55.9%); and 57.4% of the lesions were right-sided. Acral lentiginous melanoma was the major histological subtype (67.5%). Digit melanomas were associated with aggressive histological features, such as high Clark level (75%), thick Breslow depth (72.3%), presence of ulceration (74.3%), and high mitotic rate (58.3%). At admission, the rates of stage I-II, stage III, and stage IV diseases were 57.6%, 33%, and 9.4%, respectively. The recurrence and mortality rates were 41.7% and 46.2%, respectively. The 5-year RFS and OS rates were similar: 47%. Melanoma origins (skin vs. ungual), locations (finger vs. toe; first digit vs. others; and right vs. left), and histological subtypes (acral lentiginous melanoma vs. others) had no impact on survivals. The known poor prognostic histological factors, such as Clark level, Breslow thickness, mitotic rate, ulceration, and neurotropism, were found to be associated with both RFS and OS. CONCLUSION: Digit melanomas are associated with poor clinicopathological prognostic features, and they might predict unfavorable survivals.