Factors affecting survival in operated gastric cancer.

In this study, our aim was to determine the possible effects of Helicobacter pylori(HP), chronic atrophic gastritis (CAG), and gastrointestinal metaplasia (GIM) on survival in operated bowel type gastric cancer patients (INT-GC). Among 548 patients, 347(63.3%) were male. The median age was 57 years. Disease-free survival (DFS) and overall survival (OS) were significantly shorter in patients with GIM than those in patients without GIM (log rank, P = 0.003 and log rank P = 0.003, respectively). Multivariate analysis showed that presence of GIM (HR, 2.1) was found to be an independent factor of worse DFS. In our study, stage pIII patients with GIM had significantly shorter DFS and OS than those without GIM (log rank p = 0.008 and log rank p = 0.001, respectively). However, in subgroup analysis of patients with GIM, there was no significant DFS and OS difference between patients with stage pI and pII disease (log rank p = 0.999, log rank p = 0.184 vs. log rank p = 0.409, log rank p = 0.281, respectively).

The effects of taxifolin on neuropathy related with hyperglycemia and neuropathic pain in rats: A biochemical and histopathological evaluation.

BACKGROUND: Hyperglycemia can be considered a determining factor in the development of diabetic neuropathy as well as neuropathic pain. There is a relationship between the excessive production of reactive oxygen species (ROS) and the pathogenesis of diabetic neuropathic pain. Taxifolin, on the other hand, is a flavonoid that has been documented to inhibit ROS production. OBJECTIVES: To investigate the effects of taxifolin, which has antioxidant and neuroprotective effects, on alloxan-induced hyperglycemia-induced neuropathy and neuropathic pain, biochemically and histopathologically. MATERIAL AND METHODS: The albino Wistar male rats were divided into 3 groups: healthy group (HG), only alloxan group (AXG) and alloxan+taxifolin group (ATG). Hyperglycemia in animals was caused through intraperitoneal injection of alloxan at a dose of 120 mg/kg. Paw pain thresholds of animals were measured using Basile algesimeter. Sciatic nerve tissues were examined biochemically and histopathologically in order to evaluate neuropathy. RESULTS: Our experimental results revealed that taxifolin significantly prevented the increase of plasma glucose concentration level with alloxan administration, the decrease of the paw pain threshold related to hyperglycemia, the change of oxidant-antioxidant balance in the sciatic nerve tissue in favor of oxidants, and the deterioration of tissue morphology in animals. CONCLUSIONS: Our experimental results indicate that taxifolin alleviates alloxan-induced hyperglycemia-related neuropathy and neuropathic pain.

Prognostic significance of neutrophil-to-lymphocyte ratio in esophageal squamous cell carcinoma.

OBJECTIVE: The purpose of the study was to assess the effect of neutrophil-to-lymphocyte ratio (NLR) on recurrence and survival in patients with Esophageal Squamous Cell Carcinoma (ESCC) undergoing surgery. METHODS: This was a retrospective analysis of the 80 resectable ESCC patients who underwent surgery at Yuzuncu Yil University Faculty of Medicine between 2008 and 2018. Receiver operator characteristics curve of NLR was plotted for disease-free survival (DFS). The area under the curve of NLR was 0.692 (p=0.008) with 65.2% sensitivity and 2.8 with 69.5% specificity. Patients were divided into two groups based on the NLR as follows: NLR <2.8 and NLR ≥2.8. RESULTS: Among 80 ESCC patients, 54 (65.5%) were female. The median age was 55 years (range, 26-77). The NLR was <2.8 in 47 (58.7%) patients. Median DFS was 55 months in patients with NLR ≥2.8, whereas it was not reached in those with NLR <2.8 (p=0.008), with corresponding overall survival (OS) durations of 71 months and not reached (p=0.027). Eastern Cooperative Oncology Group performance score 2, presence of obstruction at diagnosis, lower 1/3 esophageal localization, neoadjuvant treatment, and NLR ≥2.8 were found to be the factors related to survival. CONCLUSION: The present study demonstrated that high pre-treatment NLR was associated with worse DFS and OS in patients with resectable esophageal cancer. We believe that pre-treatment NLR may help guide predicting treatment outcomes in non-metastatic resectable ESCC patients.

The Effect of Body Mass Index on Treatment Outcomes in Patients with Metastatic Non-Small Cell Lung Cancer Treated with Platinum-Based Therapy.

To investigate the effect of body mass index(BMI) on treatment outcomes and side-effect profile in metastatic non-small cell lung cancer(NSCLC) patients receiving platinum-based chemotherapy(ChT) in the first-line setting. This was a retrospective analysis of 233 NSCLC patients who were treated and followed up from 2008 through 2018. NSCLC patients who had metastatic disease at the time of diagnosis and were treated with platinum-based ChT in the first-line setting were included. The patients were divided into 2 groups based on the BMI as follows; BMI < 25 kg/m2 and BMI ≥ 25 kg/m2. This retrospective analysis enrolled 233 patients, 35 (15.0%) of whom were female. The BMI in 132 patients (56.2%) was < 25 kg/m2. The median age was 58 years (range, 21-90). Median progression-free survival(PFS) was 7 mo, in the patients with BMI ≥ 25 kg/m2 compared to 5.0 mo, in those with BMI < 25 kg/m2 (p = 0.032), with corresponding median overall survival(OS) durations of 12 vs. 9 mo, (p = 0.003). In multivariate analysis, ECOG PS 2, grade III histology, and brain or bone metastasis negatively affected OS, whereas BMI ≥ 25 kg/m2 positively affected OS. A high BMI prior to therapy in patients with NSCLC treated with platinum-based ChT in the first-line setting was associated with more favorable PFS and OS.

Factors affecting survival in operated pancreatic cancer: Does tumor localization have a significant effect on treatment outcomes?

OBJECTIVE: This study aims to investigate the factors affecting survival in operated pancreatic ductal adenocarcinoma (PDAC) and the possible prognostic effect of primary tumor localization on treatment outcomes. METHODS: In this study, 98 patients with curatively-operated PDAC, who were followed up and treated for the years 2008 through 2018, were enrolled. Metastatic and locally advanced stages and patients under 18 years of age were excluded from this study. Patients were divided into two groups based on the primary tumor localization as *head or *body/tail. RESULTS: Sixty-seven (68.3%) patients were male and 31 (31.7%) were female, with a median age of 62 years (range, 35-82 years). The numbers of patients with a primary tumor located in *head vs.*body/tail were 74 (75.4%) vs. 24 (24.6%), respectively. Patients with a primary tumor located in *head vs.*body/tail; median disease-free survival was 16.0 months vs. 13 months (p=0.972), respectively, with corresponding median overall survival was 25 months vs. 33 months (p=0.698). The level of carcinoembryonic antigen(CEA) at diagnosis (Hazard ratio[HR], 1.09 95%CI, 1.01-1.18), stage III disease (HR, 2.09 95%CI, 1.16-4.35), and receiving adjuvant treatment (HR, 0.20 95%CI, 0.09-4.34) were the independent predictors of survival. CONCLUSION: Our study revealed that high levels of CEA at diagnosis and stage III disease adversely affected the survival in non-metastatic PDAC patients, while receiving adjuvant therapy had a positive effect on survival. The findings suggest that primary tumor localization did not affect survival in operated PC patients. The results on this issue are still inconsistent and under debate in the literature.

Evaluation of coagulation parameters in patients with parathyroid adenoma.

Parathyroid adenoma is responsible for 80-85% of cases of primary hyperparathyroidism. Increased fibrinogen levels in patients with adenoma may increase the risk of atherosclerosis and cardiovascular events. The aim of this study was to investigate the relationship between coagulation parameters and parathyroid adenoma. A prospective study included 28 female patients with parathyroid adenoma aged 40-88 years and 27 age-matched healthy controls. The coagulation parameters were assessed for each participant. The mean ages of the patient and control groups were 57.7 ± 10.9 and 53.3 ± 9.31 years, respectively. The mean level of protein S activity was 65.79 ± 13.78 in the patient group and 77.00 ± 15.72 in the control group, and the difference was statistically significant (p = 0.013). The mean fibrinogen levels of the patient and control groups were 338.78 ± 63.87 mg/dL and 304.30 ± 45.67 mg/dL, respectively, and a significant difference was found (p = 0.041). However, no significant difference was evident between the two groups with regard to the D-dimer (p = 0.238), aPTT (p = 0.645), INR (p = 0.406), protein C (p = 0.076), and AT-III (p = 0.180) levels. A positive correlation was observed between adenoma volume and fibrinogen in the patient group (r = 0.711, p = 0.001). The protein S levels were lower and the fibrinogen levels higher in the patients with parathyroid adenoma.

Lymph Node Ratio Predicts Long-Term Survival in Lymph Node-Positive Breast Cancer.

OBJECTIVE: In this study, we aimed to evaluate the prognostic value of axillary lymph node ratio (LNR) for disease-free survival (DFS) in node positive breast cancer (BC) patients with long term follow-up. MATERIALS AND METHODS: A total of 179 stage II to III female BC patients, who were followed between December 2001 and January 2019 at the department of medical oncology, were included in this study. Patients were classified into 3 groups based on the LNR as follows; LNR<0.21, LNR=0.21-0.65, and LNR>0.65. SPSS 22 for windows was used for statistical analysis. RESULTS: The median age was 49 (range, 24-83) years. The numbers of patients with stage II and stage III disease were 81 (45.3%) and 98 (54.7%), respectively. The median number of lymph node (LN) resected and positive LN were 15 (range, 3-48) and 3 (range, 1-29), respectively. There were 90 patients (50.3%) with LNR <0.21, 62 (34.6%) with LNR=0.21-0.65, and 27 (15.1%) with LNR >0.65. The median disease-free survival (DFS) was not reached in patients with LNR <0.21, 81 months in patients with LNR=0.21-0.65, and 43 months in patients with LNR>0.65 (p<0.001). Overall survival (OS) was found to be significantly related to LNR (p=0.042). In patients with LNR<0.21 and LNR=0.21-0.65, the median OS was not reached. In patients with LNR >0.65, the median OS was 101 months. In multivariate analysis, LNR=0.21-0.65 (Hazard ratio [HR], 6.99), LNR>0.65 (HR, 28.99), and HER-2 negativity (HR, 4.64) were the factors associated with DFS (p<0.05). CONCLUSION: LNR is a more useful prognostic factor than the pathological lymph node staging for predicting survival in patients with nod-positive BC.

Assessment of pretreatment albumin-bilirubin grade in pancreatic cancer patients with liver metastasis.

PURPOSE: This study aimed to assess the effect of pretreatment albumin-bilirubin (ALBI) score on treatment outcomes in pancreatic cancer (PC) patients with liver metastasis at the time of diagnosis treated with chemotherapy (CT) in the first-line setting. METHODS: This was a retrospective study of 273 PC patients ≥18 years of age who had liver metastasis at the time of diagnosis and received CT in the first-line. ALBI score was calculated through the following formula; [(log10 bilirubin (µmol/L)×0.66)+[albumin(g/l)×-0.0852]. Patients were stratified into 3 categories based on the ALBI score as follows; grade I:ALBI ≤-2.60, grade II:-2.60-1.39. RESULTS: A total of 273 patients, [180 (65.9%) men and 93 (34.1%) women], were evaluated. The median age was 60 years. ALBI grade was I in 45 (16.4%) patients, II in 156 (57.1%) patients, and III in 72 (26.5%) patients. Based on the ALBI grade, median progression-free survival (mPFS) was 9 months in grade I patients, 6 months in grade II patients, and 4 months in grade III patients (p=0.002), with median overall survival (mOS) durations of 12 months vs. 8 months vs. 5 months, respectively (p<0.001). Multivariate analysis showed that ALBI grade II (HR,1.543) or III (HR,2.260) negatively affected survival. CONCLUSION: A higher pretreatment ALBI grade is related to worse OS and PFS in PC patients with liver metastasis treated with a first-line CT, and therefore it can help predict the treatment outcomes in these patients.

The Effect of Obesity on Response to Neoadjuvant Therapy in Locally Advanced Gastric Cancer.

INTRODUCTION: The effect of obesity on response to neoadjuvant chemotherapy (NACT) remains unknown. We aimed to investigate the effect of obesity on response to NACT and survival in locally-advanced gastric cancer (GC). METHODS: From 2010 to 2019, 142 GC patients with clinical stage III disease who underwent curative surgery after NACT were enrolled. Patients were divided into 3 groups according to body mass index (BMI) as follows; BMI < 25 kg/m2, BMI = 25-30 kg/m2, and BMI > 30 kg/m2. The Mandard tumor regression grading system was used for tumor regression grade (TRG). RESULTS: Of the 142 GC patients, 45(31.7%) were female. The median age was 58 years. BMI was < 25 kg/m2 in 60 (42.3%) patients, 25-30 kg/m2 in 44 (31%) patients, and > 30kg/m2 in 38 (26.8%) patients. The numbers of patients with TRGI-II, TRGIII, and TRGIV-V were 35 (24.6%), 44 (31%), and 63 (44.4%), respectively. There was no statistically significant difference among BMI groups in terms of disease-free survival (DFS) and overall survival (OS) (p = 0.919 and p = 0.398, respectively). According to TRG groups; mDFS was 46 months in TRG I-II, 28 months in TRG III, and 18 months in TRG IV-V (p <0.001). In multivariate analysis, presence of perineural invasion and lymphovascular invasion were the factors affecting TRG. CONCLUSION: In our study, we found that pre-treatment obesity did not affect the TRG in clinical stage III GC patients. However, a better TRG status was associated with improved survival.
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Mean platelet volume and platelet distribution width correlates with prognosis of early colon cancer.

PURPOSE: Several platelet indices have been linked to prognosis of various cancers, including metastatic colorectal cancer. The aim of this study was to investigate the prognostic effect of mean platelet volume (MPV) and platelet distribution width (PDW) in early colon cancer (CC) patients. METHODS: This retrospective study included early CC patients who were followed up and treated between 2005 and 2017. Relapse free survival (RFS) and overall survival (OS) were determined with respect to several demographic and clinical characteristics of patients, including MPV and PDW. The cut-off value was determined as >8.5 fL for MPV (sensitivity: 67.1%, specificity 54.5%) and ≤16% for PDW (sensitivity: 66.7%, specificity: 60.0%). RESULTS: The study included 394 patients, 53.3% of which were male. Stage I, II, and III patients constituted 8.9%, 46.4%, and 44.7% of the study population, respectively. Among all patients, RFS and OS were significantly longer in patients with MPV≤8.5 fL and PDW>16 fL (p<0.001 and p=0.011 for MPV, respectively; and p<0.001 and p=0.026 for PDW, respectively). In patients with stage III disease, those with MPV≤8.5 fL had significantly longer RFS and OS compared to those with MPV >8.5 fL (p<0.001 and p=0.001, respectively). On the other hand, those with PDW>16% had significantly longer RFS than that in those with PDW ≤16 fL among stage III patients (p<0.001). In multivariate analysis, stage, perineural invasion, lymphovascular invasion, adjuvant treatment, CEA, CA19-9, PDW, and MPV were found the most significant factors affecting RFS. CONCLUSION: Our study suggests that elevated MPV and decreased PDW appear to be unfavorable prognostic factors in early CC, especially in patients with stage III disease. Considering the wide availability and accessibility of these indices, it is reasonable to designate further larger prospective studies to clarify and verify their potential roles in early CC.