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Kacar M, Erzurum Alim N. The dietary risk factors on cancer patients receiving chemotherapy and correlation between serum vitamin D and B12 levels, depression and anxiety status. NUTR HOSP 2024; 41:112-121. [PMID: 37073746 DOI: 10.20960/nh.04530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Introduction Objective: the aim of this study is to evaluate the relationship between serum vitamin D and B12 levels, nutritional levels, depression, and anxiety in adult cancer patients before and after chemotherapy. Methods: a case-controlled study was carried out on 44 patients who were diagnosed with cancer and applied to the Chemotherapy Unit for treatment (patient group, PG) and 44 volunteer individuals (control group, CG) with similar characteristics to the age and gender-matched patient group but with no diagnosis of cancer. Results: the average age of individuals in PG is 52.50 ± 12.21 years and for those in CG is 52.84 ± 10.98 years. Serum D and B12 levels in the first cure in individuals in PG are higher than in the last treatment (p > 0.05). It was determined that vitamin C taken with a daily diet reduces the risk of cancer (OR: 0.920, 95 % CI: 0.899-0.942, p = 0.042). No correlation was found between depression and anxiety scores of both groups and serum vitamin D and B12 levels (p > 0.05). It was determined that the Beck Anxiety Inventory (BAI) score increased with decrease in body mass index (BMI) (β = 0.311, p = 0.040) and serum vitamin B12 level (β = -0.406, p = 0.006). In addition, it was found that the increase in the Patient-Generated Subjective Global Assessment (PG-SGA) score, which reflects the nutritional status of cancer patients, worsened the level of anxiety (β = 0.389, p = 0.009). Conclusions: as stated in the findings of the study, chemotherapy treatment mediated the development of anxiety in cancer patients by changing the vitamin B12 levels and anthropometric characteristics with its negative effect on nutritional status. It should be ensured that cancer patients treated with chemotherapy follow a healthy and balanced diet plan that is suitable for their needs and has adequate vitamin and mineral content.
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Affiliation(s)
- Mihrican Kacar
- Department of Nutrition and Dietetics. Faculty of Health Sciences. Erzincan Binali Yildirim University
| | - Nural Erzurum Alim
- Department of Nutrition and Dietetics. Faculty of Health Sciences. Ankara Yildirim Beyazit University
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Li S, Xie K, Xiao X, Xu P, Tang M, Li D. Correlation between sarcopenia and esophageal cancer: a narrative review. World J Surg Oncol 2024; 22:27. [PMID: 38267975 PMCID: PMC10809562 DOI: 10.1186/s12957-024-03304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND In recent years, the research on the relationship between sarcopenia before and after the treatment of esophageal cancer, as well as its impact on prognosis of esophageal cancer, has increased rapidly, which has aroused people's attention to the disease of patients with esophageal cancer complicated with sarcopenia. This review examines the prevalence of sarcopenia in patients with esophageal cancer, as well as the relationship between sarcopenia (before and after surgery or chemotherapy) and prognosis in patients with esophageal cancer. Moreover, we summarized the potential pathogenesis of sarcopenia and pharmacologic and non-pharmacologic therapies. METHODS A narrative review was performed in PubMed and Web of Science using the keywords ("esophageal cancer" or "esophageal neoplasm" or "neoplasm, esophageal" or "esophagus neoplasm" or "esophagus neoplasms" or "neoplasm, esophagus" or "neoplasms, esophagus" or "neoplasms, esophageal" or "cancer of esophagus" or "cancer of the esophagus" or "esophagus cancer" or "cancer, esophagus" or "cancers, esophagus" or "esophagus cancers" or "esophageal cancer" or "cancer, esophageal" or "cancers, esophageal" or "esophageal cancers") and ("sarcopenia" or "muscular atrophy" or "aging" or "senescence" or "biological aging" or "aging, biological" or "atrophies, muscular" or "atrophy, muscular" or "muscular atrophies" or "atrophy, muscle" or "atrophies, muscle" or "muscle atrophies"). Studies reporting relationship between sarcopenia and esophageal cancer were analyzed. RESULTS The results of the review suggest that the average prevalence of sarcopenia in esophageal cancer was 46.3% ± 19.6% ranging from 14.4 to 81% and sarcopenia can be an important predictor of poor prognosis in patients with esophageal cancer. Patients with esophageal cancer can suffer from sarcopenia due to their nutritional deficiencies, reduced physical activity, chemotherapy, and the effects of certain inflammatory factors and pathways. When classic diagnostic values for sarcopenia such as skeletal muscle index (SMI) are not available clinically, it is also feasible to predict esophageal cancer prognosis using simpler metrics, such as calf circumference (CC), five-count sit-up test (5-CST), and six-minute walk distance (6MWD). CONCLUSIONS Identifying the potential mechanism of sarcopenia in patients with esophageal cancer and implementing appropriate interventions may hold the key to improving the prognosis of these patients.
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Affiliation(s)
- Shenglan Li
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China
| | - Kaiqiang Xie
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China
| | - Xiaoxiong Xiao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Pingsheng Xu
- Phase I Clinical Trial Center, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China.
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China.
| | - Dai Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Phase I Clinical Trial Center, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Gupta P, Kaur N, Kumar V, Gupta A, Gupta S, Dua A, Injeti E, Mittal A. Evaluation of cinnamaldehyde derivatives as potential protective agents against oxidative-stress induced myotube atrophy using chemical, biological and computational analysis. Bioorg Chem 2023; 139:106661. [PMID: 37354662 DOI: 10.1016/j.bioorg.2023.106661] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/14/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
Skeletal muscle atrophy, associated with increased morbidity, mortality and poor quality of life, is a metabolic disorder with no FDA approved drug. Oxidative stress is one of the key mediators of atrophy that influences various cell signaling molecules. The goal of this study is to identify potential antioxidant agents that could be used to treat atrophy. In this study in vitro and in situ screening of different cinnamaldehyde (CNA) derivatives for their antioxidant effects was done along with computational analysis to understand the relationship between their chemical structure and biological activity. Data show that 2-hydroxycinnamaldehyde (2HCNA) worked better than other CNA analogues at physiological pH, while 4-Fluoro-2-methoxycinnamaldehyde (4FoCNA) showed the maximum antioxidant activity under acidic conditions. However, these derivatives (2HCNA and 4FoCNA) were found to be toxic to the cultured myotubes (mature myofiber) under both physiological and pathophysiological conditions. Immunofluorescence, bright-field microscopic and biochemical studies conducted using live C2C12 cells showed that pre-incubation with other CNA analogues i.e. 2-methoxycinnamaldehyde (2MeCNA) and 2-benzyloxycinnamaldehyde (2BzCNA) not only maintained the normal morphology of myotubes but also protected them from H2O2-induced atrophy. These compounds (2MeCNA and 2BzCNA) showed higher stability and antioxidant potential, as indicated by computer simulation data analyzed by Density Functional Theory (DFT) based molecular modeling. Overall, the chemical, biological, and computational studies reveal the therapeutic potential of CNA analogues (BzCNA and MeCNA) against oxidative-stress induced muscle atrophy in C2C12 cells.
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Affiliation(s)
- Prachi Gupta
- Skeletal Muscle Laboratory, Institute of Integrated and Honors Studies, Kurukshetra University, Kurukshetra, Haryana 136119, India
| | - Nirmaljeet Kaur
- Skeletal Muscle Laboratory, Institute of Integrated and Honors Studies, Kurukshetra University, Kurukshetra, Haryana 136119, India
| | - Vinod Kumar
- Department of Chemistry, Central University, Mahendergarh, Haryana, India
| | - Amit Gupta
- Department of Chemistry, Dronacharya Government College, Gurugram, Haryana, India
| | - Sanjeev Gupta
- Skeletal Muscle Laboratory, Institute of Integrated and Honors Studies, Kurukshetra University, Kurukshetra, Haryana 136119, India
| | - Anita Dua
- Skeletal Muscle Laboratory, Institute of Integrated and Honors Studies, Kurukshetra University, Kurukshetra, Haryana 136119, India
| | - Elisha Injeti
- Department of Pharmaceutical Sciences, Cedarville University School of Pharmacy, Cedarville, OH, USA
| | - Ashwani Mittal
- Skeletal Muscle Laboratory, Institute of Integrated and Honors Studies, Kurukshetra University, Kurukshetra, Haryana 136119, India.
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Demir L, Oflazoğlu U. The relationship between sarcopenia and serum irisin and TNF-α levels in newly diagnosed cancer patients. Support Care Cancer 2023; 31:586. [PMID: 37728785 DOI: 10.1007/s00520-023-08041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Sarcopenia in patients with cancer makes patients physically weak and adversely affects their compliance with treatment. In this study, we investigated the relationship between sarcopenia in patients with cancer and circulating irisin and tumor necrosis factor-alpha (TNF-α) levels. MATERIAL AND METHOD A total of 141 patients with different types of newly diagnosed cancer were divided into two groups, sarcopenia (n = 72) and non-sarcopenia (n = 69) groups. The body compositions of the patients were measured using bioelectrical impedance (BIA) and muscle strength using hand grip strength (HGS) tests. Serum irisin and TNF-α levels were measured using an enzyme-linked immunosorbent assay. RESULTS In our study, serum irisin levels were found to be significantly lower (p < 0.01) and TNF-α levels were found to be significantly higher (p = 0.014) in the sarcopenia group. Skeletal muscle index (SMI) and HGS values and serum irisin levels were positively correlated [(r: 0.451, p < 0.001), (r: 0.469, p < 0.001)], and SMI and HGS values and serum TNF-α levels were negatively correlated [(r: -0.181, p = 0.032) and (r: -0.143, p = 0.090), respectively]. In addition, multiple linear regression analysis showed that serum irisin and TNF-α levels were independent predictors of sarcopenia. CONCLUSION Serum irisin levels were found to be significantly lower in patients with cancer with sarcopenia, and TNF-α levels were found to be significantly higher. These two markers can be used as potential biomarkers for the diagnosis of sarcopenia in patients with cancer. The efficacy and possible mechanisms of action of irisin and TNF-α in the diagnosis of sarcopenia should be investigated with larger patient groups.
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Affiliation(s)
- Leyla Demir
- Department of Medical Biochemistry, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Utku Oflazoğlu
- Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey
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Hatt J, Smart TF, Hardy EJ, Doleman B, Lund JN, Philips BE. The impact of low muscle mass on prognosis following neoadjuvant chemotherapy for resectable locally advanced rectal cancer: a systematic review and meta‐analysis. JCSM CLINICAL REPORTS 2023. [DOI: 10.1002/crt2.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Affiliation(s)
- Jacob Hatt
- Department of General Surgery Royal Derby Hospital Derby UK
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
| | - Thomas F.F. Smart
- Department of General Surgery Royal Derby Hospital Derby UK
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
| | - Edward J. Hardy
- Department of General Surgery Royal Derby Hospital Derby UK
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
| | - Brett Doleman
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
- Department of Anaesthetics Royal Derby Hospital Derby UK
| | - Jonathan N. Lund
- Department of General Surgery Royal Derby Hospital Derby UK
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
| | - Bethan E. Philips
- Centre Of Metabolism, Ageing and Physiology, School of Medicine University of Nottingham Derby UK
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre University of Nottingham Derby UK
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Kishimoto K, Hasegawa D, Uemura S, Nakamura S, Kozaki A, Saito A, Ishida T, Mori T, Kosaka Y. Association between muscle mass evaluated by computed tomography and the serum creatinine-cystatin C ratio in children with cancer: A cross-sectional study. Nutrition 2022; 99-100:111679. [DOI: 10.1016/j.nut.2022.111679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/04/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
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The relationship between sarcopenia detected in newly diagnosed colorectal cancer patients and FGF21, irisin and CRP levels. Eur Geriatr Med 2022; 13:795-803. [DOI: 10.1007/s41999-022-00635-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 12/21/2022]
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Karabulut S, Dogan I, Usul Afsar C, Karabulut M, Karaman S, Ferhatoglu F, Tastekin D. Does nutritional status affect treatment tolarability, response and survival in metastatic colorectal cancer patients? Results of a prospective multicenter study. J Oncol Pharm Pract 2020; 27:1357-1363. [PMID: 32957862 DOI: 10.1177/1078155220959427] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The efficacy and tolerability of modern cytotoxic chemotherapy regimens used in malnourished metastatic colorectal cancer (mCRC) patients is uncertain. The aim of this study was to investigate the effect of malnutrition on efficacy and tolerability of cytotoxic chemotherapy and overall survival in mCRC patients. METHODS In this multicenter study, demographic, oncologic and nutritional data were collected prospectively from mCRC patients. Nutritional status of the patients were evaluated on the basis of NRI (Nutritional Risk Assessment), BMI (Body Mass Index) and WL (Weight Loss) before the first chemotherapy, after the first and second chemotherapy during 2 cycles of chemotherapy every 15 days. To determine the inter-treatment weight loss toxicity assessment was included to theese parameters after each chemotherapy. NRI calculation was performed as [1.51xserum albumin level (g/L)+41.7xcurrent weight/basic weight]. NRIs were examined in 3 categories as 'no malnutrition' (NRI >97.5), 'moderate malnutrition' (97.5 ≥NRI ≥83.5) or 'severe malnutrition' (NRI <83.5). Response to treatment and drug-induced toxicities were assessed based on Criteria in Solid Tumors (RECIST) 1.1 and National Cancer Institute CTCAE version 4.0 respectively. RESULTS One-hundred and thirty-seven mCRC patients were prospectively included. Median age was 48 (range 18-83). Primary location was colon in 66% of patients and 84% of their primary source was left colon. Malnutrition was detected in 39% of the cases. Response rate to treatment was twenty four percent. While there was no significant relationship between chemotherapy response and moderate/severe malnutrition (p = 0.24), moderate/severe malnutrition was associated with multipl site of metastases, WHO PS (World Health Organization Performance Status) of 1, over the median value of CEA/CA 19-9 (carcinoembryonic antigen/carbohydate antigen 19-9) levels (p = 0.003, p = 0.03, p < 0.001, and p = 0.02; respectively). Hypoalbuminemia and moderate/severe malnutrition were associated with all types of toxicity (p < 0.001 and p < 0.001). Moderate/severe malnutrition was associated with thrombocytopenia, and diarrhea following chemotherapy predominately, (p = 0.02 and p = 0.04; respectively). In moderate/severe malnutrition group median overall survival was prominently shorter than those with no malnutrition [6.6 moths (95%CI, 5.6-7.6) vs 11.9 moths (95% CI, 11.1-12.7) respectively, p < 0.001]. CONCLUSIONS Our study showed that moderate/severe malnutrition in mCRC patients was associated with decreased overall survival and increased chemotherapy toxicity.
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Affiliation(s)
- Senem Karabulut
- Department of Medical Oncology, Institute of Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Izzet Dogan
- Department of Medical Oncology, Institute of Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Cigdem Usul Afsar
- Department of Internal Medicine and Medical Oncology, Research and Practice Hospital, Balıkesir University, Balıkesir, Turkey
| | - Mehmet Karabulut
- Department of General Surgery, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Sule Karaman
- Department of Radiation Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ferhat Ferhatoglu
- Department of Medical Oncology, Institute of Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Didem Tastekin
- Department of Medical Oncology, Institute of Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Oflazoglu U, Alacacioglu A, Varol U, Kucukzeybek Y, Salman T, Onal HT, Yilmaz HE, Yildiz Y, Taskaynatan H, Saray S, Butun O, Tarhan MO. The role of inflammation in adjuvant chemotherapy-induced sarcopenia (Izmir Oncology Group (IZOG) study). Support Care Cancer 2020; 28:3965-3977. [PMID: 32335732 DOI: 10.1007/s00520-020-05477-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/15/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Although the chemotherapy-induced sarcopenia has some explanatory presence in clinical practice, the mechanisms underlying this phenomenon have not been clearly distinguished in patients with cancer. Therefore, we aimed with this study to investigate the role of inflammation by examining the inflammatory markers in the physiopathology of adjuvant chemotherapy-induced sarcopenia in patients with gastrointestinal tract cancer. MATERIAL AND METHOD To detect the presence of sarcopenia, patients' body composition measurements were assessed using the BIA, and their muscular strength was assessed with a handgrip dynamometer in both pre- and post-adjuvant chemotherapy. At the same time, we examined the baseline and post-adjuvant chemotherapy anthropometric measurements and inflammatory markers in serum (Hs-CRP, IL8, and TNF-α). Patients were divided in three groups. Group 1 consisted of patients who presented post-treatment sarcopenia although they did not have it prior to the treatment, group 2 included the patients who had no pre- or post-treatment sarcopenia, and group 3 was comprised of patients who presented pre-treatment sarcopenia. Each group included 30 patients. RESULTS A total of 90 patients were included in the study. Fifty-one of them were female patients. Median age was 60.5 (range 27-83). The patients consisted of cases with colorectal and gastric cancers. In group 1, Wilcoxon signed-rank test revealed a significant difference between scores of IL-8 (pg/mL), TNF-α (pg/mL) and Hs-CRP (mg/dL) given for the post-chemotherapy compared with the pre-chemotherapy ((Z 3.61, p < 0.001), (Z 3.254, p = 0.001), (Z 3.319, p = 0.001)). The post-chemotherapy median scores of IL-8 (pg/mL), TNF-α (pg/mL), and Hs-CRP were 76.31, 7.34, and 1.55, respectively, which remained on the levels of 12.25, 1.6, and 0.51 for the pre-chemotherapy. For group 2, a Wilcoxon signed-rank test indicated no significant difference between scores of the same markers given for the post-chemotherapy compared with the pre-chemotherapy. In all patients (including groups 1, 2, and 3), a comparison of the patients with pre-treatment sarcopenia (n = 30) and non-sarcopenic patients (n = 60) in terms of baseline IL-8, TNF-α, and Hs-CRP mean levels, IL-8 and Hs-CRP were found to be statistically different (146.02 (SD 311.96) vs. 47.24 (SD 66.3) (p = 0.009), 3.91 (SD 4.26) vs. 0.75 (SD 1.08) (p < 0.001), respectively). CONCLUSIONS The present prospective observational study suggested an association of chemotherapy-induced sarcopenia with inflammatory markers Hs-CRP, IL8, and TNF-α. Inflammation may play a role in chemotherapy-induced sarcopenia in newly diagnosed non-metastatic patients.
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Affiliation(s)
- Utku Oflazoglu
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Ahmet Alacacioglu
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Umut Varol
- Department of Medical Oncology, Izmir Demokrasi University, Izmir, Turkey
| | - Yuksel Kucukzeybek
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Tarik Salman
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Hulya Tas Onal
- Department of Biochemistry, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Huriye Erbak Yilmaz
- Department of Biochemistry, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yasar Yildiz
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Halil Taskaynatan
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Seray Saray
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Osman Butun
- Department of Medical Oncology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - M Oktay Tarhan
- Department of Medical Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
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