Real-world treatment outcomes from nationwide Onco-colon Turkey registry in RAS wild-type patients treated with biologics second-line mCRC

BACKGROUNDS AND OBJECTIVES

Colorectal cancer is one of the leading causes of mortality both globally and in our country. In Turkey, we conducted a multicenter investigation into the effectiveness of second-line treatments and real-life data for patients with RAS wild-type metastatic colorectal cancer (NCT04757311).

MATERIALS AND METHODS

In this retrospective analysis, records from 28 centers were collected, and histopathological, molecular, and clinical characteristics were documented. Patients were categorized into groups based on their second-line biological treatments: anti-EGFR (Group A and Group B, panitumumab and cetuximab) and anti-VEGF (Group C, bevacizumab and aflibercept). They were then compared within these groups.

RESULTS

A total of 588 patients with documented RAS wild-type status were evaluated. The median OS was 15.7, 14.3 and 14.7 months in Group A, Group B and Group C, respectively (p  =  0.764). The median PFS of the patients in second-line setting that received panitumumab, cetuximab and bevacizumab/aflibercept were 7.8, 6.6 and 7.4 months, respectively (p  =  0.848).

CONCLUSION

According to the results of our real-life data study, there is no significant difference in efficiency between the combination of biological agent and chemotherapy used in the second-line treatments.

Regorafenib therapy as a third-line treatment for metastatic colorectal cancer: A single center long term experience

This study examined the effects of regorafenib (Reg) on progression-free survival (PFS), overall survival (OS), and adverse events (AEs) in metastatic colorectal cancer (mCRC) patients who underwent targeted treatment and chemotherapy. Reg was administered as a third-line treatment to 84 patients who had undergone 2 rounds of chemotherapy and targeted therapy and subsequently experienced progression. Treatment was initiated with a daily dose of 80 or 120 mg, based on the patient's ability to tolerate the medication, which was increased to 160 mg/day. The median PFS with Reg was 4 ± 0.2 months, while the median OS was 9 ± 1.2 months. When compared to patients who started Reg treatment at 80 mg, patients starting at 160 mg had longer median PFS and OS (PFS:6 ± 2.1 months vs 4 ± 0.2 months; P = .05; OS:13 ± 0.7 months vs 6 ± 1.3 months; P = .069). Patients with right-sided colon cancer who received Reg as third-line therapy had a significantly longer mPFS than those with left-sided colon cancer (8 months ± 4 vs 4 months ± 0.3, P = .039). Patients with KRAS mutations had a prolonged mPFS than those with panRAS-wild type (6 ± 1.6 months vs 4 ± 0.3 months, P = .06). The mPFS contribution in the BRAF mutant subgroup with poor prognosis is promising, as it is similar to that of patients without BRAF mutations (4 months ± 0.8 × 4 months ± 0.5, P = .74). The most common AEs reported were elevated liver enzyme levels and dermatological toxicities.

Investigation of the relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions in unilateral breast cancer surgery survivors: a cross-sectional study

PURPOSE

Despite the research on structural and functional changes that may occur in breast cancer survivors, no study has investigated the relationship between spinal characteristics and the respiratory system. Therefore, we aimed to investigate the relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions in breast cancer patients who have completed their treatment METHODS: This cross-sectional study included 38 female breast cancer surgery survivors. Participants underwent the following evaluations: Chest wall mobility with a tapeline; postural assessments (spinal curvature, spinal mobility, and spinal inclination) with a non-invasive, computer-assisted electromechanical device; and pulmonary function test and respiratory muscle strength with a portable digital spirometer device. The relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions was analyzed by the bivariate correlation analysis.

RESULTS

Increased thoracic curvature angle was associated with decreased FEV1 (r=-0.360, p=0.026) and decreased subcostal mobility (r=-0.385, p=0.017), and the increase in thoracic frontal mobility was associated with decrease in PEF (r=-0.342, p=0.036). Increased lumbar mobility was associated with increased FVC (r=0.324, p=0.047), and increased total spinal inclination mobility was associated with decreased MIP (r=-0.396, p=0.017). Chest wall mobility was associated with postural assessments at varying rates (the r value ranged from -0.357 to 0.661, p<0.05).

CONCLUSION

The changes in spinal posture and mobility of women who have undergone unilateral breast cancer surgery were associated with respiratory parameters and thoracic cage mobility. These patients' spinal posture and mobility should be taken into account in conjunction with respiratory functions for a comprehensive assessment.

The prognostic role of epidermal growth factor receptor mutation in completely resected ampullary adenocarcinoma

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 found 27 patients as pancreatobiliary type and 56 patients as intestinal type adenocarcinoma. The median survival of patients with intestinal and pancreatobiliary type adenocarcinoma was 23 months and 76 months ( p = 0.201), respectively. When the survival of PD1-positive ( n = 23) and PD-L1-positive ( n = 18) patients were 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 intestinal type tumours and one in a pancreatobiliary type tumour. A significant difference was determined in terms of overall survival for the patients with EGFR mutations compared to those without ( p = 0.008). In conclusion, we could reveal the prognostic significance of EGFR mutation, which is also a target molecule.

The effectiveness and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early-stage human epidermal growth factor receptor 2-positive breast cancer: Turkish Oncology Group study

In our study, we aimed to evaluate the pathological response rates and side effect profile of adding pertuzumab to the treatment of HER2+ locally advanced, inflammatory, or early-stage breast cancer. This study was conducted by the Turkish Oncology Group (TOG) with data collected from 32 centers. Our study was multicentric, and a total of 364 patients were included. The median age of the patients was 49 years (18-85 years). Two hundred fifteen (60%) of the cases were hormone receptor/HER2+ positive(ER+ or PR+, or both), and 149 (40%) of them were HER2-rich (ER and PR negative). The number of complete responses was 124 (54%) in the docetaxel+trastuzumab+pertuzumab arm and 102 (45%) in the paclitaxel+trastuzumab+pertuzumab arm, and there was no difference between the groups in terms of complete response. In 226 (62%) patients with complete response, a significant correlation was found with DCIS, tumor focality, removed lymph node, and ER status P < 0.05. Anemia, nausea, vomiting, myalgia, alopecia, and mucosal inflammation were significantly higher in the docetaxel arm, P < 0.05. In our study, no statistical difference was found between the before-after echocardiography values. DCIS positivity in biopsy before neoadjuvant chemotherapy, tumor focality; the number of lymph nodes removed and ER status were found to be associated with pCR. In conclusion, we think that studies evaluating pCR-related clinicopathological variables and radiological imaging features will play a critical role in the development of nonsurgical treatment approaches.

Real-world treatment outcomes from nationwide Onco-colon Turkey registry in RAS wi̇ld-type patients treated with biologics second-line mCRC

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Background: Varieties of systemic treatments in second-line treatment for metastatic colorectal cancer (mCRC) patients have showed an improvement on survival. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. Therefore, we aimed to investigate second-line treatment selection in patients with RAS-wild type mCRC. Methods: Medical records from 28 centers were collected for patients diagnosed with RAS wild-type and were included into the study. Histopathological, molecular and clinical characteristics of the patients were recorded. The treatment duration, response rate, progression-free survival and safety results were determined. Patients were compared according to the second-line biological treatments as anti-EGFR group (Group A and B; panitumumab and cetuximab) and anti-VEGF group (group C; bevacizumab or aflibercept). Results: A total of 1064 patients with documented RAS wild-type status were evaluated. Fifty-six percent of all first line patients were treated with regimen including biologics received second line treatment. Median age was 60 years. 34,7 percent of the patients were female. Nineteen percent of the patients had a right-sided colon tumor. 16,3 %, 22,5% and 61,2 % of all second-line patients were treated with regimen including panitumumab, cetuximab and anti-VEGF, respectively. Patients received median 5 (1-21) cycles of treatment. Also, responded patients received median 4 (1-23) cycles of treatment as maintenance treatment with biologics plus fluoropyrimidine. Overall response rate was 28,5 % for all patients. Disease control rate also was 70,6 %. The median OS was 15,7, 14,3, and 14,7 months in A, B and C group respectively (p = 0.764). The median PFS of the patients in second-line setting that received panitumumab, cetuximab and bevacizumab/ aflibercept were 7,8, 6,6 and 7,4 months respectively (p = 0.848). There was not found as independent prognostic factors in multivariate analysis. Conclusions: According to the results of our real-life data study, there is no significant difference in efficacy between the combinations of biological agent and chemotherapy used in the second-line treatments. Therefore, the results of the first-line treatment become important and the use of the most effective agent at this setting also increases survival.

Real-world treatment outcomes from nationwide ONCO-colon Turkey registry in RAS wi̇ld-type patients treated with biologics first-line metastatic colorectal cancer

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Background: Efficacy of anti-angiogenic and anti-EGFR agents has been demonstrated metastatic colorectal cancer (mCRC). Real-world evidence is especially important to detect the findings of patients outside of clinical trials. It complements together with clinical trials. However, there are a few studies that evaluated these treatments with biologics in the real-world setting. Recognizing the change that has occurred over the years will also shed light on future approaches. Therefore, we aimed to investigate the real-world data of patients with RAS-wild type mCRC. Methods: Medical records from 28 centers were collected for patients diagnosed with RAS wild-type mCRC between January 2016 and April 2019 and were included into the study. Histopathological, molecular and clinical characteristics of the patients were recorded. The treatment duration, response rate, progression-free survival and safety results were determined. Also, changes over the years were compared. Patients were compared according to the first-line biological treatments as anti-EGFR group (Group A and B) (panitumumab and cetuximab) and anti-VEGF group (group C). Results: Patients with KRAS mutant type were 43,6% and 6.1% patients were NRAS mutant type. A total of 1064 patients with documented RAS wild-type status were evaluated. 33%, 37% and 30% of all first line patients were treated with regimen including panitumumab, cetuximab and anti-VEGF, respectively. The median follow-up time was 24 (1-59) months. Median age was 61 (17-88) years. Thirty-five percent of the patients were female. Twenty percent of the patients had a right-sided colon tumor. Patients received median 6 cycles of treatment. Also, responded patients received median 6 cycles of treatment as maintenance treatment with biologics plus fluoropyrimidine. Overall response rate was 46,4%, 41,9% and 41,5% in A, B and C group respectively (p = 0,170). The median OS was 26, 27, and 23 months in A, B and C group respectively (p = 0.044). The median PFS of the patients in first-line setting that received panitumumab, cetuximab and bevacizumab were 11.6 (SE:0,6; 95% CI: 10.4-12.7), 11.0 (SE:0,5; 95% CI: 9.9-12.0), and 9.6 (SE:0,4; 95% CI: 8.8-10.4) months respectively (p = 0.012). In univariate analysis, female gender (p = 0.030), left sided tumors(p = 0.001), ECOG performance status (PS) 0-1 (p = 0.001), normal CEA level at initial diagnosis(p = 0.001) and treatment with anti-EGFR agents(p = 0.016) were found as favorable factors. PS 0-1 and normal CEA level at initial diagnosis were found as independent prognostic factors in multivariate analysis (p = 0.049, p = 0.031 respectively). Conclusions: This analysis of real-world data confirms the comparable efficacy of anti-EGFR agents in RAS-wild type mCRC. However, anti-EGFR treatment provides PFS and OS advantage when compared with anti-VEGF treatment in these patients.

Prognostic value of De Ritis ratio (aspartate transaminase/alanine transaminase) in patients with non-metastatic colorectal carcinoma [izmir oncology group(IZOG) study]

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Background: We aimed to assess the prognostic effect of preoperative De Ritis (aspartate aminotransaminase/Alanine aminotransaminase) ratio and pathological variables to find out whether it is an independent prognostic factor in patients with non-metastatic CRC. Methods: We retrospectively evaluated the patients who underwent curative surgery for non-metastatic CRC between 2006 and 2017. The potential prognostic value of De Ritis ratio was assessed by using a ROC curve analysis. The effect of the De Ritis ratio was analyzed by the Kaplan–Meier method and Cox regression hazard models for patients’ disease-free survival (DFS) and overall survival (OS). Results: We had 921 CRC patients in total. The univariate analysis demonstrated that low De-Ritis ratio and several well-established prognostic factors, including well-differentiated tumor,negative lymph node involvement, lymphatic invasion, perineural invasion and surgical margin, left tumor localization and early-stage tumor were good prognostic factors in terms of DFS and OS. On the multivariate analysis, De-Ritis ratio, lymph node involvement, perineural invasion status, surgical margin statusand tumor localization were independent prognostic factors for DFS [ De-Ritis ratio HR 0.468, 95% CI 0.358-0.613,p < 0.001]. We also found that De-Ritis ratio, degree of differentiation, lymphatic invasion status, perineural invasion statusand stage were independent prognostic factors for OS on multivariate analysis [ De-Ritis ratio HR 0.354, 95% CI 0.407-0.702, p < 0.001]. Conclusions: Our study first established a connection between the preoperative De-Ritis ratio and patients undergoing curative resection for non-metastatic colorectal cancer, suggesting that De-Ritis ratio was a simple, inexpensive, and easily measurable marker as a prognostic factor and may help to identify high-risk patients for treatment decisions.

The role of inflammation in adjuvant chemotherapy-induced sarcopenia (Izmir Oncology Group (IZOG) study)

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.

An analysis of adjuvant treatment strategies in operated pancreatic cancer patients: An Izmir oncology group study

BACKGROUND

Adjuvant treatment is necessary in pancreatic cancer patients, but the optimal approach is not clear yet. Our aim was to explore the effectiveness of adjuvant treatment modalities in patients with operated pancreatic cancer.

METHODS

There were five groups of patients operated for primary pancreas adenocarcinoma. The first two groups included patients who were treated with only adjuvant chemotherapy or radiotherapy. The patients in third group had received combination chemotherapy and radiotherapy either sequentially or concomitantly. The fourth group was composed of patients who were treated with adjuvant chemotherapy after concurrent chemoradiotherapy, whereas the patients in the fifth group were only observed after surgery without any adjuvant treatment.

RESULTS

There were 83 operated pancreatic cancer patients available for analysis. Median age of the patients was 63 years (range, 40-82 years). There were 55 patients who had local disease recurrence (n = 14) or metastasis (n = 41) during or after adjuvant treatment. The median overall survival for all patients was 14 months. When we compared the median survival of patients who had any adjuvant treatment with the patients treated without any adjuvant therapy, we found a significant statistical difference between the groups (32.4 vs 6.5 months; P = 0.000). In addition, survival of each treatment group was also compared with each other but we did not find any significant statistical difference.

CONCLUSIONS

Our result suggests that any adjuvant therapy in the treatment of pancreatic cancer patients is important. However, we could not find any superiority between adjuvant treatment modalities.

Preliminary study of serum Galectin-1 in breast cancer carcinogenesis [Izmir Oncology Group (IZOG) study]

PURPOSE

Galectin-1 is a lectin involved in the carcinogenesis of many cancers. In the present study, we aimed to investigate the importance of galectin-1 in breast cancer carcinogenesis and its relationship with tumor development.

METHODS

Patients who were diagnosed with new breast cancer and a healthy volunteer population were included in the study. Preoperative and postoperative (1 month following visit at the medical oncology outpatient clinic) serum samples were collected from breast cancer patients and the healthy volunteer control group.

RESULTS

There was no statistically significant difference between patients' age, height, weight and body mass index (BMI) (p>0.05). The mean galectin-1 value of the preoperative group was 2.16±0.69 ng/ml, in the postoperative group; 1.75±0.31 ng/ml, and the healthy control group 1.64±0.40 ng/ml. A comparison of mean galectin-1 values between the groups showed that the highest galectin-1 level was found in the preoperative patients. When the mean serum galectin-1 levels of preoperative and postoperative patients were compared, a statistically significant difference was found between the two groups (p<0.001). Furthermore, a comparison of the control group and preoperative patients also revealed a statistically significant difference between the groups (p<0.001). When the control group and postoperative patients were compared, no statistically significant difference was found between them (p=0.16).

CONCLUSION

Serum galectin-1 levels were higher in breast cancer patients than in the healthy control group. In addition, postoperative galectin-1 levels of breast cancer patients tended to decrease. This suggests that serum galectin-1 levels are important in breast carcinogenesis and positively correlated with the presence of tumors.

Prognostic role of De Ritis and basal neutrophil to lymphocyte ratio in patients with advanced stage pancreatic cancer [Izmir Oncology Group (IZOG) Study]

PURPOSE

We aimed to investigate the prognostic significance of neutrophil/lymphocyte ratio (NLR), an indirect indicator for the immune response and AST/ALT ratio (De Ritis), liver enzymes that are commonly used in various clinical fields, in patients with advanced-stage pancreatic cancer.

METHODS

NLR and De Ritis of the patients with diagnosis of locally advanced and metastatic pancreatic cancer between the 2010-2017 were evaluated retrospectively. All patients were divided into two groups as high and low according to NLR and De Ritis cut-off values which were 2.4 and 0.75, respectively.

RESULTS

A total of 191 patients were evaluated. The mean overall survival (OS) in patients with NLR<2.4 at the time of diagnosis was 10±0.8 months, while it was 4±0.49 months in patients with NLR>2.4 (p<0.0001). The mean OS of the patients with a De Ritis <0.75 was 8±1.2 months, whereas the survival of those with De Ritis >0.75 was 6±0.74 months (p=0.024). The mean progression free survival (PFS) in patients with NLR<2.4 and De Ritis <0.75 at diagnosis were 5±0.76 months and 6±0.87 months respectively, whilst it was 3±0.37 months in patients with NLR>2.4 (p=0.017) and 4±0.3 months in patients with De Ritis >0.75 (p=0.14).

CONCLUSIONS

The NLR and De Ritis are associated with prognosis in many cancers and have been found to be associated with survival outcome in advanced-stage pancreatic cancer patients.

Is the platelet-to-lymphocyte ratio a new prognostic marker in multiple myeloma?

BACKGROUND

Recent reports showed neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as a predictor of progression-free survival (PFS) and overall survival (OS) in various malignancies.

MATERIALS AND METHODS

We retrospectively examined the PLR, NLR, and MLR in a cohort of 186 newly diagnosed multiple myeloma (MM) patients. This study investigated the prognostic relevance of NLR, PLR, and MLR in MM patients. NLR, PLR, and MLR were calculated from whole blood counts before therapy. The Kaplan-Meier curves and multivariate Cox models were used for the evaluation of survival.

RESULTS

Applying cutoff of 1.9 (NLR), 120.00 (PLR), and 0.27 (MLR), decreased PLR showed a negative impact on the outcome. Decreased PLR is an independent predictor for PFS and OS. There were no significant differences in median survival between the high and low NLR (P = 0.80) and MLR (P = 0.87) groups.

CONCLUSIONS

In this study, thrombocytopenia and low PLR are associated with poor survival in MM patients does this P value apply to thrombocytopenia or low PLR and may serve as the cost-effective prognostic biomarker.

Cancer-Related Stigma and Depression in Cancer Patients in A Middle-Income Country

Objective:

The aim of the current study are to determine the depression levels of adult oncology patients in the cancer treatment phase and identify both cancer-related stigma and the factors affecting their depression levels.

Methods:

In this correlational study, 303 adult patients who had been treated at a medical outpatient clinic were surveyed using the convenience sampling method. The “questionnaire for measuring attitudes toward cancer – patient version,” a sociodemographic characteristics questionnaire, and the beck depression inventory were used. A multivariable linear regression model was used for the analysis.

Results:

The questionnaire and its subscale scores indicated a positive relationship between depression and attitudes toward cancer. The predictive variables for depression were “being younger than 40-year-old” and “feelings of social exclusion,” which accounted for 4% of the total variance. Four factors indicating negative attitudes toward cancer were “being more than 60-year-old,” “higher education,” “low income,” and “feelings of social exclusion,” which accounted for 11% of the total variance.

Conclusions:

Cancer-related stigma, which underlies patients' emotional and behavioral outlooks, should be reduced in cancer patients. Members of health teams should be sensitive to cancer-related stigma.

High expression of mesothelin in advanced serous ovarian cancer is associated with poor prognosis

PURPOSE

Mesothelin is a cell surface glycoprotein which is highly expressed in various types of epithelial cancers. Its expression level is associated with poor prognosis in many cancer types. The aim this study was to evaluate the association of the level of mesothelin expression with clinicopathological characteristics and its prognostic significance in patients with advanced serous ovarian cancer (SOC).

METHODS

Tissue blocks from a total 42 patients with advanced SOC treated at the medical oncology clinic of Izmir Katip Celebi University Ataturk Training and Research Hospital between 2006 and 2013 were evaluated. Immunohistochemical staining for mesothelin was performed. Clinical characteristics, optimal or suboptimal operation, response to platinum-based chemotherapy, and overall survival (OS) were analyzed.

RESULTS

The cut-off value of 45 for mesothelin H-score determined by ROC analysis predicted survival with 86% sensitivity and 75% specificity (p=0.020). We found a notable negative correlation between mesothelin H-score and OS (r = -0.570, p=0.0001). The median OS was 67 months (95%CI, 36.114 to 97.886) in the low-staining mesothelin H-score group and 27 months (95%CI, 22.238 to 31.762) in the high-staining mesothelin H-score group (p=0.002). Univariate analysis showed that the clinical stage IV disease (p=0.023), platinum chemoresistance (p=0.001), higher mesothelin H-score (p=0.002), and suboptimal surgery (p=0.024) were associated with worse OS. In the multivariate Cox regression model, mesothelin H-score (B=1.15, 95%CI=1.016 to 9.850, p=0.047) and the status of platinum sensitivity (B=-.916, 95%CI=.185 to -.864, p=0.020 were statistically significant predictors for OS.

CONCLUSION

These results indicated that high mesothelin H-scores were significantly associated with poor prognosis in patients with advanced SOC.

Prevalence and related factors of sarcopenia in newly diagnosed cancer patients

INTRODUCTION

Sarcopenia is defined as the loss of muscle mass and muscular functioning. Although sarcopenia prevalence is highly variable in the literature, pre-chemotherapy sarcopenia prevalence was not well studied in newly diagnosed cancer patients. In this context, the present study aims to determine the prevalence of sarcopenia and its related factors in this population.

MATERIAL AND METHODS

Prospectively, newly diagnosed cancer patients were evaluated for body composition measurement and muscle strength by employing the bioelectric impedance analysis method and handgrip dynamometer tool.

RESULTS

A total of 461 patients were included in the study. The median age of patients was 59 years (range 18-83) and 258 patients (56%) were women. Sarcopenia was present in 77 patients (16.7%) and was at significantly higher frequencies in men (p = 0.015), advanced age (≥ 65 years, p = 0.014), lower body mass index (BMI < 25, p = < 0.001), and poor performance status (ECOG status > 0, p = 0.026). In multivariate analyses, advanced age (over 65 years), gender (men), and lower body mass index (BMI < 25) were significantly associated with sarcopenia (p values 0.033, < 0.001, and < 0.001, respectively).

CONCLUSIONS

Our study is the first prevalence study conducted with bioelectric impedance analysis on Turkish cancer patients and sarcopenia was detected to be notably prevalent among our patients with newly diagnosed cancer. Given the likely negative outcomes of sarcopenia reported in the literature (treatment failure, increased complications, and impaired survival), it is important to know the presence of sarcopenia before treatment and take preventive precautions.

Is Monitoring Mean Platelet Volume Necessary in Breast Cancer Patients?

Background

Mean platelet volume (MPV) is a parameter that increases during thrombotic and cardiovascular events. Tamoxifen (Tmx) and aromatase inhibitors (AIs), which are adjuvant endocrine therapies, may cause serious side effects, such as vascular thrombosis. The present study investigated the changes in MPV values of breast cancer patients receiving long-term adjuvant hormone therapy and the relationship of MPV with adverse effects of hormonotherapy.

Methods

Data of 261 patients who had pathologically confirmed estrogen or progesterone receptor positive invasive breast cancer and had received hormonotherapy for at least a 5-year period were retrospectively analyzed. MPV levels were measured at baseline and at the first and fifth year of hormone therapy.

Results

All patients were females and their median age was 50 years (range, 27–78 years). The mean MPV value was significantly increased in all patients in the Tmx, AI, and switch groups over time (p<0.001).

Conclusion

This is the first study evaluating the relationship between the 5-year adjuvant endocrine therapy and changes in MPV values in breast cancer patients. Monitoring changes in MPV values may be predictive for severe side effects in breast cancer patients receiving hormone therapy.

Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes

PURPOSE

In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients.

METHODS

This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers.

RESULTS

Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure.

CONCLUSIONS

Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.

Is adjuvant chemotherapy necessary for Luminal A-like breast cancer?

PURPOSE

Patients with breast cancer with Luminal-A subtype have a better prognosis but poor chemotherapy response. Chemotherapy is controversial in lymph node-positive patients with Luminal-A subtype. In this retrospective study, we aimed to evaluate the efficacy and benefit of chemotherapy in the Luminal A-like subtype of breast cancer.

METHODS

Patients diagnosed with breast cancer within 2006 and 2011 were retrospectively evaluated. Patients with pathologically confirmed Luminal A-like breast cancer were analyzed , and were divided in those receiving taxane-based adjuvant chemotherapy and those who did not.

RESULTS

A total of 136 patients with Luminal-A type were included in the study. The 10-year cumulative disease-free survival (DFS) was 85.6 vs 96.7% (p=0.230) for the chemotherapy and non-chemotherapy groups, and overall survival (OS) was 88.6 vs 100%, respectively (p=0.242). The 10-year cumulative DFS was 80 vs 98.1% for the taxane-based chemotherapy group and taxane-free chemotherapy group (p=0.501), while the OS was 87.5 vs 95.2%, respectively (p=0.391). There was a positive correlation between relapse status and lymph node involvement in the multivariate analysis (p=0.031).

CONCLUSION

Adjuvant chemotherapy in Luminal-A showed no significant difference for DFS and OS. Taxane-based chemotherapy did not demonstrate any benefit for OS and DFS with relatively more advanced stage and lymph node involvement. We believe that adjuvant chemotherapy plays a minor role in a significant proportion of Luminal-A subtype of breast cancer.

BRCA genes: BRCA 1 and BRCA 2

BRCA1 and BRCA2 are the genes related with breast and ovarian cancer. They have function in DNA repair processes and thus they are tumor suppressor genes. There are hundreds of mutations identified in these genes. Functional deficiencies due to these mutations impair DNA repair and cause irregularities in the DNA synthesis. The standard method for the laboratory assessment of these BRCA genes includes comprehensive sequencing and testing of broad genomic rearrangements. Members of the families with BRCA mutations have an increased risk for early onset of breast cancer and ovarian cancer occurring at any age. Surveillance of patients with mutations in BRCA 1/2 is done by yearly mammography and breast MRI and by transvaginal ultrasonography and serum CA-125 levels every 6-12 months for ovarian cancer.

The alterations of serum FGF-21 levels, metabolic and body composition in early breast cancer patients receiving adjuvant endocrine therapy

BACKGROUND

In early breast cancer patients, the effects of hormonal therapy (tamoxifen and aromatase inhibitors) on plasma fibroblast growth factor 21 (FGF-21), lipid levels and body composition have not yet been investigated. Therefore, we aimed to analyze the relationship between FGF-21 and body composition as well as the effects of tamoxifen and aromatase inhibitors on plasma lipid levels, FGF-21, and body composition.

METHODS

A total of 72 patients were treated with either tamoxifen or aromatase inhibitors due to their menopausal status after adjuvant radiotherapy. Each patient was followed-up over a period of 1 year. Changes in body composition and serum lipid profile, glucose and FGF-21 levels were evaluated. We recorded the type of hormonal therapy, body mass index, waist-to-hip ratio, lipid profile, and FGF-21 levels both at the beginning and after 12 months.

RESULTS

There was a statistically significant decrease in serum FGF-21 levels after 12 months of adjuvant endocrine therapy (46 ± 19.21 pg/ml vs. 30.99 ± 13.81 pg/ml, p< 0.001). Total body water (p< 0.001), serum glucose (p= 0.036) and triglyceride levels (p< 0.001) also exhibited a significant decrease. The decreases in total cholesterol and low-density lipoprotein were not statistically significant. Likewise, high-density lipoprotein increased after adjuvant endocrine therapy, although it did not reach statistical significance. The changes in body composition, glucose, lipid profile and FGF-21 were similar in tamoxifen and aromatase inhibitor groups. A positive correlation was found between basal weight, fat mass, fat-free mass and serum FGF-21 levels; however, the correlation was maintained only for the fat-free mass at the 12th month.

CONCLUSION

As part of the present study, we suggest that both tamoxifen and aromatase inhibitors can reduce FGF-21 levels independently of body compositions, and these drugs can provide antihyperlipidemic, antidiabetic and cardio-protective effects. We also recommend that serum FGF-21 level can be utilized as a tumor biomarker in early-stage breast cancer and for monitoring purposes. FGF-21 levels may help physicians estimate prognosis, too. Further studies with larger populations may shed light on the role of FGF-21 in breast cancer.

Breast Metastasis of Anaplastic Oligodendroglioma: A Case Report

Extracranial metastasis of primary brain tumors is rarely observed. Of all brain malignancies, glioblastomas, medulloblastomas and astrocytomas metastasize most frequently. Metastasis of oligondendroglioma is rare. We present a case of breast metastasis in a 58-year-old man with an anaplastic oligodendroglioma.

The prognostic significance of cyclin D1 expression in patients with triple-negative breast cancer

PURPOSE

Breast cancer (BC) is the most common cancer and the second leading cause of cancer death among women. While receptor-targeted therapies are used for other subtypes due to the presence of such receptors, studies are still continuing on receptor expression in order to identify new therapeutic targets as the triple-negative breast cancer (TNBC) lacks a target receptor and its prognosis is worse than the other subtypes. Cyclin D1 (CycD1) is a cell cycle regulator protein. It is stated that its overexpression plays a role in carcinogenesis. With the present study, we aimed to evaluate the prognostic significance of immunohistochemical expression of CycD1 in patients with TNBC.

METHODS

The study included 56 operated patients with TNBC who were diagnosed between 2006 and 2011 at Izmir Katip Celebi University, Ataturk Research and Training Hospital, Department of Pathology. In tumor paraffin-embedded sections, CycD1 was immunohistochemically (IHC) studied. Demographic and survival data of the patients were obtained from the Department of Medical Oncology follow-up files. ROC curve analysis was used to calculate the cutoff value for CycD1 staining density. Patients were divided into two groups using 11.5 cutoff value for the expression of CycD1, obtained by ROC analysis. Kaplan-Meier analysis was utilized for survival analyses, and log rank test for comparisons between the two groups.

RESULTS

Of the patients, 62.5% had CycD1 expression (37.5% had not). In the whole group, the 5-year disease-free survival (DFS) was 51%, and the 5-year overall survival (OS) was 65%. No difference in DFS between the two groups was noticed (p=0.37). The 5-year DFS was 47% in the group with CycD1 expression below 11.5, while it was 57% in the group above the 11.5 value. The difference in OS between the groups was statistically significant (p=0.044). The 5-year OS was 55% in the group with a CycD1 expression below 11.5, while it was 79% in the group above the 11.5 value (p=0.044).

CONCLUSION

OS differed significantly between the high and low-CycD1 expression. It was also demonstrated that CycD1 may have prognostic significance in TNBC. Further studies with larger populations are required to confirm the prognostic significance of CycD1.

Leptin, insulin and body composition changes during adjuvant taxane based chemotherapy in patients with breast cancer, preliminary study

BACKGROUND

The objectives of the present study were to compare the effect of adjuvant chemotherapy for breast cancer on serum insulin levels, serum leptin levels, and body composition in early stage breast cancer patients.

MATERIALS AND METHODS

17 breast cancer patients underwent 6 cycles of docetaxel (75 mg), epirubicine (100 mg) and cyclophosphamide (500 mg) (TEC). Anthropometrical and foot-to-foot body fat analyzer BIA, serum glucose, insulin, lipids, HOMA-IR and leptin were compared pre- and post-treatment.

RESULTS

There was no statistically significant weight gain after treatment; however, there was an overall trend toward weight gain (69.7 ± 9.8 kg vs 71.03 ± 9.8; P= 0.05). From baseline to the end of the study, percentage of body fat and body fat mass showed an upward trend at the end of chemotherapy (1%; 2 kg P> 0.05). Pre and post-treatment period, leptin was strongly correlated with insulin and HOMA-IR (Spearman's pre-T; r = 0.74; P <0.001, r = 0.66; P = 0.004 post-T; r = 0.549; P =0.022, r = 0.51; P =0.036, respectively). Insulin levels were significantly increased in the post-treatment period (P < 0.05). On correlation analysis, post-T insulin levels were correlated with leptin, weight, fat-mass and fat percentage (Spearman's r = 0.549; P=.022, r = 0.567; P= 0.018, r = 0.498, P= 0.042, r = 0.502; P= 0.040, respectively).

DISCUSSION

High insulin and leptin levels, important factors that were previously shown to be related to breast cancer outcome, and insulin resistance may be increased in taxane based chemotherapy regimen. These data may have broad implications for diet and lifestyle strategies for the prevention and treatment of cancers.

Prognostic value of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with epithelial ovarian cancer

PURPOSE

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently been evaluated in many cancers in prediction of survival outcomes. The purpose of this study was to investigate the impact of NLR and PLR on the prognosis of patients with epithelial ovarian cancer (EOC).

MATERIALS AND METHODS

A total of 208 patients with EOC were included in the study. Hematological parameters and clinicopathological data during diagnosis were retrospectively evaluated. The cut-off values were determined by calculating receiver operating characteristic (ROC) curve analysis of the patients.

RESULTS

The median over-all survival (OS) of patients with low NLR was 69 months (95% CI, 43.0-94.9) whereas high NLR was 36 months (95% CI, 29.1-42.8). The median OS with low PLR patients was 76 months (95% CI, 46.4-105.5) and high PLR was 35 months (95% CI, 28.5-41.4). In serous tumors (70.7%), the median OS with low NLR and high NLR was 54 months (95% CI, 27.9-80.0) and 34 months (95% CI, 28.2-39.7), and for the median OS with low PLR and high PLR it was 51 months (95% CI, 2 1.2-80.7) and 35 months (95% CI, 27.8-42.1), respectively.

CONCLUSION

The present findings showed that the high NLR and high PLR were associated with poor prognosis and these values are significantly remarkable in EOC patients.

Reliability and Validity Study of a Tool to Measure Cancer Stigma: Patient Version

Objective:

The aim of this methodological study is to establish the validity and reliability of the Turkish version of “A Questionnaire for Measuring Attitudes toward Cancer (Cancer Stigma) - Patient version.”

Methods:

The sample comprised oncology patients who had active cancer treatment. The construct validity was assessed using the confirmatory and exploratory factor analysis.

Results:

The mean age of the participants was 54.9±12.3 years. In the confirmatory factor analysis, fit values were determined as comparative fit index = 0.93, goodness of fit index = 0.91, normed-fit index=0.91, and root mean square error of approximation RMSEA = 0.09 (P <0.05) (Kaiser–Meyer–Olkin = 0.88, χ² = 1084.41, Df = 66, and Barletta's test P <0.000). The first factor was “impossibility of recovery and experience of social discrimination” and the second factor was “stereotypes of cancer patients.” The two-factor structure accounted for 56.74% of the variance. The Cronbach's alpha value was determined as 0.88 for the two-factor scale.

Conclusions:

“A questionnaire for measuring attitudes toward cancer (cancer stigma) - Patient version” is a reliable and valid questionnaire to assess stigmatization of cancer in cancer patients.

Serum apelin levels and body composition changes in breast cancer patients treated with an aromatase inhibitor

PURPOSE

The adipose tissue plays a role in carcinogenesis with the adipokines it generates. Apelin is an anti-obesigenic adipokine, and assumes roles in both vascularization and tumor cell proliferation. The present study aimed to investigate changes in apelin levels, in postmenopausal breast cancer (BC) patients receiving aromatase inhibitors (AIs).

METHODS

Forty early-stage postmenopausal BC patients treated with AIs with no history of chemotherapy administration were included in the study. At the beginning, we measured serum apelin levels in postmenopausal BC patients who were receiving AIs and healthy women of similar age and normal body mass index (BMI) (control group). We evaluated changes in the body composition, serum lipid profile and serum apelin levels at the beginning and the 12th month through anthropometric measurements and bioelectric impedance analysis.

RESULTS

Forty subjects with postmenopausal BC had a median age of 57 years (range 44-82)). BC patients exhibited significantly higher apelin levels and body mass index (BMI) scores compared to the control group (p=0.0001, p=0.0001, respectively). The 12th month's measurements indicated reduced apelin levels in 24 patients (60%) and increased apelin levels in 16 patients (40%) compared to the initial figures. With respect to the parameters, the patients with reduced apelin levels had significantly different waist-to-hip ratio (WHR) and fat mass scores compared to those with higher apelin levels (p=0.008, p=0.047, respectively).

CONCLUSION

This study showed that postmenopausal BC patients had high levels of apelin and high BMI scores. This finding suggests that apelin promoted carcinogenesis particularly in obese individuals. The massive and metabolic changes observed in the fat tissues of the postmenopausal BC patients receiving AIs will especially affect the BC-associated outcome.

Increased Concentration of Soluble CD40 Ligand in Preeclampsia

Preeclampsia has been associated with increased platelet activation detected before disease onset. Platelets are involved in hemostasis and also directly initiate an inflammatory response of the vessel wall. Inappropriate activation of platelets may be involved in pathogenesis in preeclampsia by promoting coagulation and thrombosis, and also as a mediator of inflammation. Platelets may release inflammatory mediators such as soluble CD40 ligand. The plasma level of soluble CD40 ligand was investigated during preeclamptic (n =20) and normal pregnancies (n = 20) to emphasize inflammatory response in preeclampsia. The mean soluble CD40 ligand levels were 1.08 ± 0.43 ng/mL in patients with preeclampsia and 0.76 ± 0.24 ng/mL in healthy pregnant women, which was statistically significant ( P = .01). To clarify whether inflammation may cause inappropriate endothelial cell activation or inappropriate endothelial cell activation may start this inflammatory response, future studies are needed in a larger study population.

Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Patients with Neuroendocrine Tumors: An Izmir Oncology Group Study

BACKGROUND

Several studies evaluating the prognostic factors of gastrointestinal and pancreatic neuroendocrine tumors (GEP-NETs) have been published. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been accepted as prognostic factors for cancer patients.

MATERIALS AND METHODS

This study included 132 patients diagnosed with GEP-NETs. Peripheral blood samples were collected before the pretreatment period.

RESULTS

NLR and PLR were increased as the grade increased in NETs. The embryonic origin analysis revealed higher NLR and PLR rates in NETs of foregut origin. NLR and PLR were also higher in pancreatic NET patients compared to the gastroenteric NET patients. Analysis of NETs by TNM indicated that an advanced stage was accompanied by significantly higher NLR and PLR. We found a strong negative correlation between progression-free survival and NLR and PLR.

CONCLUSION

The study verified that NLR and PLR are simple laboratory findings that can be used to identify NETs with a worse outcome.

Thrombin activatable fibrinolysis inhibitor, tissue factor pathway inhibitor, and prothrombin fragment 1+2 levels in patients with advanced colorectal cancer

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Background: Thromboembolism is common in cancer patients.Thrombin activatable fibrinolysis inhibitor (TAFI), tissue factor pathway inhibitor (TFPI) and prothrombin fragment 1+2 (F1+2) are newly identified molecules involved in coagulation and fibrinolysis. The aim of this study was to investigate the relationship between clinicopathologic characteristics and TAFI, TFPI and F1+2 levels in patients with advanced colorectal cancer. Methods: Eighty-two patients (32 metastatic, 50 locally advanced disease) diagnosed with colorectal cancer in the medical oncology clinic, without history of thromboembolism, had not undergone an intervention, and not on medication affecting coagulation were included in the study. Serum TAFI, TFPI, and prothrombin F1+2 levels were evaluated via enzyme-linked immunosorbent assay. Clinicopathologic characteristics of the patients were investigated retrospectively from the medical records of the patients. Results: The plasma TAFI, TFPI, and prothrombin F1+2 levels were high in 70, 71, and 96% of the patients, respectively. Prothrombin F1+2 levels were higher among patients with lower performance scores. TFPI levels were higher among patients with tumor grades of 2 and 3. TAFI levels were higher among rectal cancer cases. Conclusions: There is an association between tumor grade and coagulation cascade. The higher prothrombin F1+2 levels, an indicator of active coagulation cascade, among patients with low performance scores may indicate that the coagulation cascade of these patients is more active. Higher TAFI levels among rectal cancer patients may be related to the natural course of the disease

Evaluation of c-kit (CD 117) expression as a prognostic factor in testicular germ cell tumors: An Izmir Oncology Group (IZOG) study

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Background: Little progress has been made in the management of testicular germ cell tumors (TGCTs). c-kit (CD 117) is a good target for cancer treatment and possesses an impressive role in the current oncological practice. We aimed to evaluate c-kit expression in early stage TGCTs as a prognostic factor. Methods: Patients with TGCTs who were referred to the Medical Oncology Clinic were included in our study before starting chemotherapy. Immunohistochemistry was performed on formalin-fixed and paraffinembedded three-micrometer thick sections with CD 117 Rabbit Anti c-kit in vitro gene kit. Biochemically, we utilized AFP and β-HCG Immunlite 2000 device with solid phase chemiluminescent immunometric method, and LDH Roche models with the DP-standardized UV method. AFP 0-15 ng/ml, β-HCG < 0.1 mlu/ml and LDH 240-480 mg/dl were considered as normal values. Results: Sixty-five patients were included in our study. Forty-one (63%) patients had nonseminoma tumors (NSGCTs) and 24 (37%) had seminoma. Statistically significant c-kit expression was found in patients with seminoma (p<0.0001). There was no difference between negative or positive c-kit expression in terms of clinicopathological characteristics, including preoperative serum levels of AFP, β-HCG, LDH, lymph node involvement, distant metastasis, and IGCCCG risk classification. No correlation was found between these parameters and 5-year progression free survival (PFS) rate except for tumor stage, presence of lymph node metastasis and IGCCCG score (p=0.001, p=0.04, and p=0.0001, respectively). Five-year PFS rate of patients with positive CD 117 was 72.2% (95% CI, 54.6-89.8), and6.6% (95% CI, 31.2-82.1) for those without CD 117 expression involvement (p=0.12). Conclusions: So far, there has been no significant breakthrough in the treatment of cisplatinrefractory TGCTs in the era of targeted therapies. No prognostic importance of c-kit expression has been found in our study. However, we believe that c-kit expression, in numerical terms, can be considered as a good prognostic factor for patients with TGCTs. The fact that all seminoma cases displayed positive c-kit expression is what we think has driven this result.

The Effects of Adjuvant Endocrine Treatment on Serum Leptin, Serum Adiponectin and Body Composition in Patients with Breast Cancer: The Izmir Oncology Group (IZOG) Study

Background: A limited number of studies have been conducted on the effects of hormonal therapy with tamoxifen (TMX) or aromatase inhibitors (AIs) on plasma levels of leptin and adiponectin, as well as body composition in breast cancer (BC) patients. Therefore, we aimed to analyze the relationship between adipocytokines and body composition as well as the effects of TMX and AIs on plasma adiponectin, leptin, leptin/adiponectin ratio (LAR) and body composition. Methods: Patients were treated with either TMX or AI according to their menopausal status after adjuvant radiotherapy. Changes in body composition and serum leptin and adiponectin levels were evaluated. We recorded the type of hormonal therapy, BMI, waist/hip ratio (WHR), leptin and adiponectin levels at study entry, and after 6 and 12 months. Results: From baseline to the 6- and 12-month follow-ups, there were statistically significant increases in WHR (p = 0.003), fat mass (p = 0.041), and serum leptin (p < 0.001) and adiponectin levels (p < 0.001). The changes in body composition and serum leptin and adiponectin levels were similar in TMX and AI groups. A statistically significant decrease was found in total body water and LAR (p < 0.001). Although weight and body fat percentage increased, such increases were not statistically significant. A positive correlation was found between baseline BMI and serum leptin levels. This correlation was maintained at 6 and 12 months. The negative correlation found between serum adiponectin levels at baseline and baseline BMI did not last throughout the study. Conclusion: In this study, increased leptin and adiponectin levels and a decreased LAR were found in both AI and TMX groups. These changes might have occurred through both mechanisms of hormonal therapy and body composition changes. Therefore, AIs and TMX may exert their protective effects for BC patients by decreasing LAR rather than affecting leptin or adiponectin alone.

Depression, anxiety and sexual satisfaction in breast cancer patients and their partners-Izmir oncology group study

BACKGROUND

We aimed to investigate anxiety, depression and sexual satisfaction levels and the effects of depression and anxiety upon the sexual satisfaction of Turkish breast cancer patients and their partners.

MATERIALS AND METHODS

Data were collected from one hundred breast cancer patients and their partners, using three forms: one covering information about socio-demographic characteristics of the patients, the Hospital Anxiety and Depression Scale (HADs) and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

RESULTS

The frequencies, avoidance and touch subscores were statistically significantly high in the patients. Among those with high anxiety scores, the frequency, communication, satisfaction, touch, and anorgasmic subscale scores of GRISS were found to be significantly high. Among the partners whose anxiety scores were high, only the premature ejaculation subscale was statistically significant. It was determined that for partners with higher depression scores, the communication, satisfaction, avoidance, premature ejaculation and erectile dysfunction subscores of GRISS were statistically higher compared to partners with lower depression scores.

CONCLUSIONS

Patients' quality of life may be increased by taking precautions to reduce their and their partners' psychosocial and psychosexual concerns.

Hormone receptor, HER2/NEU and EGFR expression in ovarian carcinoma--is here a prognostic phenotype?

PURPOSE

We aimed to evaluate the effects of hormone receptor, HER2, and epidermal growth factor receptor (EGFR) expression on epithelial ovarian cancer (EOC) prognosis and investigate whether or not phenotypic subtypes might exist.

MATERIALS AND METHODS

The medical records of 82 patients who were diagnosed with EOC between 2003 and 2012 and treated by platinum-based chemotherapy were retrospectively evaluated. Expression of EGFR, oestrogen (ER), progesterone (PR), and cerbB2 (HER2) receptors were assessed immunohistochemically on paraffin-embedded tissues of these patients. Three phenotypic subtypes were defined according to ER, PR, and HER2 expression and associations of these with EGFR expression, clinicopathologic features, platinum sensitivity, and survival were investigated.

RESULTS

When we classified EOC patients into three subtypes, 63.4% had hormone receptor positive (HR(+)) (considering breast cancer subtypes, luminal A), 18.3% had triple negative, and 18.3% had HER2(+) disease. EGFR positivity was observed in 37 patients (45.1%) and was significantly more frequent with advanced disease (p=0.013). However, no significant association with other clinicopathologic features and platinum sensitivity was observed. HER2(+) patients had significantly poorer outcomes than HER2(-) counterparts (triple negative and HR positive patients) (p=0.019). Multivariate analysis demonstrated that the strongest risk factor for death was residual disease after primary surgery.

CONCLUSIONS

Triple negative EOC may not be an aggressive phenotype as in breast cancer. The HER2 positive EOC has more aggressive behaviour compared to triple negative and HR(+) phenotypes. EGFR expression is more frequent in advanced tumours, but is not related with poorer outcome. Additional ovarian cancer molecular subtyping using gene expression analysis may provide more reliable data.

Evaluation of c-kit (CD 117) expression as a prognostic factor in testicular germ cell tumors: an Izmir Oncology Group (IZOG) study

PURPOSE

Despite the successful use of targeted and molecular therapies in other cancers, little progress has been made in the management of testicular germ cell tumors (TGCTs). c-kit (CD 117) is a good target for cancer treatment and possesses an impressive role in the current oncological practice. We aimed to evaluate c-kit expression in early stage TGCTs as a prognostic factor.

METHODS

Patients with TGCTs who were referred to the Medical Oncology Clinic and underwent curative surgical operation were included in our study before starting chemo- therapy. Immunohistochemistry was performed on formalin-fixed and paraffin-embedded three-micrometer thick sections with CD 117 Rabbit Anti c-kit in vitro gene kit. Biochemically, we utilized AFP and β-HCG Immunlite 2000 device with solid phase chemiluminescent immunometric method, and LDH Roche models with the DP-standardized UV method. AFP 0-15 ng/ml, β-HCG < 0.1 mlu/ml and LDH 240-480 mg/dl were considered as normal values.

RESULTS

Sixty-five patients were included in our study. Forty-one (63%) patients had non-seminoma tumors (NSGCTs) and 24 (37%) had seminoma. Statistically significant c-kit expression was found in patients with seminoma (p<0.0001). There was no difference between negative or positive c-kit expression in terms of clinicopathological characteristics, including preoperative serum levels of AFP, β-HCG, LDH, lymph node involvement, distant metastasis, and IGCCCG risk classification. No correlation was found between these parameters and 5-year progression free survival (PFS) rate except for tumor stage, presence of lymph node metastasis and IGCCCG score (p=0.001, p=0.04, and p=0.0001, respectively). Five-year PFS rate of patients with positive CD 117 was 72.2% (95% CI, 54.6-89.8), and 56.6% (95% CI, 31.2-82.1) for those without CD 117 expression involvement (p=0.12).

CONCLUSION

So far, there has been no significant breakthrough in the treatment of cisplatin-refractory TGCTs in the era of targeted therapies. No prognostic importance of c-kit expression has been found in our study. However, we believe that c-kit expression, in numerical terms, can be considered as a good prognostic factor for patients with TGCTs. The fact that all seminoma cases displayed positive c-kit expression is what we think has driven this result.

Quality of life in colorectal cancer patients: an Izmir Oncology Group (IZOG) study

PURPOSE

To investigate the variables of quality of life (QoL) among Turkish patients with colorectal cancer (CRC).

METHODS

In this prospective study we investigated the QoL of Turkish CRC patients. Two hundred and twenty two patients with CRC were included. The sociodemographic form and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were used.

RESULTS

The study group consisted of 142 males (64%) and 80 females (36%). The mean patient age was 55.68±11.387 years. The majority of the patients (36.9%) had local disease while advanced-stage disease and locally advanced stage disease had 32.2% and 28.8% of the patients; respectively. The mean QoL score was moderate (62.81± 27.0). The most common complaints were fatigue, economic difficulties and constipation. Gender, education level and disease stage were associated with QoL. Physical, role and social functioning were more adversely affected in female patients. Compared to women, men had significantly more favorable global QoL (p=0.044). Some functional scales were worse in advanced disease compared to other stages.These outcomes were statistically significant in the functional scales of global health (p=0.007), physical (p=0.03), cognitive (p=0.01) and emotional function (p=0.007). Patients with advanced disease had worse outcomes in some symptoms (nausea, vomiting, dyspnea, loss of appetite and financial distress).

CONCLUSIONS

Female gender and advanced disease were strongly associated with poorer QoL among Turkish CRC patients.