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Guven DC, Yekeduz E, Erul E, Yazgan SC, Sahin TK, Karatas G, Aksoy S, Erman M, Yalcin S, Urun Y, Kilickap S. The benefit of treatment beyond progression with immune checkpoint inhibitors: a multi-center retrospective cohort study. J Cancer Res Clin Oncol 2023; 149:3599-3606. [PMID: 35960374 DOI: 10.1007/s00432-022-04268-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Treatment beyond progression (TBP) with immune checkpoint inhibitors (ICIs) is an evolving field due to the limitations of conventional imaging in response evaluation. However, real-life data on the benefit of TBP is scarce, especially from the limited resource settings and patients treated in the later lines. Therefore, we aimed to investigate the survival benefit of TBP with ICIs in patients with advanced tumors from a limited resource setting. METHODS For this multi-center retrospective cohort study, we included 282 patients treated with ICIs and had radiological progression according to RECIST 1.1 criteria. We evaluated post-progression survival according to the use of TBP (TBP and non-TBP groups) with univariate and multivariate analyses. RESULTS The cohort's median age was 61, and 84.4% were treated in the second or later lines. 82 (29.1%) of 282 patients continued on ICIs following the initial progression. In multivariate analyses, patients in the TBP group had improved post-progression survival compared to non-TBP (13.18 vs. 4.63 months, HR: 0.500, 95% CI: 0.349-0.717, p < 0.001). The benefit of the TBP was independent of the tumor type, treatment line, and age. Furthermore, TBP with ICIs remained associated with improved post-progression survival (HR: 0.600, 95% CI: 0.380-0.947, p = 0.028) after excluding the patients with no further treatment after progression in the non-TBP arm. CONCLUSIONS In this study, we observed that patients receiving ICIs beyond progression had considerably longer survival. Continuation of ICIs after progression should be considered a reasonable management option for patients with advanced cancer, specifically for patients with limited alternative options.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey.
| | - Emre Yekeduz
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Enes Erul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sati Coskun Yazgan
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokturk Karatas
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Saadettin Kilickap
- Faculty of Medicine, Istinye University, Istanbul, Turkey
- Medical Oncology Unit, Liv Hospital Ankara, Ankara, Turkey
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Gumussoy M, Koc O, Karatas G, Ozercan M, Ellik Z, Duman S, Kiremitci S, Gokcan H, Elhan AH, Savas B, Idilman R. Factors associated with the development of extrahepatic malignancy in patients with nonalcoholic fatty liver disease: a single-center longitudinal study. Eur J Gastroenterol Hepatol 2022; 34:1172-1177. [PMID: 36170687 DOI: 10.1097/meg.0000000000002448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS The aim of the present study was to determine incident cases of extrahepatic malignancy in patients with nonalcoholic fatty liver disease (NAFLD) and to identify whether the factors are associated with cancer development. METHODS Between 15 January 2001 and 14 March 2021, a total of 1365 patients had been diagnosed with NAFLD were enrolled in the study. RESULTS The median follow-up period was 59.5 months. The mean age was 50.9 ± 10.9 years. The female gender was predominant (57%). During the follow-up period, 62 extrahepatic malignancies and 11 hepatocellular carcinomas were identified. Of all extrahepatic malignancies, 51 were solid organ malignancies and 11 were hematological malignancies. Female breast cancer was the most frequent (25.8%), followed by thyroid cancer (19.4%), lymphoma (12.9%), and lung cancer (9.7%). In univariate and multivariable analyses, after adjusting for age and sex, the presence of diabetes and high initial baseline gamma glutamyl transpeptidase (GGT) levels were significantly associated with the development of extrahepatic malignancies [hazard ratio (HR) = 1.82, 95% confidence interval (CI): 1.04-3.20, P = 0.036] and HR = 1.96, 95% CI: 1.14-3.38, P = 0.015, respectively). In 424 biopsy-proven NAFLD patients, the development of extrahepatic cancer was significantly associated with the severity of hepatic fibrosis (HR = 3.31, 95% CI: 1.36-8.07; P = 0.008). CONCLUSION Extrahepatic malignancies are frequently seen in patients with NAFLD. Diabetes mellitus, high baseline GGT levels, and significant hepatic fibrosis are associated with the development of extrahepatic cancer in patients with NAFLD.
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Torgutalp M, Sahin Eroglu D, Sezer S, Yayla ME, Karatas G, Uslu Yurteri E, Turgay TM, Kinikli G, Ates A. Analysis of vascular involvement in 460 patients with Behçet's syndrome: Clinical characteristics and associated factors. Joint Bone Spine 2021; 89:105277. [PMID: 34536626 DOI: 10.1016/j.jbspin.2021.105277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe demographic and clinical characteristics of vascular involvement in patients with Behçet's syndrome (BS) and to evaluate associations with such involvement. METHODS We retrospectively evaluated records of 2118 BS patients. In total, 460 patients diagnosed with superficial thrombophlebitis (ST) and/or major vascular events (venous and/or arterial involvements) were included in current analysis. Isolated ST with no accompanying deep venous thrombosis might be accepted as part of skin involvement; therefore, we defined two different outcomes for vascular involvement ("any vascular event" and "major vascular events") and performed univariable and multivariable logistic regression to assess factors associated with these outcome variables. RESULTS Overall, 68 (14.8%) patients had isolated ST, and 392 (85.2%) had major vascular events. The mean age of vascular BS was 33.8 (SD: 10.5) years and median follow-up was 13.9 (Q1-Q3: 8.3-22.9) years. The primary sites of major vascular events were deep venous thrombosis (n=358, 77.8%), pulmonary arterial involvement (n=66, 14.3%), extrapulmonary arterial involvement (n=52, 11.3%), and intracardiac thrombosis (n=14, 3.0%), respectively. Male sex was significantly associated with a higher risk for both outcome variables. When it was added to analysis, ST itself was the strongest explanatory variable that was associated with major vascular events in all multivariable models (ORs=11.9, 12.0, 13.0, and 18.9). While HLA-B51 was significantly associated with any vascular event, there was no similar observation for major vascular events. CONCLUSION Male sex is a well-known risk factor for major vascular events in BS, but our study established that presence of ST was the strongest risk factor.
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Affiliation(s)
- Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Didem Sahin Eroglu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Serdar Sezer
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey; Clinic of Rheumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mucteba E Yayla
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey; Clinic of Rheumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gokturk Karatas
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emine Uslu Yurteri
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey; Clinic of Rheumatology, Hatay Training and Research Hospital, Hatay, Turkey
| | - Tahsin M Turgay
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gulay Kinikli
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Askin Ates
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
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Sadioglu RE, Karatas G, Memikoglu O, Kutlay S, Nergizoglu G, Ates K. An Unusual Association of Candida Guilliermondii and Mycobacterium Avium Complex in a Peritoneal Dialysis Patient with Refractory Peritonitis. Turk J Nephrol 2021. [DOI: 10.5152/turkjnephrol.2021.4543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Karatas G, Bal A, Yüceege M, Fırat I, Dulgeroglu D, Çakcı A, Ardıç S. SAT0110 Evaluation of Sleep Quality and the Effects of anti Tnf-Alpha Treatment on Sleep in Rheumatoid Arthritis Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Özkaya A, Alkin Z, Karatas G, Karakucuk Y, Perente I, Taylan Yazici A, Demirok A. Photoreceptor outer segment layer thickness measured manually on images from spectral domain optical coherence tomography in healthy volunteers. J Fr Ophtalmol 2014; 37:475-9. [PMID: 24810972 DOI: 10.1016/j.jfo.2013.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate photoreceptor outer segment layer thickness measured with a manual technique on images from spectral domain optical coherence tomography (OCT) in healthy volunteers. MATERIALS AND METHODS In 60 eyes of 30 healthy volunteers, a spectral domain OCT device (Spectralis, Heidelberg Engineering) was used to obtain cross-sectional images of the retina. For each volunteer, two images of each eye were obtained in one sitting. Images were digitally enlarged and the manual calipers feature of the device's software was used to measure, at the lowest point in the fovea, the thickness of the photoreceptor outer segment layer. All measurements were performed by the same investigator. Repeatability was evaluated with the Bland-Altman repeatability coefficient, and intersubject variability with Pearson's coefficient of variation. RESULTS The mean values of measurements across all the volunteers were as follows: right eye first image 38.1 micrometers, right eye second image 37.9 micrometers, left eye first image 37.9 micrometers, left eye second image 37.9 micrometers. The repeatability coefficient, i.e. the difference between repeated measurements which would be exceeded in only 5% of cases, was 1.6 micrometers. Coefficients of variation for the right eye were 3.4% for the first images and 3.4% for the second images, and for the left eye they were 3.2 and 4.0% respectively. CONCLUSION With a manual method based on spectral domain OCT, the thickness of the photoreceptor outer segment layer at the central fovea can be measured within a useful range of repeatability and appears to be relatively constant across healthy volunteers.
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Affiliation(s)
- A Özkaya
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey.
| | - Z Alkin
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey
| | - G Karatas
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey
| | - Y Karakucuk
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey
| | - I Perente
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey
| | - A Taylan Yazici
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey
| | - A Demirok
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey
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Abstract
OBJECTIVE The aim of this study was to evaluate the effect of hemiplegia on diaphragmatic movements using motion-mode ultrasonography. METHODS 23 hemiplegic patients who were diagnosed with a single-hemisphere lesion (mean age 60.5 years; 13 males and 10 females) and a control group of 20 patients (13 males and 7 females) were all evaluated by ultrasonography. Ultrasonography recordings were made of the amplitude of diaphragmatic movement during spontaneous and deep breathing. The patients underwent lung function tests. RESULTS When the hemiplegic and control groups were compared, the forced vital capacity, forced expired volume in 1 s, maximum inspiratory pressure and maximum expiratory pressure values were significantly lower in the groups with right and left hemiplegia (p<0.05). When a comparison was made between the right hemiplegic group and the control group and between the left hemiplegic group and the control group in terms of diaphragmatic excursions, for both groups, no significant difference was determined between the movements of the right hemidiaphragm during spontaneous and deep breathing and those of the left hemidiaphragm in spontaneous respiration. In contrast, for both hemiplegic groups, a significant decrease was noted in the movements of the left hemidiaphragm in deep respiration. CONCLUSION The diaphragm is both contralaterally innervated and ipsilaterally innervated, and innervation exhibits marked variations from person to person. This provides an explanation for varying diaphragmatic movements in hemiplegic cases during deep respiration.
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Affiliation(s)
- N Voyvoda
- Department of Radiology, Kocaeli Derince Education and Training Hospital, Kocaeli, Turkey.
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Tamam L, Karatas G, Ozpoyraz N. Comorbidity of adult attention deficit hyperactivity disorder in adult patients with bipolar disorder: prevalence and clinical correlates. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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