The impact of Ki-67 index, squamous differentiation, and several clinicopathologic parameters on the recurrence of low and intermediate-risk endometrial cancer

Endometrial endometrioid carcinoma (EEC) represents approximately 75-80% of endometrial carcinoma cases. Three hundred and thirty-six patients with EEC followed-up in the authors’ medical center between 2010 and 2018 were included in our study. Two hundred and seventy-two low and intermediate EEC patients were identified using the European Society for Medical Oncology criteria and confirmed by histopathological examination. Recurrence was reported in 17 of these patients. The study group consisted of patients with relapse. A control group of 51 patients was formed at a ratio of 3:1 according to age, stage, and grade, similar to that in the study group. Of the 17 patients with recurrent disease, 13 patients (76.5%) were Stage 1A, and 4 patients (23.5%) were Stage 1B. No significant difference was found in age, stage, and grade between the case and control groups (p > 0.05). Body mass index, parity, tumor size, lower uterine segment involvement, SqD, and Ki-67 index with p<0.25 in the univariate logistic regression analysis were included in the multivariate analysis. Ki-67 was statistically significant in multivariate analysis (p = 0.018); however, there was no statistical significance in SqD and other parameters. Our data suggest that the Ki-67 index rather than SqD needs to be assessed for recurrence in patients with low- and intermediate-risk EEC

Retrospective analysis of the effect of arteriovenous fistula on graft functions in kdney transplant recipients

Günümüzde başarılı bir böbrek nakli sonrası bir arteriyovenöz (A-V) fistülün açık kalmasının gerekliliği konusunda tartışma devam etmektedir. Bu retrospektif çalışmada böbrek nakli alıcılarında nakil sonrası A-V fistüllerin durumunun, klinik sonuçlarının ve graft fonksiyonu üzerine etkisinin incelenmesi amaçlanmıştır. Çalışmaya merkezimizde böbrek nakli yapılan 247 hasta dâhil edildi. Hastalar nonAVF ve AVF olarak 2 gruba ayrıldı. Sonra A-V fistül olan hastalar 3 alt gruba ayrıldı: Nakil sonrası fistülü kendiliğinden kapananlar (AVFs), açık kalanlar (AVFp) ve cerrahi olarak kapatılanlar (AVFc). Gruplarda hastaların özellikleri karşılaştırıldı. AVF grubundaki hastaların yaşları nonAVF grubundakilerden daha yüksekti. A-V fistül olan 40 hastada fistül nakil sonrası cerrahi olarak kapatılmıştı. Fistül 14 hastada kardiyak yakınmalar, 8 hastada kolda ödem ve 6 hastada enfeksiyon nedeniyle kapatıldı. AVFs ve AVFc gruplarının ortanca nakil süreleri, AVFp grubuna göre daha yüksekti. AVFs grubunda hipertansiyon görülme sıklığı AVFp grubuna göre daha yüksekti. Nakil sonrası A-V fistül ile ilişkili en sık görülen semptomlar efor dispnesi, taşikardi ve hipertansiyondu. En sık görülen bulgular ise tril, A-V kol periferik nabız palpasyonu ve pulzasyon idi. AVFp ve AVFc gruplarındaki ortanca akım hızları, AVFs grubuna göre daha yüksekti. AVFc grubunda sol ventrikül hipertrofisi oranı, AVFs grubuna göre daha yüksekti. AVFs grubunda hipertansiyon görülme sıklığı AVFp grubuna göre daha yüksekti. Hemoglobin düzeyi AVF grubunda daha yüksek bulundu. AVFs grubunda proteinüri varlığı, AVFp grubuna göre daha yüksekti. Hem AVF ve nonAVF grupları arasında hem de nakil sonrası A-V fistülü açık olan 3 grupta son izlemdeki serum kreatinin ve GFH ölçümleri arasında fark bulunamadı. AVF ve nonAVF gruplarında diyalize dönen ve ölen alıcı oranları benzerdi. Sonuç olarak, A-V fistül varlığının graft fonksiyonu üzerine olumsuz bir etkisi olmadığını gözlemledik.Nowadays, there is still a debate about the necessity of an arteriovenous (A-V) fistula to remain open after a successful kidney transplant. The aim of this retrospective study was to evaluate the effects of A-V fistulas on the clinical outcome and graft function in transplant recipients. A total of 247 patients underwent kidney transplantation in our center were included in the study. The patients were divided into two groups as nonAVF and AVF. The patients with A-V fistula were then subdivided into three subgroups: Subjects with fistula closed spontaneously (AVFs), remained open (AVFp) and closed surgically (AVFc) after transplantation. The characteristics of the patients were compared. The age of the patients in the AVF group was higher than in the nonAVF group. In 40 patients with A-V fistula, the fistula was surgically closed after transplantation. Fistula was closed due to cardiac complaints in 14 patients, edema in 8 patients and infection in 6 patients. The median transplant durations of the AVFs and AVFc groups were higher than those of the AVFp group. The frequency of hypertension in the AVFs group was higher than in the AVF group. The most common symptoms associated with A-V fistula were exercise dyspnea, tachycardia and hypertension after transplantation. The most common findings were thrill, peripheral pulse palpation in A-V fistula arm and pulsation. The median flow rates in the AVFp and AVFc groups were higher than in the AVFs group. The rate of left ventricular hypertrophy in the AVFc group was higher than in the AVFs group. The incidence of hypertension in the AVFs group was higher than in the AVF group. The hemoglobin level was higher in the AVF group. The presence of proteinuria in the AVFs group v was higher than in the AVF group. There were no significant differences in serum creatinine and GFR measurements between the AVF and non-AVF groups and between the three groups with open A-V fistula. Dialysis and mortality rates were similar in nonAVF and AVF groups. In conclusion, we did not observe a negative effect of A-V fistula presence on graft function

Early thrombocytopenia predicts longer time‑to‑treatment discontinuation in trastuzumab emtansine treatment

Thrombocytopenia is a characteristic adverse event of trastuzumab emtansine (T‑DM1), one of the essen‑ tial treatment options for human epithelial growth factor receptor 2 (HER2)‑positive breast cancer. The present study investigated the predictive value of thrombocytopenia for time‑to‑treatment discontinuation (TTD) in patients receiving T‑DM1 for advanced‑stage HER2‑positive breast cancer. The present observational study enrolled 138 patients who received T‑DM1 at six oncology centers from January 2016 to December 2021. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting TTD. The median age of patients was 50 years (range, 26‑83). The median number of T‑DM1 cycles was 9 (range, 2‑58), the overall response rate was 50.0% and the disease control rate was 69.6%. At a median follow‑up time of 19.3 months, the median TTD was 9.5 months [95% confidence interval (CI), 7.3‑11.7], and the median overall survival was 28.2 months (95% CI, 19.2‑37.2). Thrombocytopenia during treatment was observed in 39% of all patients, and 66.7% of these patients experienced early thrombocytopenia (in the first four treatment cycles). Multivariate analysis revealed that the independent factors for TTD were hormone receptor status [hazard ratio (HR), 1.837; 95% CI, 1.249‑2.701; P=0.002], Eastern Cooperative Oncology Group performance status score (HR, 3.269; 95% CI, 1.788‑5.976; P<0.001) and thrombocytopenia during treatment (HR, 0.297; 95% CI, 0.198‑0.446; P<0.001). Patients with early thrombocytopenia had a significantly longer TTD of 17.3 months (95% CI, 11.8‑22.8) compared with 7.6 months (95% CI, 5.8‑9.4) for patients without early thrombocytopenia (P<0.001). The results of the present study indicated that patients with early thrombocytopenia had improved survival outcomes compared with those without. Thus, maximum benefit from T‑DM1 treatment may be achieved by confirming the predictive role of thrombocytopenia in T‑DM1 treatment in prospective studies and large‑scale cohorts