Predictive factor for lymph node metastasis in non-metastatic colorectal adenocarcinomas

Objectives: To evaluate the predictive factors of lymph node involvement in non-metastatic colorectal adenocarcinomas (nmCRC). Methods: A total of 453 patients diagnosed with nmCRC were analyzed regarding T stage, lymphovascular invasion status, tumor grade and proposed risk score (RS), determined by the combination of these three factors for lymph node metastasis. Results: The median age was 62 (25-90 years), M/F ratio was 1.4:1 and majority of the patients had tumors localized on the left colon (70.6%). The number of excised lymph nodes was ≥12 in 77% of the cases. The postoperative pathological assessments revealed that 57.2% of patie,nts had N0 disease, 29.1% had N1 disease, and 13.7% had N2 disease. The T stages (p=0.007), grade (p<0.001), lymphovascular invasion (p=0.002), RS (p<0.001), and number of excised lymph nodes (p=0.029) were significantly different between N0, N1, and N2 patients. Higher RS was associated with lymph node metastasis (p<0.001). Conclusion: The risk score may predict lymph node metastasis in patients with nmCRC and if validated may be helpful in the decision-making of adjuvant chemotherapy, especially in the elderly and patients with inadequate lymph node dissection

Energy securıty: Regıonal energy centre Turkey

Gelişmekte olan Türkiye ürettiği enerjiden daha fazlasını ithal eden ülkeler arasında bulunmaktadır. Türkiye enerji ihtiyacının büyük bir kısmını dışarıdan sağlamasına rağmen, dünya enerji nakil hatlarının önemli bir kısmına sahiptir. Bu durum Türkiye’yi enerji savaşlarının merkezinde önemli bir aktör kılmaktadır. Günümüzde komşu ülkelerde yaşanan kaotik ortam ve Türkiye’nin terörle vermiş olduğu mücadele, Türkiye’yi terör örgütlerinin hedefi haline getirmektedir. Bu durum Türkiye’den geçmekte olan enerji nakil hatlarının güvenliği için büyük bir risk oluşturmaktadır. Özellikle terör örgütlerinin kırsal ve şehirlerde başarısız olmaları, terör saldırıları açısından daha kolay hedef konumunda bulunan petrol ve doğalgaz nakil hatlarını hedef almaktadırlar. Terör örgütleri enerji nakil hatlarına yapmış oldukları saldırılarda, birinci olarak ses getirmek ikinci olarak da Türkiye’nin enerji nakil hatları konusunda rekabet halinde oldukları ülkelere avantaj sağlamak için gerçekleştirmektedirler. Böylece son yıllarda mevcut ve halen yapımı devam eden enerji nakil hatlarına yüzlerce sabotaj ve saldırı gerçekleştirildiği bilinmektedir. Genel olarak enerji güvenliği konusunda iki farklı yaklaşım bulunmaktadır. Bunlardan birincisi enerjiye, ikincisi de güvenliğe ağırlık vermektedir. Enerji güvenliğinin enerji ağırlıklı tanımı enerji kaynaklarının bulunabilirliği, erişilebilirliği ve kabul edilebilirliği hususlarını kapsamaktadır. Enerji güvenliğinin güvenlik açısından tanımı ise enerji arama, geliştirme, üretim, iletim, çevrim, dağılım, pazarlama ve tüketim ağındaki tesislerin her türlü saldırıya karşı fiziki olarak korunması anlamını içermektedir (Ediger, 2007). Bu çalışmada; enerji güvenliğ kavramının özellikle güvenlik kısmı ele alınmıştır. Türkiye’nin enerji güvenlik politikaları ve enerji güvenliğine yönelik fiziki saldırılar, petrol ve doğal gaz nakil hatlarının literatür incelemesi yapılmıştır. Türkiye’nin sahip olduğu enerji nakil hatları ve bölgedeki jeopolitik konumu, analiz yapabilmek adına ortaya konularak konu hakkında öneriler sunulmuştur.Although Turkey consumes a higher amount of energy than it manufactures, it targets to be a new energy centre in its region. The key of being energy centre lies at the safe transit of the energy resources of other countries. Turkey sets the best example in this regard. Turkey has a more important position than ever since it is located at key location for the transit of gas and oil in the game of pipelines passing through other destinations. While Iran, Iraq and Azerbaijan supply only to Turkey, Turkey distributes oil and gas to far away countries. The most important factor is security at this point. Pipelines in Turkey which cost millions of dollars are subject to numerous illegal acts including terrorist actions and oil theft. In recent years, debates over the emerging energy deficit throughout the world have given priority to this issue. There is need for international cooperation with neighbouring countries and reforms in the current security concept in our country in order to solve this security problem. A Turkey which has active and international connections in the region will be highly useful in terms of the security of pipelines. At this point, energy lines in Turkey and security of these lines are brought to agenda. This research focuses on the steps to be taken with respect to security as well as solution suggestions by emphasizing the security of energy lines within the framework of the studies included in the literature and relevant research

A revıew of the renewable energy resources ın the energy productıon of Turkey

Küreselleşmeyle birlikte son zamanlarda sanayi alanında gelişmelerin yaşanması, teknolojinin ilerlemesi nüfusun artması gibi birçok sebep enerji kaynaklarının kullanımını hızla arttırmaktadır. Sınırlı olarak bulunan fosil yakıtlarının gelecek dönemlerde yetersiz olacağı bilinmektedir. Aynı zamanda dünya ülkelerinin bu yakıtları ele geçirme isteği gün geçtikçe artmaktadır. Bunun için Enerji geçmişten günümüze her toplumun önemli sorunlarından birini oluşturmaktadır. Ayrıca enerji kaynaklarının bilinçsizce kullanılması ve mevcut kaynakların hızla tükenmesi sonucu insanlar farklı enerji kaynağı arayışına girmektedir. Hali hazırda kullanılan fosil yakıtların ömrünün azalması aynı zamanda çevreye ve insan sağlığına olumsuz etkisi ülkelerin yenilenebilir enerji kaynaklarına yönelmesine sebep olmaktadır. Güneş, jeotermal, rüzgar, biyokütle, dalga enerjisi gibi yenilenebilir enerji kaynakları son dönemlerde ülkeler tarafından tercih edilen alternatif enerji kaynaklarıdır. Bu çalışmada hem dünyanın hem de Türkiye’ nin enerji kaynaklarını tüketme payları incelenmekte ve buna bağlı olarak alternatif enerji kaynaklarının gerekliliği üzerinde durulmaktadır. Aynı zamanda Türkiye’ de yenilenebilir enerji kaynaklarının mevcut kapasiteleri ve potansiyelleri üzerine bir değerlendirme yapılmaktadır.Due to numerous reasons such as the emergence of developments in the industrial fields seen recently along with globalization, the rapid improvement of technology and the increase in the population; the use of energy resources increases rapidly. It is known that the limited fossil fuels will become insufficient in the near future. At the same time, the desire of the countries in the world to capture those fuels is gradually increasing day by day. For that reason, energy has been one of the important problems for all the societies. Moreover, human beings are in the search of different resources of energy due to insensibly consumption of the energy resources and gradual depletion of the current resources. The decrease in the economic life of the currently used fossil fuels and their negative effects on environment human health caused countries head for the renewable energy resources. The renewable energy resources such as sun, geo-thermal, wind, bio-mass, and wave energy are the alternative energy resources preferred by the countries in recent years. In this study, the shares of both the world and Turkey for consuming the energy resources are analyzed and accordingly, the necessity of alternative energy resources is discussed. In the same time, the current capacity of renewable energy resources in Turkey and their potential are assessed

Long-term outcome and safety in patients treated with immune checkpoint blockade therapies for urothelial carcinoma: Experience from real-world clinical practice

Background: Anti-tumor activity and manageable safety profile of immune checkpoint blockade therapies (ICT) have been demonstrated in previous clinical trials in patients with metastatic urothelial carcinoma. To the best of our knowledge, very limited real-life data is available with the long follow-up time that confirms the durable antitumor activity and safety of ICT. In this study, we reported the real-life results of 56 months follow-up data of urothelial carcinoma patients who were treated with ICT. Methods: Metastatic urothelial carcinoma patients treated with at least one course of ICT included in the study. The primary endpoint was the overall response rate (ORR); secondary endpoints were overall survival (OS), progression-free survival (PFS), duration of the ICT treatment, and safety. Median follow-up, PFS, and OS were estimated by using the Kaplan-Meier method. Results: Data of 185 eligible patients were analyzed, 11.9% of these patients received the ICT as the first line, 76.8 % as the second line, and 11.3 % as the third or more line of treatment. The median age of the patients was 66 years, and 156 (84.3%) were male (37-86). The majority of patients (93.5%) had ECOG PS scores of 0–1 and primary tumor in the bladder was predominant (86.7%). The median follow-up time was 47(1.15-56) months. The complete response rate to ICT, partial response rate, and ORR were 10.3% (n = 19), 19.5% (n = 36), and 29.8% (n = 55), respectively. The median duration of response was 33.1 months (95% CI, 16.5–49.7). Of the fifty-five patients who responded to treatment, 28 (51%) had an ongoing response at the time of the analysis. Median PFS and OS was 3.8 (2.6–5.1) months and 8.9 (6.8–11.1) months, respectively. 56-month PFS and OS rate was 9.2% and 11.4%, respectively. 56-month PFS and OS rate for CR and PR was 56.2% and 20%, respectively. Fifty-nine percent of patients experienced a treatment-related adverse event of any grade, and 32 (17.3%) of patients had a grade 3–4 treatment-related adverse event. Because of treatment-related side effects, treatment was discontinued in 8 (4.3%) patients and adverse event that required systemic steroid use was reported in only 13 (7%) patients. Four patients (2.2%) died due to treatment-related causes. Conclusions: This 56-month analysis of real-world data confirms the durable response and long-term survival with ICT in metastatic urothelial carcinoma patients. The safety profile was consistent with prior reports, and no new safety signals emerged

Systemic Immune-Inflammation Index as a Prognostic Marker of Late Recurrence in Operable Gastric Cancer: a Dual-Center Study

Aim To evaluate the prognostic role of the systemic immune-inflammation index (SII) in patients with operable gastric cancer. Methods We assessed 354 patients with operable gastric cancer from tertiary centers in Turkey. SII was calculated by following formula: [neutrophil (cells x 10(9)/L) x platelet (cells x 10(9)/L)]/lymphocyte (cells x 10(9)/L). The best cut-off value for SII was determined by using "receiver operating characteristics (ROC)" analysis. We used log-rank and Cox-regression analysis for survival analyses. Results One hundred twenty patients were in the late recurrence group (recurrences have developed 36 months after the surgery). SII was not a prognostic factor in the early recurrence group. However, relapse-free survival (RFS) was longer in SII-low patients than SII-high patients in the late recurrence group. In multivariable analysis, SII was the only independent prognostic factor for RFS in the late recurrence group (hazard ratio (HR): 5.42, 95% CI: 1.18-24.82, p = 0.03). Conclusion SII was an independent prognostic factor for RFS in GC patients with late recurrence. Late recurrence risk was higher in SII-high patients than SII-low patients. Inflammation contributes to tumor progression, invasion, and metastasis. Prolonged exposure to chronic inflammation could explain the results of this study

Comparison of objective response rate and long-term overall survival in patients with treated immune checkpoint inhibitors in metastatic urothelial carcinoma.

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Five-year outcome and safety in patients treated with immune checkpoint blockade therapies for urothelial carcinoma: Experience from real-world clinical practice

This 5-year analysis of real-world data confirms the durable response and long-term survival with ICTs in a broader range of patients with metastatic urothelial carcinoma. After 24 months, PFS and OS curves remained nearly flat. The safety profile was consistent with previous reports, and no new safety signals were observed. Background: In this study, we report real-world results from the 5-year follow-up data of urothelial carcinoma patients treated with immune checkpoint blockade therapies (ICTs). Patients and Methods: Metastatic urothelial carcinoma patients treated with at least one course of ICT were included in the study. The primary endpoint was overall response rate (ORR), and secondary endpoints were overall survival (OS), progression-free survival (PFS), duration of treatment with ICT, and safety. Median follow-up, PFS, and OS were estimated by using the Kaplan-Meier method. Results: Data of 201 eligible patients were analyzed. The median age of the patients was 66 (37-86) years, and 156 (84.3%) were male. The majority of patients (94.6%) had Eastern Cooperative Oncology Group (ECOG) PS scores of 0 to 1 and primary tumor in the bladder was predominant (87.5%). The median follow-up time was 54 (1.15-65) months. The rate of complete response (CR) to ICT, partial response (PR) rate, and ORR were 10.4% (n = 21), 22.4% (n = 45), and 32.4% (n = 66), respectively. The median duration of response (DOR) was 34.8 months (95% confidence interval [CI], 29.2-42.1). Of the 66 patients who responded to treatment, 28 (42%) had an ongoing response at the time of the analysis. Median PFS and OS were 3.8 (2.6-5.8) months and 9.4 (7.4-11.4) months, respectively. The 5-year PFS and OS rates were 9.8% and 12.8%, respectively. Fifty-eight percent of patients experienced a treatment-related adverse event of any grade, and 33 (16.4%) patients had a grade 3 to 4 adverse event. Conclusion: This 5-year analysis of real-world data confirms the durable response and long-term survival with ICT in metastatic urothelial carcinoma patients

Prognostic factors for regorafenib treatment in patients with refractory metastatic colorectal cancer: A real-life retrospective multi-center study

Regorafenib, an oral multikinase inhibitor, has improved survival in metastatic colorectal cancer (mCRC) patients who have progressed on standard therapies. Our study aimed to evaluate prognostic factors influencing regorafenib treatment and assess the optimal dosing regimen in a real-life setting. We retrospectively analyzed 263 patients with mCRC from multiple medical oncology clinics in Turkey. Treatment responses and prognostic factors for survival were evaluated using univariate and multivariate analysis. Of the patients, 120 were male and 143 were female; 28.9% of tumors were located in the rectum. RAS mutations were present in 3.0% of tumors, while BRAF, K-RAS, and N-RAS mutations were found in 3.0%, 29.7%, and 25.9% of tumor tissues, respectively. Dose escalation was preferred in 105 (39.9%) patients. The median treatment duration was 3.0 months, with an objective response rate (ORR) of 4.9%. Grade ≥ 3 treatment-related toxicity occurred in 133 patients, leading to discontinuation, interruption, and modification rates of 50.6%, 43.7%, and 79.0%, respectively. Median progression-free survival (PFS) and overall survival (OS) were 3.0 and 8.1 months, respectively. RAS/RAF mutation (hazard ratio [HR] 1.5, 95% confidence interval [CI] 1.1–2.3; P = 0.01), pre-treatment carcinoembryonic antigen (CEA) levels (HR 1.6, 95% CI 1.1–2.3; P = 0.008), and toxicity-related treatment interruption or dose adjustment (HR 1.6, 95% CI 1.1–2.4; P = 0.01) were identified as independent prognostic factors for PFS. Dose escalation had no significant effect on PFS but was associated with improved OS (P < 0.001). Independent prognostic factors for OS were the initial TNM stage (HR 1.3, 95% CI 1.0–1.9; P = 0.04) and dose interruption/adjustment (HR 0.4, 95% CI 0.2–0.9; P = 0.03). Our findings demonstrate the efficacy and safety of regorafenib. Treatment line influences the response, with dose escalation being more favorable than adjustment or interruption, thus impacting survival

The relationship between pan-immune-inflammation value and survival outcomes in patients with metastatic renal cell carcinoma treated with nivolumab in the second line and beyond: a Turkish oncology group kidney cancer consortium (TKCC) study

Background Pan-immune-inflammation value (PIV) is an easily accessible immune marker based on peripheral blood to estimate prognosis in patients with cancer. This study evaluates the prognostic value of PIV in patients with metastatic renal cell carcinoma (mRCC) treated with nivolumab