An epidemiologic study on urothelial carcinomas of bladder

Objectives: In this study, the epidemiological analysis of the bladder cancers was performed accompanied by the known environmental factors.Materials and methods: In this retrospective study, pathology archival materials of 420 patients (350 men (83.4%) and 70 women (16.6%)), consisting of bladder by transurethral resection, cystectomy and cystoprostatectomy specimens, histopathologically diagnosed as urothelial carcinoma and papillary urothelial neoplasia with low malignant potential, were included. For bladder carcinomas, the parameters such as tumor types, age, sex, and invasiveness of tumor were evaluated and analyzed.Results: In the study, it was found that 24.7% of papillary urothelial neoplasia with low malignant potential, 46.1% of low-grade urothelial carcinoma, and 29.0% of high grade urothelial carcinoma. The rate of bladder urothelial carcinomas was 5 times greater in men than in women. In addition, the high-grade papillary urothelial carcinoma was seen more frequently in men than in women (31.2% and 23.1% respectively), while low-grade papillary urothelial carcinoma was seen more frequently in women than in men (32.9% and 18.5% respectively) (p<0.05).Conclusion: The bladder urothelial carcinoma was more common in men than women, and high-grade urothelial carcinoma invading the lamina propria and the muscularis propria also found in a higher ratio in male. Further clinical and experimental studies are needed to explore the cause of high frequency of high-grade types in male gender

Blood Group and COVID-19 Transmission and Mortality in Patients With Malignant Disease

Aim: The study aimed to investigate risk factors affecting the transmission of and mortality from COVID-19 in patients diagnosed with a malignant disease. In this context, ABO blood groups, gender, age, type of malignant disease, type of anti-tumoral agents, comorbidities and stage were examined. Materials and Methods: Files of 1,256 patients who presented to our clinic between March and December 2020 were retrospectively reviewed. Patients diagnosed with a malignant disease who became infected with COVID-19 and those who did not were compared with regard to demographic, clinical characteristics and laboratory results (status of having been infected with COVID-19, ABO blood groups). Results: Of 1256 patients in total, 72 (5.7%) were diagnosed with COVID-19. Median age of cancer patients infected with COVID-19 was 53 years (18-80). The most common types of cancer included gastrointestinal cancer (22.2%), breast cancer (20.8%), genitourinary cancer (20.8%) and lung cancer (16.7%). Of the patients diagnosed with COVID-19, 18.1% (n=13) died. Multivariate analysis identified disease stage as an independent prognostic factor for the risk of mortality [HR: 0.07, 95% CI (0.007-0.74), (p=0.02)]. A comparison of patients who became infected with COVID-19 and those who did not with regard to ABO blood groups (p=0.39) showed no statistically significant differences between the two groups. There was also no correlation between ABO blood groups and the risk of COVID-19-related mortality (p=0.83). Conclusion: In patients suffering from malignant diseases, the ABO blood type exhibited no correlation with the risk of COVID-19 transmission and mortality. This study determined the presence of metastatic disease as a negative prognostic factor. Patients suffering from a metastatic malignant disease represent a high risk group for COVID-19 and should be treated using all necessary precautions

Comparison of CYFRA 21-1, CEA, CA 19-9 and CA 72-4 levels in gastric cancer

Objective: Gastric cancer is the fourth most common malignancy,and the second most common cause of cancermortality worldwide. The aim of this study was to investigatethe role of biomarkers CYFRA 21-1, CA 19-9, CEA,CA72.4 at diagnosis and throughout the follow-up in patientswith gastric cancer.Methods: 30 patients with gastric cancer diagnosed and31 healthy people as a control group were included in thisstudy. According to the TNM staging system, there were16 patients with stage II and 14 patients with stage III inthe group of patients with gastric cancer. CEA, CA 19-9,CA 72-4 and CYFRA 21-1 levels were studied by elektrochemiluminescenceimmunasay (ECLIA) method in theCobas e 601 instrument.Results: Statistically the level of CA 72-4, CA 19-9, CEAand CYFRA 21-1 gastric cancer groups was found significanthigh accaording to healthy control group (p<0.01).Statistically compared with II stage patient group, the levelof CA 19-9, CEA and CYFRA 21-1 of III stage patientgroup was found significant high (p<0.01). The diagnosticcut-off, sensitivity and specificity for CEA were 4.15 ng/mL, 46 % and 96%, respectively; for CA 19-9 were 24.50U/mL, 17 % and 96 %; for CA 72-4 were 2.46 U/mL, 53% and 96% and for CYFRA 21-1 were 3.36 ng/mL, 46%and 100%.Conclusion: Our study demonstrates that the associationof biomarkers CYFRA 21-1, CEA, and CA72.4 providesa valuable contribution in the follow-up of gastriccancer patients.Key words: Gastric cancer, tumor markers, CYFRA 21-

Efficacy of pemetrexed plus a platinum rechallenge in the treatment of pleural mesothelioma

Introduction. Pemetrexed-based rechallenge therapies can be used as an option in the treatment of pleural mesothelioma. We aimed to investigate the efficacy of pemetrexed-based rechallenge in mesothelioma. Material and methods. A total of 132 patients who received chemotherapy for unresectable or metastatic pleural mesothelioma in the Medical Oncology Clinic of Dicle University Medical Faculty between 2005 and 2020 were included in our study. Pemetrexed plus platinum rechallenge treatments were compared with other chemotherapy regimens in terms of survival. Results. In our study, 31 (23.4%) of a total of 132 patients received rechallenge pemetrexed plus platinum treatment. There was no statistically significant difference between median progression-free survival of patients who received pemetrexed plus cisplatin or gemcitabine plus cisplatin in the first-line therapy [5 months vs. 8 months (HR = 1.43; 95% CI 0.59–3.45; p = 0.376)]. In the second-line treatment, patients who received rechallenge pemetrexed plus platinum therapy had statistically significantly higher median PFS than those who received gemcitabine plus platinum [6 months vs. 4 months (HR = 0.46; 95% CI: 0.22–0.94; p = 0.011)] due to a previous good response. In the second-line treatment, median overall survival was 15 months with gemcitabine plus platinum and 29 months with pemetrexed plus platinum rechallenge (p = 0.007). Conclusions. This study demonstrated that the pemetrexed plus platinum regimen was more effective than gemcitabine plus platinum in the second-line treatment in terms of both progression-free and overall survival in patients who had previously benefited from pemetrexed-based chemotherapy and had not progressed up to 6 months after first-line treatment

Evaluation of the effectiveness and tolerability of sunitinib and pazopanib in the first line treatment of metastatic renal cell carcinoma

Introduction. It is known that sunitinib and pazopanib are effective in the first-line and subsequent treatment of metastatic renal cell carcinoma (mRCC). This study aims to investigate the effectiveness and tolerability of sunitinib and pazopanib in the first-line treatment of mRCC.  Material and methods. This study included 78 patients followed up in our clinic due to a diagnosis of mRCC, who received pazopanib or sunitinib treatment between 2006 and 2020. Along with clinical and laboratory findings, survival times obtained with each treatment and medication side effects were assessed. Sunitinib and pazopanib were compared in terms of effectiveness (ORR, PFS and OS) and tolerability.  Results. The patients’ median age at diagnosis was 55 years (25–81). In the first-line treatment, 54 patients (69.2%) received sunitinib and 24 (30.8%) received pazopanib. The comparison of sunitinib and pazopanib yielded an ORR of 66.7% vs. 45.8% (p = 0.08), PFS of 24 months vs. 19 months (p = 0.66) and OS of 27 months vs. 30 months (p = 0.73), respectively. The most common side effect was hypothyroidism in those on sunitinib (25.9%) and nausea-vomiting in those on pazopanib (41.7%). In our study, hemoglobin ≥ 13 g/dL, an ECOG PS of 0–1 and the occurrence of hypothyroidism as a medication side effect were found to be predictive factors of PFS for both agents. An International Metastatic RCC Database Consortium score corresponding to the poor risk group was associated with a poor PFS.  Conclusions. This study, which provides current real-world data, confirms that sunitinib and pazopanib have similar effectiveness and side-effect profiles in the first-line treatment of mRCC

COVID-19 infection in cancer patients: the effect of Hepatitis B immunization

Introduction: To investigate the clinical characteristics and outcomes of cancer patients with COVID-19 infections and evaluate the effect of hepatitis B immunization status on susceptibility to COVID-19 infection and mortality risk. Materials and methods: The records of 1,515 patients who presented to the Medical Oncology clinic between March 2020 and December 2020 were analysed retrospectively. The demographic and clinical characteristics and laboratory findings of cancer patients with (case group) and without (control group) COVID-19 infection were compared. Results: Of the 1,515 patients, 153 (10.1%) had been diagnosed with COVID-19, and the median age of cancer patients with COVID-19 infection was 53.9 (range; 18–82) years. The most common types of cancer were breast cancer (26.2%), gastrointestinal system cancers (22.3%), genitourinary-system cancers (16.5%) and lung cancer (15.5%). The presence of metastatic disease [hazard ratio (HR): 0.09, 95% CI (0.01–0.83), (p = 0.03)] and receipt of palliative chemotherapy in the cancer patients with COVID-19 infections [HR: 0.1, 95% CI (0.01–0.69), (p = 0.02)] were identified as prognostic factors in multivariate analysis as univariate analysis did not indicate palliative treatment as a prognostic factor. When the case group and control groups were compared in terms of hepatitis B immunization status (p = 0.24), no statistically significant difference was identified between the two groups. Furthermore, hepatitis B immunization status (p = 0.37) were not found to be associated with COVID-19-related mortality risk. Conclusion: Hepatitis B immunization status were not associated with the risk of COVID-19 transmission and mortality. The present study identified the presence of metastatic disease and palliative chemotherapy as negative and positive prognostic factors, respectively

Factors influencing the prognosis in Braf wild-type metastatic malignant melanoma and the role of novel inflammation indices

Background and Design: This study aims to investigate the prognostic factors in BRAF wild-type metastatic cutaneous melanoma and the prognostic role of inflammation indices. Materials and Methods: Metastatic BRAF wild-type cutaneous melanoma patients who presented to our clinic between 2011 and 2021 were enrolled. To investigate their prognostic roles, age, gender, performance status, first immunotherapy regimen received by the patient, metastatic sites, and seven inflammation indices [C-reactive protein (CRP)/albumin ratio (CAR), neutrophil lymphocyte ratio (NLR), prognostic nutritional index (PNI), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and advanced lung cancer inflammation index (ALI) and hemoglobin, albumin levels, lymphocyte and platelet counts (HALP)] were studied. Results: Fourty-seven patients, consisting of 22 (46.8%) females and 25 (53.2%) males, were included in this study. Mean patient age was 54 (18-88) years. In our study, there were 16 (34%) patients with liver metastasis, 17 (36.2%) patients with lung metastasis, and 9 (19.1%) patients with brain metastasis. As immunotherapy, 34 (72.3%) patients had received Nivolumab, while 13 (27.7%) patients had received Ipilimumab therapy. When the relationships of the prognostic variables with overall survival were inspected in univariate and multivariate analyses, brain metastasis was found to be an independent prognostic factor (p=0.02). Lung metastasis approached the threshold of statistical significance in univariate analysis (p=0.09) and liver metastasis in multivariate analysis (p=0.07). The seven inflammation indices examined in the analyses [CAR, NLR, PNI, PLR, SII ALI and HALP] were found to have no prognostic role in both univariate and multivariate analyses. Conclusion: Our study determined that brain metastasis is an independent poor prognostic factor in BRAF wild-type metastatic melanoma. Prognostic roles of the CAR, NLR, PNI, PLR, SII ALI and HALP indices could not be demonstrated

Survival outcomes of patients diagnosed with muscle-invasive bladder cancer who showed a response after neoadjuvant chemotherapy and refused radical cystectomy, and patients who had radical cystectomy or received chemoradiotherapy

Introduction. We aimed to compare the survival results of patients with muscle-invasive bladder cancer who responded after neoadjuvant chemotherapy (NAC) and did not accept further treatment and those who underwent radical cystectomy or received chemoradiotherapy (CRT).  Material and methods. The study included 53 patients with non-metastatic muscle-invasive bladder cancer who received NAC between 2009 and 2020. Clinical findings and post-NAC survival analysis were evaluated. Survival analyses of patients who underwent radical cystectomy (RC) after NAC, received CRT, and refused treatment were compared.  Results. The median age at diagnosis was 61 (33–80) years. After NAC, 18 patients (34%) received CRT, 9 patients (17%) underwent RC, and 18 patients (34%) refused further treatment. Complete response (CR) was present in 10 (18.4%) patients, partial response (PR) in 35 (66%) patients, stable disease (SD) in 1 (1.9%) patient, and progression in 7 (13.2%) patients. Median overall survival (OS) was 78 months. Median OS was not reached in the RC arm; it was 97 months in the CRT arm and 78 months in the declined-treatment arm. There was no statistical difference between the arms (p = 0.94). Median disease-free survival (DFS) was 32 months. Median DFS in the RC arm was 30 months, in the CRT arm — 34 months, and 28 months in the declined-treatment arm after NAC. There was no statistically significant difference between the arms (p = 0.74).  Conclusions. We did not find any difference in terms of OS and DFS between patients who after NAC underwent RC, CRT, or refused treatment

The relationship between inflammation markers, positron emission tomography/ /computed tomography parameters and disease prognosis in advanced non-small-cell lung cancer patients

Introduction. Inflammation is known to be related to the development, spread, prognosis, and treatment response in cancer patients. Our study aimed to evaluate the correlation between inflammation indices and positron emission tomography-computed tomography (PET/CT) parameters and investigate their relationship with progression-free survival (PFS) and overall survival (OS) in patients diagnosed with stage-IV non-small cell lung cancer (NSCLC).  Material and methods. Demographic, clinicopathological, laboratory, and PET/CT data of 179 patients diagnosed with stage-IV NSCLC who presented to the Oncology Department of Dicle University, Faculty of Medicine between 2010–2020 were retrieved from patient files and the hospital database system.  Results. The median age at diagnosis was 64 (27–87) years. All patients included in the study had NSCLC: 72.6% had adenocarcinoma, 21.2% had squamous cell carcinoma, and 6.1% had other histological types. Of the 78 patients who were subjected to molecular analysis, 26 (33.3%) were EGFR-mutation positive. During the 10-month median follow-up, median first-line PFS was 6 months (95% CI 5.00–6.99), and median OS was 10 months (95% CI 7.8–12.1). The multivariate analysis performed for first-line PFS determined hemoglobin (HR = 1.01; 95% CI 1.003–1.02; p = 0.005) and PET total lesion glycolysis (TLG) (HR = 1.002; 95% CI 1.001–1.003; p = 0.003) values as independent prognostic factors. The multivariate analysis for OS determined positive EGFR mutation status (HR = 0.385; 95% CI 0.213–0.696; p = 0,014) and performance status (HR = 1.88; 95% CI 1.092–3.238; p = 0,008) as independent prognostic factors.  Conclusions. Our study determined the hemoglobin level and PET TLG from PET/CT parameters to be independent prognostic factors for PFS, and performance status and EGFR mutation positivity to be independent prognostic factors for OS