Comprehensive Analysis of Prognostic Factors in Advanced Gastric Cancer Patients Treated with Chemotherapy

Objective: To evaluate the strongest prognostic factors in advanced gastric cancer. Study Design: Observational study. Place and Duration of Study: Department of Medical Oncology, Tekirdag Namik Kemal University, Tekirdag, Turkey, between March 2012 and April 2022. Methodology: Adult patients with metastatic cancer who had completed at least two months of chemotherapy, without any other comorbidity were included. Using Kaplan-Meier methodology and Cox regression methods, potential prognostic factors were analysed for overall survival. Two different models were created for multivariate analysis by using statistically significant factors in univariate analysis. Results: The median overall survival in 216 patients was 7.8 months. The univariate analysis showed that body-mass index, performance status, liver metastasis, albumin, gamma-glutamyl transferase, carcinoembryonic antigen, carbohydrate antigen (CA 19-9), neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index, albumin-to-alkaline phosphatase ratio, sodium-globulin ratio (SGR) prognostic nutritional index (PNI), albumin-bilirubin ratio, and albumin-globulin ratio were associated with survival. In Model 1, which included only laboratory indices, multivariate analyses revealed that NLR (p= 0.001), SGR (p=0.025), and PNI (p=0.032) were prognostic for overall survival. In Model 2, established with all parameters, NLR (p=0.003), albumin (p=0.003), performance status (p<0.001), and CA 19-9 (p<0.001) were found to be independent prognostic factors. Conclusion: Pretreatment NLR, SGR, PNI, albumin, performance status, and CA 19-9 are strong prognostic factors in patients with advanced gastric cancer. These prognostic factors, which are easily accessible in clinical practice, may be utilised as useful tools for clinicians

Use of Complementary Therapy in Lung Cancer Patients Treated with Chemotherapy and its Effect on Survival: A Cross-sectional Study

Aim: Complementary therapies are being increasingly preferred in patients receiving anticancer therapy to strengthen the effect of chemotherapy and control cancer-related symptoms. In this study, we investigated the prevalence of complementary therapy (CT), the factors associated with its use, physician-patient information sharing about CT use, and the effect of CT on the survival and treatment process in lung cancer patients receiving chemotherapy. Methods: This study was designed as a cross-sectional study including patients who underwent chemotherapy for lung cancer between November 2020 and March 2022 in the department of medical oncology at Tekirdag Namik Kemal University. A structured questionnaire with twenty questions was used. Fluor-18-fluorodeoxyglucose positron emission tomography/CT, and brain magnetic resonance imaging were used to stage the patients. The stages were grouped as early (stages 1B-3A) and advanced (stages 3B-4A). Results: A total of 242 patients included in the study. One hundred and forty-seven (60.7%) patients reported using at least one type of CT since the first diagnosis. “Families/relatives” (n=128; 63.7%) and “other patients” (n=67; 33.3%) were the primary sources from which patients obtained CT information. The most widely used CT methods were recorded as phytotherapy (79.6%) and apitherapy (59.2%). 125 (85%) of the patients said that they used CT to support their existing anticancer treatments. Of the patients using CT, 94 (63.9%) stated that they did not disclose their use of CT to their physicians. The majority of patients stated that their physicians did not inquire about using CT. In the cox regression analysis performed to determine survival benefit, no survival benefit from the use of CT was determined (hazard ratio=0.86, p=0.495). In the subgroup analysis, the use of CT was associated with survival in early-stage patients, but no survival relationship was found in advanced-stage patients (log-rank p=0.027 and p=0.842, respectively). Conclusion: The use of CT in conjunction with medical treatment is common among patients with lung cancer. The influence of the oncologist in guiding the use of CT in cancer patients is weak. Additionally, the use of CT does not provide benefits in terms of survival. © 2023 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi

Investigation of Serum Folate-Receptor-1 in Patients with Non- Small Cell Lung Cancer

Objective: Histopathological overexpression of folate receptor-1(FOLR1) involved in folate transport in cell growth has been reported in various cancers. Increased serum FOLR1 (sFOLR1) has also been reported in epithelial ovarian cancer. The aim was to investigate sFOLR1 levels in non-small cell lung cancer(NSCLC) patients and the response prediction of the standard chemotherapy targeting folic acid metabolism. Methods: In this prospective study, sFOLR1 levels were investigated in 30 healthy individuals and 60 patients with stage4 malign metastatic NSCLC before and after standard chemotherapy. The commercial immunoassay(ELISA) kit was used for the analysis of sFOLR1. Serum carcinoembryonic antigen(CEA), vitamin B12, and folate levels were also investigated. Results: In NSCLC patients sFOLR1 levels were significantly higher(p<0.001) than the healthy individuals. After 3 months of standard treatment, sFOLR1 was significantly lower than pre-treatment values in NSCLC patients(p<0.001). Diagnostic accuracy was strong in the differentiation of NSCLC patients from healthy individuals(AUC= 0.966). with the cut-off point of 82.45 pg/ml, the sFOLR1 level was performed with 95% sensitivity and 99% specificity. Pretreatment sFOLR1 levels were significantly lower in patients with-response to standard chemotherapy(p<0.01). The best predictive value was determined as 393.80 pg/ml. At the end of the 401 days, a significant difference was found in patients with high sFOLR1 predictive value. The median overall survival(OS) duration was 288 days for all patients (95% GA 198.13-377.87). Median progression-free survival(PFS) was 321 days(95% GA 211.90-430.10). Conclusions: For monitoring standard chemotherapy with drugs targeting folic acid metabolism, sFOLR-1 levels be an biomarker

A logarithmic model for hormone receptor-positive and breast cancer patients treated with neoadjuvant chemotherapy

OBJECTIVE: The aim of this study was to investigate the predictive importance of the previously validated log(ER)*log(PgR)/Ki-67 predictive model in a larger patient population.METHODS: Patients with hormone receptor positive/HER-2 negative and clinical node positive before chemotherapy were included. Log(ER)*log(PgR)/ Ki-67 values of the patients were determined, and the ideal cutoff value was calculated using a receiver operating characteristic curve analysis. It was analyzed with a logistic regression model along with other clinical and pathological characteristics.RESULTS: A total of 181 patients were included in the study. The ideal cutoff value for pathological response was 0.12 (area under the curve=0.585, p=0.032). In the univariate analysis, no statistical correlation was observed between luminal subtype (p=0.294), histological type (p=0.238), clinical t-stage (p=0.927), progesterone receptor level (p=0.261), Ki-67 cutoff value (p=0.425), and pathological complete response. There was a positive relationship between numerical increase in age and residual disease. As the grade of the patients increased, the probability of residual disease decreased. Patients with log(ER)*log(PgR)/Ki-67 above 0.12 had an approximately threefold increased risk of residual disease when compared to patients with 0.12 and below (odds ratio: 3.17, 95% confidence interval: 1.48-6.75, p=0.003). When age, grade, and logarithmic formula were assessed together, the logarithmic formula maintained its statistical significance (odds ratio: 2.47, 95% confidence interval: 1.07-5.69, p=0.034).CONCLUSION: In hormone receptor-positive breast cancer patients receiving neoadjuvant chemotherapy, the logarithmic model has been shown in a larger patient population to be an inexpensive, easy, and rapidly applicable predictive marker that can be used to predict response