Güngör Utkan

The effect of venous thromboembolism on survival of cancer patients and its relationship with serum levels of factor VIII and vascular endothelial growth factor: a prospective matched-paired study.

BACKGROUND Venous thromboembolism (VT) increases mortality and morbidity in cancer patients. The primary aim of this study was to evaluate the effect of VT on the survival of cancer patients and its relationship with serum vascu-lar endothelial growth factor (VEGF) and plasma factor VIII levels. PATIENTS AND METHODS Eighty-two patients with locally advanced or metastatic cancer were included in this study between September 2001 and March 2004, and 31 of them had VT. Fifty-one matched-paired cancer patients without VT were prospectively selected as a control group in the same period. Criteria for the selection of control group patients were hav-ing the same malignancy, stage, metastatic site, performance status and age (5 years) as patients in the VT group. RESULTS Plasma factor VIII and serum D-dimer levels in the VT group were significantly higher than those in the control group (p=0.030 and p=0.016, respectively). However, mean serum VEGF levels were similar in both groups (p=0.199). In the VT group, the median survival of patients who had higher serum VEGF levels (>150 pg/mL) was significantly shorter than that of patients in the same group with lower serum VEGF levels (p=0.005). The median survival of the VT group was 14 months, whereas it was 25 months in the control group (p=0.199). CONCLUSION There was a worse prognostic trend for cancer patients with VT. Nevertheless, the difference in survival was not statistically significant between the groups. Plasma factor VIII and serum D-dimer levels might have prognostic value in cancer patients with VT. Cancer patients with VT and higher serum VEGF levels had a significantly poorer prognosis.

Association of ABO blood group and risk of lung cancer in a multicenter study in Turkey.

BACKGROUND The ABO blood groups and Rh factor may affect the risk of lung cancer. MATERIALS AND METHODS We analyzed 2,044 lung cancer patients with serologically confirmed ABO/Rh blood group. A group of 3,022,883 healthy blood donors of Turkish Red Crescent was identified as a control group. We compared the distributions of ABO/Rh blood group between them. RESULTS The median age was 62 years (range: 17-90). There was a clear male predominance (84% vs. 16%). Overall distributions of ABO blood groups were significantly different between patients and controls (p=0.01). There were also significant differences between patients and controls with respect to Rh positive vs. Rh negative (p=0.04) and O vs. non-O (p=0.002). There were no statistically significant differences of blood groups with respect to sex, age, or histology. CONCLUSIONS In the study population, ABO blood types were associated with the lung cancer. Having non-O blood type and Rh-negative feature increased the risk of lung cancer. However, further prospective studies are necessary to define the mechanisms by which ABO blood type may influence the lung cancer risk.

Clinicopathological Features of Patients with Malignant Mesothelioma in a Multicenter, Case-Control Study: No Role for ABO-Rh Blood Groups

BACKGROUND Malignant mesothelioma (MM) is an aggressive tumor of mesothelial surfaces. Previous studies have observed an association between ABO blood groups and risk of certain malignancies, including pancreatic and gastric cancer; however, no information on any association with MM risk is available. The aim of this study was to investigate possible associations amoong MM clinicopathological features and ABO blood groups and Rh factor. MATERIALS AND METHODS In 252 patients with MM, the ABO blood group and Rh factor were examined and compared with the control group of 3,022,883 healthy volunteer blood donors of Turkish Red Crescent between 2004 and 2011. The relationship of blood groups with various clinicopathological features were also evaluated in the patient group. RESULTS The median age was 55 (range: 27-86) and 61.5% of patients were male. While 82.8% of patients had a history of exposure to asbestos, 60.7% of patients had a smoking history. Epithelioid (65.1%) was the most common histology and 18.7% of patients had mixed histology. Overall, the ABO blood group distribution of the 252 patients with MM was comparable with the general population. The median overall survival (OS) was 14 months (95% confidence interval, 11.3-16.6 months). The median OS for A, B, AB, and O were 11, 15, 16, and 15 months respectively (p=0.396). First line chemotherapy was administered to 118 patients. The median OS of patients on pemetrexed or gemcitabine was longer than patient who was not administered chemotherapy [17 months (95%CI, 11.7-22.2) vs. 9 months (95%CI, 6.9-11.0); p<0.001]. CONCLUSIONS The results of this study suggest that patients with MM can benefit from treatment with pemetrexed or gemcitabine in combination with cisplatin. We did not observe a statistically significant association between ABO blood group and risk of MM.

Medication Errors in Chemotherapy Preparation and Administration: a Survey Conducted among Oncology Nurses in Turkey

BACKGROUND Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. MATERIALS AND METHODS This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. RESULTS Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). CONCLUSIONS Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.

A rare gastric neoplasm: gastric medullary carcinoma

A 57-year-old female patient with early stage gastric medullary carcinoma is presented with review of the literature.

Widespread Metastatic Prostate Carcinoma Shown by 68Ga-PSMA PET/CT.

We present the F-FDG and Ga prostate-specific membrane antigen PET/CT images of a 61-year-old patient with a newly diagnosed prostate carcinoma (4 + 4 Gleason score) and high serum prostate-specific antigen levels (460 ng/mL). In F-FDG PET/CT, minimal uptake was demonstrated in the prostatic mass without any accompanying pathological uptake. However, Ga prostate-specific membrane antigen PET/CT revealed multiple pathological uptake in the lung nodules, mediastinal nodes, abdominal-pelvic lymph nodes, bone lesions, and prostatic mass.

Neoadjuvant Chemotherapy Followed by Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma: Is It Safe?

TO THE EDITOR: We read with interest the article by Weder et al. They conducted a pilot study with neoadjuvant gemcitabine and cisplatin followed by extrapleural pneumonectomy in patients with malignant pleural mesothelioma. The response rate to neoadjuvant chemotherapy was 32% and extrapleural pneumonectomy was performed in 16 of 19 patients. Thirteen patients received postoperative radiotherapy. Weder et al concluded that extrapleural pneumonectomy can be performed safely after neoadjuvant chemotherapy in an experienced center. Unfortunately, this conclusion is somewhat incorrect. Although Weder et al reported no perioperative death, the perioperative morbidity rate was quite high. Perioperative morbidity was observed in seven of the 16 patients (43.75%) on whom extrapleural pneumonectomy was performed: pulmonary embolism in one patient, chylothorax in three patients, thrombosis of the brachiocephalic vein in one patient, bronchopleural fistula in one patient, and pyothorax in one patient. Two patients were operated on for the treatment of these operative complications. Two patients were hospitalized for bleeding intrathoracically and retroperitoneally. It is unclear whether neoadjuvant chemotherapy is responsible for this high rate of perioperative morbidity. Therefore, the safety of this treatment modality should be questioned before further studies on uncured malignant pleural mesothelioma. Quality of life related to the treatment becomes more important in this group of patients because of the high rate of perioperative morbidity, and Weder et al should have assessed this in their study. On the other hand, although Weder et al reported in the abstract of their article that the major toxicity of neoadjuvant gemcitabine and cisplatin was thrombocytopenia, if we consider their Table 2, it is seen that grade 3 and 4 leukopenia and neutropenia are more frequent than thrombocytopenia. Gungor Utkan, Bulent Yalcin, and Abdullah Buyukcelik Department of Medical Oncology, Ankara University School of Medicine, Ibni Sina Hospital, Sihhiye, Ankara, Turkey.

Lower folate levels in gastric cancer: Is it a cause or a result?

Folate deficiency and its association with cancer have been studied in the literature, but its clinical impact is still unknown. Folate deficiency and its result on gastric cancer is a mysterious part of oncology, with ongoing studies hopefully clarifying its impact on gastric cancer management. Lee et al studied folate deficiency and its impact on staging and clinical results. Here we try to contribute to the field by expressing our own thoughts about the paper.

First-line crizotinib in ALK-positive lung cancer.

To the Editor: Solomon and colleagues (Dec. 4 issue)1 suggest that, as compared with platinum– pemetrexed chemotherapy, crizotinib treatment was associated with significantly longer progression-free survival and an improved objective response rate. However, the interpretation of these results needs some consideration. In the study, platinum–pemetrexed chemotherapy was used every 3 weeks for up to six cycles. However, pemetrexed was not continued beyond the planned six cycles of the combination chemotherapy. The phase 3 PARAMOUNT trial2 suggested that maintenance therapy with pemetrexed after four cycles of combined cisplatin–pemetrexed therapy resulted in a significant reduction of 22% in the risk of death and in an improvement of almost 3 months in median overall survival. Also, in the PARAMOUNT study,3 maintenance therapy with pemetrexed was associated with improved progression-free survival among patients without disease progression after four cycles. The fact that pemetrexed was not continued beyond the planned chemotherapy may have influenced the outcome of the study by Solomon et al. Deniz Tural, M.D.

Fine Needle Aspiration Biopsy Features with Histologic Correlation in Mediastinal Hepatoid Yolk Sac Tumor Presenting with Sternum Metastasis

BACKGROUND The hepatoid variant of yolk sac tumor (H-YST) is an exceedingly rare and highly malignant neoplasm. We present and discuss our experience with cytologic and histopathologic features of a mediastinal H-YST presenting with sternum metastasis, which to the best of our knowledge has not been previously reported. CASE A 38-year-old man presented with a large mass on the sternum. Computed tomography of the thorax showed a large anterior mediastinal mass with sternum metastsis and multiple lung metastases. Laboratory examination revealed elevated serum alpha-fetoprotein (60,000 IU/mL). No tumor was found in the other organ systems. A percutaneous fine needle aspiration biopsy and subsequent open surgical biopsy were performed on the sternum metastasis. Cytologically, the tumor was composed of monotonous, large, round to polygonal hepatoid cells forming solid sheets and trabeculae entrapped with endothelial cells resembling hepatocellular carcinoma. Histopathologic sections of tumor showed tumor cells with eosinophilic to clear cytoplasm arranged in a solid, trabecular growth pattern, with some acinar formations. Immunohistochemical study supported the hepatoid origin. CONCLUSION Fine needle aspiration cytology, together with the characteristic clinical presentations and specific tumor markers, is crucial to the initial diagnosis of H-YST.