Metin Seker

Could the Neutrophil to Lymphocyte Ratio be a Poor Prognostic Factor for Non Small Cell Lung Cancers

BACKGROUND Although many prognostic factors have been identified for lung cancers, new ones are needed to determine the course of the disease. Recently, a high neutrophil to lymphocyte ratio (NLR) prior to surgery or treatment has been shown to be an indicator of prognosis for cancer. The aim of this study was to investigate the value of NLR as a prognostic factor and the correlation between NLR and other probable clinical prognostic factors in non small cell lung cancer patients prior to treatment. MATERIALS AND METHODS Data of patients who were diagnosed with non-small cell lung cancer in our institution were retrospectively reviewed. Demographic and clinicopathologic characteristics were recorded. NLR was calculated before the application of any treatment. RESULTS A total of 299 patients, 270 (90%) males and 29 (10%) females, were included in the study. Age (p<0.001) stage (p<0.001), Eastern Cooperative Oncology Group performance status (p<0.001), weight loss (p<0.001), anemia (p<0.001), histopatology (p<0.001), NLR ≥ 3 (p=0.048), NLR ≥ 4 (p=0.025) and NLR ≥ 5 (p=0.018) were found to be the prognostic factors. Age, anemia, Eastern Cooperative Oncology Group performance status, the stage, NLR (≥ 5) were an independent prognostic factors. There was a positive correlation between NLR and the Eastern Cooperative Oncology Group performance status (0.23, p=0.001), the C reactive protein levels (r=0.36, p<0.001). CONCLUSIONS Prior to treatment high NLR was found as an independent poor prognosis factor. Besides, NLR correlated with Eastern Cooperative Oncology Group performance status and the C reactive protein levels.

Evaluation of the effect of comorbidity on survival in pancreatic cancer by using “Charlson Comorbidity Index” and “Cumulative Illness Rating Scale”

SummaryBackgroundEffect of comorbidity on the treatments that patients receive is not clear, as healthy elderly patients and the elderly with less comorbid diseases are included in the studies. In the present study, the effect of comorbidity on the survival was evaluated using Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale (CIRS).Material and methodThe general features and comorbid diseases of the pancreatic cancer patients were retrospectively screened from the patient files using the automated system. CCI and CIRS were used as the comorbidity indices.ResultsA total of 106 patients with pancreatic cancer were included in the study. The median overall survival rate was 9.0 [95 % confidence interval (CI): 6.7–11.3] months. The median overall survival rate was found as 9.4 (95 % CI: 6.7–12.1) months in the patients whose CCI score was ≤ 2 and was found as 6.2 (95 % CI: 4.0–8.3) months in the patients with CCI scores ≥ 3 (p = 0.05). The median overall survival rate was calculated as 9.8 (95 % CI: 6.3–13.4) months in the patients with CIRS scores ≤ 2 and was calculated as 8.3 (95 % CI: 6.0–10.6) months in the patients with CIRS scores ≥ 3 (p = 0.51). When surgery, radiotherapy, grading, and CCI score were evaluated using multivariate analysis, it was observed that only the treatment modality had a significant effect on the survival rate.ConclusionThe results on the use of comorbidity indices are contradictory for the cancers with lower survival rates such as pancreatic cancer. New prognostic scales might be developed for this patient group by considering the side effects of chemotherapy.ZusammenfassungGrundlagenDie Auswirkung von Begleiterkrankungen auf den Erfolg der Therapien, die Patienten erhalten, ist ungesichert, da oft gesunde ältere Patienten beziehungsweise Ältere mit nur wenigen Begleiterkrankungen in die Studien eingeschlossen werden. In der vorliegenden Studie wurde der Einfluss von Begleiterkrankungen auf das Überleben durch Verwendung des Charlson Komorbiditäts Index (CKI) und der Kumulativen Erkrankungs-Bewertung Skala (KEBS) bewertet.Material und MethodenDie Allgemeinsituation und Begleiterkrankungen von Patienten mit Pankreaskrebs wurden retrospektiv an Hand der Krankengeschichten mit Hilfe eines automatisierten Systems erhoben. CKI und KEBS wurden als Indices verwendet.ErgebnisseInsgesamt wurden 106 Patienten mit Pankreaskrebs in die Studie aufgenommen. Die mediane Gesamt-Überlebenszeit betrug 9 Monate (95 % CI; 6,7–11,3). Bei den Patienten mit einen CKI < 2 lag die Gesamtüberlebenszeit bei 9,4 Monaten (95 % CI; 6,7–12,1); bei den Patienten mit einem CKI ≥ 3 lag sie bei 6,2 Monaten (95 % CI; 4,0–8,3). Bei der Einteilung nach KEBS ergab sich eine Gesamtüberlebenszeit von 9,8 Monaten (6,3–13,4) bei jenen ≤ 2 und von 8,3 (95 % CI: 6,0–10,6) bei einem KEBS Wert von ≥ 3 (p = 0,51). Die Berücksichtigung der Operation, der Bestrahlung, des Stadiums und des CKI Scores in der Multivarianz Analyse ergab, dass nur die Therapiemodalität einen signifikanten Einfluss auf die Überlebensrate hatte.SchlussfolgerungDie Ergebnisse des Einsatzes von Komorbiditätsindices sind bei Krebserkrankungen mit geringer Lebenserwartung, wie dem Pankreaskrebs, widersprüchlich. Neue prognostische Skalen sollten für diese Patienten unter Berücksichtigung der Nebenwirkungen der Chemotherapie erstellt werden.

Clinicopathologic features of gastric cancer in young patients.

Background/Aim: Gastric cancer (GC) is considered to be a disease of elderly patients. It has been suggested that GC in young adults has more aggressive clinical and pathologic features than in adults. In this study we aimed to evaluate clinical and pathologic features of GC under age 40 years. Patients and Methods: Patients included in this study were those treated and followed up for GC under age 40 years in Ankara Numune Education and Research Hospital from 2002 to 2011. Results: Clinical and pathologic features of 82 patients have been evaluated retrospectively. Of the patients 44 were male (54%) and 38 were (46%) female, and the median age was 35 years (min-max: 18-40 years). The tumor was grade 3 in 77% of the patients, 79% had diffuse type tumor, 64% had lymphovascular invasion, and 76% had perineural invasion. Forty-seven patients (57%) were metastatic at the time of diagnosis. The median follow up was 9 (1-101) months. The median overall survival (OS) was 9 months in metastatic patients and 8-year OS was 64% in nonmetastatic patients. Conclusions: We observed that young GC patients had more aggressive histopathologic features and more than half was metastatic at the time of diagnosis. We need more studies comparing young and elderly patients to confirm that young patients had more aggressive disease.

Is There an Association between Blood Group and Survival in Pancreatic Cancer

BACKGROUND An association between the ABO groups and pancreatic cancer has been shown previously, group A being significantly commoner in affected patients. We conducted the present study to investigate the prognostic effect of ABO blood group on overall survival of pancreas cancer patients. METHODS Patients who were diagnosed between 2005 and 2010 with pancreas cancer at Ankara Numune Education and Research Hospital were analyzed retrospectively. Patient demographics and ABO blood groups were obtained from medical charts. RESULTS Fifty pancreas cancer patients with known ABO blood group were included, 26 (52%) group A, 12 patients (24%) group 0, 9 (18%) group B, and 3 (6%) group AB. Blood group A pancreas cancer patient median age was 61.5 (39-80) years, with the median age of the other blood groups (B, AB,O) being 55.5 (32-74) years (p=0.14). 18% of patients with blood group A and11%of the other blood group patients had metastasis (p=0.17) at the time of diagnosis. The median overall survival of blood group A pancreas patients was significantly lower than the other blood group patients, 7.6 (95%CI: 5.0-10.2) months versus 29.0 (95%CI: 0.0-68.8) months (p=0.05). CONCLUSIONS Acccording to previously published cohort studies a relation may exist between ABO blood groups and cancer of pancreas. In this study we observed that pancreas cancer patients with blood group A have significantly worse overall survival than other blood groups.

Everolimus as an mTOR Inhibitor Suppresses Endometriotic Implants: an Experimental Rat Study

Introduction Mammalian target of rapamycin is a pathway to block apoptosis. Recent studies showed that the activity of mammalian target of rapamycin pathway increases in endometriotic lesions. Aim of the present study was to study the effect of everolimus agent, a rapamycin analog, in an experimental endometriosis model. Materials and Methods Endometriosis established by the autotransplantation of uterine tissue in the peritoneal cavity was confirmed in 24 rats. The animals were then randomly divided into three groups to receive either everolimus (1.5 mg/kg/day, p. o.), anastrozole (0.004 mg/day, p. o.), or normal saline (0.1 mL, i. p.) for 14 days. Endometriotic foci were excised, stained with hematoxylin and eosin, and endometriosis was scored semiquantitatively. In addition, immunohistochemical examination were performed using primary antibodies of vascular endothelial growth factor, CD117, and Bax. Results Both anastrozole and everolimus lowered endometriosis scores. Significant decreases in ovarian follicles were observed following anastrozole treatment but not everolimus treatment. Conclusion Through its apoptosis-promoting effect, everolimus suppressed endometriotic foci without negatively affecting ovarian reserve. These findings support the hypothesis that everolimus merits further study on the way to developing a new endometriosis drug.

Effect of imatinib on growth of experimental endometriosis in rats

OBJECTIVE Currently, medical and surgical treatment options for endometriosis are limited due to suboptimal efficacy, and also safety and tolerance issues. Long-term use of gonadotrophin-releasing hormone analogs, androgenes, and the danazol, which are widely used drugs for endometriosis, is usually not possible due to their suboptimal safety and tolerance profile. The lack of an effective, tolerable and safe treatment option for endometriosis makes animal models of experimental endometriosis necessary to study candidate drugs. The aim of this study was to investigate the efficacy of imatinib on the experimental endometriosis in a rat model. STUDY DESIGN Endometriosis was induced by autotransplantation of uterine tissue into the peritoneal cavity. Twenty-four rats, which had visually confirmed endometriotic implants on subsequent laparotomy, were randomized into three groups to receive imatinib (25mg/kg/day, p.o.), anastrozole (0.004 mg/day, p.o.), or normal saline (0.1 mL, i.p.) for 14 days. After removal of endometriotic tissue and H & E staining, endometriosis score was determined according to a semiquantitative histological classification. Also, immunostaining with primary antibodies including VEGF, CD117, and Bax were used for immunohistochemical (IHC) examination. RESULTS Both anastrozole and imatinib suppressed the growth of endometriotic tissue and reduced the number of ovarian follicles. Although the difference was not statistically significant, imatinib was less effective than anastrozole for treatment of endometriosis. CONCLUSION Imatinib effectively treats experimental endometriosis by its inhibitor effects on angiogenesis and cell proliferation.