Suna Cokmert

Hormone receptor, HER2/NEU and EGFR expression in ovarian carcinoma--is here a prognostic phenotype?

PURPOSE We aimed to evaluate the effects of hormone receptor, HER2, and epidermal growth factor receptor (EGFR) expression on epithelial ovarian cancer (EOC) prognosis and investigate whether or not phenotypic subtypes might exist. MATERIALS AND METHODS The medical records of 82 patients who were diagnosed with EOC between 2003 and 2012 and treated by platinum-based chemotherapy were retrospectively evaluated. Expression of EGFR, oestrogen (ER), progesterone (PR), and cerbB2 (HER2) receptors were assessed immunohistochemically on paraffin-embedded tissues of these patients. Three phenotypic subtypes were defined according to ER, PR, and HER2 expression and associations of these with EGFR expression, clinicopathologic features, platinum sensitivity, and survival were investigated. RESULTS When we classified EOC patients into three subtypes, 63.4% had hormone receptor positive (HR(+)) (considering breast cancer subtypes, luminal A), 18.3% had triple negative, and 18.3% had HER2(+) disease. EGFR positivity was observed in 37 patients (45.1%) and was significantly more frequent with advanced disease (p=0.013). However, no significant association with other clinicopathologic features and platinum sensitivity was observed. HER2(+) patients had significantly poorer outcomes than HER2(-) counterparts (triple negative and HR positive patients) (p=0.019). Multivariate analysis demonstrated that the strongest risk factor for death was residual disease after primary surgery. CONCLUSIONS Triple negative EOC may not be an aggressive phenotype as in breast cancer. The HER2 positive EOC has more aggressive behaviour compared to triple negative and HR(+) phenotypes. EGFR expression is more frequent in advanced tumours, but is not related with poorer outcome. Additional ovarian cancer molecular subtyping using gene expression analysis may provide more reliable data.

Second-Line Capecitabine and Oxaliplatin Combination for Gemcitabine-Resistant Advanced Pancreatic Cancer

BACKGROUND The role of second-line therapy in metastatic pancreatic cancer is not clear. In this study, we aimed to explore the second-line efficiency of capecitabine and oxaliplatin (XELOX) in patients with advanced pancreatic cancer who have received gemcitabine-based first-line therapy. MATERIALS AND METHODS We retrospectively evaluated 47 patients with locally advanced or metastatic pancreatic cancer previously treated with gemcitabine-based first-line regimens. Treatment consisted of oxaliplatin 130 mg/m2 and capecitabine 1000 mg/m2 twice daily with a 3 week interval, until unacceptable toxicity or disease progression. RESULTS Median number of cycles was 4 (range, 2-10). The overall disease control rate was 38.3%. The median overall survival and progression-free survival from the start of second-line therapy were 23 weeks (95%CI: 16.6-29.5 weeks) and 12 weeks (95%CI: 9.8-14.4 weeks), respectively. The most common grade 3-4 toxicities were nausea, vomiting and hematologic side effects. CONCLUSIONS Our result suggests that the combination of capecitabine and oxaliplatin was tolerated with manageable toxicity and showed encouraging activity as second-line treatment of advanced or metastatic pancreatic cancer patients with ECOG performance status 0-2.

Role of increased mean platelet volume (MPV) and decreased MPV/platelet count ratio as poor prognostic factors in lung cancer

In this study, they investigated whether mean thrombocyte volume (MPV) and MPV/platelet count ratio have a prognostic significance in advanced NSCLC or not.

The impact of cell proliferation markers and p53 mutation status on prognosis of non-metastatic colon cancer

We aimed to evaluate the prognostic value of cell cycle proteins and p53 together with clinicopathologic features in non‐metastatic resected colon cancer.

Pretreatment Serum Albumin Level is an Independent Prognostic Factor in Patients with Stage IIIB Non-Small Cell Lung Cancer: A Study of the Turkish Descriptive Oncological Researches Group

BACKGROUND Several prognostic factors have been studied in NSCLC, although it is unknown which is most useful. In this study, we aimed to investigate whether pre-treatment serum albumin level has prognostic value in patients with Stage IIIB NSCLC. MATERIALS AND METHODS This cross-sectional study included a total of 204 patients with Stage IIIB NSCLC who met the inclusion criteria. Pre-treatment serum albumin levels and demographic, clinical, and histological characteristics, as well as laboratory variables were recorded. A cut-off value was defined for serum albumin level and the patients were stratified into four groups on thios basis. RESULTS The majority of the patients was males and smokers, with a history of weight loss, and squamous histological type of lung cancer. The mean serum albumin level was 3.2±1.7 g/dL (range, 2.11-4.36 g/dL). A cut-off value 3.11 g/dL was set and among the patients with a lower level, 68% had adenocarcinoma and 82% were smokers. The patients with low serum albumin levels had a lower response rate to e first-line chemotherapy with a shorter progression-free survival and overall survival. Multivariate analysis showed that low serum albumin level was an independent poor prognostic factor for NSCLC. CONCLUSIONS This study results suggest that low serum albumin level is an independent poor prognostic factor in patients with Stage IIIB NSCLC, associated with reduction in the response rate to first-line therapy and survival rates.

The Prognostic Value of the Metabolic Syndrome in Colon Cancer Patients

Background: The aim of this study is to investigate the relationship between the Metabolic Syndrome the parameters of it and the manifest prognostic factors of the Colon Cancer in newly-diagnosed phase 2-4 colon cancer patients. Patients and Method: 104 newly-diagnosed and phase 2-4 Colon Cancer patients were prospectively included in the study at A°zmir Ataturk Training and Research Hospital Medical Oncology Policlinic between June 2010 and December 2012. Demographic, anthropometric and laboratory data belonging to the patients were recorded. To detect the presence of Metabolic Syndrome at the time of the diagnosis, patients were tested for hunger blood glucose, LDL, HDL, triglyceride, total cholesterol levels besides the metric measurement of the waist and hip perimeters. To detect the presence of hypertension, blood pressures were measured from both arms by a physician using a sphygmomanometer. Heights and weights of the patients were measured to calculate their BMI (Body Mass Index). The frequency of the Metabolic Syndrome was searched in colon cancer patients. The clinical phase, lymph node involvement, distant metastasis, histologic grade, perineural invasion and lymphovascular invasion were recorded. Frequency of the metabolic syndrome was looked into in colon cancer patients. The frequency of the Metabolic Syndrome parameters in colon cancer patients were looked into. Patients were divided into two groups as Colon Cancer patients with and without Metabolic Syndrome. Prognostic factors of the Colon Cancer were compared between these two groups. Results: The average age of the patients included in the study was 61.67 ± 10.09 in those with Metabolic Syndrome and 58.45 ± 10.39 in those without Metabolic Syndrome. 47.1% of patients suffered from the Metabolic Syndrome. 61.2% and 38.8% of colon cancer patients with Metabolic Syndrome were female and male, respectively. Parameters of the Metabolic Syndrome revealed that manifest prognostic values (tumor size, lymph node involvement, metastatic status, tumor grade, differentiation, obstruction, perforation, perineural invasion, lymphovascular invasion, tumor localization) at the time of the diagnosis between the Colon Cancer patient groups with newly-diagnosed Metabolic Syndrome and those without the Metabolic Syndrome were not found to be statistically different. Conclusions: In some of the former studies, it was found that the Metabolic Syndrome was negatively correlated with prognostic factors in Colon Cancer patients. Due to the insufficient number of patients, the lack of information on the duration of the Metabolic Syndrome in patients and the insufficient time for observation in our study, we were not able to draw clear-cut conclusions regarding the relationship between the newly-diagnosed colon cancer and the Metabolic Syndrome. Further research on this subject that includes higher number of patients is required.

Synchronous Appearance of a High-Grade Neuroendocrine Carcinoma of the Ampulla Vater and Sigmoid Colon Adenocarcinoma

Neuroendocrine carcinoma is a relatively rare tumor and its coexistence with other primary cancers is very exceptional. We present a case of a 63-year-old woman with biliary obstruction due to a high-grade neuroendocrine carcinoma located in ampulla of Vater who was found to have a synchronous sigmoid colon adenocarcinoma while undergoing staging laparotomy and pancreas head resection. Medical history was significant only for basal cell skin cancer. Immunohistochemical examination revealed the concurrence of histologically proved neuroendocrine carcinoma (chromogranin A, synaptophysin, and CD56 were positive) and Stage II (T3, N0, and M0) according to the TNM staging classification of colorectal cancer. The coexistence of neuroendocrine tumors with either synchronous or metachronous unrelated cancer is increasingly recognized. The patients with neuroendocrine carcinoma should be evaluated for secondary primary malignancies.

The Case of an Elderly Male Patient with Unknown Primary Mucinous Adenocarcinoma within Presacral Teratoma (Teratoma with Malignant Transformation).

Teratomas are rarely seen in adults, and presacral region is an area where they rarely settle in. Similarly, only about 1% of teratomas show malignant transformation. Malignant transformation is often associated with the area where teratoma settles in. Malignant transformation of mediastinal teratomas is more frequent than the ones located in retroperitoneal area and gonad. They most commonly show rhabdomyosarcoma, primitive neuroectodermal tumor, enteric adenocarcinoma, and leukemia transformation. In teratomas showing malignant transformation, the clinical course is aggressive; and survival of patients with metastatic disease is very low. The primary treatment of teratomas with malignant transformations is surgical. Effect of radiotherapy and chemotherapy is not clear in patients, to whom surgical operation cannot be applied, or those who are with residual tumor, even if surgical operation can be applied to them, or those who are at metastatic stage. In this paper, we presented a 76-year-old male patient due to the histologic diagnosis of mucinous adenocarcinoma within teratoma, in whom approximately 7 cm presacral mass was found during the radiographic examination made by the reason of low back pain and pelvic pain.

Clitoris metastasis from a retroperitoneal leiomyosarcoma: A case report.

Leiomyosarcoma is a rare form of cancer commonly found in the retroperitoneum, uterus, stomach, small intestine and vascular tissue. Surgery with a wide margin of resection is the most effective treatment. Nevertheless, metastasis is common and generally occurs within the first 3 years. The liver and lungs are the most common sites of metastasis in leiomyosarcoma. Other sites of metastasis include bone, spleen, soft tissues and brain. Metastatic tumours of the clitoris are extremely rare. As cited in the literature, the most common cancers that metastasize to the clitoris are breast, bladder, renal and gastric. Here, we report a case of a clitoral mass in a 64-year-old woman who received an operation for retroperitoneal leiomyosarcoma 4 years prior. Mass resection was performed. The pathological diagnosis was a leiomyosarcoma metastasis. The patient also presented with brain and lung metastases at the time of the clitoral metastasis. This is the first case of clitoral and brain metastases originating from a retroperitoneal leiomyosarcoma.

Isolated Liver Metastasis of Sacrococcygeal Chordoma: Case Report and Review of the Literature

Chordomas are rare neoplasms arising from notochordal remnants and may develop anywhere in the body while the most common anatomic site is the sacrococcygeal area. The most effective treatment of chordoma is surgery. Chordomas rarely metastasize to lung, bone, soft tissue, liver, lymph nodes, and skin. However, there is currently no standard systemic treatment for advanced stage chordoma. Here, we reported a rare presentation of chordoma patient with liver only metastases and poor prognosis.