Clinicopathologic Analysis and Prognostic Factors for Survival in Patients with Operable Ampullary Carcinoma: A Multi-Institutional Retrospective Experience.

Background and Objectives: In ampullary cancer, 5-year survival rates are 30-50%, even with optimal resection and perioperative systemic therapies. We sought to determine the important clinicopathological features and adjuvant treatments in terms of the prognosis of patients with operable-stage ampullary carcinomas. Materials and Methods: We included 197 patients who underwent pancreaticoduodenectomy to treat ampullary carcinomas between December 2003 and May 2019. Demographics, clinical features, treatments, and outcomes/survival were analyzed. Results: The median disease-free survival (mDFS) and median overall survival (mOS) were 40.9 vs. 63.4 months, respectively. The mDFS was significantly lower in patients with lymphovascular invasion (p < 0.001) and lymph node involvement (p = 0.027). Potential predictors of decreased OS on univariate analysis included age ≥ 50 years (p = 0.045), poor performance status (p = 0.048), weight loss (p = 0.045), T3-T4 tumors (p = 0.018), surgical margin positivity (p = 0.01), lymph node involvement (p = 0.001), lymphovascular invasion (p < 0.001), perineural invasion (p = 0.007), and poor histological grade (p = 0.042). For the multivariate analysis, only nodal status (hazard ratio [HR]1.98; 95% confidence interval [CI], 1.08-3.65; p = 0.027) and surgical margin status (HR 2.61; 95% CI, 1.09-6.24; p = 0.03) were associated with OS. Conclusions: Nodal status and a positive surgical margin were independent predictors of a poor mOS for patients with ampullary carcinomas. Additional studies are required to explore the role of adjuvant therapy in patients with ampullary carcinomas.

A New Prognostic Parameter Associated With Recurrence in Patients With Nasopharyngeal Cancer Treated With Chemoradiotherapy: The Ratio of the Hemoglobin-to-Red Cell Distribution Width.

INTRODUCTION: This study aims to investigate the prognostic significance of the pre-treatment hemoglobin-red blood cell distribution width (RDW) ratio (HRR) in terms of overall survival (OS) and disease-free survival (DFS) in patients with locally advanced nasopharyngeal cancer (LANC) treated with chemoradiotherapy. METHODS: Patients with LANC who attended the oncology clinic between October 2010 and June 2020 were retrospectively screened. HRR was calculated as hemoglobin (g/dL) divided by the RDW (%). Patients were assigned to either the low HRR group or the high HRR group. RESULTS: A total of 102 patients were included in the study. The cut-off value for HRR was taken as 0.97. Between the low and high HRR groups, mean age, Eastern Cooperative Oncology Group (ECOG) performance score, gamma-glutamyl transferase (GGT), albumin and lactate dehydrogenase (LDH) levels, weight loss at diagnosis, and recurrence and metastasis rate were significantly different. In the low HRR group, OS and DFS were 44.4 (95% CI: 4.9-83.8) and 15.7 months (95% CI: 0.1-36.2), respectively, but could not be reached in the high HRR group (p<0.001). In the multivariate analysis, low HRR was shown to be an independent factor in terms of both OS (p=0.004, hazard ratio (HR)=3.07, 95% CI: 1.444-6.529) and DFS (p<0.001, HR=3.94, 95% CI: 1.883-8.244). CONCLUSION: This is the first study showing that HRR is an independent prognostic marker for OS and DFS in patients with LANC treated with chemoradiotherapy. Thus, HRR can be used as an easily applicable, inexpensive marker in clinical practice in this patient group.

Is the prognostic nutritional index a prognostic and predictive factor in metastatic non-small cell lung cancer patients treated with first-line chemotherapy?

PURPOSE: We aimed to assess the prognostic and predictive significance of pretreatment Onodera's prognostic nutritional index (OPNI) in metastatic non-small cell lung cancer patients (NSCLC) treated with first-line chemotherapy. MATERIALS AND METHODS: Patients with metastatic NSCLC who attended five different medical oncology clinics between December 2008 and January 2018 were retrospectively analyzed. The optimal cut-off point for OPNI was performed by a receiver operating characteristic (ROC) curve analysis. Patients were assigned to either the low OPNI group or high OPNI group. RESULTS: A total of 333 patients were included in the study. Significant differences between the low and high OPNI groups were found regarding the rates of response to chemotherapy, sex, and hemoglobin level (p < 0.05). The patients in high OPNI group had a longer overall survival (OS) (15.3 vs. 10.6 months, p < 0.001) and progression-free survival (PFS) (6.7 vs. 5.3 months, p < 0.001) compared to the patients in low OPNI group. A multivariate analysis using Cox regression model revealed that a high OPNI score was an independent prognostic factor of OS (HR = 1.535, p = 0.002) and PFS (HR = 1.336, p = 0.014), but failed to demonstrate a statistical significance of pretreatment OPNI scores in predicting treatment response (p = 0.56). CONCLUSIONS: Pretreatment OPNI is an independent prognostic factor for OS and PFS in metastatic NSCLC patients treated with first-line chemotherapy. Thus, it may be used as easily calculated and low-cost prognostic tool in the routine clinical practice in this patient group.

Clinical outcomes of patients with pure small cell carcinoma of the urinary bladder.

OBJECTIVES: There is not yet a standardized approach to treat patients with small cell carcinoma of the bladder (SmCCB). This study aims to investigate the clinical features, treatment, and survival outcomes of patients with pure SmCCB. MATERIALS AND METHODS: Patients diagnosed with SmCCB between January 2006 and September 2015 were retrospectively evaluated. RESULTS: A total of 34 patients with a median age of 63.0 years were included in the study, with a male to female ratio of 4.6:1.0. At the time of diagnosis, 22 patients (64.7%) had stage IV disease. At a median follow-up time of 12.7 months, 67.6% of patients died of bladder carcinoma, with an overall survival (OS) of 15.7 months for all patients. In the patients with stages I-III, nodal involvement, and distant metastases, the median OS was 31.8, 15.7, and 8.4 months, respectively (P = 0.005). Considering the survival rates of the patients (stages I-III) treated with surgery vs. local therapy, there was not a statistically significant difference (26.6 months and 31.8 months, P = 0.97, respectively). A multivariate analysis revealed that stage IV disease and poor ECOG performance status were associated with OS. CONCLUSION: The optimal treatment of SmCCB has been under debate. For the patients with advanced stage of disease (T4b, N+, M+), platinum containing chemotherapeutic agents should be preferred. Stage IV disease and poor ECOG performance status were associated with shorter OS.

Is the Charlson Comorbidity Index a Prognostic Indicator for Toxicity and Mortality in Elderly Patients with Locally Advanced Rectal Cancer?

BACKGROUND: Aging is significantly related to multiple comorbidities. Even with a good performance score, some elderly patients may have poor survival outcomes. We aimed to evaluate the prognostic value of the Charlson comorbidity index (CCI) for mortality and toxicity in elderly patients with locally advanced rectal cancer (LARC). METHODS: Seventy-two elderly patients with LARC who were treated with neoadjuvant chemoradiotherapy (CRT) were included. Based on their CCI score, severity of the comorbidity was categorized into 2 groups: CCI<7 and CCI≥7. RESULTS: The overall survival (OS) at 5 years was 54.4 percent in patients treated with neoadjuvant CRT. Median OS was not reached for all patients as well as patients with CCI score <7, but median OS was 25 (95% CI 1.0-62.1) months in patients with CCI≥7 (P=0.002). The OS at 2 years was 79.1 percent in the patients with CCI <7 and 50.0 percent in the patients with CCI score ≥7 (P=0.002). Moreover, there was a trend toward, patients with higher CCI score who had more treatment related to grade 3 or 4 toxicity compared to those with CCI score <7 (33.3% vs 13.3%, respectively, P=0.09). Multivariable analysis indicated that the CCI score ≥7, presence of down-staging after therapy and clinical stage (III) independently predict mortality (HR 6.14, 95%CI 2.45-15.35, P<0.001) in patients with LARC. CONCLUSION: Although CCI score was not significantly associated with both toxicity and disease-free survival (DFS), we suggest that baseline CCI score might be a valuable prognostic indicator for physicians to evaluate elderly patiens with LARC for optimal treatment.

A rare case: Branch retinal vein occlusion associated with the use of tamoxifen.

Tamoxifen-induced ocular complications including cataracts, keratopathies, retinopathy, impaired visual acuity, ocular irritation, optical neuritis, and retinal vein occlusion are uncommonly reported in the literature. Herein, we report on a premenopausal patient with right-side breast carcinoma who received adjuvant tamoxifen therapy (20 mg/day) for 1.5 years and developed sudden visual loss. Fundal examination revealed an obstruction in the branch of the retinal vein. The diagnosis was confirmed by fluorescein angiography and optical coherence tomography. Thus, tamoxifen was switched to an aromatase inhibitor. Tamoxifen-induced ocular complications should be kept in mind when visual symptoms are seen in patients undergoing tamoxifen therapy. In such cases, a complete ocular examination should be performed.

Prognostic significance of gamma-glutamyl transferase in patients with metastatic non-small cell lung cancer.

BACKGROUND: The prognostic significance of serum gamma-glutamyl transferase (GGT) level at diagnosis in patients with metastatic non-small lung cancer (NSCLC) is not clear. We aimed to assess the relationship between serum GGT level and overall survival (OS) and progression-free survival (PFS) in this patient population. METHODS: Data of patients with metastatic NSCLC who were admitted to the medical oncology clinic of our hospital during April 2013-December 2017 were retrospectively analyzed. Patients were divided into two groups based on GGT levels, normal and high (as defined by normal reference levels), and then compared. RESULTS: Significant differences between the high and normal GGT level groups were found regarding female sex, Eastern Cooperative Oncology Group performance score, weight loss at the time of diagnosis, and lactate dehydrogenase level (p < 0.05). The high GGT group had a shorter median OS (11.5 vs. 3.4 months, p < 0.001) and PFS (7.8 vs. 3.0 months, p = 0.001). High GGT level is an independent risk factor for OS (hazard ratio [HR] 2.270; 95% confidence interval [CI], 1.398-3.686; p < 0.001) and PFS (HR 2.489; 95% CI, 1.323-4.684; p = 0.005). CONCLUSIONS: High serum GGT level is an independent prognostic factor for OS and PFS in metastatic NSCLC patients.

A prognostic parameter in advanced non-small cell lung cancer: the ratio of hemoglobin-to-red cell distribution width.

BACKGROUND: This study aims to investigate the prognostic value of the ratio of hemoglobin-RDW (HRR) at diagnosis, in terms of overall survival (OS) and progression-free survival in patients with advanced non-small cell lung cancer (NSCLC). METHODS: Patients with metastatic NCCLC who attended two separate medical oncology clinics between April 2013 and December 2017 were retrospectively screened. HRR was calculated as Hgb (g/dL) divided by the RDW (%). Patients were assigned to either the low HRR group or high HRR group. RESULTS: A total of 153 patients were included in the study. The cuff-value for HRR was taken as 0.88. Among the low and high HRR groups, Glasgow prognostic scores (GPS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and weight loss were statistically significantly different (p < 0.05). OS was found to be 5.6 months in the low HRR group and 13.9 months in the high HRR group (p < 0.001) while PFS was 5.1 months and 8.6 months in these two groups, respectively (p < 0.001). Univariate and multivariate analyses revealed that low HRR was an independent factor, predictive of both OS (p = 0.03, Hazard Ratio (HR) = 1.607, 95% CI = 1.041-2.480) and PFS (p < 0.001, HR = 2.635, 95% CI = 1.667-4.166) in advanced NSCLC. CONCLUSION: This is the first study to show that low HRR is associated with poor OS and PFS in patients with advanced NSCLC. Thus, hemoglobin and RDW which can be easily measured in routine practice may be used as a prognostic tool in these patients.

Prognostic importance of the albumin to globulin ratio in metastatic gastric cancer patients.

AIM: The aim of this study was to evaluate the prognostic importance of the albumin to globulin ratio (AGR) in terms of overall survival (OS) and progression free survival (PFS) in metastatic gastric cancer patients. METHODS: The patients diagnosed with metastatic gastric cancer between 2009 and April 2016 at the hospital have been studied retrospectively. The clinicopathological characteristics, laboratory, and treatment parameters have been assessed. AGR value has been calculated using the following formula (AGR = serum albumin/total protein - serum albumin). RESULTS: In total, 251 patients were included in the study population. The median value of AGR was 1.206 (range = 0.460-3.130), and the cut-off value was set as 1.20. Based on the cut-off value, 126 patients were categorized in the low AGR group, while the remaining 125 patients were categorized in the high AGR group. ECOG (Eastern Cooperative Oncology Group) performance scores, CEA levels, CA19-9 levels, hemoglobin levels, lactate dehydrogenase levels, and liver metastasis ratios varied significantly between the low and high AGR groups (p < .05). The Kaplan-Meier curve has shown that, compared to the low AGR group, the high AGR group has better OS (12.2 vs 9.3 months, p = .002) and better PFS (8.0 vs 5.7 months, p < .001) rates. The univariate and multivariate analyses also proved that low AGR is an independent bad risk factor in metastatic gastric cancer patients, both in terms of OS (p = .019, Hazard Ratio (HR) = 1.380, 95% Confidence Interval (CI) = 1.055-1.805) and PFS (p = .002, HR = 1.514, 95% CI = 1.164-1.968). CONCLUSION: In metastatic gastric cancer patients, AGR is an independent prognostic factor for OS and PFS. Thus, in this patient group, the low cost albumin and globulin which can be measured with routine clinical practice may be used as an appropriate prognostic tool.

In case of anastrozole-related hallucinations, can switching to letrozole be a treatment option? A case report and literature review.

Arthralgia, myalgia, paresthesia, reduced bone mineral density, vasomotor side effects including hot flashes and night sweats, genitourinary symptoms including decreased libido, vaginal dryness and dyspareunia are common side effects of aromatase inhibitors. Unlike the common side effects, the information on neurological side effects like hallucination of aromatase inhibitor was limited in literature cases. Herein, we reported a case of hallucination related to anastrozole in a patient with metastatic breast cancer. A 62-year-old female patient with breast cancer developed repetitive hallucinations on the following days of anastrozole initiation. There was no other significant finding in the differential diagnosis of hallucination. Neurological symptoms disappeared after termination of anastrozole. The patient had no neuropsychiatric complaints during letrozole treatment. We aimed to emphasize that neurological side effect like hallucination may rarely occur during the treatment of anastrozole and in case of aromatase inhibitor-related hallucinations, switching to another aromatase inhibitor (letrozole) can be a treatment option.

Mortality risk analysis of asymptomatic and symptomatic venous thromboembolism in patients with metastatic colorectal cancer.

BACKGROUND: The current study aimed to compare the clinicopathological characteristics and survival data of the patients with metastatic colorectal cancer who had symptomatic or asymptomatic venous thromboembolism (VTE) and non-VTE. PATIENTS AND METHODS: The files of the patients diagnosed with 521 metastatic colorectal cancer in our hospital between April 2001 and January 2015 were analyzed retrospectively. VTE was divided into four groups in relation with their locations as extremity, port, visceral, and nonvisceral VTE. VTE was also categorized as symptomatic or asymptomatic in relation with the presence of thrombus-related symptoms. The median overall survival was considered as the period from the diagnosis of metastasis to death or last control. RESULTS: A total of 424 patients were included in the study. The median age was 62 (range 24-95) years. Seventy-two (16.9%) patients developed VTE. Among all, 8.9% of the patients had asymptomatic VTE, 8% of them had symptomatic VTE, and remaining 83.1% of them were in the non-VTE group. Visceral thrombosis located in pulmonary and the thrombosis located in extremities and port location was usually symptomatic while nonvisceral thrombosis and nonpulmonary visceral thrombosis were frequently asymptomatic and found incidentally on radiological imaging obtained for tumor. Anticoagulant treatment was administered to all patients with symptomatic thrombosis. None of the patients with asymptomatic thrombosis was given anticoagulants. The median survival was 16.3 months (95% confidence interval [CI]: 13.8-18.9) in symptomatic, 22.5 months (95% CI: 18.6-26.4) in asymptomatic, and 21 months (95% CI: 20.5-21.5) in the non-VTE groups (P = 0.03). CONCLUSIONS: Symptomatic VTE is a predictor of poor survival in patients with metastatic colorectal cancer. The presence of an asymptomatic thrombus does not have any effect on prognosis, and follow-up without anticoagulant treatment may be appropriate in those patients.

Advanced signet-ring cell carcinoma of the stomach: Clinicopathological characteristics of patients and efficacy of the modified docetaxel, cisplatin, and fluorouracil regimen.

BACKGROUND: The aim of this retrospective study was to investigate the clinicopathological characteristics of patients with signet-ring cell carcinoma (SRCC) of the stomach, and the efficacy of the modified docetaxel, cisplatin, and fluorouracil (mDCF) chemotherapy regimen. PATIENTS AND METHODS: Sixty-five patients diagnosed with metastatic or recurrent SRCC and treated with at least one course of mDCF regimen as the first-line treatment at our hospital July 2007 and January 2015, were included in this study. The mDCF protocol comprised docetaxel at 60 mg/m2/day (day 1), cisplatin at 60 mg/m2/day (day 1), and 5-fluorouracil at 600 mg/m2/day (days 1-5) for every 3 weeks. RESULTS: The median age was 53 years (range, 25-69 years). The most frequent sites of metastasis were the peritoneum (50.8%) and liver (21.5%). The median number of chemotherapy courses was six. In assessing 61 patients for response evaluation, one patient (1.6%) achieved a complete response, and 36 (59.0%) achieved a partial response. Fifteen patients (24.6%) had stable disease and nine (14.8%) had progressive disease. Grades 3-4 hematological toxicity revealed anemia in three (4.6%) patients, thrombocytopenia in two (3.1%), and neutropenia in five (7.7%). Grades 3-4 nonhematological side effects revealed nausea and vomiting in four (6.1%) patients and mucositis in one (1.5%). The overall survival (OS) and progression-free survival (PFS) were 10.4 months (95% confidence interval [95% CI], 8.9-12.0) and 6.1 months (95% CI, 5.1-7.0), respectively. Multivariate analysis showed that Eastern Cooperative Oncology Group (ECOG) performance score of 2 and a high pretreatment carcinoembryonic antigen level were statistically significant. CONCLUSIONS: mDCF is an effective regimen in patients with SRCC of the stomach who have ECOG performance score of 0-1 when the PFS, OS, and tumor response rate are considered. Further prospective studies including more patients should be conducted on this subject.

Is serum survivin expression a predictive biomarker in locally advanced gastric cancer patients treated with neoadjuvant chemotherapy?

BACKGROUND: The potential prognostic value of survivin is variably reported depending on the gastric cancer. OBJECTIVE: Evaluation of the prognostic and predictive significance of serum survivin and its relation with survival and treatment response rates in patients with locally advanced gastric cancer (LAGC). METHODS: Serum samples were prospectively collected from 50 patients with newly diagnosed LAGC. Serum samples of 32 healthy subjects were also collected as control groups for survivin levels. Serum survivin levels were evaluated at baseline and after three cycles of neoadjuvant chemotherapy in LAGC patients. RESULTS: Median survivin level was 147 IU/L (range = 4.4-4936) at baseline and was 27 IU/L (range = 4.2-4737) after neoadjuvant chemotherapy. The difference between survivin levels of the control group (26 IU/L, range = 3.8-1430) and pre-treatment patient group was statistically significant (p< 0.001). Clinical response to mDCF regimen was classified as progressive (progressive disease) and non-progressive groups (partial response + stable disease). Baseline survivin levels were similar between patients in progressive and non-progressive groups (p= 0.55). Survivin levels were significantly reduced after chemotherapy in non-progressive group (p< 0.001). In contrast, serum survivin levels increased in a stepwise fashion from baseline to post-chemotherapy in patients with progressive disease (p= 0.06). Patients were divided into low and high survivin groups according to baseline median survivin levels. Median DFS was 12.4 and 14.6 months for low and high groups, respectively (p= 0.18). Moreover, median OS was 14.4 and 24.9 months for low and high group, respectively (p= 0.14). CONCLUSION: It can be suggested that serum survivin can be used as a predictor of response to chemotherapy- but not survival- in LAGC patients receiving neoadjuvant mDCF chemotherapy. However, large multicenter prospective studies are required to confirm these results.

A Modified Epirubicin and Oxaliplatin Plus Capecitabine (EOX) Regimen as a Second- Line Therapy in Patients with Advanced Gastric Cancer

Objective: We aimed to evaluate the effectiveness of an mEOX (modified epirubicin, oxaliplatin plus capecitabine) regimen as second line therapy after failure of mDCF (modified docetaxel, cisplatin plus fluorouracil). Methods: Gastic cancer patients for whom first-line therapy was unsuccessful and who subsequently received mEOX (epirubicin 50 mg/ m2 on day 1, oxaliplatin 85 mg/m² day 1 and capecitabine twice-daily dose of 625 mg/ m2, p.o. for 2 weeks) every 3 weeks until disease progression or unacceptable toxicity, were retrospectively analyzed. Results: The study population comprised 129 cases with a median age of 55 years (range= 27-78), the majority being male (76 %). Most (75.2%) had ≥ 2 sites of metastasis. The median number of chemotherapy courses was five (range= 2­9). Forty-nine achieved a partial response and 33 showed stable disease, resulting in a ORR (overall response rate) of 38% and a DCR (disease control rate) of 63.6%. The most frequent features of grade 3-4 hematological and non-hematological toxicity were neutropenia (8.5%) and nausea/vomiting (5.4%). None of the patients suffered death due to toxicity. The median PFS was 4.7 months (95% CI, 4.1­5.3) and the OS was 7.4 months (95% CI, 6.3­8.5). On multivariate analysis, age ≥ 60 years and ECOG performance status (0-1) were independent prognostic factors affecting PFS and OS. Conslusions: In advanced gastric cancer patients, who progress after first line chemotherapy and have an ECOG performance status of 0-1, mEOX is a well tolerated triple regimen associated with a promising OS and PFS.

5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) as a third-line chemotherapy treatment in metastatic gastric cancer, after failure of fluoropyrimidine, platinum, anthracycline, and taxane.

Studies on the effects of third-line chemotherapy (CT) in advanced gastric cancer (GC) patients are still scarce. The aim of this study was to evaluate the efficacy and safety of the modified 5-fluorouracil, leucovorin, and irinotecan (mFOLFIRI) regimen as a third-line CT in metastatic GC patients, after failure of fluoropyrimidine, platinum, anthracycline, and taxane. After failure of first- and second-line therapies, 42 patients received third-line FOLFIRI (180 mg/m² irinotecan and 400 mg/m² leucovorin administered concomitantly as a 90-minute intravenous (IV) infusion on day 1, followed by a 400 mg/m² 5-fluorouracil IV bolus then 2600 mg/m² continuous infusion over 46 hours), between January 2009 and December 2015. FOLFIRI was administered for a median of 6 cycles (range 4-12 cycles). Eight patients achieved partial response, while 13 patients showed stable disease, resulting in the overall response rate (ORR) of 19% and disease control rate (DCR) of 50%. The most frequent grade 3-4 hematological and non-hematological toxicities were neutropenia (14.2%) and diarrhea (7.1%). The median progression-free survival (PFS) and overall survival (OS) from the start of third-line CT were 3.8 months (95% confidence interval [CI], 3.0-4.5) and 6.8 months (95% CI, 5.6-7.9), respectively. According to the multivariate analysis, two factors were independently predictive of the poor OS: >2 regions of metastasis (relative risk [RR], 2.6; 95% CI, 1.3-5.4) and a high level of carcinoembryonic antigen [CEA] (RR, 3.4; 95% CI, 1.6-7.4). In conclusion, FOLFIRI was well tolerated as third-line CT and showed promising PFS and OS in advanced GC patients, after failure of fluoropyrimidine, platinum, anthracycline, and taxane.

Small bowel and cecal Involvement: Unusual metastasis sites from adenoid cystic carcinoma of the minor salivary gland.

Adenoid cystic carcinoma (ACC) is a rare neoplasm and the most frequent pathology occurring in the minor salivary glands. Lung, bone, liver, and brain are the most frequent metastasis sites in ACC cases. To our knowledge, cecal and ileum metastasis from ACC has not been previously reported in literature. Herein, we reported a case of cecal and small bowel metastasis (ileum) in a patient with ACC. A 41-year-old male patient with ACC developed iron and Vitamin B12 deficiency anemia during further controls. Lower gastrointestinal (GI) endoscopy detected an ulcerated polypoid lesion with raised margins in cecum. Pathological evaluation of polyp biopsy was consistent with metastasis from ACC. The patient underwent surgery of right hemicolectomy. Pathological examinations revealed an ACC of cecum and small bowel (ileum) showing positive staining with CD117, CK7, and panCK. We aimed to emphasize that performing GI stromal screening in ACC patients presenting with iron deficiency is important for early diagnosis of metastasis.

Gastric adenocarcinoma with neuroendocrine differentiation: Clinicopathological features and efficacy of modified DCF chemotherapy.

PURPOSE: The aim of this study was to investigate the clinicopathological characteristics of patients with gastric carcinoma with neuroendocrine differentiation (NEDGC) and the efficacy of the modified DCF (mDCF) chemotherapy regimen. METHODS: Patients with NEDGC and non-NEDGC (pure adenocarcinoma) were evaluated comparatively in terms of pathological parameters, clinical parameters and treatment efficacy. Patients received treatment with mDCF (docetaxel, cisplatin and 5-fluorouracil). RESULTS: In total, 391 patients (35 with NEDGC and 356 with non-NEDGC) were included in this study. In particular, in the NEDGC group, the presence of lymphovascular invasion (LVI), presence of perineural invasion (PNI), median tumor size, and metastasis at the time of diagnosis were significantly higher than in the non-NEDGC group. mDCF was used as first-line chemotherapy regimen in 16 patients in the NEDGC group, and in 151 patients in the non-NEDGC group. In NEDGC and non-NEDGC groups overall disease control rate was 87.5% [partial response (PR) (50.0%), stable disease (SD) (37.5%)] and 80.8% [complete response (CR) (2.6%), PR (38.4%), SD (39.8%)], respectively. In the advanced-stage patients who had first-line mDCF, the median overall survival (OS) was 10.6 months (95% CI: 5.9-15.4) and 12.2 months (95% CI: 10.3-14.2) in NEDGC and non-NEDGC groups, respectively (p=0.88). The median progression-free survival (PFS) in the NEDGC and the non-NEDGC groups were 7.6 months (95% CI: 5.5-9.7) and 7.5 months (95% confidence interval/CI: 6.8-8.1), respectively (p=0.82). CONCLUSION: NEDGC patients usually have higher LVI and PNI rates, and they present with advanced disease. In this group of patients, mDCF regimen may be an effective treatment option. However this statement needs to be verified by further prospective and multi-centered studies including a larger patient cohort.