Relationship between immune checkpoint proteins and neoadjuvant chemotherapy response in breast cancer.

INTRODUCTION: Following major developments in cancer immunotherapy, treatments targeting immune checkpoint proteins (ICP) gained interest in breast cancer, though studies mostly focus on patients with metastatic disease as well as patients nonresponsive to the conventional treatments. Herein, we aimed to investigate the levels of ICP in tumor stroma and tumor infiltrating lymphocytes, and tumor tissue prior to neoadjuvant chemotherapy administration to evaluate the relationship between ICP levels, clinicopathological parameters, and NAC response. MATERIALS AND METHODS: This study was conducted with 51 patients where PD-1, PD-L1, CTLA-4, TIM-3, CD24 and CD44 levels were investigated in CD45+ cells while CD326, CD24, CD44 and PD-L1 protein expression levels were investigated in CD45- population. In addition, CD44 and CD24 levels were evaluated in the tumor stroma. TIL levels were investigated according to the TILS Working Group. Treatment responses after NAC were evaluated according to the MD Anderson RCB score. RESULTS: Our results revealed positive correlation between CTLA-4 and CD44 expression in cases with high TIL levels as well as TIL levels and CTLA-4 expression in cases with partial response. Similarly, positive correlation was detected between TIM3 and PD-L1 levels in cases with good response. In addition, a negative correlation between TILs after NAC and PD-1/PD-L1 expression in lymphocytes in cases with partial complete response. CONCLUSIONS: Our study provides preliminary data about the correlation between ICP and clinicopathological status and NAC response in breast cancer, in addition to underlining the requirement for further research to determine their potential as therapeutic targets.

A new risk scoring system for early prediction of surgical need in patients with adhesive small bowel obstruction: a single-center retrospective clinical study.

Purpose: Cases of adhesive small bowel obstruction are a nuisance to surgeons. There have been years of ongoing discussions, and various guidelines have been published for the management of this disease. Both surgical and conservative approaches can have their own complications. It is often difficult to decide which treatment to apply to which patient. We aimed to create a multiparametric scoring system for the optimal management of adhesive small bowel obstruction patients. Methods: The retrospective laboratory, clinical and radiological records of 100 patients who were hospitalized and followed-up/treated for adhesive small bowel obstruction secondary to surgery in the General Surgery Clinic of Haydarpasa Numune Education and Research Hospital (Istanbul) between 2011 and 2021 were reviewed and statistically analyzed. Results: Admittance CRP and the largest diameter of the small intestine in the horizontal section of the admittance CT scans were significantly higher (P = 0.006 and P = 0.007), and the admittance albumin and sodium values were significantly lower (P < 0.001 and P = 0.031) in patients operated on for adhesive small bowel obstruction than in patients not operated on. Free intraperitoneal fluid in CT scans was detected at a higher rate in the operated group. An adhesive small bowel obstruction surgery score above 3.5 points out of 7 was found to be significant (P < 0.001). Conclusion: With this easy and applicable scoring system, complications of existing disease may be avoided by considering earlier surgical intervention in patients with a score of 4 and above.

Use of the Systemic Immune Inflammation Index, TNM classification, and CEA in pre- and post- prognostic evaluation of sporadic colorectal cancer.

AIM: The aim of this study was to investigate the correlation between preoperative systemic immune inflammatory index (SII) and carcinoembryonic antigen (CEA) and postoperative lympho-vascular invasion and TNM stage in patients with colorectal carcinoma. MATERIAL AND METHODS: A total of 153 patients with colorectal cancer admitted to our tertiary hospital between 2014 and 2018 were included in the study. RESULTS: While 71.2% of the patients had low preoperative CEA values, 28.8% had high preoperative CEA values. Lymphovascular invasion rate was found to be significantly higher in patients with high CEA levels than those in low levels (70.4% vs. 39.4%, p=0.002). The percentage of patients with lymphovascular invasion with a high SII (60.0%) was significantly higher than those without lymphovascular invasion (p=0.015). CONCLUSION: In our study, serum CEA and SII index values were found to provide critical information in terms of showing lympho-vascular invasion, which is considered as an independent "bad" prognostic factor in patients with colorectal carcinoma. In conclusion, we consider that CEA and SII index values can be used to determine the prognosis of patients with colorectal cancer. KEY WORDS: Carcinoembryonic antigen, Colorectal carcinoma, Microsatellite, lymphovascular invasion, TNM.

Diagnostic Value of Axillary Ultrasound, MRI, and 18F-FDG-PET/ CT in Determining Axillary Lymph Node Status in Breast Cancer Patients.

OBJECTIVE: Knowing axillary lymph node (ALN) status before surgery affects decisions about treatment modalities. Therefore, reliable, noninvasive diagnostic methods are important for determining ALN metastases. We aimed to accurately evaluate the patient's ALN status with noninvasive imaging modalities while making treatment decisions. MATERIALS AND METHODS: Patients who received the axillary ultrasound (AUS), magnetic resonance imaging (MRI), or 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) imaging modalities and whose ALNs were confirmed histopathologically by fine needle aspiration cytology (FNAC), sentinel lymph node biopsy (SLNB), or ALN dissection (ALND) were included in the study. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of AUS for the detection of ALN metastases were 83%, 62%, 59.2%, 54.8%, and 79.1%, respectively. For MRI they were 86.1%, 75%, 68.5%, 51.6%, and 85.3%, respectively, and for 18F-FDG-PET/CT they were 78%, 53%, 56.2%, 51.4%, and 72.5%, respectively. ALNs were found to be metastatic in all patients who were reported positive in all three imaging modalities. ALN metastases were detected in 19 of 132 patients (false negativity, 14.3%) in whom AUS, MRI, and 18F-FDG-PET/ CT images were all reported as negative. CONCLUSION: In our study, we found that the diagnostic performance of MRI was slightly better than AUS and 18F-FDG-PET/CT. When we used imaging modalities together, our accuracy rate was better than when we used them alone. For accurate evaluation of axillary lymph nodes, imaging modalities should be complementary rather than competitive.