Effects of VDR and CYP24A1 gene polymorphisms on the outcome of supraglottic larynx cancer.

OBJECTIVE: Vitamin D has been demonstrated to play a protective role in carcinogenesis. Polymorphisms of the vitamin D receptor (VDR) genes and 24-α-hydroxylase (encoded by CYP24A1) may affect the outcome of some cancers. This study examines the effects of the VDR gene and CYP24A1 single nucleotide polymorphisms on the outcome of supraglottic larynx cancer. PATIENTS AND METHODS: Patients diagnosed with supraglottic larynx cancer between 2017 and 2022 were enrolled. Single nucleotide polymorphisms of the VDR gene (rs2228570, rs731236, rs7975232, rs11574113, rs11168267 and rs11168266) and CYP24A1 gene (rs4809960, rs6022999, rs6068816, rs2259735 and rs2296241) were investigated. All patients were followed up for any evidence of local recurrence, regional recurrence, distant metastasis, and second primary tumor development. Cox regression analysis was performed to evaluate the prognostic value of single-nucleotide polymorphisms (SNPs). Kaplan-Meier method was used for survival analysis. RESULTS: 87 patients were included. The mean follow-up time was 45.02±24.47 months. Cox regression analysis for locoregional recurrence revealed that the hazard ratio of rs731236 GG was 2.098 (95% CI, range: 1.047-4.202, p=0.037). Locoregional recurrence for rs731236 AA, AG, and GG were 38.6%, 23.1%, and 53.3%, respectively. In the presence of rs731236 GG polymorphism, disease-specific survival was significantly shorter (47.63±7.48 months, p=0.015), and disease-free survival (45.71±6.3 months) was significantly shorter (p=0.040). Rates of metastases and second primary tumors were not significantly different between SNPs. CONCLUSIONS: This study has demonstrated the possible effects of VDR rs731236 SNP on the locoregional recurrence and prognosis of supraglottic larynx cancer.

Are the GLIM Criteria Guiding in the Course of Hematological Malignancies?

BACKGROUND: Different degrees of malnutrition are seen in patients with hematological malignancies. None of the approaches used to determine malnutrition risk have general acceptance. The use of the GLIM criteria developed by the Global Leadership Initiative on Malnutrition has promising results. MATERIALS AND METHODS: A total of 67 patients with leukemia, lymphoma, and multiple myeloma were included in the study. NRS-2002 (Nutritional Risk Screening-2002) was used to screen the nutritional status of the patients, and malnutrition was diagnosed and graded using the GLIM criteria in patients who were found to be at risk of malnutrition in this test. The parameters followed in the groups with and without malnutrition were compared. The Kolmogorov-Smirnov, Mann-Whitney U, and Chi-square test were used for statistical analysis. RESULTS: Patients were analyzed by dividing them into two groups as those with and without malnutrition. The presence of infection, duration of fever, antibiotic, and antifungal use were significantly higher in malnourished than in nonmalnourished patients. Platelet counts and sodium levels were significantly lower in the malnourished arm. CONCLUSION: Early nutritional support can increase the immunological status of patients with malignant disorders as well as their tolerability to treatment. Minimizing the risk of malnutrition and providing timely calorie and vitamin support are factors that may directly affect febrile neutropenia, duration of fever, and antifungal use, which will consequently lead to a decrease in the length of hospitalization.

Are premenstrual syndrome and aggression related to body mass index in adolescents?

OBJECTIVE: This cross-sectional study aimed to examine the relationship between premenstrual syndrome (PMS) and aggression during adolescence with body mass index (BMI), which is a topic not yet investigated in the literature. PATIENTS AND METHODS: This cross-sectional study was conducted with 1,450 adolescents aged 12-18 years, who applied to the Pediatric Adolescent Outpatient Clinic and voluntarily agreed to participate in the study. Anthropometric measurements of the adolescents were taken and the Premenstrual Syndrome Scale and Buss-Perry Aggression Questionnaire were administered to the adolescents. It was discovered that all the adolescents participating in the study had PMS. RESULTS: It was determined that as the levels of PMS were elevated, physical aggression, hostility, anger and verbal aggression gradually increased. Additionally, this increase was statistically significant (p<0.001). It was further discovered that there were statistically significant differences between the BMI classifications of the adolescents and PMS, physical aggression, hostility, anger and verbal aggression statuses (p<0.001). Accordingly, it was determined that as the BMI values of the adolescents increased, PMS and aggressive attitude levels increased. CONCLUSIONS: This study is the first in the literature to examine the relationship between PMS and aggression, and BMI in adolescents. Within this framework, it was determined that PMS frequency and aggression levels were high in overweight/obese adolescents. Accordingly, it is predicted that both PMS and aggression levels can decrease with healthy body weight in adolescents.

The prognostic impact of comorbidity, nutritional and performance status on patients with diffuse large B cell lymphoma.

Background: The aim of the study was to investigate the impact of nutritional status, comorbidity, and performance status on patients with diffuse large B-cell lymphoma (DLBCL). Methods: A retrospective study was conducted on 112 DLBCL patients who were diagnosed at our center between 2009 and 2018. Demographic and disease characteristics and laboratory test results were recorded. Assessments were made using the age-adjusted Charlson comorbidity index (CCI-A) for comorbidity, albumin level for nutritional status, and Eastern Cooperative Oncology Group (ECOG) score for performance status. Results: The mean age of the patients was found to be 62.63 ± 15.16 years. The ECOG score of 65 patients (69.1%) was in the range of 0-1. The mean follow-up time of the patients was determined to be 25.24 ± 25.11 months, and at the end of the follow-up period, 64 patients (57.1%) were survivors. The progression-free survival (PFS), overall survival (OS), and 5-year OS rates of those with CCI-A > 4 were found to be significantly lower than those with CCI-A score ≤4 (P < 0.05). As a result of the Cox-Regression (Backward: LR method) analysis, ECOG and albumin levels were found to be independent risk factors for both OS and PFS (P < 0.05). Conclusion: This study demonstrated that CCI-A, ECOG, and nutritional status are independent prognostic markers for DLBCL patients. Initial evaluation of these patients should include all these parameters, which are easily available at the time of diagnosis.

The utility of CONUT score in indolent lymphoma patients.

Background and Aim: Similar to the uncertainties in the treatment criteria for indolent non-Hodgkin lymphoma (iNHL), the prognostic criteria have not been fully clarified. The Controlled Nutritional Status (CONUT) score is not only used as a predictor of malnutrition but also indicates prognosis in many chronic or malignant diseases. The aim of this study is to investigate the predictive and prognostic significance of the CONUT score in patients with iNHL. Patients and Methods: A retrospective evaluation was made of 109 patients with iNHL. The CONUT scores of the patients were compared between those with an indication for treatment and those followed without treatment. The same analysis was performed between patients who developed relapse after treatment. Survival analysis was performed on all patients, and associations between survival and the CONUT score were examined. Results: The median CONUT score was found to be higher in those who had treatment indications compared to those who did not (2 vs 1; P = 0.014). In the regression model, a CONUT absolute value above 5 was found as an independent risk factor predicting relapse. In the whole study population, a CONUT absolute value >2 predicted the risk of mortality with 53.9% sensitivity and 68.7% specificity (AUC ± SE = 0.639 ± 0.07; +PV = 35%; -PV = 82.6%; P = 0.034). Conclusion: CONUT score is a predictive and prognostic factor for patients with iNHL. The development of simple, low-budget prognostic and predictive biomarkers is critical not only for determining the course of the disease but also for follow-up and treatment management.

The relationship between healthcare workers' satisfaction level and patients' satisfaction: Results of a path analysis model.

INTRODUCTION: Patient and healthcare workers' satisfaction is an important issue in the healthcare sector today. This study aims to evaluate the relationship between healthcare workers and patient satisfaction levels among Turkish individuals, with particular emphasis on the contribution of the former to the latter. MATERIALS AND METHODS: The current study was conducted in a state hospital in Istanbul, Türkiye. Face-to-face surveys were conducted from January to April 2022 to administer two diverse questionnaires for inpatients and attending healthcare workers in the same clinic. Path analysis was used to examine the relationships. RESULTS: The path analysis demonstrated that 25.2% of patient satisfaction was constituted by the satisfaction of healthcare workers. The final model had an excellent fit with the data x2 (112.89), x2/df (2.130); SRMR=0.0679, CFI=0.956, RMSEA=0.0798. According to the results of this analysis, healthcare worker satisfaction positively influences patient satisfaction and causes it to increase. CONCLUSION: Healthcare satisfaction plays a central role in providing patient satisfaction, which in turn helps with the challenges that healthcare faces today.

Orthorexia and eating attitudes in health sciences students.

Background: The prevalence of eating disorders and orthorexia nervosa has steadily increased and this situation may lead to severe physical, psychological, and social disorders. Aim: The aim of this study was to investigate the prevalence of disordered eating attitudes and orthorexia tendencies among university students studying in various Health Sciences departments in Turkey. Subjects and Methods: The study subjects were selected from Health Sciences Faculty students. Among the students who accepted the study, 639 people were reached by simple random sampling method. The EAT-40 and ORTO-15 which are validated instruments for the screening of abnormal eating behaviors and orthorexia nervosa respectively, were used as measurement tools. Results: The majority of the students who participated in the study were found to exhibit orthorexic tendencies, and male students had a higher orthorexic tendency in comparison to female students (p = 0.022). More specifically, the students studying in the Department of Nutrition and Dietetics had lower orthorexic tendencies compared with the students from other departments. There was no significant relationship between BMI values and the mean ORTO-15 scores, whereas the mean EAT-40 score was found to increase statistically significantly with increased BMI (p = 0.038). There was a statistically significant difference between the departments and classes in terms of mean EAT-40 scores, whereas no difference was found regarding gender. Conclusion: Orthorexia nervosa is a common problem for university students studying in health-related departments. Interestingly, the orthorexic tendencies of girls and students studying in the Nutrition and Dietetics department were found to be lower in this study. It was determined that all students except the Nutrition and Dietetics department had orthorexia tendencies. More comprehensive studies are needed to better understand orthorexia nervosa and healthy lifestyle interaction.

Effects of different storage media on dentin moisture, microhardness, and bond strength of resin composite.

Background: In in vitro studies, it is desirable that the storage solutions in which dental samples kept between extraction and experiment should prevent dehydration and have antimicrobial properties. However, it should be taken into consideration that these solutions may have some effects that directly change test results on physical and mechanical properties of laboratory samples. Aims: The aim of this in vitro study was to evaluate the effects of different storage media on dentin moisture, microhardness, and microshear bond strength of resin composite to dentin. Thirty non-carious human premolars were randomly divided into three groups: 1. 0.1% Thymol (T), 2. Distilled water (DW), 3. Dry storage (DS) (control) (n = 10). Dentin moisture was measured with a digital grain moisture meter. Dentin microhardness was measured with the Vickers test. The bond strength was measured with a microshear test. Materials and Methods: Analysis of variance (ANOVA) followed by the Bonferroni test was used for statistical evaluation (p = 0.05). Results: Dentin moisture of the experimental groups was statistically higher than that of the control group (p < 0.05). In addition, the dentin moisture of group DW was significantly higher than that of group T (p < 0.05). The mean microshear bond strength of resin composite to dentin was higher in group DW than in group T and group DS (p < 0.05), while there was no statistical difference between group T and group DS. The microhardness values of all groups were statistically similar. Conclusions: Storage solutions used for disinfection and to prevent dehydration may have negative effects on dentin moisture and bond strength.

The relationship between hemoglobin-RDW ratio and clinical outcomes in patients with advanced pancreas cancer.

OBJECTIVE: The prognostic significance of hemoglobin (HGB) -red cell distribution width (RDW) ratio (HRR) has been indicated in various cancer types. However, its clinical significance in patients with metastatic pancreas cancer (MPC) is unknown. In this study, we aimed to investigate the prognostic importance of pre-treatment HRR in patients with metastatic pancreas cancer. PATIENTS AND METHODS: MPC patients (≥18 years of age) who received at least one course of chemotherapy between January 2001 and January 2021, were evaluated retrospectively in terms of pre-treatment HRR values. RESULTS: Of 111 patients, the mean HRR value was 0.84, and the patients were divided into low HRR and high HRR groups. The median follow-up was 8.7 months (95% CI 1.8-51.6). The median duration of first-line treatment was 4.4 months (95% CI 0.5-31.3). The median overall survival (OS) was 7.6 months (95% CI 3.4-11.8) in the low HRR group and 8.7 months (95% CI 5.7-11.8 months) in the high HRR group (p=0.276) (Figure 1). The median progression-free survival (PFS) was 4.2 months (95% CI 2.7-5.6 months) in the low HRR group and 5.1 months (95% CI 2.8-7.4 months) in the high HRR group (p=0.044) It was found that high HRR decreased progression event in both univariate (HR 0.67, 95% CI 0.45-0.99, p=0.046) and multivariate (HR 0.62, 95% CI 0.42-0.93, p=0.022) analysis. CONCLUSIONS: The present study emphasized that low HRR was a poor prognostic factor for PFS in patients with MPC. There was no statistically significant difference between the HRR groups regarding OS. This is the first study evaluating the prognostic significance of HRR in MPC.

Evaluation of postprandial symptoms in two different laparoscopic sleeve gastrectomy techniques using gastric emptying scintigraphy.

Background: Laparoscopic sleeve gastrectomy (LSG) is a frequently used procedure in the surgical treatment of obesity in recent years. However, surgeons have different opinions regarding the distance from the antrum to the pylorus. In addition, postprandial symptoms significantly affect the overall quality of life. Aim: Therefore, this study aimed to understand the relationship between postprandial symptoms with gastric emptying time and surgical procedures. Patients and Methods: Sixty patients who underwent LSG surgery were analyzed retrospectively and divided into two groups: antrum preserved (AP) and antrum resected (AR). The antral resection margin was 2 cm from the pylorus in 35 patients (AR group) and 6 cm in 25 patients (AP group). Semisolid gastric emptying scintigraphy (GES) was performed prospectively in both groups. Postprandial symptoms were standardized with a questionnaire. The relationship of symptoms with a half time of gastric emptying (GE T½), retention percentage at 30 and 60 minutes, lag phase, body mass index (BMI), and a decline in excess weight (% EWL), and antrum resection were investigated. The obtained results were compared between the two groups and with the control group. Results: The study group comprised 60 patients (49 F/11 M, mean age: 40.3 ± 20.1 years, BMI 31.6 ± 8.1 kg/m2). The half-time of gastric emptying in the AR and AP groups (28.00 min ± 9.58, 28.24 min ± 11.90, respectively), percentage gastric retention at 30 and 60 minutes in the AR and AP groups (30 minutes: %44.37 ± 17.88, %40.52 ± 14.56 and 60 minutes: 17 ± 8.9, 19 ± 3.1) was significantly different compared with the control group, but no significant difference was observed between the study groups. In addition, there was no statistically significant difference between the AR and AP groups in postprandial symptom scores >9 (68.6%, 60%, P = 0.681), GER (77.1%, 64%, P = 0.253), and postoperative BMI (p = .397), % EWL (p = .975), and T lag phase (p = .332). Conclusions: In our study, the postprandial symptoms were not affected between two different surgical procedures in LSG.

The prognostic significance of blood counts in patients with hodgkin lymphoma.

Background and Aim: The aim of the study was to examine the demographic, clinical features, treatment responses, and outcomes of Hodgkin lymphoma (HL) patients and to investigate the factors affecting their survival. Patients and Methods: A retrospective analysis was made of patients diagnosed with HL in our department between 2009 and 2019. Treatment regimen, treatment response, and follow-up times were recorded for all patients. Using these data, complete response (CR) rates, overall survival (OS), and progression-free survival (PFS) were calculated. The effects of parameters on survival were investigated with Cox regression analysis. Results: Evaluation was made of 60 patients with a median age of 33.5 years [18.0-80.0] and mean follow-up duration of 29.34 ± 23.64 months. Median OS and PFS could not be reached with a mean OS of 85.6 months, and PFS of 71.7 months at the final visit. Only initial leukocyte and neurophil count were determined to have a statistically significant impact on survival (OR = 1.004; P = 0.031 vs OR = 0.996; P = 0.036). Conclusion: In HL patients, in addition to the many prognostic scoring systems, leukocyte and neutrophil count can be used as an independent prognostic parameter. Patients with higher leukocyte and lower neutrophil counts at the time of diagnosis should be managed more carefully.

Hounsfield units: A promising non-invasive tool for diagnosing benign prostatic hyperplasia.

OBJECTIVE: The clinical symptoms in benign prostatic hyperplasia (BPH) are directly proportional to prostate volume. We aimed to show whom and when to intervene in a noninvasive way, correlating the patient's subjective symptoms with objective diagnostic tools. MATERIAL AND METHOD: International Prostate Symptom Score (IPSS) was evaluated in patients who consulted the urology outpatient clinic for the first time with lower urinary tract symptoms (LUTS). Subsequently, PSA, urea, creatinine, complete urinalysis, uroflowmetry, urinary tract ultrasound and non-contrast lower abdominal computed tomography (CT) examinations were requested. Prostate central (transitional zone) zone and peripheral zone HU scores, prostatic urethral length and bladder wall Hounsfield units (HU) scores were recorded by using computed tomography (CT). The ellipsoid formula was used for ultrasonographic and tomographic measurements of prostate size (anteroposterior diameter × transverse diameter × longitudinal diameter × 0.52). RESULTS: A statistically significant negative correlation was found between the prostate peripheral zone/central zone HU ratio and the maximum flow rate measured in the uroflowmetry test. CONCLUSION: This is the first study in the literature to evaluate the correlation between voiding parameters such as Qmax, Qave and IPSS scores, and prostate and bladder wall HU scores obtained by computed tomography examination in BPH patients. A significant relationship has been detected between the peripheral zone/central zone HU ratio and Q max. Additional studies with larger patient populations could better clarify the contribution of HU in the diagnosis of BPH and treatment decision making of these patients.

The clinicopathological features and survival of Castleman disease: a multicenter Turkish study.

OBJECTIVE: In this study, we aimed to investigate the clinicopathological features and survival of CD, which is quite rare and has many unknowns. PATIENTS AND METHODS: This study was conducted by retrospectively evaluating patients diagnosed with CD in six different centers in Turkey. RESULTS: The median age of 33 patients included in the study was 49 and 51.5% (n = 17) of these patients were women. 18 (54.5%) patients were in the hyaline vascular subtype and most of the patients were UCD (n = 20, 60.6%). The most common involvement region was head and neck (n = 19, 57.5%). The UCD group was younger than the MCD group (p=0.027). Visceral lymph node involvement was higher in MCD than in UCD (p=0.001). Similarly, it was observed that there was more hepatomegaly (p=0.035) and splenomegaly (p=0.013) in the MCD group. During the median 19.5 months follow-up period, there were no patients who died. CONCLUSIONS: It was observed that UCD and MCD are different clinical entities. Promising survival times can be achieved with surgical and systemic treatments in both subtypes of this extremely rare disease. However, this result should be supported by well-designed prospective comprehensive studies.

The effect of different preservation media and temperatures on sperm quality and DNA integrity in mouse cauda spermatozoa.

BACKGROUND: Mouse sperm can be stored for long or short-time periods. Nevertheless long-term storage leds to significantly reduced sperm quality and fertility because of cryodamage. Thus, in the storage of semen in mice, it is necessary to focus on media and temperatures that gives good results in short-term storage. OBJECTIVE: To determine favorable media for short-term storage of mice spermatozoa by evaluating progressive motility, viability, membrane function integrity, acrosome integrity and fragmented DNA rates at various storage temperatures. MATERIALS AND METHODS: Mouse spermatozoa were collected from epididymides of mature CD1 males and samples were stored at 24 degree C and 4 degree C for 60 h. RESULTS: Motility, viability and membrane function of mice spermatozoa were greatest when stored in KSOM media. Motility and viability were not different when stored at refrigerator or room temperature in KSOM compared to HTF or PBS mediums for 48 h, but were after 60 h. There was not any significant variation in terms of acrosome integrity in different preservation conditions. Fragmented DNA rates were similar in fresh sperm with KSOM and HTF media, while there was higher damage in PBS medium at 60 h. Overall, sperm parameters were affected significantly by the time of storage and type of preservation medium, and PBS extender was not suitable for mice spermatozoa at room and refrigerated temperatures as it caused the lowest progressive motility, viability, membrane function integrity and the highest DNA damage. CONCLUSION: Mice spermatozoa stored in KSOM retained the best sperm quality parameters both 24 degree C and 4 degree C for the first 48 h. doi.org/10.54680/fr22610110612.

Red blood cell distribution width is a predictor of chronic kidney disease progression and all-cause mortality.

OBJECTIVES: The aim of this study was to investigate the association of RDW with all-cause mortality and disease progression in patients with CKD in stage 3-4. METHODS: This longitudinal observational cohort study of patients with CKD was conducted at a single center. We categorized baseline RDW into two groups by its median (14.9 %). The associations between baseline RDW values and all-cause mortality over 56 months were examined in unadjusted and adjusted models. The effect of RDW value on renal outcomes and mortality was evaluated by using Cox regression analysis. RESULTS: A total of 261 patients were enrolled in the study. During an average follow-up of 56 months, 19.8 % of patients died. The area under the ROC curve for RDW for all-cause mortality was 0.746, with sensitivity of 0.74 and specificity of 0.69 for a cut-off point of 14.3 %. The incidence of all-cause mortality in the group with increased RDW was significantly higher than in the normal RDW group (p < 0.001). The Cox proportional hazard model showed that the elevated RDW level was an independent risk factor for all-cause mortality in patients with CKD in stage 3-4. CONCLUSION: RDW is a powerful and independent prognostic marker for predicting all-cause mortality and disease progression in stage 3-4 of CKD (Tab. 4, Fig. 4, Ref. 29).

The dosage-dependent prenatal caffeine exposure adversely affects levels of integrin αVß3 and MMP-9 in a rat model of embryo implantation.

OBJECTIVE: In the pregnancy period, it is recommended to limit the consumption of caffeine.​ However, the mechanisms of caffeine effect during pregnancy are not fully known.​ In our study, we aimed to investigate the effect of prenatal caffeine consumption on the embryonic implantation in rats as well as shed light on the relationship between the molecules and implantation stages.​MATERIALS AND METHODS: ​Forty-five Wistar albino pregnant rats were randomly divided into 3 main groups, namely into control, low­dose and high­dose groups, representing the dose-dependent effects of caffeine. Each main group was divided into 3 subgroups, namely those to be sacrified on days 4 (pre-implantation), 5 (peri-implantation) and 6 (post-implantation) ​. Different doses of caffeine were given on consecutive days, starting from day 1 of pregnancy up to the day of euthanasia. The implantation sites were investigated with the use of hematoxylin et eosin, Masson trichrome and immunostaining of VEGF, MMP-9, integrin αVß3, mucin-1 and HB-EGF. RESULT: ​ Prenatal caffeine consumption in rats resulted in a dose-dependent decrease in the number of implantation sites.​ It has been shown that the immunoreactivity of integrin αVß3 and MMP-9 underwent a change. CONCLUSION: ​ It has been shown that the levels of integrin αVß3 and MMP-9 were decreased by prenatal caffeine consumption in rats, which resulted in a decrease in embryo implantation in a dose-dependent manner, especially in the high-dose group (Fig. 5, Ref. 36). Text in PDF www.elis.sk Keywords: caffeine, embryo implantation, integrin, MMP-9.

Determination of ecologically sensitive areas in Denizli province using geographic information systems (GIS) and analytical hierarchy process (AHP).

Ecological sensitivity is defined as the ecosystem's reaction to environmental change caused by internal and external factors. The degree of ecological sensitivity varies in spatial dimension depending on the natural and cultural features. Ecological sensitivity analysis is based on basis of mapping these differences. As a result of the analysis, an important data that can be a base for spatial plans at different scales is provided. In accordance with this aim, Denizli province was selected for the study area in this research. The factors affecting sensitivity were determined by the literature survey, which was conducted by considering the characteristics of the study area. In this context, elevation, slope, aspect, the proximity to water surface, land cover, and vegetation coverage were evaluated as natural factors, and the proximity to primary traffic roads and residential areas as cultural factors. Each factor was spatially grouped by means of geographic information systems (GIS) according to the degree of impact on ecological sensitivity. Scale 1 (lowest ecological sensitivity) to 5 (highest ecological sensitivity) was used for the spatial grouping. A analytical hierarchy process (AHP) was applied to weight the factors. The overlay method was used in line with the weighted scores in order to determine the composite ecological sensitivity. As a result of the study, the area of 286.26 sq km (2.37%) as highly and more sensitive, 5267.47 sq km (43.50%) as moderately sensitive, and 6554.56 sq km (54.13%) as mildly and less sensitive was determined. In line with the results, suggestions for protection-utilization balance were developed.

Is there any improvement in clinical staging with 18F-FDG PET/CT compared to surgical staging in cases of lung cancer? / ¿Hay alguna mejora en la estadificación clínica con PET/TC con 18F-FDG en comparación con la estadificación quirúrgica en el cáncer de pulmón?

OBJECTIVE: 18F-Fluorine fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is considered the standard imaging modality for patients with non-small cell lung carcinoma. The aim of this study was to compare clinical staging (cTNM) performed with 18F-FDG PET/CT and surgical staging (sTNM) in patients with non-small cell carcinoma treated with surgery. MATERIAL AND METHODS: We performed a retrospective analysis of 99 surgical patients with non-small cell carcinoma who underwent 18F-FDG PET/CT examination. Semiquantitative measures were calculated from the primary lesions and mediastinal lymph nodes. Findings of cTNM were compared with final surgical-pathological evaluation. Subjects were divided into two groups as postsurgical cTNM changed and cTNM unchanged. Patients in the cTNM changed group were further classified as postsurgical upstaged (US) and downstaged (DS). Results of the US patients were compared with the results of the remaining patients consisting of cTNM unchanged and DS to evaluate the predictable roles of semiquantitative parameters for postsurgical upstaging. To determine mediastinal tumoral involvement, cut-off values were obtained from calculated semiquantitative results of FDG uptakes in lymph nodes. A p value<0.05 was considered statistically significant. RESULTS: Subjects were aged 40-82 years with a mean age of 64.78±8.70 years. Classification agreement was observed in 43 patients (43%) and in 57%, postsurgical stage migration was seen. Concurrence of cTNM and sTNM was more pronounced in the T1 and N0 subsets which were 84% and 74%, respectively. The lowest concurrence was observed in N1 classification followed by T4 and N2 (1%, 50% and 58%, respectively). Change in T staging occurred in 20 of 56 (36%), in N staging 22 of 56 (39%) and change in T and N in 14 patients (25%). Distribution of US and DS patients in the cTNM changed group was 43% (24 of 56) and 57% (32 of 56), respectively. Results of semiquantitative measures were significantly higher in US patients than the results of the group consisting of DS patients and cTNM unchanged patients, for all parameters. Cut-off value calculated from mediastinal uptakes was most specific for metastases in MTV (metabolic tumor volume) with an acceptable sensitivity (90% and 67%, respectively). CONCLUSIONS: The concordance between cTNM and sTNM was better in staging T category compared to N stations. Semiquantitative measures of primary tumor may play a role in predicting postsurgical upstaging. Taking MTV into consideration in the mediastinal region may be more valuable than other parameters in the assessment of nodal involvement.