Evaluation of the effects of red blood cell distribution width on survival in lung cancer patients.

AIM OF THE STUDY: Data are available indicating that red blood cell distribution width (RDW) is higher in cancer patients compared to healthy individuals or benign events. In our study, we aimed to investigate the influence of different RDW levels on survival in lung cancer patients. MATERIAL AND METHODS: Clinical and laboratory data from 146 patients with lung cancer and 40 healthy subjects were retrospectively studied. RDW was recorded before the application of any treatment. Patients were categorised according to four different RDW cut-off values (median RDW, RDW determined by ROC curve analysis, the upper limit at the automatic blood count device, and RDW cut of value which used in previous studies). Kaplan-Meier survival analysis was used to examine the effect of RDW on survival for each cut-off level. RESULTS: The median age of patients was 56.5 years (range: 26-83 years). The difference in median RDW between patients and the control group was statistically significant (14.0 and 13.8, respectively, p = 0.04). There was no difference with regard to overall survival when patients with RDW ≥ 14.0 were compared to those with RDW < 14.0 (p = 0.70); however, overall survival was 3.0 months shorter in low values of its own group in each of the following cut-off values: ≥ 14.2 (p = 0.34), ≥ 14.5 (p = 0.25), ≥ 15 (p = 0.59), although no results were statistically significant. DISCUSSION: We consider that the difference between low and high RDW values according to certain cut-off values may reflect the statistics of larger studies although there is a statistically negative correlation between RDW level and survival.

A retrospective comparison of early stage primary extranodal with nodal non-Hodgkin lymphoma patients: A single center experience.

PURPOSE: The primary extranodal non Hodgkin's lymphoma 'EN-NHL) is a heterogeneous group of diseases with expression of different oncogenes compared to nodal NHLs. In this study, we aimed to compare the clinical and pathological findings, the prognostic factors, the treatment and the survival data in patients with stage I-II primary EN-NHL with nodal NHL 'N-NHL). METHODS: Between January 1991 and January 2014, 853 patients with diagnosis of NHL were reviewed. Of 853 patients, 379 '44%) with stage I-II disease were included in the study and were divided into two groups according to involved sites as nodal and extranodal. The N-NHL group consisted of stage I-II patients without extranodal involvement, who were diagnosed by incisional or excisional lymph node biopsy. The EN-NHL group consisted of patients with a single primary extranodal involvement and/or a locoregional lymph node involvement, and who were diagnosed by means of a biopsy from the extranodal region. RESULTS: A total of 112 patients with N-NHL and 267 with EN-NHL were enrolled in the study. About 3/4 of the N-NHL patients had stage II, while 50% of the EN-NHL patients had stage I 'p<0.01). There was no statistically significant difference between EN-NHL and NHL in terms of 5-year overall survival '0S) 'p=0.25). The median 5-year OS in the diffuse large B cell lymphoma 'DLBCL) subgroup with N-NHL was 52%, while that of the EN-NHL was 68% 'p=0.006). CONCLUSION: Patients with stage I-II N-NHL had a poorer prognosis than EN-NHL patients. However, 5-year OS rates were similiar between groups.

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.

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.

Comparison of clinicopathological and prognostic characteristics in patients with mucinous carcinoma and signet ring cell carcinoma of the stomach.

AIM: To determine whether there are any clinicopathological or prognostic differences between mucinous gastric carcinoma (MGC) and signet ring cell carcinoma (SRCC). METHODS: Pathological parameters, clinical parameters, and treatment efficacy were compared in patients with MGC and SRCC. RESULTS: In total, 193 patients (51 with MGC and 142 with SRCC) were included in this study. Patients with SRCC in particular had notably higher lymphovascular invasion, perineural invasion, rate of Borrmann types III and IV, and stage III-IV cancer (according to its TNM stage) compared with patients with MGC. However, tumor size was larger in patients with MGC (tumor size ≥5 cm). Median overall survival (OS) was 29.8 months in the MGC group and 16.6 months in the SRCC group (p = .04). The median OS in stage I-III patients was 59.9 and 42.5 months in the MGC and SRCC groups, respectively (p = .35). Comparing OS between MGC and SRCC stage IV patients revealed that the median OS was 10.1 and 8.8 months, respectively (p = .96). Multivariate analysis of the entire patient group revealed that the presence of weight loss at diagnosis, distant metastasis, and lymph node involvement were significantly related to OS. Multivariate analysis also revealed that weight loss at the diagnosis and T3-4 tumors were significant factors influencing OS in the stage I-III group. CONCLUSIONS: Patients with SRCC had generally poorer prognosis and lower survival rates compared with patients with MGC. Further studies on the prognosis and treatment plan based on the pathological subtypes of SRCC and MGC are still needed.

The clinical and pathological features affecting the time of relapse in patients with early stage colorectal cancer.

BACKGROUND: The relapses of colorectal cancer (CRC) frequently occur in 2 years period after the time of diagnosis. However, a considerable proportion of patients relapse in the late period. AIM: The aim of the present study is to define the factors predicting the early and late relapses of patients with early stage CRC. MATERIALS AND METHODS: A total of 250 patients with CRC, who relapsed after completion of primary therapy between 2005 and 2014, were enrolled in the study. According to the time of relapse, patients were divided into two groups as follows: Early relapse (Group 1: Within first 24 months) and late relapse (Group 2: Later than 24 months). Clinicopathological features and survival rates of the two groups were compared. RESULTS: Of 250 patients, 151 (60.4%) (Group 1) were relapsed within the first 24 months after completion of the primary therapy and 105 (39.6%) were relapsed later than 24 months. The patients with T1-T2 and Grade I tumors were relapsed in late period (P < 0.05). The rates of administered systemic chemotherapy and targeted therapies after relapse were similar in both groups. The median overall survival rates in patients relapsed within the first 24 months and after 24 months were 18 months and 21 months, respectively (P = 0.05). CONCLUSIONS: In patients with CRC, the time duration of relapse after completion of the operation and adjuvant chemotherapy was a prognostic factor. Grade I and superficial tumors (T1-T2) are the predictors of late relapses (after >24 months). The patients relapsed within the first 24 months after primary therapy had poor prognosis compared to those who relapsed in late period.

Prognostic role of pretreatment platelet/lymphocyte ratio in patients with non-small cell lung cancer.

BACKGROUND: It was reported that hematological markers of systemic inflammatory response might be prognostic in various cancer types. We aimed to evaluate the platelet/lymphocyte ratio (PLR) as a prognostic factor and its effect on overall survival in non-small cell lung cancer (NSCLC). METHODS: Clinicopathological characteristics and basal (pretreatment) PLR of 145 patients with NSCLC were evaluated retrospectively. The preoperative or pretreatment blood count data were obtained from the recorded computerized database. PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. RESULTS: A total of 145 patients were enrolled. Median age was 57 years(range 26-83). Receiver operating characteristic curves for overall survival prediction were plotted to verify the optimum cut-off point for PLR. The recommended cut-off values for PLR was 198.2 with a sensitivity of 65.0 % and a specificity of 71.4 %. Median overall survival was 34.0 (95 % confidence interval (CI) 14.7-53.3) months in the group with low PLR (< 198.2), while it was 11.0 (95 % CI 5.6-16.3) months in the group with high PLR (≥ 198.2). The difference between the groups was statistically significant (p < 0.0001). CONCLUSIONS: Our study supports the view that a high basal PLR is a poor prognostic factor in NSCLC. However, the validity of the cut-off values for PLR identified in our study needs further prospective trials.

Concordance of positron emission tomography and computed tomography in patients with locally advanced gastric and esophageal cancer.

BACKGROUND: PET-CT is important for evaluating the cancer stage preoperatively. In patients with locally advanced disease, who are candidates for curative treatment modalities following computed tomography (CT) and ultrasonography evaluation, PET-CT can show distant metastases and spare patients unnecessary surgical interventions. We aimed to evaluate the contribution of PET-CT scans compared to conventional imaging studies on the change of treatment plan in patients with locally advanced esophagogastric cancer from neoadjuvant to palliative setting. MATERIALS AND METHODS: In this study, 91 patients with histopathologically proven diagnosis of esophageal or gastric cancer in our clinic between the years 2010-2014 were included. Prior to PET-CT evaluation, all of the patients were evaluated with thorax and abdomen computed tomography. Seventy-six of these patients were further evaluated by PET-CT due to ambiguous findings on computed tomography and 15 of them for staging purposes. The patients, who were shown to have distant metastases on conventional radiological imaging, were excluded from the study population. RESULTS: Ninety-one patients were included in the study. Their median age was 57 (range 30-80) years and three-quarters of the patients were male. Most of the patients were evaluated by PET-CT due to suspicion of distant metastasis (83.5%). Primary sites of the tumors on PET-CT were: esophagus 38.5% and stomach 61.5%. Between CT and PET-CT tumor stage and pathological lymphadenopathy concordance rates were 75.8, and 69.2%, respectively. On PET-CT evaluation 47.3% of patients had distant metastasis. New metastases were detected in 34.1% of patients by PET-CT despite entering to scanning field of tomography. Following the PET-CT evaluation due to detected metastasis, 47.3% of patients' treatment plan was changed from neoadjuvant to palliative therapy. CONCLUSION: In the current study, 47.3% (n = 43) of patients had distant metastasis that were not detected by CT evaluation. These patients were spared unnecessary surgical interventions. Evaluating the locally advanced gastric and esophageal cancer patients for PET-CT new metastasis could be indicated when the treatment plan of these patients would be changed from curative to palliative.

Assessment of Prognostic Value of "Neutrophil to Lymphocyte Ratio" and "Prognostic Nutritional Index" as a Sytemic Inflammatory Marker in Non-small Cell Lung Cancer.

BACKGROUND: Systemic inflammatory response was shown to play an important role in development and progression of many cancer types and different inflammation-based indices were used for determining prognosis. We aimed to investigate the prognostic effects of neutrophil to lymphocyte ratio (NLR) and prognostic nutritional index (PNI) in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: NSCLC patients diagnosed in our institution were retrospectively reviewed. Demographic and clinicopathologic characteristics were recorded. NLR and PNI was calculated before the application of any treatment. RESULTS: A total of 138 patients were included in the study. Patients were divided into two groups according to NLR (<3.24 or ≥3.24) and PNI (<49.5 or ≥49.5). While median overall survival was 37.0 (95% CI 17.5-56.5) months in the group with low NLR, it was calculated as 10.0 (95%CI 5.0-15.0) months in the group with high NLR (p<0.0001). While median overall survival was 7.0 (95%CI 3.5-10.5) months in the group with low PNI, it was calculated as 33.0 (95% CI 15.5-50.4) months in the group with high PNI (p<0.0001). Stage, NLR and PNI levels were evaluated as independent risk factors for overall survival for all patients in multivariate analysis (p<0.0001, p=0.04 and p<0.001, respectively). CONCLUSIONS: NLR (≥3.24) and PNI (<49.5) at diagnosis is an independent marker of poor outcome in patients with NSCLC. NLR and PNI is an easily measured, reproducible prognostic tests that could be considered in NSCLC patients.

The clinicopathological characteristics with long-term outcomes in malignant mesothelioma.

Malignant mesothelioma (MM) is a neoplasm which originates from serous membranes. It is relatively more common in Turkey. Ninety-nine patients between 2002-2009 were evaluated for survival and patient characteristics with chest pain, dyspnea, weight loss, loss of appetite, anemia, leukocytosis, thrombocytosis and lactate dehydrogenase (LDH) elevation, retrospectively. Male/female ratio was 1.41(58/41). Median age was 53(27-88). Asbestosis exposure rate was 78.5%. Most of the patients had better ECOG-PS (88.7% for 1-2). Chest pain (47.7%), dyspnea (44.8%), weight loss (49%), loss of appetite (50%), anemia (38%), leukocytosis (37.2%), thrombocytosis (26.6%) and LDH elevation (10.1%) were found with median values such as 11.8 g/dL (5-17.1) for hemoglobin, 8,800/mm3 for WBC (2,600-38,300), 382,000/mm(3) for platelets (28,000-1,504,000) and 253 IU/L for LDH (85-1,877), respectively. The most common site was pleura (62.3%). Half of the patients were unclassified, while epitheloid histopathology (39.4%) was most common in classified ones. RT rate was 42.1% in operated patients and all had pleural MM. Median OS was 22.9 months. Eighty percent of the patients had first-line CT with a clinical benefit rate of 63.3%. Second-line CT rate was 29% with a clinical benefit rate of 44%. Most preferred CT regimen was cisplatinum and pemetrexed. Most of the patients were male in their 50 s with pleural MM. They had chest pain, dyspnea, weight loss and loss of appetite as the most common symptoms at diagnosis. Only half of the patients could be subtyped with a predominance of epitheloid histology.