The impact of charlson comorbidity index on mortality from SARS-CoV-2 virus infection and A novel COVID-19 mortality index: CoLACD.

OBJECTIVE: The aim of this study is to find out the potential risk factors including charlson comorbidity index (CCI) score associated with death in COVID-19 patients hospitalised because of pneumonia and try to find a novel COVID-19 mortality score for daily use. METHODS: All patients diagnosed as confirmed or probable COVID-19 pneumonia whom hospitalised in our Chest Diseases Education and Research Hospital between March 11, 2020 and May 15, 2020 were enrolled. The optimal cut-off values, sensitivity and specificity values and odds ratios to be used in mortality prediction of the novel scoring system created from these parameters were calculated by ROC analysis according to the area under the curve and Youden index. RESULTS: Over 383 patients (n: 33 deceased, n: 350 survivors) univariate and multivariate regression analysis showed that CCI and lymphocyte ratio were prognostic factors for COVID-19-related mortality. Using this analysis, a novel scoring model CoLACD (CoVID-19 Lymphocyte ratio, Age, CCI score, Dyspnoea) was established. The cut-off value of this scoring system, which determines the mortality risk in patients, was 2.5 points with 82% sensitivity and 73% specificity (AUC = 0.802, 95% CI 0.777-0.886, P < .001). The risk of mortality was 11.8 times higher in patients with a CoLACD mortality score higher than 2.5 points than patients with a score lower than 2.5 (OR = 11.8 95% CI 4.7-29.3 P < .001). CONCLUSION: This study showed that by using the CoLACD mortality score, clinicians may achieve a prediction of mortality in COVID-19 patients hospitalised for pneumonia.

Characteristics of hospitalised COVID-19 patients and parameters associated with severe pneumonia.

BACKGROUND: After the first case of coronavirus disease 2019 (COVID-19) was reported in China in December 2019, it caused a global pandemic, including Turkey. OBJECTIVES: The aim of this study was to analyse the characteristics of hospitalised COVID-19 patients and assess the parameters related to severe pneumonia. METHODS: Included in the study were hospitalised COVID-19 patients with positive naso-oropharyngeal swabs. Patients' demographics, admission symptoms, laboratory and radiological findings were recorded retrospectively. RESULTS: Of 1013 patients, 583 were males (57.6%) and 430 were females (42.4%), with a mean age of 53.7 ± 17.9. More than half of the patients had at least one comorbidities, the most common of which were hypertension and diabetes mellitus. Cough (59.8%), fatigue (49.5%) and fever (41.2%) were the most common presenting symptoms. Of the hospitalised COVID-19 patients, 84.9% had pneumonia and 83.5% had typical radiological COVID-19 appearances (94.5%: ground-glass areas). The most common laboratory findings were high C-reactive protein (CRP) (73.6%) and lactate dehydrogenase (LDH) (46.2%) levels, as well as lymphopenia (30.1%). Severe pneumonia was present in 28.1% of COVID-19 patients. Multivariate logistic regression analysis indicated that advanced age, hypotension, anaemia and elevated CRP and LDH serum levels were independent risk factors for the severity of COVID-19 pneumonia (P = .011, .006, .017, .003 and .001, respectively). CONCLUSION: This study, as one of the first multicentre studies about characteristics of COVID-19 in Turkey, may guide about disease-related parameters and severity of pneumonia. Age, blood pressure, complete blood count and routine biochemical tests (including CRP and LDH) would appear to be important parameters for the evaluation of the severity of COVID-19 pneumonia.

The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients.

CLINICAL TRIAL NUMBER: NCT03319108.

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA).

INTRODUCTION: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey. MATERIALS AND METHODS: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials. RESULT: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency. CONCLUSIONS: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.

The effect of obesity on dyspnea, exercise capacity, walk work and workload in patients with COPD.

INTRODUCTION: COPD and obesity are major public health problems that cause mortality and morbidity all over the world. The combined of COPD and obesity is predicted to increase further in the coming years. Obesity primarily affects the pulmonary system by altering respiratory functions, exercise capacity, pulmonary gas exchange, and endurance and power of respiratory muscles. In this study, we aimed to compare the dyspnea sensation, exercise capacity, walk work and workload in obese COPD patients compared to preobese and normal overweight COPD patients. MATERIALS AND METHODS: 218 patients with COPD were included in the study. According to the WHO criteria for body mass index (BMI), the patients were classified as normal-weight (BMI=18.5-24.9 kg/m2), pre-obese (BMI= 25-29.9 kg/m2) and obese (BMI= 30-39.9 kg/m2). All patient respiratory function tests and arterial blood gas analysis were performed. The mMRC dyspnea scale was used to assess the dyspnoea of the patients. The exercise capacities of the patients were determined by the 6-min walking test. Walk work and workload were calculated based on 6 minutes walking distance. The obtained values were compared between the three groups. RESULT: The FEV1/FVC ratio and TLCO value in pulmonary function tests are significantly higher in obese COPD patients than in other patients, while the VC value is significantly lower in patients with COPD (p= 0.001, p< 0.001, p= 0.01). Partial carbon dioxidewas significantly higher in obese COPD patients compared to other patients (p= 0.001). Dyspnea perceptions and walking distances did not differ significantly between groups. Walkwork and workload were significantly higher in obese COPD patients (p< 0.001, p= 0.005). CONCLUSIONS: Obesity causes partial changes in blood gas and pulmonary function tests of patients with COPD. At the same time, it increases walkwork and workload. Despite all these changes, it has no negative effect on dyspnea perception and exercise capacity.

Impact of vaccination on ICU admissions of hospitalized COVID-19 patients in a country with a heterologous vaccine policy.

INTRODUCTION: Vaccination against coronavirus disease-19 (COVID-19) is highly effective in preventing severe disease and mortality. Adenoviral vector and mRNA vaccines were effective against intensive care unit (ICU) admission, but the effectiveness of inactivated vaccine on ICU admission was unclear. We aimed to evaluate the effect of vaccination status on ICU admission in hospitalized COVID-19 patients in a country with heterologous vaccination policy. METHODOLOGY: This is a retrospective multicenter study conducted in three hospitals in Izmir, Turkey between 1 January 2021 and 31 March 2022. Patients aged ≥ 18 years and hospitalized due to COVID-19 were included in the study. Patients who had never been vaccinated and patients who had been vaccinated with a single dose were considered unvaccinated. A logistic regression analysis was performed for evaluating risk factors for ICU admission. RESULTS: A total of 2,110 patients were included in the final analysis. The median age was 66 years (IQR, 53-76 years) and 54% of the patients were vaccinated. During the study period, 407 patients (19.3%) were transferred to the ICU due to disease severity. Patients who were admitted to the ICU were older (median age 68 vs. 65 years, p < 0.001); and the number of unvaccinated individuals was higher among ICU patients (57% vs. 45%, p < 0.001). In multivariate regression analysis, being unvaccinated was found to be the most important independent risk factor for ICU admission with an OR of 2.06 (95% CI, 1.64-2.59). CONCLUSIONS: Vaccination against COVID-19 is effective against ICU admission and hospital mortality.

Investigation of factors associated with static and dynamic balance in early-stage lung cancer survivors.

PURPOSE: Balance impairment and falls are common among patients after cancer treatment. This study aimed to compare static and dynamic balance functions in lung cancer survivors (LCS) and healthy controls and to investigate the factors related to balance in LCS. METHODS: Cross-sectional data were collected from lung cancer patients whose treatment had been completed within the previous 3 months (n = 60) and age and gender-matched healthy controls (n = 60). Clinical characteristics and history of falls were recorded. Pulmonary function tests and measurements of respiratory muscle strength were performed. Dynamic and static balance, fear of falling, knee-extension strength, physical activity level, dyspnea, comorbidity, and quality of life (QoL) were assessed using the Time Up and Go Test, Single Leg Standing Test, the Fall Efficacy Scale-International, hand-held dynamometer, the International Physical Activity Questionnaire, the Modified Medical Research Dyspnea Scale, the Charlson Comorbidity Index, and the European Organization for Research and Treatment of Cancer QoL Scale. RESULTS: LCS reported a higher fall rate and exhibited lower dynamic balance compared to controls (p < 0.05). The number of chemotherapy cycles, number of falls in the past year, fear of falling, perceived dyspnea, forced expiratory volume in 1 s (%), maximal inspiratory pressure (%), knee-extension strength, physical activity score, and QoL score related to physical function were correlated with balance function in LCS (p < 0.05). CONCLUSION: LCS had a higher risk of falls and lower dynamic balance function which might be related to various clinical and physical parameters. IMPLICATIONS FOR CANCER SURVIVORS: Identifying factors related to balance should be considered within the scope of fall prevention approaches for these patients.

Comparison of Self-Efficacy and Problem-Solving Skills Between Women with Asthma and Healthy Controls: A Cross-Sectional Study.

OBJECTIVE: Problem-solving skills and self-efficacy are among the topics that are frequently investigated in people with various chronic conditions. However, there are limited studies on asthma patients. Our study aims to compare self-efficacy and problem-solving skills in asthma patients and healthy controls. MATERIAL AND METHODS: We included 23 women with asthma [age: 39 (34-56) years] and 23 healthy controls [age: 42 (30-55) years] in the study. Participants' sociodemographic and disease-related characteristics, Asthma Control Test, and the Modified Medical Research Council Dyspnea Scale scores were recorded. We examined problem-solving skills with the Problem-Solving Inventory and self-efficacy with General Self-Efficacy Scale. We compared groups with the chi-square test, Mann-Whitney U-test, and Independent Sample t-test. RESULTS: Age, body mass index, educational status, marital status, and occupational status were similar among the groups (P > .05). However, smoking was significantly higher in healthy controls (P < .05). It was found that women with asthma had worse self-efficacy and problem-solving skills compared to healthy controls (P < .05). CONCLUSION: These results showed that there may be problems in socio-cognitive skills associated with the disease. Our study focused on the possibility that female asthma patients may have low levels of self-efficacy and problem-solving skills. Therefore, health professionals designing the rehabilitation program should take these skills into account while conducting the assessment as they may be useful in developing an efficient rehabilitation program.

Prognostic value of diffuse cancer inflammation index (ALI), serum neutrophil/lymphocyte (NLR) and platelet/lymphocyte (PLR) in advanced-stage lung cancer.

INTRODUCTION: Lung cancer is the most common type of cancer that causes death worldwide. Systemic inflammation has been shown to play a role in cancer etiopathogenesis and can be activated from oncogenic changes in cancer cells. In our study, the prognostic effects of inflammatory parameters calculated from serum were investigated in lung cancer. METHOD: One hundred fifteen patients with locally advanced and advanced lung cancer who were diagnosed in our chest diseases clinic between 2013 and 2015 were retrospectively analyzed. The relationship between advanced lung cancer inflammation index (ALI index), serum neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) levels at the time of diagnosis were calculated, and their relationship with overall survival (OS), disease-free survival, and the treatment response and their effect on predicting prognosis were investigated. FINDINGS: When the ALI value was examined in the group with non-small cell lung, the OS was found to be 9.018 months in the group over 18 years of age and it was 3.78 months in the group below. Low ALI index was significantly associated with short survival (P <.05). When the NLR values were examined in the entire patient group, OS more than 5 was 5.95 months and less than 9.63 months. A high NLR value was significantly associated with short survival (P <.05). No significant relationships were detected between PLR and OS. When the determined cut-off values were used, no significant correlation was found between NLR, ALI, and PLR levels and progression-free survival (P >.05). CONCLUSION: In our study, it was concluded that elevated NLR levels and low ALI values at the time of diagnosis of advanced-stage lung cancer were associated with poor survival, and those values may be useful in predicting survival and prognosis when the cut-off values were used. These parameters can be useful in routine use because they can be easily calculated without additional costs.

Investigation of EGFR and ALK mutation frequency and treatment results in advanced non-small cell lung cancer.

Aim: Lung cancer has opened a new era in cancer treatment by elucidating the tumor's molecular structure and identifying the targetable mutations. Identifying the targeted mutations in lung cancer constitutes one of the main steps of treatment planning. The frequency of EGFR (epidermal growth factor receptor gene) and ALK (anaplastic lymphoma kinase gene) mutations in non-small cell lung cancer (NSCLC) also varies in populations depending on ethnicity, gender, smoking, and histopathological subtype. In general, limited data are available regarding the frequency and regional distribution of these mutations in the Turkish population. Our study aimed to determine the frequency of EGFR and ALK mutations in patients with advanced-stage NSCLC and compare the clinical characteristics, treatment, and survival results of cases with mutations with the group without mutations. Materials and Methods: In our study, 593 patients with advanced-stage NSCLC diagnosis and mutational analyses were evaluated retrospectively. Demographic characteristics, tumor stages (tumor, node, metastasis, TNM), EGFR and ALK analysis results, treatments applied, and survival of the cases were recorded. EGFR analysis, exon 18, 19, 20, and 21 mutations were studied with real-time PCR (RT-PCR) Rotor-Gene system from patients' samples. For ALK analysis, the ALK Break Apart kit (Zytovision GmbH; Germany) was used with the fluorescent in situ hybridization (FISH) method. Results: In our study, EGFR mutation was detected in 63 patients (10.6%) and ALK mutation in 19 patients (3.2%) out of 593 patients. EGFR mutation was observed more frequently in women and non-smokers (P = 0.001, P = 0.003). No correlation was found between the presence of EGFR mutation and metastases regions and recurrence (P > 0.05). ALK mutation was observed more frequently in non-smokers and females (P = 0.001, P = 0.003). Patients with ALK mutations were younger than other groups (P = 0.003). There was also no significant relationship between ALK mutation and metastates regions and recurrence after treatment (P > 0.05). Patients with EGFR or ALK mutations had a longer life span than other cases (P = 0.474). Those who had ALK mutations and received targeted therapy had a longer average life expectancy (P < 0.05). No difference was observed in those who had EGFR mutations and received targeted treatment in terms of survival (P > 0.05). Conclusion: In our study, conducted in the Aegean region of Turkey, the positivity rates of EGFR and ALK mutations were found to be at similar rates with the Caucasian race across the world. EGFR mutation was more common in women, non-smokers, and patients with adenocarcinoma histology. ALK mutation was also detected more frequently in younger patients, women, and non-smokers. Patients with EGFR and ALK mutations had a longer life expectancy than those without the mutation. It was observed that testing patients diagnosed with advanced-stage NSCLC for genetic mutations of the tumor in the first step of the treatment and initiating treatment in patients with mutations provided a significant survival advantage.

Prognostic and predictive role of liquid biopsy in lung cancer patients.

Introduction: Lung cancer (LC) is a leading cause of cancer-related mortality worldwide. Approximately 80% of LC cases are of the non-small cell lung cancer (NSCLC) type, and approximately two-thirds of these cases are diagnosed in advanced stages. Only systemic treatment methods can be applied to patients in the advanced stages when there is no chance of surgical treatment. Identification of mutations that cause LC is of vital importance in determining appropriate treatment methods. New noninvasive methods are needed to repeat and monitor these molecular analyses. In this regard, liquid biopsy (LB) is the most promising method. This study aimed to determine the effectiveness of LB in detecting EGFR executive gene mutations that cause LC. Methods: One hundred forty-six patients in stages IIIB and IV diagnosed with non-squamous cell non-small cell LC were included. Liquid biopsy was performed as a routine procedure in cases where no mutation was detected in solid tissue or in cases with progression after targeted therapy. Liquid biopsy samples were also obtained for the second time from 10 patients who showed progression under the applied treatment. Mutation analyses were performed using the Cobas® EGFR Test, a real-time PCR test designed to detect mutations in exons 18, 20, and 21 and changes in exon 19 of the EGFR gene. Results: Mutation positivity in paraffin blocks was 21.9%, whereas it was 32.2% in LB. Solids and LB were compatible in 16 patients. Additionally, while no mutation was found in solid tissue in the evaluation of 27 cases, it was detected in LB. It has been observed that new mutations can be detected not only at the time of diagnosis, but also in LB samples taken during the follow-up period, leading to the determination of targeted therapy. Discussion: The results showed that "liquid biopsy" is a successful and alternative non-invasive method for detecting cancer-causing executive mutations, given the limitations of conventional biopsies.

Pulmonary hydatid cyst: The characteristics of patients and diagnostic efficacy of bronchoscopy.

BACKGROUND AND OBJECTIVES: Pulmonary hydatid cyst (PHC) is a parasitic infestation caused by larvae of Echinococcus granulosus. The lung is the most commonly involved organ after the liver. There is lack of enough data on the efficacy of bronchoscopy in patients with PHC, and the diagnostic usefulness of bronchoscopy is still controversial. We aimed to present the diagnostic efficacy of bronchoscopy and disease characteristics of patients with PHC. METHODS: PHC was diagnosed in 72 patients--51% of patients in Group I (uncomplicated PHC) and 49% of patients in Group II (complicated PHC)--in Dr Suat Seren Education and Research Hospital for Chest Diseases and Thoracic Surgery. The data of patients including age, gender, symptoms, and radiological, bronchoscopic, microbiological, and pathological findings were retrospectively evaluated. RESULTS: The bronhoscopic findings were defined as hyperemia (44%), normal (38%), edema (32%), purulent secretion (24%), external bronchial compression (24%), and endobronchial cyst membrane (21%), respectively. Cyst membranes were seen during bronchoscopy in 7 (20.5%) of the patients and 6 (86%) of them were in Group II. Hydatoptosis (expectoration of cyst contents), cough, hemoptysis, leukocytosis, Echinecoccus IgG positivity, chest pain, and fever were significantly higher in Group II. According to radiological images, the multiple cystic nodular lesions and well-shaped cystic nodular lesions were significantly higher in Group I. However, water-lily sign, images of abscess, and pneumonic infiltration were significantly higher in Group II. CONCLUSION: The diagnosis of PHC is usually made with the combination of clinical, radiological, serological, and surgical procedures. We suggest that the fiberoptic bronchoscopy can be used as a diagnostic method, especially in complicated PHC.

ALK, ROS1 and EGFR status of lung cancers in the Aegean Region of Turkey.

Background/Aims: As targeted therapies are promising in the treatment of lung cancer (LC), it is important to identify the genetic variations in tumors. The present research aimed to determine the regional prevalence of alterations in ALK, ROS1, and EGFR genes. Materials and. Methods: ALK rearrangement in 1152, ROS1 rearrangement in 390, and EGFR mutations in 1054 cases with LC were evaluated. Results: Alteration rates of ALK, ROS1, and epidermal growth factor receptor (EGFR) genes were 3.5%, 0.4%, and 11.2% in the samples, respectively. ALK rearrangements were mainly detected in young patients (P < 0.01) and in females (P < 0.01). Females were also more often inflicted by EGFR variations, especially from the exon 19 deletion. Exon 21 L858R mutations were more frequently found in men. However, any statistical significance between EGFR alterations and gender or age was not discovered. Conclusion: In this study, molecular changes were less frequent than expected. We thought that this low rate confirmed the aphorism of "smokes like a Turk, " which could be because almost all patients were active or passive smokers.

Correlation between chest CT severity scores and clinical and biochemical parameters of COVID-19 pneumonia.

BACKGROUND: The COVID-19 pandemic, which first appeared in Wuhan, China, in December 2019 and spread rapidly around the globe, continues to be a serious threat today. Rapid and accurate diagnostic methods are needed to identify, isolate and treat patients as soon as possible because of the rapid contagion of COVID-19. In the present study, the relation of the semi-quantitative scoring method with computed tomography in the diagnosis of COVID-19 in determining the severity of the disease with clinical and laboratory parameters and survival of the patients were investigated along with its value in prognostic prediction. MATERIAL AND METHOD: A total of 277 adult patients who were followed up in the chest diseases clinic because of COVID-19 pneumonia between 11.03.2020 and 31.05.2020 were evaluated retrospectively in the present study. Both lungs were divided into five regions in line with their anatomical structures, and semiquantitative radiological scoring was made between 0 and 25 points according to the distribution of lesions in each region. The relations between semiquantitative radiological score and age, gender, comorbidity, and clinical and laboratory parameters were examined. RESULTS: A significant correlation was detected between advanced age, lymphopenia, low oxygen saturation, high ferritin, D-dimer, and radiological score in the univariate analysis performed in the present study. The cut-off value of the semiquantitative radiology score was found to be 15 (AUC: 0.615, 95% CI: 0.554-0.617, p = 0.106) in ROC analysis. The survival was found to be better in cases with a radiology score below 15, in Kaplan-Meier analysis (HR: 4.71, 95% CI: 1.43-15.46, p < 0.01). In the radiological score and nonparametric correlation analyses, positive correlations were detected between CRP, D-dimer, AST, LDH, ferritin, and pro-BNP, and a negative correlation was found between partial oxygen pressure and oxygen saturation (p = 0.01, r = 0.321/0.313/0.362/0.343/0.313/0.333/-0.235/-0.231, respectively) CONCLUSION: It was found that the scoring system that was calculated quantitatively in thorax HRCTs in Covid-19 patients is a predictive actor in determining the severity and prognosis of the disease in correlation with clinical and laboratory parameters. Considering patients who have a score of 15 and above with semiquantitative scoring risky in terms of poor prognosis and short survival and close follow-up and early treatment may be effective to reduce mortality rates.

Correlation of preoperative PET/computer tomography 18F-fluorodeoxyglucose uptake (maximum standardized uptake value) with prognosis in patients with operated lung cancer.

PURPOSE: The aim of this study was to investigate the correlation of preoperative 18F-fluorodeoxyglucose PET/computed tomography maximum standardized uptake value (SUVmax) in operated non-small cell lung cancer (NSCLC) cases with other prognostic parameters and survival. PATIENTS AND METHODS: NSCLC patients treated by surgical resection were imaged with PET within 60 days before surgery. RESULTS: Overall, 525 cases consecutive patients were retrospectively reviewed. The median value of SUVmax in a total of 525 cases was 12.1, and the mean was 13.3 ± 7.13. Logistic regression analysis performed to identify the variables that have an impact on SUVmax revealed that histology [hazard ratio (HR: 1.893; 95% CI; P = 0.001) and T status (HR: 8.991; 95% CI; P = 0.000) are correlated with SUVmax. Kaplan-Meier analysis revealed a mean survival of 73.7 ± 1.95 months and a median survival of 85.6 ± 6.03 months. In the group with an SUVmax value of less than 10, the mean survival was 81.9 ± 3.02 months (76.0-87.8), and in the group with SUVmax greater than 10.1, the mean survival was 68.6 ± 2.4 months (63.9-73.3) (P = 0.000). In the multivariate analysis, SUVmax, age, tumor histology, lymph node metastasis, comorbid diseases and complete/incomplete status of the resection were identified as the factors predictive of prognosis. CONCLUSION: It is seen that preoperative SUVmax is a parameter with prognostic significance at least as much as histopathology, age, complete/incomplete status of resection and lymph node involvement.

Comparison of Brock University, Mayo Clinic and Herder models for pretest probability of cancer in solid pulmonary nodules.

OBJECTIVE: Risk analysis models, which are used in the diagnostic algorithm of incidental pulmonary nodules, are based on patient data from developed countries. Mayo Clinic, Brock University and Herder are among the most known models. We aim to compare the reliability of these models in patients with indeterminate solid nodules and to investigate the contribution of the predictors used to the model. METHODS: We analysed 305 patients who performed transthoracic needle biopsy and positron emission tomography/computed tomography for solid nodules, retrospectively. For all three models, the malignancy risk probabilities of patients were calculated, and patients were classified as low (<5%), moderate (60%) and high (<60%) risk groups. Later, the malignancy rates of each model in three different risk groups were compared within each other and among the models. RESULTS: The malignancy rate is 73% in 305 patients. In the Mayo Clinic and Herder models, the difference in the low-, medium- and high-risk groups is significant (p < 0.001). In the medium-risk group, the rate of malignancy is 96.8% in the Brock model. In the high-risk group, the rate of malignancy in Herder is 88.3% and the rate of malignancy in Mayo Clinic is 28.8%. The optimal cutoff values for the Mayo Clinic, Brock University, and Herder were 29.6, 13.4 and 70 (AUC, respectively; 0.71, 0.67 and 0.73). Age, smoking, gender, size, emphysema and spiculation increase the likelihood of malignancy. CONCLUSION: Close results were obtained in all three models. In the high-risk group, the Herder model has the highest reliability rate (odds ratio 3.3, confidence interval [1.1, 10.2]). Upper lobe predilection is not a reliable predictor.

Iterative surgical resections in non-small cell lung cancer.

INTRODUCTION: We reviewed our surgical preferences and the prognosis for recurrent and second primary tumors in patients who underwent surgical treatment for non-small cell lung carcinoma (NSCLC). AIM: We report our experience with patients undergoing iterative pulmonary resection for lung cancer. MATERIAL AND METHODS: Among patients who underwent anatomical resection for primary NSCLC, those who underwent a second surgical resection between 2010 and 2020 due to recurrent or second primary tumor were included in the study. Operative mortality, survival, and prognostic factors were investigated. RESULTS: In total, 77 cases were included: 31 (40.3%) underwent the second resection for the recurrent disease and 46 (59.7%) underwent the second resection for the second primary tumor. Postoperative mortality occurred in 8 (10.4%) patients. All patients with postoperative mortality were in the group that underwent thoracotomy in both surgical procedures. The 5-year survival rate was 46.5%. The 5-year survival of those operated on for recurrent or second primary tumor was 32.8% and 51.1%, respectively (p = 0.81). The 5-year survival rate was 68.8% in patients under the age of 60 years, while it was 27.5% in patients aged 60 years and above (p = 0.004). The 5-year survival was 21.8% in patients with an interval of 36 months or less between two operations and 72.2% in those with a longer interval (p = 0.028). CONCLUSIONS: Our study shows that survival results similar to or better than primary NSCLC surgery can be obtained with lower mortality if more limited resections are performed via video-assisted thoracic surgery, especially in young patients. In addition, the prognosis is better in patients with an interval of more than 36 months between two operations.

Comparison of typical and atypical computed tomography patterns regarding reversibility and fibrosis in pulmonary sarcoidosis.

PURPOSE: This study aims to investigate whether there is a significant difference between typical and atypical parenchymal patterns in the development of fibrosis, which is the most crucial factor affecting morbidity in pulmonary sarcoidosis. METHODS: In our hospital, 145 cases with Siltzbach Types 2 and 3 sarcoidoses diagnosed by clinical, radiological, and histopathologic were retrospectively investigated. Perilymphatic nodules, accompanying mosaic attenuation, and interlobular septal thickening and central peribronchovascular bunch-like thickening on high-resolution computed tomography were assessed as typical. Solid nodules, galaxy finding, consolidation, ground-glass opacity, isolated mosaic attenuation, and interlobular septal thickening, and pleural fluid were accepted as atypical findings. Findings indicating fibrosis were fine and rough reticular opacity, traction bronchiectasis, volume loss, and cystic changes. For the analysis of variables, SPSS 25.0 program was used. RESULTS: Ten (16%) of the 61 cases with typical findings and 16 (19%) of the 84 with atypical findings developed fibrosis (P = 0.827). The mean age of cases with fibrosis was higher. With the cut-off of 50 years, sensitivity was 61.5%, and specificity was 68.9%. The highest fibrosis rate was in cases with ground glass pattern (n = 7/17), whereas higher reversibility rates were in those with miliary pattern (n = 9/12) and galaxy sign (n = 5/6). CONCLUSION: The incidence of fibrosis is higher in the atypical group with no significant difference. The incidence of fibrosis differs in each atypical pattern, being highest in ground-glass opacity and lowest in the miliary pattern.

Effect of Asbestos Exposure on the Frequency of EGFR Mutations and ALK/ROS1 Rearrangements in Patients With Lung Adenocarcinoma: A Multicentric Study.

OBJECTIVE: The aim of this study is to investigate the effect of asbestos exposure on cancer-driver mutations. METHODS: Between January 2014 and September 2018, epidermal growth factor receptor (EGFR), anaplastic lymphoma receptor tyrosine kinase (ALK), and c-ros oncogene 1 receptor tyrosine kinase gene (ROS1) alterations, demographic characteristics, asbestos exposure, and asbestos-related radiological findings of 1904 patients with lung adenocarcinoma were recorded. RESULTS: The frequencies of EGFR mutations, ALK, and ROS1 rearrangements were 14.5%, 3.7%, and 0.9%, respectively. The rates of EGFR mutations and ALK rearrangements were more frequent in asbestos exposed non-smokers (48.7% and 9%, respectively). EGFR mutation rate was correlated to female gender and not-smoking, ALK rearrangement rate was correlated to younger age, not-smoking, and a history of asbestos exposure. CONCLUSIONS: The higher rate of ALK rearrangements in asbestos-exposed lung adenocarcinoma cases shows that asbestos exposure may most likely cause genetic alterations that drive pulmonary adenocarcinogenesis.

The relation between distant metastasis and genetic change type in stage IV lung adenocarcinoma patients at diagnosis.

INTRODUCTION: Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma. OBJECTIVES: The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. METHODS: The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed. RESULTS: A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). CONCLUSION: In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.