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PURPOSE: Vascular endothelial growth factor (VEGF) inhibition is one of the cornerstones of treatment in the treatment of metastatic renal cell carcinoma (mRCC). Since RCC is a disease of advanced age and hypertension as a side effect of VEGF receptor inhibitors, beta-blocker use is common in these patients. We aimed to compare the treatment efficacy and survival results in case of concomitant use of these two drugs due to the inhibition of VEGF in beta-blockers. METHODS: A total of 121 patients with a diagnosis of mRCC who used sunitinib or pazopanib in first-line therapy were included in the study. These patients were divided into two groups as those using concomitant beta-blockers and those not using them. RESULT: The median overall survival (mOS) of the patient using sunitinib or pazopanib and concomitant beta-blocker was 47 (95% CI 29.0-65.0) months, and the mOS of those not using concomitant beta-blocker was 18 (95% CI 8.9-27.1) months (p < 0.001). The median progression-free survival (mPFS) of the patients using sunitinib or pazopanib and concomitant beta-blocker was 20.4 (95% CI 4.5-40.1) months, and the mPFS of those not using it was 11.4 (95% CI 5.9-16.9) months (p = 0.042). Concomitant beta-blocker use was found to be a good prognostic factor for OS in the multivariate analysis (p = 0.029). In the multivariate analysis, concomitant beta-blocker use had a trend towards statistical significance for PFS (p = 0.062). CONCLUSION: Concomitant use of betablockers with sunitinib or pazopanib is associated with longer overall survial and progression free survival.
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Antagonistas Adrenérgicos beta , Carcinoma de Células Renais , Neoplasias Renais , Receptores de Fatores de Crescimento do Endotélio Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Adrenérgicos beta/uso terapêutico , Antineoplásicos/uso terapêutico , Antineoplásicos/efeitos adversos , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/mortalidade , Indazóis/uso terapêutico , Indazóis/efeitos adversos , Indazóis/administração & dosagem , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Intervalo Livre de Progressão , Pirimidinas/uso terapêutico , Pirimidinas/efeitos adversos , Pirimidinas/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Estudos Retrospectivos , Sulfonamidas/uso terapêutico , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversos , Sunitinibe/uso terapêuticoRESUMO
AIM: In this study, we aimed to evaluate the diagnostic sensitivity of [68 Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of primary or recurrent tumor, and nodal, peritoneal, and distant organ metastases in patients with newly diagnosed or relapsed colorectal cancer (CRC) in comparison with [18F]FDG PET/CT. MATERIALS AND METHOD: Thirty-nine patients with histopathologically confirmed primary or relapsed CRC were included in our study. All patients underwent both [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 PET/CT imaging in the same week. Primary lesions, lymph nodes, and metastatic lesions were recorded on both scans. SUVmax and background values were measured from the primary and metastatic lesions; tumor-to-background ratio (TBR) was calculated and compared. The results of the operation were compared with PET findings in patients who underwent surgical treatment without neoadjuvant chemotherapy (NAC). RESULTS: The sensitivity and specificity of [68 Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of primary tumors were 100%, while the sensitivity of [18F]FDG PET/CT was 100% and its specificity was 85.3%. When evaluated with surgical results in the detection of lymph nodes, [68 Ga]Ga-DOTA-FAPI-04 PET/CT had a sensitivity of 90% and a specificity of 100%, whereas [18F]FDG PET/CT had a sensitivity of 80% and a specificity of 81.8%. The sensitivity and specificity of [68 Ga]Ga-DOTA-FAPI PET/CT for peritoneal implants were 100%, and the sensitivity of [18F]FDG PET/CT was 55%. The SUVmax of primary lesions was higher with [18F]FDG (p < 0.001), while TBR was higher in [68 Ga]Ga-DOTA-FAPI PET/CT than [18F]FDG PET/CT (p: 0.008). SUVmax and TBR of the lymph nodes were significantly higher in [68 Ga]Ga-DOTA-FAPI PET/CT than [18F]FDG PET/CT (p < 0.001 for both). CONCLUSION: [68 Ga]Ga-DOTA-FAPI-04 PET/CT achieved much higher sensitivity and specificity in the detection of primary lesions, and especially the lymph nodes and peritoneal metastases, suggesting that it can be employed in the assessment of primary tumor and metastases in patients with CRC in routine clinical practice.
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Neoplasias Colorretais , Fluordesoxiglucose F18 , Neoplasias Colorretais/diagnóstico por imagem , Radioisótopos de Gálio , Compostos Heterocíclicos com 1 Anel , Humanos , Recidiva Local de Neoplasia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , QuinolinasRESUMO
INTRODUCTION: Cetuximab, an anti-EGFR monoclonal antibody, often cause skin toxicity, most commonly acneiform rash. We present a rare case of glomerulonephritis associated with cetuximab therapy. CASE REPORT: A 58-year-old male patient recently completed cetuximab-based chemotherapy for metastatic colorectal adenocarcinoma. He presented with acute renal failure, anasarca edema and nephrotic proteinuria. The amount of protein in the 24-h urine test was over 15.6 grams. MANAGEMENT & OUTCOME: The patient showed a dramatic improvement in renal function shortly after terminated of cetuximab therapy without immunosuppressive therapy. DISCUSSION: Therefore, drugs targeting epidermal growth factor receptor (EGFR) monoclonal antibody were thought to trigger nephrotic syndrome by causing glomerular damage. As a result, physicians using EGFR monoclonal inhibitors should be very careful about renal functions and proteinuria in patients.
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Antineoplásicos , Neoplasias do Colo , Neoplasias Colorretais , Síndrome Nefrótica , Neoplasias Retais , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/efeitos adversos , Cetuximab/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Receptores ErbB , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/induzido quimicamente , Inibidores de Proteínas Quinases/uso terapêutico , Proteinúria , Neoplasias Retais/tratamento farmacológicoRESUMO
INTRODUCTION: Trastuzumab emtansine (TDM-1) is an antibody-drug conjugate effective in human epidermal growth factor receptor-2 - expressing advanced breast cancer. Pulmonary complications of TDM-1 are rarely reported. TDM-1-associated interstitial lung disease is referred to as pneumonitis. CASE REPORT: A 47-year-old female patient who underwent modified radical mastectomy and axillary lymph node dissection operations due to a palpable mass in the right breast and axillary region. The patient who had received multiple chemotherapy was last receiving TDM-1 treatment. Fatigue, dyspnea, and tachypnea were detected for the first time on 20 days after the 6th treatment. MENAGEMENT AND OUTCOME: In our case, we first considered metastasis, pneumonia and fungal infection based on radiological findings, but the lack of response to the treatments and the results of the investigations suggested drug-induced pneumonia and steroid treatment was started. Our case had a complete radiological recovery and complete response to sterod therapy. In such cases, it is important to first exclude infections and metastasis. In cases of drug-induced pneumonia, the first treatment option is systemic corticosteroids and generally responded well. DISCUSSION: Unlike other cases of interstitial pneumonia, lung imaging of our case was resembling a metastasis, pneumonia and fungal infection. With increasing use of TDM-1, we will have more experience in both efficacy and complications of TDM-1. Although TDM-1 is a well-tolerated drug, clinicians should be aware of rare pulmonary complications and prepared to respond appropriately.
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Neoplasias da Mama , Doenças Pulmonares Intersticiais , Maitansina , Pneumonia , Ado-Trastuzumab Emtansina , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Feminino , Humanos , Doenças Pulmonares Intersticiais/induzido quimicamente , Mastectomia , Maitansina/efeitos adversos , Pessoa de Meia-Idade , Pneumonia/induzido quimicamente , Receptor ErbB-2 , Trastuzumab/efeitos adversosRESUMO
INTRODUCTION: Sweet Syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory disease characterized by the sudden emergence of painful, edematous, and erythematous papules, plaques, or nodules on the skin, which usually fully responsive to systemic corticosteroids. Skin lesions are often accompanied by fever and leukocytosis. Here we present a case of Sweet Syndrome caused by pemetrexed in metastatic lung adenocarcinoma. CASE REPORT: A 52-year-old patient with metastatic lung adenocarcinoma received multiple lines of chemotherapy. The patient presented with extensive skin lesions after performing of pemetrexed chemotherapy. He had a fever and elevations in blood levels of C-reactive protein (CRP), sedimentation, leucocytes, and neutrophils. Neutrophil predominant perivascular and interstitial dermatitis, focal micropustule formation, and severe neutrophilic dermatosis were reported in skin biopsy. Topical steroid and oral antihistamine treatment were started as initial treatment.Discussion and conclusions: Cutaneous side effects related to pemetrexed are often reported as 'skin rash,' which is a non-specific term. Therefore, the diagnosis of Sweet Syndrome must be confirmed by skin biopsy. It is essential to exclude the presence of an infection and medication history. Recovery in drug-induced Sweet Syndrome occurs after the drug that caused it was discontinued. Systemic corticosteroids are the first-line treatment for most cases.
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Pemetrexede/efeitos adversos , Síndrome de Sweet/induzido quimicamente , Biópsia , Feminino , Febre/induzido quimicamente , Humanos , Leucocitose/induzido quimicamente , Pessoa de Meia-Idade , Neutrófilos/citologia , Pele/patologiaRESUMO
Background/aim: Increase in publications supporting myocardial involvement in the COVID-19 disease has led to need to gain insight into the the global burden of heart failure after pandemic. We examined the course of myocardial systolic function in patients without elevated troponin levels. Materials and methods: We performed a prospective study. Patients with high troponin levels were excluded from the study in order to definitively exclude complications known to cause permanent left ventricular systolic dysfunction, such as acute coronary syndromes. Two echocardiographic examinations were performed. The first evaluation was performed within the days of hospitalization, if possible, on the day when dyspnea is severe. The second evaluation was performed during the outpatient clinic controls one month after the patient was recovered. Left ventricular ejection fraction (LVEF) was measured using the biplane method of disks (modified Simpson's rule). Results: In the first evaluation, LVEF was found to be significantly lower in the severe illness group than mild/moderate illness group (50 ± 6% and 59 ± 6%; p = 0.03). LVEF decrease (<50%) was found in fifteen patients (43 ± 4%) and detected as global hypokinesia but not segmental. All of these patients were in the severe illness group. In the second evaluation, LVEFs of the fifteen patients with decreased LVEF in the first evaluation were improved and detected in normal limits (first evaluation = 43 ± 4% and second evaluation = 55 ± 2%, p = 0.01). Conclusion: Considering patients without elevated troponin levels during COVID-19 infection, no permanent systolic dysfunction was detected after first month of recovery. We found that transient myocardial dysfunction may develop in the severe illness group with normal troponin levels, LVEF may decrease in the acute phase and improve with the recovery period.
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COVID-19/complicações , SARS-CoV-2/isolamento & purificação , Troponina/sangue , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Adulto , COVID-19/diagnóstico , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2/genética , Índice de Gravidade de Doença , Volume SistólicoRESUMO
PURPOSE: Postoperative LV dysfunction is associated with poor prognosis and increased mortality in patient with mitral regurgitation undergoing surgery. With this study, we aimed to investigate the predictive value of classic and speckle tracking echocardiographic (STE) LV deformational parameters for estimating postoperative LV dysfunction. METHODS: Fifty-nine asymptomatic patients with severe mitral regurgitation (MR) due to mitral valve prolapse, who had sinus rhythm and LV ejection fraction (EF) ≥50%, were included. Patients underwent comprehensive and speckle tracking echocardiographic examination before and 6 months after the surgical procedure. Patients were divided into two groups according to postoperative LV function: group A postoperative LV EF≥50% and group B postoperative LV EF<50%. RESULTS: Patients in group A were found to have higher LV twist (19.7±6.8° vs 11.9±4.2°; P<.001), LV global longitudinal peak strain (GLPS) (-21.7±4 vs -16.5±3.4%; P<.001), and circumferential strain (-19.5±5.2 vs -14.4±5.1%; P=.004) values but lower end-systolic diameter (ESD) (3.2±0.6 vs 4.1±0.9 cm; P<.001) when compared to group B. Multivariate logistic regression analysis revealed that GLPS, ESD, and twist were independent predictors of postoperative LV functions. In the ROC analysis, GLPS ≥18.4% and twist>14.4° predicted postoperative LVEF ≥50%. CONCLUSION: GLPS and twist measured by 2DSTE are predictors of LV preservation after surgery in severe MR. These parameters may also be used as prognostic predictors and optimal timing of operation in this patient population.
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Ecocardiografia , Insuficiência da Valva Mitral/cirurgia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias , Valor Preditivo dos Testes , Curva ROC , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: The Glasgow prognosis score is a simple parameter calculated using serum levels of albumin and C-reactive protein. The aim of this study was to examine whether this parameter may predict ischemic stroke in patients with infective endocarditis. METHODS: A total of 80 patients who were diagnosed with definitive infective endocarditis according to Duke criteria between 2016 and 2023 were included in the study. Glasgow prognosis score was based on serum levels of albumin and C-reactive protein. In imaging methods, patients were divided into two groups according to whether they had a stroke or not. These two groups were compared in terms of biochemical parameters, and infective endocarditis findings on echocardiography and Glasgow prognosis score. RESULTS: We found that the results were statistically similar except for serum C-reactive protein (Group 1: 54.9±71.1 and Group 2: 39±70.7; p=0.03), neutrophil (Group 1: 19.8±10.8*109/L and Group 2: 13.3±7.3*109/L; p=0.014), albumin (Group 1: 2.3±0.6 and Group 2: 2.8±0.5; p=0.03), and Glasgow prognosis score (Group 1: median 2, min.-max. (1-2) and Group 2: median 1, min.-max. (0-1); p=0.004). In the receiver operating characteristics analysis, Glasgow prognosis score had 82.4% sensitivity and 58.3% specificity in predicting ischemic stroke if the Glasgow prognosis score cutoff was ≥1. In multivariate logistic regression analysis, chronic renal failure [odds ratio (OR): 1.098; 95% confidence interval: 1.054-1.964; p=0.044], age (OR: 1.050; 95%CI 1.006-1.096; p=0.024), and Glasgow prognosis score (OR: 0.695; 95%CI 0.411-0.949; p=0.035) were independent variables in predicting ischemic stroke. CONCLUSION: High Glasgow prognosis score is an independent predictor of ischemic stroke in patients with infective endocarditis. Glasgow prognosis score, determined using albumin and C-reactive protein levels, is a simple and practical index for predicting the prognosis of patients hospitalized with infective endocarditis.
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Proteína C-Reativa , AVC Isquêmico , Albumina Sérica , Humanos , Feminino , Masculino , Proteína C-Reativa/análise , Prognóstico , Pessoa de Meia-Idade , AVC Isquêmico/sangue , AVC Isquêmico/complicações , Albumina Sérica/análise , Idoso , Endocardite/sangue , Endocardite/complicações , Adulto , Ecocardiografia , Biomarcadores/sangue , Fatores de Risco , Valor Preditivo dos TestesRESUMO
BACKGROUND: It is well known that patients with ST-elevation myocardial infarction (STEMI) show both systolic and diastolic left ventricular dysfunction. The aim of this study was to assess post-myocardial infarction diastolic dysfunction using left atrial ejection force (LAEF) in patients treated with primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: We enrolled 58 patients presenting with STEMI who were treated with primary PCI and 23 healthy subjects as a control group. A detailed transthoracic echocardiogram, including mitral flow velocities, tissue Doppler mitral annular velocities, and left atrial (LA) phasic volumes, was performed in both groups. We also measured the level of B-type natriuretic peptide (BNP). LAEF was calculated using the formula: 0.5 × P × Mitral orifice area × (Peak A velocity)(2) . Correlations between variables were studied using "Pearson and Spearman's rho" test. In the test group, we found that the level of BNP in the plasma, E/E' ratio, and the LA volume measurements were higher than that of the control group, and those differences were statistically significant. LAEF was increased in patients with myocardial infarction (MI); moderately correlated to BNP (r = 0.383 and P = 0.001) and E/E' (r = 0.473 and P = 0.001), and strongly correlated to A-wave velocity (r = 0.731 and P = 0.001). LAEF was also negatively correlated to E/A ratio (r = -0.419 and P = 0.001) and LVEF (r = -0.339 and P = 0.003). CONCLUSION: Impaired diastolic function in STEMI affects LA and increased LAEF is one of its manifestations. LAEF may also have diagnostic importance in diastolic dysfunction, but these findings should be confirmed by further studies.
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Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Pressão Sanguínea , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/etiologiaRESUMO
Morphological, physiological and molecular changes were investigated in in vitro salt-stressed barley (Hordeum vulgare L. cv. Tokak). Mature embryos were cultured in Murashige and Skoog medium containing 0 (control), 50 and 100 mM NaCl for 20 days. Both concentrations inhibited shoot growth, decreased fresh weight and protein content, and increased SOD (EC 1.15.1.1) activity in a dose-dependent manner. The lower concentration increased root growth. Salinity caused nucleotide variations in roots, but did not affect shoot DNAs. The higher concentration caused methylation changes, mainly hypermethylation in shoots. This is the first study on genetic and epigenetic effects of salinity in barley.
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OBJECTIVE: We designed a retrospective study to evaluate the performance and outcomes of a novel iopromide-based paclitaxel-coated balloon for the treatment of chronic total occlusion of femoropopliteal arteries. METHODS: Patients with femoropopliteal chronic total occlusion (<100 mm) on angiogram were screened from hospital management system and were included in the study. The width and length of the drug-eluting peripheral balloon was chosen to ensure a vessel/balloon ratio of 1: 1 and exceed the lesion by 10 mm on both ends (based on visual estimation). RESULTS: The proportion of patients with ankle-brachial index improvement was 89.8% (106 of 118). The mean ankle-brachial index was 0.5 (0.4-0.7) at baseline and 0.8 (0.7-0.9) at 12 months (P < 0.001). Changes in the Rutherford category between baseline and 12 months were statistically signiï¬cant (P < 0.001), with the majority of patients (77.9%, 92/118) having ≥1 level improvement. The rate of clinically driven target lesion revasculariza-tion at 12 months was 13.5%(16/118). Overall, the 1-year primary patency rate was 86.4% (102 of 118). The major adverse limb event rate was 9.8% (16/162). Acute limb ischemia was detected in 14 patients, and amputation was performed in 2 patients. CONCLUSION: Our study is a non-randomized clinical study focusing on the use of drug-eluting balloon as a single treatment strategy. There was signiï¬cant clinical beneï¬t to patients, as clearly demonstrated by the improvement in ankle-brachial index and the reduction in Rutherford class in the short term, and these results may oï¬er clear insights on the revascularization strategy outlook of interventionalists.
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Angioplastia com Balão , Fármacos Cardiovasculares , Doença Arterial Periférica , Humanos , Artéria Poplítea , Paclitaxel/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Doença Arterial Periférica/terapia , Angioplastia com Balão/métodos , Artéria Femoral , Fármacos Cardiovasculares/efeitos adversosRESUMO
OBJECTIVE: In our study, we aimed to find simple, useful biomarkers in patients with non-ST elevation myocardial infarction to predict coronary artery severity. METHODS: Between May 2022 and December 2022, patients diagnosed with non-ST elevation myocardial infarction according to the European cardiology guidelines were included in our study. The Synergy between PCI with Taxus and Cardiac Surgery score was calculated to determine the severity of coronary artery disease. These patients were classified into two groups according to Synergy between PCI with Taxus and Cardiac Surgery≥23 and Synergy between PCI with Taxus and Cardiac Surgery<23 scores. Biochemical markers such as platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were studied in blood tests taken before coronary angiography in patients diagnosed with non-ST elevation myocardial infarction according to current guidelines. These two groups were compared in terms of the data obtained. RESULTS: There were 281 patients in group 1 and 67 patients in group 2. There was no significant difference between the two groups in terms of demographic data such as age and gender. Platelet-to-lymphocyte ratio [group 1=125 (26-134) and group 2=156 (73-293); p=0.001] and neutrophil-to-lymphocyte ratio [group 1=2.71 (1.3-30.2) and group 2=3.2 (2.1-32.1); p=0.002] were higher in the group of patients with a Synergy between PCI with Taxus and Cardiac Surgery score of <23, while lymphocyte-to-monocyte ratio [group 1=3.6 (0.56-11) and group 2=3.4 (0.64-5.75); p=0.017] was lower in group 2. CONCLUSION: We observed that elevated platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios showed coronary artery severity. Multivessel disease and chronic total occlusion rates were observed to be higher in patients with high platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios.
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Doença da Artéria Coronariana , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Humanos , Doença da Artéria Coronariana/cirurgia , Fatores de Risco , Angiografia CoronáriaRESUMO
Objective: Bevacizumab (BEV) is a humanized monoclonal antibody of vascular endothelial growth factor receptors and, as a result of clinical trials, was approved for the treatment of recurrent ovarian cancer (ROC). The aim of this study was to assess the clinical utility of BEV in patients with ROC in real-world practice beyond clinical trials. Materials and Methods: In this single-center retrospective cohort study, we evaluated the medical data of all patients with ROC who were treated with BEV between October 2013 and March 2020. Results: A total of 76 females were evaluated. Forty-nine (64.5%) patients were platinum sensitive and 27 (35.5%) patients were platinum resistant. BEV was used in combination with chemotherapy agents in all patients, and the most preferred combinations were gemcitabine/carboplatin (GC) (78.9%) and carboplatin/paclitaxel (14.5%). In all patients, the BEV dose was 7.5 mg/kg every 3 weeks. The median progression-free survival (PFS) was 11.1 months (95% confidence interval [CI]: 9.6-12.6), and the median overall survival (OS) was 22.3 months (95% CI: 17.5-27.2). In multivariate analysis, serous histological type (P = 0.01), maintenance BEV administration (P = 0.001), and combination of GC-BEV (P < 0.001) were associated with better PFS, while serous histological type (P = 0.016) and good performance status (P = 0.006) were associated with prolonged OS. Conclusions: Low-dose (7.5 mg/kg) BEV was found to be effective in the second-line treatment of patients with ROC in our real-life study. In addition, the combination of BEV with GC was shown to be a viable option, especially in the treatment selection of platinum-resistant patients.
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Neoplasias Ovarianas , Humanos , Feminino , Bevacizumab , Estudos Retrospectivos , Carboplatina , Neoplasias Ovarianas/patologia , Fator A de Crescimento do Endotélio Vascular , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Recidiva Local de Neoplasia/patologia , Carcinoma Epitelial do Ovário/tratamento farmacológicoRESUMO
BACKGROUND: Coronary slow flow (CSF) refers to delayed distal vessel opacification in the absence of epicardial coronary artery stenosis. The etiopathogenic mechanism of CSF is still unclear. OBJECTIVES: This study investigates the relationship between CSF and the triglyceride-glucose (TyG) index. METHODS: The study sample consisted of 118 CSF patients and 105 patients with normal coronary flow (NCF). The coronary flow rate was measured via the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) method in all patients. The TyG index was calculated as the logarithm of the [fasting triglyceride (mg/dL)×fasting glucose (mg/dL)]/2 value. A significance level of < 0.05 was adopted as statistically significant. RESULTS: The TyG index, low-density lipoprotein (LDL), body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR) and TFC values, male ratio, and the ratio of smokers were higher, whereas high-density lipoprotein (HDL) levels were significantly lower in the CSF group compared to the NCF group (p<0,05). The correlation analysis revealed that CSF was significantly correlated with TyG index, BMI, NLR, and HDL values. The strongest of these correlations was between CSF and TyG index (r= 0.57, p<0.001). Additionally, the multivariate analysis revealed that TyG index, BMI, NLR ratio, and male gender were independent predictors for CSF (p<0.05). Receiver operating characteristic (ROC) curve analysis indicated that a cut-off value of ≥ 9.28 for the TyG index predicted CSF with a sensitivity of 78% and a specificity of 78.1% [Area under the curve (AUC): 0.868 and 95% Confidence Interval (CI): 0.823-0.914]. CONCLUSION: The findings of this study revealed a very strong relationship between CSF and TyG index.
FUNDAMENTO: O fluxo lento coronariano (FLC) refere-se à opacificação retardada dos vasos distais na ausência de estenose da artéria coronária epicárdica. O mecanismo etiopatogênico do FLC ainda não está claro. OBJETIVOS: Este estudo investiga a relação entre o FLC e o índice de triglicerídeos-glicose (TyG). MÉTODOS: A amostra do estudo consistiu de 118 pacientes com FLC e 105 pacientes com fluxo coronariano normal (FCN). A taxa de fluxo coronariano foi medida por medio do método de contagem de quadros (TFC) Thrombolysis in Myocardial Infarction (TIMI) em todos os pacientes. O índice TyG foi calculado como o logaritmo do valor [triglicerídeos em jejum (mg/dL)×glicose em jejum (mg/dL)]/2. Adotou-se como estatisticamente significativo o nível de significância < 0,05. RESULTADOS: O índice TyG, lipoproteína de baixa densidade (LDL), índice de massa corporal (IMC), relação neutrófilo-linfócito (RNL) e valores de TFC, proporção masculina e proporção de fumantes foram maiores, enquanto os níveis de lipoproteína de alta densidade (HDL) foram significativamente menores no grupo FLC em comparação com o grupo FNC (p<0,05). A análise de correlação revelou que o FLC estava significativamente correlacionado com os valores do índice TyG, IMC, RNL e HDL. A mais forte dessas correlações foi entre o FLC e o índice TyG (r= 0,57, p<0,001). Além disso, a análise multivariada revelou que o índice TyG, IMC, razão RNL e sexo masculino foram preditores independentes para FLC (p<0,05). A análise da curva ROC (Receiver Operating Characteristic) indicou que um valor de corte ≥ 9,28 para o índice TyG previu FLC com sensibilidade de 78% e especificidade de 78,1% [Área sob a curva (AUC): 0,868 e 95% intervalo de confiança (IC): 0,823-0,914]. CONCLUSÃO: Os achados deste estudo revelaram uma relação muito forte entre o FLC e o índice TyG.
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Glicemia , Glucose , Humanos , Masculino , Estudos Retrospectivos , Estudos de Casos e Controles , Glicemia/análise , Triglicerídeos , BiomarcadoresRESUMO
BACKGROUND: Not all RAS wild-type metastatic colorectal cancer (mCRC) patients experience the same benefit from anti-epidermal growth factor receptor (EGFR) treatments. Studies have shown that nuclear factor-κB (NF-κB), hypoxia-inducible factor-1α (HIF-1α), interleukin 8 (IL-8) and transforming growth factor ß (TGF-ß) may be therapeutic targets for mCRC. The aim of this study was to clarify the prognostic value of NF-κB, HIF-1α, IL-8, and TGF-ß expression in patients with left-sided mCRC receiving EGFR inhibitors. METHODS: Patients with RAS wild-type, left-sided mCRC treated with anti-EGFR on the first line between September 2013 and April 2022 were included. Immunohistochemical staining for NF-κB, HIF-1α, IL-8 and TGF-ß was performed from tumor tissues of 88 patients. Patients were divided into NF-κB, HIF-1α, IL-8 and TGF-ß expression positive and negative group, moreover, expression positive group were also divided into two group as expression intensity low and high group. The median follow-up was 25.2 months. RESULTS: Median progression-free survival (PFS) was 8.1 (6-10.2) months in the cetuximab group, 11.3 (8.5-14) months in the panitumumab group (p = 0.09). Median overall survival (OS) was 23.9 (4.3-43.4) months in the cetuximab group, 26.9 (15.9-31.9) months in the panitumumab group (p = 0.8). Cytoplasmic NF-κB expression was present in all patients. The mOS was 19.8 (11-28.6) months in NF-κB expression intensity low group and 36.5 (20.1-52.8) months in high group (p = 0.03). The mOS of the HIF-1α expression negative group was significantly longer compared with expression positive group (p = 0.014). There was no significant difference in IL-8 and TGF-ß expression status on mOS and mPFS (for all, p > 0.05). Positive expression of HIF-1α was poor prognostic for mOS in the univariate analysis (HR:2.7, 95% CI 1.18-6.52, p = 0.02) and in multivariate analysis (HR 3.69, 95% CI 1.41-9.6, p = 0.008). High cytoplasmic expression intensity of NF-κB was found to have a good prognostic value for mOS (HR 0.47, 95% CI 0.26-0.85, p = 0.01). CONCLUSION: High cytoplasmic expression intensity of NF-κB and negative expression of HIF-1α could be a good prognostic marker for mOS in RAS wild-type left-sided mCRC.
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Neoplasias do Colo , Neoplasias Colorretais , Neoplasias Retais , Humanos , Panitumumabe , Cetuximab/uso terapêutico , Prognóstico , NF-kappa B , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Interleucina-8/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia , Neoplasias do Colo/tratamento farmacológico , Neoplasias Retais/tratamento farmacológicoRESUMO
PURPOSE: The prognostic nutritional index (PNI), like other systemic inflammatory markers, has been shown to be a prognostic factor in various cancer patients. In this study, we aimed to show whether PNI calculated before adjuvant chemotherapy is a prognostic factor for overall survival (OS) and disease-free survival (DFS) in patients with lymph node-positive stage II-III gastric cancer. METHODS: The PNI was calculated using the albumin and lymphocyte count. The PNI cut-off value was found to be 39.5. They were divided into two groups as being ≤ 39.5 (PNI low group) and > 39.5 (PNI high group). RESULTS: Our study included 168 patients with lymph node-positive stage II-III gastric cancer who received adjuvant chemotherapy. Of the patients, 116 (69.0%) were 65 years or younger, and 52 (31.0%) were over 65 years old. Of the patients, 117 (69.6%) were pT3, 51 (30.4%) were pT4. Seventy-three (43.4%) patients had pN1-2 disease and 95 (56.6%) patients had pN3 disease. The number of stage II patients was 73 (43.5%) and the number of stage III patients was 95 (56.5%). There were 73 patients with PNI ≤ 39.5 and 95 patients with PNI > 39.5. The mOS of the patients with low PNI group was 39.5 months, while the OS of the patients with high PNI group was 96.8 months (p = 0.002). In the group of patients with PNI low group, mDFS 24.4 months was significantly higher than those with PNI high group was 50.7 months (p = 0.021). The PNI score was statistically significant in univariate and multivariate analyzes for both DFS and OS. CONCLUSION: PNI can be used as an independent prognostic factor for both OS and DFS in patients lymph node-positive, stage II-III gastric cancer who will receive adjuvant chemotherapy.
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Avaliação Nutricional , Neoplasias Gástricas , Humanos , Idoso , Neoplasias Gástricas/tratamento farmacológico , Prognóstico , Estado Nutricional , Estudos Retrospectivos , Quimioterapia AdjuvanteRESUMO
Aim: The aim of this study was to evaluate the presence of small bowel wall edema (SBWE) on computed tomography (CT) images in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib and to investigate the relationship between the presence of SBWE and survival. Materials and Methods: We retrospectively evaluated the presence of SBWE on CT images of 27 mRCC patients who received at least one cycle of sunitinib. Then, we analyzed the relationship between the presence of SBWE and progression-free survival (PFS) and overall survival (OS). RESULTS: All 27 patients had SBWE on at least one CT scan. The median value of SBWE thickness was 2.5 mm. SBWE thickness was ≤2.5 mm in 13 patients (group A) and >2.5 mm in 14 patients (group B). The median OS was significantly higher in group B (55 vs. 18 months, respectively, P = 0.02). Although it was not statistically significant (13 vs. 8 months, respectively, P = 0.69), the median PFS was longer in group B than in group A. CONCLUSIONS: This study showed that sunitinib treatment caused SBWE in all patients with mRCC who received the drug. Also, this study demonstrated an association between higher SBWE thickness and better survival outcomes.
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Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/tratamento farmacológico , Sunitinibe , Prognóstico , Estudos Retrospectivos , Neoplasias Renais/tratamento farmacológico , EdemaRESUMO
OBJECTIVE: In this article, we investigated the association of chromogranin A with coronary artery disease. METHODS: Biochemical parameters and chromogranin A levels obtained from peripheral blood samples during coronary angiography were analyzed in 90 patients. Patients were classified into two groups, namely, SYNergy between PCI with TAXUS and Cardiac Surgery score ≥1 (n=45) and SYNergy between PCI with TAXUS and Cardiac Surgery score=0 (n=45). This is a cross-sectional, prospective study. RESULTS: Serum chromogranin A levels were significantly higher in the group with SYNergy between PCI with TAXUS and Cardiac Surgery score ≥1 compared to the group with SYNergy between PCI with TAXUS and Cardiac Surgery score=0 (1381.5±418.9 ng/mL and 1121.2±290.7 ng/mL, respectively; p=0.002). Serum chromogranin A levels were correlated with SYNergy between PCI with TAXUS and Cardiac Surgery score (r=0.556, p<0.04). ROC analysis showed that the area under the curve for serum chromogranin A levels was 0.687 (p=0.007), and the best cutoff value of 1,131 ng/mL had a sensitivity of 67% and a specificity of 65% for the prediction of coronary artery disease. CONCLUSION: Serum chromogranin A levels were increased in coronary artery disease patients with SYNergy between PCI with TAXUS and Cardiac Surgery score ≥1. Increasing serum chromogranin A levels are proportional to the SYNergy between PCI with TAXUS and Cardiac Surgery score.
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Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Humanos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Cromogranina A , Ponte de Artéria Coronária , Estudos Prospectivos , Estudos Transversais , Resultado do Tratamento , Fatores de Risco , Angiografia CoronáriaRESUMO
Aim: It is red cell distribution width (RDW) that has been reported to show an inflammatory response which has been studied recently. The aim of this study is to investigate whether the pre-treatment RDW in patients using first-line vascular endothelial growth factor tyrosine kinase inhibitor (VEGFR TKI) with the diagnosis of metastatic renal cell carcinoma (mRCC) predicts treatment response and is a prognostic factor or not. Methods: About 92 patients diagnosed with mRCC who were being treated with sunitinib or pazopanib in the first line between January 2015 and June 2021 were included in the study. The patients were divided into 2 groups, as being ≤15.3 and >15.3, according to the RDW cut-off value calculated by ROC analysis. Results: The mOS of patients with a RDW of ≤15.3% was 45.0 (30.0-59.9) months, and of 21.3 (10.4-32.2) in those with a RDW of >15.3%. This difference was statistically significant (p < 0.001). In the group of patients with a RDW of ≤15.3, median progression free survival (mPFS) (38.04 [16.3-59.7] months) was found to be significantly higher than those with a RDW of >15.3 (17.1 [11.8-22.5] months) (p = 0.04). In multivariate analysis, RDW level (≤15.3, >15.3), was determined to be prognostic markers (p = 0.022). Conclusion: In mRCC patients, the RDW value measured before first-line VEGFR TKI therapy is an independent prognostic marker.
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Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/patologia , Fator A de Crescimento do Endotélio Vascular , Neoplasias Renais/patologia , Índices de Eritrócitos , Inibidores de Proteínas Quinases , Prognóstico , Inibidores da Angiogênese/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular , Eritrócitos , Estudos RetrospectivosRESUMO
INTRODUCTION: Osimertinib, an irreversible third-generation EGFR-TKI, is the standard of care for second-line treatment of T790M-mutant advanced NSCLC patients whose disease progressed after first-line EGFR-TKI therapy. In this multicenter study, we aimed to determine the real-life efficacy and safety of Osimertinib in pretreated advanced NSCLC patients with T790M mutation. MATERIALS AND METHODS: This retrospective trial included advanced T790M-mutant pretreated NSCLC patients who received Osimertinib from 24 different centers in Turkey. Primary endpoint was time-to-treatment discontinuation (TTD). Secondary endpoints were objective response rate (ORR), overall survival (OS), and safety. RESULTS: Of 163 patients, 68.7% had EGFR exon 19 deletion and 22.7% had exon 21 L858R mutation. Osimertinib was given as second-line treatment in 96 patients (58.9%) and third-line in 48 patients (29.4%). After median of 13-month follow-up, median TTD was 21.6 months with an 82.2% ORR. Estimated median OS was 32.1 months. Grade 3-4 adverse events were seen in 11.7% of the patients. CONCLUSION: Osimertinib is a highly effective option in second- or third-line treatment of NSCLC patients with T790M mutation, with a favorable safety profile.