Factors affecting survival in operated gastric cancer.

In this study, our aim was to determine the possible effects of Helicobacter pylori(HP), chronic atrophic gastritis (CAG), and gastrointestinal metaplasia (GIM) on survival in operated bowel type gastric cancer patients (INT-GC). Among 548 patients, 347(63.3%) were male. The median age was 57 years. Disease-free survival (DFS) and overall survival (OS) were significantly shorter in patients with GIM than those in patients without GIM (log rank, P = 0.003 and log rank P = 0.003, respectively). Multivariate analysis showed that presence of GIM (HR, 2.1) was found to be an independent factor of worse DFS. In our study, stage pIII patients with GIM had significantly shorter DFS and OS than those without GIM (log rank p = 0.008 and log rank p = 0.001, respectively). However, in subgroup analysis of patients with GIM, there was no significant DFS and OS difference between patients with stage pI and pII disease (log rank p = 0.999, log rank p = 0.184 vs. log rank p = 0.409, log rank p = 0.281, respectively).

The prognostic effect of pretreatment 18F-FDG PET/CT metabolic parameters in locally advanced Esophageal Squamous Cell Carcinoma treated with definitive chemoradiotherapy.

INTRODUCTION: In this study, we aimed to examine the relation between pre-treatment 18F-FDG PET/CT metabolic parameters [(including the maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG)] and treatment response and survival in locally-advanced Esophageal Squamous Cell Cancer (ESCC) treated with definitive chemoradiotherapy (dCRT). METHODS: A total 76 patients with locally-advanced ESCC who received dCRT between June 2015 and December 2019 were included in this retrospective study. Patients were divided into two groups as complete response (CR) or non-complete response (Non-CR) according to response to treatment. AUC was obtained as 0.749 (p < 0.001) in the ROC curve drawn by MTV for the CR. The MTV value was ≤12 cm3, with 72.1% sensitivity and 73.0% specificity. RESULTS: Of the 76 patients, 38 (50%) were male and 38 (50%) were female. The median age was 62 (39-84) years. The treatment response in 35 (46%) patients was CR. MTV value was >12cm3 in 41(54%) patients. Median follow-up time was 14.5 months. In patients with MTV>12cm3, median progression-free survival(mPFS) and median overall survival(mOS) were 9 months and 11 months, respectively, whereas mPFS and OS could not be reached in those with MTV≤12 cm3 (p < 0.001 and p < 0.001, respectively). In patients with non-CR, mPFS and mOS were 8 months and 9 months, respectively, whereas mPFS and OS could not be reached in patients with CR (p < 0.001 and p < 0.001, respectively). In multivariate analysis, age (odds ratio [OR], 1.07), ECOG PS (OR, 11.1), and MTV (OR, 4.73) were found to be the factors affecting treatment response. CONCLUSION: In our study, treatment response and MTV were found to be the factors associated with survival in patients treated with dCRT, showing the pre-treatment MTV value as a predictor of treatment response.

Factors Affecting Survival in Operated Esophageal Squamous Cell Carcinoma.

PURPOSE: Esophageal squamous cell carcinoma (ESCC) is an extremely fatal and relatively rare gastrointestinal system malignancy. This study aimed to investigate the factors affecting survival in operated patients with ESCC. MATERIALS AND METHODS: We included 110 patients (38 [34.5%] male; 72 [65.5%] female) aged ≥ 18 (median age, 54 [26-77]) years who were operated without any signs of metastases and followed up at Van Yüzüncü Yil University Dursun Odabasi Medical Center between 2004 and 2019. RESULTS: Initially, 39 (35.5%) patients were clinical lymph node-positive and 71 (64.5%) patients were negative. Thirty-five (31.8%) patients underwent surgery after neoadjuvant chemoradiotherapy (nCRT), and 75 (%68.2) patients underwent direct surgery without nCRT. Five-year overall survival (OS) was 84.4% and 59.2% in patients who underwent surgery after nCRT and in those who underwent direct surgery, respectively. Median OS was significantly longer in patients who underwent surgery after nCRT (p = 0.003). There was a statistically significant difference in OS in patients who underwent surgery after nCRT depending on tumor response (p = 0.04). In multivariate analysis, advanced pathologic stage (p = 0.002) adversely affected survival, whereas nCRT administration (p = 0.031) positively affected OS. CONCLUSION: We suggest that nCRT should be administrated before surgery, especially in locally advanced ESCCs. In addition, we believe that nCRT response can be used as a good parameter for survival. These results, however, should be supported by prospective studies.

Prognostic significance of neutrophil-to-lymphocyte ratio in esophageal squamous cell carcinoma.

OBJECTIVE: The purpose of the study was to assess the effect of neutrophil-to-lymphocyte ratio (NLR) on recurrence and survival in patients with Esophageal Squamous Cell Carcinoma (ESCC) undergoing surgery. METHODS: This was a retrospective analysis of the 80 resectable ESCC patients who underwent surgery at Yuzuncu Yil University Faculty of Medicine between 2008 and 2018. Receiver operator characteristics curve of NLR was plotted for disease-free survival (DFS). The area under the curve of NLR was 0.692 (p=0.008) with 65.2% sensitivity and 2.8 with 69.5% specificity. Patients were divided into two groups based on the NLR as follows: NLR <2.8 and NLR ≥2.8. RESULTS: Among 80 ESCC patients, 54 (65.5%) were female. The median age was 55 years (range, 26-77). The NLR was <2.8 in 47 (58.7%) patients. Median DFS was 55 months in patients with NLR ≥2.8, whereas it was not reached in those with NLR <2.8 (p=0.008), with corresponding overall survival (OS) durations of 71 months and not reached (p=0.027). Eastern Cooperative Oncology Group performance score 2, presence of obstruction at diagnosis, lower 1/3 esophageal localization, neoadjuvant treatment, and NLR ≥2.8 were found to be the factors related to survival. CONCLUSION: The present study demonstrated that high pre-treatment NLR was associated with worse DFS and OS in patients with resectable esophageal cancer. We believe that pre-treatment NLR may help guide predicting treatment outcomes in non-metastatic resectable ESCC patients.

Chemoradiotherapy followed by surgery versus observation in esophageal squamous cell carcinoma.

PURPOSE: We aimed to examine the effect of esophagectomy after chemoradiotherapy (CRT) or non-surgical follow-up after CRT in patients with locally advanced esophageal squamous cell carcinoma (ESCC). METHODS: A total of 653 patients under follow-up for locally advanced ESCC between 2010-2019 were reviewed for enrollment. Patients with no distant metastasis at the time of diagnosis who underwent esophagectomy or were taken under observation following CRT were included in the study. Overall, 127 eligible patients were included, 55 of whom were male (43.3%) and 72 female (56.7%). RESULTS: After CRT, 59 patients (53.5%) had undergone surgery and 68 (46.5%) were taken under observation. Median disease-free survival (mDFS) was not reached in the group that underwent surgery and was 13 months in the observation group (p<0.001). Median overall survival (mOS) was significantly longer in the operated group (p=0.006). There was no statistically significant difference in DFS and OS between patients who underwent surgery and those included in the observation group after achieving clinical and pathological complete response following CRT (p=0.119, p=0.699, respectively). The multivariate analysis identified surgery and increased CRT response as the factors that affect DFS (p=0.042, p<0.001, respectively). CONCLUSION: In this study, surgery provided no additional benefit on survival in locally advanced ESCC patients with complete response while prolonged survival was observed in those without complete response. Key words: esophageal cancer, chemoradiotherapy, squamous cell carcinoma, observation .

The Prognostic Value of Postoperative Lymph Node Ratio in Gastric Adenocarcinoma Patients Treated With Neoadjuvant Chemotherapy.

Objective In this study, we aimed to investigate the prognostic value of postoperative lymph node ratio (LNR)in locally advanced gastric cancer (GC) patients receiving neoadjuvant chemotherapy (NACT). Methods LNR was calculated as the ratio of positive LNs to the total LNs removed. The receiver operating characteristic (ROC) curve was plotted to estimate the cut-off value of LNR for recurrence. The area under the curve of LNR was 0.714 (95% CI: 0.604-0.825, p<0.001) with 60% sensitivity and >0.255 with 76% specificity. Patients were grouped as group I (≤0.255) and group II (>0.255). Results In this study, 157 GC patients were included (39.5% female and 60.5% male). Of the patients, 97 (61.8%) were in group I and 60 (38.2%) were in group II. Disease­free survival (DFS) was not reached in group I, and it was 16 months in group II (p<0.001). Overall survival (OS) was 58 months in group I and 28 months in group II (p>0.001). In multivariate analysis, lymphovascular invasion, neoadjuvant response, adjuvant treatment, and LNR were found to be the factors associated with DFS and OS (p<0.05). Conclusion In our study, it was observed that LNR can predict survival rates better than LN staging.

Prognostic significance of basal 18F-FDG PET / CT maximum standardized uptake value in patients with metastatic renal cell carcinoma who were treated with sunitinib.

PURPOSE: To determine whether there is a relationship between maximum standardized uptake (SUVmax) value of basal 18-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) that was performed before sunitinib treatment and treatment-related survival in patients with metastatic renal cell carcinoma (mRCC). METHODS: The data of 36 patients (female/male: 1/1, median age 57.36 years, range 31-74) were retrospectively analyzed in whom sunitinib treatment was started due to mRCC between 2008 and 2019 and who underwent basal 18F-FDG PET/CT examination before this treatment. The median SUVmax value was 6.8. Progression-free survival (PFS) and overall survival (OS) rates of patients, who had SUVmax value >6.8 (group I) (50%, n=18) and ≤ than 6.8 (group II) (50%, n=18), were compared. RESULTS: Both PFS and OS were significantly lower in the group with high SUVmax (SUVmax> 6.8, group I) before the sunitinib treatment than the group with low SUVmax (SUVmax ≤6.8, group II). When patients with SUVmax value> 6.8 (group I) (50%, n=18) and ≤6.8 (group II) (50%, n=18) were compared the median PFS of group I patients was 6.83 months (95%CI: 6.14-7.52), while the median PFS of group II patients was 11.24 months (95%CI: 8.4-14.06) (p=0.035). The median OS in group I and II was 12.91 months (95%CI: 10.17-15.65) and 54.54 months (95%CI: 8.51-100), respectively (p=0.042). CONCLUSION: In this study it was found that PFS and OS were low in patients with high SUVmax value in 18F-FDG PET/CT performed before sunitinib treatment. As a result, 18F-FDG PET/CT SUVmax values measured before sunitinib treatment can be used to predict survival in mRCC patients.

Lymph Node Ratio Predicts Long-Term Survival in Lymph Node-Positive Breast Cancer.

OBJECTIVE: In this study, we aimed to evaluate the prognostic value of axillary lymph node ratio (LNR) for disease-free survival (DFS) in node positive breast cancer (BC) patients with long term follow-up. MATERIALS AND METHODS: A total of 179 stage II to III female BC patients, who were followed between December 2001 and January 2019 at the department of medical oncology, were included in this study. Patients were classified into 3 groups based on the LNR as follows; LNR<0.21, LNR=0.21-0.65, and LNR>0.65. SPSS 22 for windows was used for statistical analysis. RESULTS: The median age was 49 (range, 24-83) years. The numbers of patients with stage II and stage III disease were 81 (45.3%) and 98 (54.7%), respectively. The median number of lymph node (LN) resected and positive LN were 15 (range, 3-48) and 3 (range, 1-29), respectively. There were 90 patients (50.3%) with LNR <0.21, 62 (34.6%) with LNR=0.21-0.65, and 27 (15.1%) with LNR >0.65. The median disease-free survival (DFS) was not reached in patients with LNR <0.21, 81 months in patients with LNR=0.21-0.65, and 43 months in patients with LNR>0.65 (p<0.001). Overall survival (OS) was found to be significantly related to LNR (p=0.042). In patients with LNR<0.21 and LNR=0.21-0.65, the median OS was not reached. In patients with LNR >0.65, the median OS was 101 months. In multivariate analysis, LNR=0.21-0.65 (Hazard ratio [HR], 6.99), LNR>0.65 (HR, 28.99), and HER-2 negativity (HR, 4.64) were the factors associated with DFS (p<0.05). CONCLUSION: LNR is a more useful prognostic factor than the pathological lymph node staging for predicting survival in patients with nod-positive BC.

The Effect of Obesity on Response to Neoadjuvant Therapy in Locally Advanced Gastric Cancer.

INTRODUCTION: The effect of obesity on response to neoadjuvant chemotherapy (NACT) remains unknown. We aimed to investigate the effect of obesity on response to NACT and survival in locally-advanced gastric cancer (GC). METHODS: From 2010 to 2019, 142 GC patients with clinical stage III disease who underwent curative surgery after NACT were enrolled. Patients were divided into 3 groups according to body mass index (BMI) as follows; BMI < 25 kg/m2, BMI = 25-30 kg/m2, and BMI > 30 kg/m2. The Mandard tumor regression grading system was used for tumor regression grade (TRG). RESULTS: Of the 142 GC patients, 45(31.7%) were female. The median age was 58 years. BMI was < 25 kg/m2 in 60 (42.3%) patients, 25-30 kg/m2 in 44 (31%) patients, and > 30kg/m2 in 38 (26.8%) patients. The numbers of patients with TRGI-II, TRGIII, and TRGIV-V were 35 (24.6%), 44 (31%), and 63 (44.4%), respectively. There was no statistically significant difference among BMI groups in terms of disease-free survival (DFS) and overall survival (OS) (p = 0.919 and p = 0.398, respectively). According to TRG groups; mDFS was 46 months in TRG I-II, 28 months in TRG III, and 18 months in TRG IV-V (p <0.001). In multivariate analysis, presence of perineural invasion and lymphovascular invasion were the factors affecting TRG. CONCLUSION: In our study, we found that pre-treatment obesity did not affect the TRG in clinical stage III GC patients. However, a better TRG status was associated with improved survival.
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Relationship between 18-FDG-PET/CT and Clinicopathological Features and Pathological Responses in Patients with Locally Advanced Breast Cancers.

OBJECTIVE: We investigated the relationship between the maximum standardized uptake value (SUVmax) of whole-body positron emission tomography/computed tomography (PET/CT) performed before treatment and the demographical and histopathological features in locally advanced breast cancer (LABC), as well as the role of PET/CT in the evaluation of pathological complete response (pCR) after neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: Fifty-one LABC patients who received NAC in our center between 2011 and 2015 were retrospectively analyzed. Basal PET/CT was performed in all the patients before NAC. The SUVmax levels and demographical and histopathological results were compared. The relationship between the SUVmax values after NAC and pathological responses were evaluated. RESULTS: The mean age of the patients was 49 (32-69) years. PET/CT performed after NAC showed complete response in 20 patients (39.2%), partial response in 28 patients (54.9%), stable disease in 2 patients (3.9%), and progressive disease in 1 patient (2%). There was no significant difference between the mean SUVmax values of the patients according to age (>50 and ≤50 years), menopausal status, tumor localization, clinical stage, and grade. The mean SUVmax value was higher in the triple-negative group than those in the HER2 positive and luminal groups. There was a significant difference in the SUVmax values between the group that achieved pCR after NAC and the group that could not achieve pCR (SUVmax value for breast 2.92 vs. 0.30; p=0.01; SUVmax value for axilla 1.5 vs. 0.0, p=0.02). CONCLUSION: The SUVmax values are independent of demographical features. There was a significant relationship between the pCR and SUVmax values after NAC. PET/CT could be useful in the evaluation of patients to predict the biological characteristics of tumors.

Relationship between Serum Vitamin D Levels and Health-Related Quality of Life in Maintenance Hemodialysis Patients.

OBJECTIVES: Aim of the study was investigating the effect of serum vitamin D levels on health-related quality of life in hemodialysis patients. METHOD: One-hundred and twenty-three maintenance hemodialysis patients were enrolled in this cross-sectional study. Patients divided into 2 groups according to serum vitamin D levels. A serum 25-hydroxyvitamin D (25[OH] D) level of < 20 ng/mL was identified as vitamin D deficiency (n = 78), and a serum level of ≥20 ng/mL was identified as normal (n = 45). Kidney Disease Quality of Life 36 (KDQOL-36) survey was used for quality of life measurement. Scores of the all of 5 subscales of KDQOL-36 were calculated. Multiple linear regression analyses were used to define independent risk factors affecting the survey. RESULTS: Mean age of patients was 62 and 56% of patients were male. Mean 25(OH) D levels were 11.86 and 29.57 ng/mL, respectively, in 2 groups. There was statistically significant difference between age and Kt/V levels between 2 groups (p = 0.008 and p = 0.041). Age and gender were found as significant predictors of vitamin D deficiency (p = 0.026 and p = 0.021). In symptom and problem list subscale, gender and comorbidity were detected as independent risk factors (p = 0.050 and p = 0.032). Comorbidity was the only independent risk factor for effect of kidney disease subscale (p < 0.001). Independent risk factors associated with burden of kidney disease subscale were comorbidity and serum 25 (OH) D levels (p = 0.003 and p = 0.023). Serum 25(OH) D, gender, and comorbidity were independently associated with physical component summary (PCS) subscale (p < 0.001, p = 0.008, and p = 0.011). The only independently associated factor with mental component summary (MCS) was serum 25(OH) D (p < 0.001). CONCLUSION: We first showed the relationship between serum vitamin D levels and KDQOL-36 in hemodialysis patients. Lower serum vitamin D levels were negatively associated with burden of kidney disease, PCS, and MCS subscales.

Serum vaspin levels and carotid intima media thickness in pre dialysis patients.

BACKGROUND AND OBJECTIVE: Vaspin is a molecule belonging to adipokine family which is associated with insulin resistance and obesity in humans. Several studies have evaluated the serum levels of vaspin in various conditions including coronary artery disease and chronic hemodialysis patients. To our best knowledge, serum vaspin levels have not yet been studied in pre dialysis patients. Carotid intima-media thickness (CIMT) is a noninvasive procedure used to diagnose the extent of carotid atherosclerotic vascular disease. The objective of this study is to evaluate serum vaspin levels in pre dialysis patients and their relationships with glomerular filtration rate and CIMT levels. METHODS: A total of twenty-five pre dialysis patients (14 female and 11 male) and 22 healthy controls (8 female and 14 male) were included in the study. CIMT was measured through B-mode ultrasonography. RESULTS: Serum vaspin levels were significantly lower (p<0.05) and CIMT levels were significantly higher (p<0.001) in pre dialysis patients than in control subjects. Serum vaspin levels were found to be significantly correlated with glomerular filtration rate (r=0.42, p<0.001) and CIMT (r=-0.47, p<0.05) in pre dialysis patients. CONCLUSIONS: This is the first report to describe the correlation between serum vaspin levels and CIMT in pre dialysis patients. We concluded that serum vaspin levels were decreased in pre dialysis patients compared to the control subjects. In addition, serum vaspin levels were found to be significantly correlated with glomerular filtration rate and CIMT. This article is protected by copyright. All rights reserved.

Are We Late in the Diagnosis of Malignities Occurring in Solid Organ Transplant Patients? 11 Years' Experience.

OBJECTIVE: Our aim is to evaluate the frequency and characteristics of cancer in the population of patients with solid organ transplant who are under immunosuppressive medication. In this study we aimed to emphasize the importance of early diagnosis of cancer in solid organ transplant recipients. An aging population began to receive solid organ transplantation and survival times prolonged. But this had a cost and new problems came forward. Especially de novo cancers because of immunosuppressive therapy took notice. Risk of malignancy increases after organ transplantation and cancer incidence was about 2.3-3.1% in these patients including skin cancer, lung cancer, malign lymphoma, cervix cancer, kaposi sarcoma, and hepatobiliary cancer. MATERIALS AND METHODS: The files of 328 organ transplant recipients followed from January 2004 to April 2015 at Atatürk University Medical Faculty were retrospectively reviewed. RESULTS: Eight patients developed cancer (2.4%). There were six males and two females. Age at cancer diagnosis ranged from 42 to 79 years old with average of 55 years. The interval from solid organ transplantation to cancer diagnosis ranged from 6 months to 30 years. Among the patients, five were renal transplant recipients and two were liver transplant recipients. Four patients had stage IV disease, one patient stage IIIB, and three patients had stage I disease. For none of the patients a diagnosis with screening methods was used for cancer before any complaints of tumor emerged. CONCLUSION: To diagnose cancer at early stages in solid organ transplant recipients, earlier and detailed cancer screening is very important. The association between diagnosis of cancer at early stages and prolonged overall survival time is well known. Detailed and careful evaluation for occult malignancies in pre-transplantation period is also important.

Impact of adjuvant treatment modalities on survival outcomes in curatively resected pancreatic and periampullary adenocarcinoma.

BACKGROUND: We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma (PAC). METHODS: A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013. RESULTS: Of 563 patients, 472 received adjuvant chemotherapy (CT) alone, chemoradiotherapy (CRT) alone, and chemoradiotherapy plus chemotherapy (CRT-CT) were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival (RFS) and overall survival (OS) were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant difference between groups when patients with node-negative disease or patients with or without positive surgical margins were considered. CONCLUSIONS: Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.

Prognostic Value of Baseline Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Local and Advanced Gastric Cancer Patients.

BACKGROUND: We aimed to investigate the prognostic value of baseline neutrophil, lymphocyte, and platelet counts along with the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in local and advanced gastric cancer patients. MATERIALS AND METHODS: In this retrospective cross-sectional study, a total of 103 patients with gastric cancer were included. For all, patient characteristics and overall survival (OS) times were evaluated. Data from a complete blood count test including neutrophil, lymphocyte, monocyte, white blood cell (WBC) and platelet (Plt) count, hemoglobin level (Hb) were recorded, and the NLR and PLR were obtained for every patient prior to pathological diagnosis before any treatment was applied. RESULTS: Of the patients, 53 had local disease, underwent surgery and were administered adjuvant chemoradiotherapy where indicated. The remaining 50 had advanced disease and only received chemotherapy. OS time was 71.6±6 months in local gastric cancer patients group and 15±2 months in the advanced gastric cancer group. Univariate analysis demonstrated that only high platelet count (p=0.013) was associated with better OS in the local gastric cancer patients. In contrast, both low NLR (p=0.029) and low PLR (p=0.012) were associated with better OS in advanced gastric cancer patients. CONCLUSIONS: This study demonstrated that NLR and PLR had no effect on prognosis in patients with local gastric cancer who underwent surgery and received adjuvant chemoradiotherapy. In advanced gastric cancer patients, both NLR and PLR had significant effects on prognosis, so they may find application as easily measured prognostic factors for such patients.

Efficacy and tolerability of weekly docetaxel, cisplatin, and 5-fluorouracil for locally advanced or metastatic gastric cancer patients with ECOG performance scores of 1 and 2.

BACKGROUND: Docetaxel, cisplatin, 5-fluorouracil (DCF) given every three weeks is an effective, but palliative regimen and significantly toxic especially in patients who have a low performance score. Here, we aimed to evaluate the efficacy and tolerability of a weekly formulation of DCF in locally advanced and metastatic gastric cancer patients. MATERIALS AND METHODS: 64 gastric cancer patients (13 locally advanced and 51 metastatic) whose ECOG (Eastern Cooperative Oncology Group) performance status (PS) was 1-2 and who were treated with at least two cycles of weekly DCF protocol as first-line treatment were included retrospectively. The weekly DCF protocol included 25mg/m2 docetaxel, 25mg/m2 cisplatin, and 24 hours infusion of 750mg/m2 5-fluorouracil, repeated every week. Disease and patient characteristics, prognostic factors, treatment response, grade 3-4 toxicity related to treatment, progression free survival (PFS) and overall survival (OS) were evaluated. RESULTS: Of the patients, 41 were male and 23 were female; the median age was 63 (29-82) years. Forty-one patients were ECOG-1 and 23 were ECOG-2. Of the total, 81.2% received at least three cycles of chemotherapy. Partial response was observed in 28.1% and stabilization in 29.7%. Overall, the disease was controlled in 57.8% whereas progression was noted in 42.2%. The median time to progression was 4 months (95%CI, 2.8-5.2 months) and median overall survival was 12 months (95%CI, 9.2-14.8 months). The evaluation of patients for grade 3-4 toxicity revealed that 10.9% had anemia, 7.8% had thrombocytopenia and 10.9% had neutropenia. Non-hematologic toxicity included renal toxicity (7.8%) and thrombosis (1.6%). CONCLUSIONS: In patients with locally advanced or metastatic gastric cancer who were not candidates for DCF administered every-3-weeks, a weekly formulation of DCF demonstrated modest activity with minimal hematologic toxicity, suggesting that weekly DCF is a reasonable treatment option for such patients.

Abnormal liver function test in hydatidiform moles: a retrospective study comparing the hyperthyroid state and the euthyroid state.

INTRODUCTION: The effect of a hyperthyroid or euthyroid state on liver function tests in patients with hydatidiform moles (HM) is not known. The aim of this study was to determine the effect of hyperthyroidism on liver transaminases in HM. PATIENTS AND METHODS: We retrospectively reviewed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in 80 patients with HM (23 complete moles and 57 partial moles). RESULTS: Of the 80 HM patients, 52 (65%) were euthyroid and 28 (35%) were hyperthyroid. The number of gravida and the levels of serum ß-human chorionic gonadotropin (ß-HCG), AST, and ALT were significantly higher in the hyperthyroid state than in the euthyroid state (p = 0.033, p = 0.001, p = 0.001 and p = 0.001; respectively). Number of gravida, serum TSH and total T4 were significantly higher in complete HM than partial HM (p < 0.05, p < 0.001, p < 0.05; respectively). CONCLUSIONS: Our results demonstrated that HM-related ß-HCG may activate thyroid cells via TSH-related signalling, resulting in the release of high levels of FT4, FT3, TT3 and TT4, and a subsequent decrease in TSH.

Skin bleeding time for the evaluation of uremic platelet dysfunction and effect of dialysis.

INTRODUCTION: In patients with chronic kidney disease (CKD) predisposition to bleeding is frequently seen due to disturbances in platelet adhesion and aggregation. Various tests have been utilized to evaluate the disturbance of hemostasis in end-stage renal disease patients. In this trial; we evaluated skin bleeding time in patients admitted to our hospital with uremic symptoms and having hemodialysis (HD) for the first time. We also examined the effects of HD and uremia on this test and investigated its effectiveness in predicting the hemorrhagic complications before implementation of invasive procedures in uremic patients. MATERIAL-METHOD: Twenty nine patients (13 men,16 women; mean age 59.7 ± 18.1) with CKD who presented with symptoms of uremia and treated with HD for the first time were enrolled in this trial. The skin bleeding time were measured before initiation of first hemodialysis and after the second hemodialysis session. RESULTS: The skin bleeding time after the second dialysis was significantly shorter when compared to pre-dialysis values (p < 0.05). Correlation analysis between the skin bleeding time and urea, creatinine, hemoglobin, platelet, and bicarbonate showed no correlation. CONCLUSIONS: Skin bleeding time could reveal the uremic platelet dysfunction and beneficial effect of dialysis in the patients who presented with uremic symptoms and treated with HD for the first time. We suggest that skin bleeding time may be an appropriate test for the evaluation of hemostasis disturbance in uremic patients and prediction of the bleeding risk before invasive procedures.

The course of hypercalciuria and related markers of bone metabolism parameters associated with corticosteroid treatment.

BACKGROUND AND OBJECTIVE: Prolonged corticosteroid (CS) use induces osteoporosis; the pathogenesis of this condition is multifactorial and includes CS-induced hypercalciuria. We investigated the course of hypercalciuria and related markers of bone metabolism parameters during and after the CS treatment. MATERIALS AND METHODS: We recruited 42 patients who were taking at least 10 mg/day of methylprednisolone or an equivalent dose of CSs for at least 30 days. The 24-h urinary calcium and sodium, a spot urinary calcium/creatinine ratio, and urinary deoxypyridinoline were measured prior to the treatment, at day 7, at days 30-60, and after the cessation of the treatment. Additionally, the serum levels of phosphorus, calcium, alkaline phosphatase (ALP), albumin, creatinine, osteocalcin, and parathyroid hormone (PTH) were analyzed. RESULTS: The 24-h urinary calcium excretion was significantly increased at day 7 (182.2 ± 158.6 mg/day; p < 0.001) and at days 30-60 (196.9 ± 167.8 mg/day; p < 0.001) compared with baseline (98.7 ± 88.1 mg/day) and returned to basal level after the cessation of the CSs (118.9 ± 90.2 mg/day; p = 0.725). The urinary deoxypyridinoline level was significantly higher at days 30-60 compared with basal level. The serum osteocalcin level was decreased at days 30-60 when compared with day 7. No significant changes were detected in the PTH, phosphorus, creatinine, and ALP levels. CONCLUSIONS: CS treatment induces hypercalciuria just after starting the treatment until the end of it. CS-induced hypercalciuria promptly improved after cessation of the treatment. By days 30-60, the excretion of urinary deoxypyridinoline was accompanied by hypercalciuria. The serum osteocalcin level was decreased at days 30-60 when compared with day 7.

Relationship between visfatin and some clinical and biochemical parametres in peritoneal dialysis patients.

OBJECTIVE: To characterise the relationship between visfatin levels and various clinical and biochemical parameters in peritoneal dialysis patients. METHODS: The case-control study was conducted at the Medical Faculty Hospital, Yuzuncu Yil University, Van, Turkey, between May 2007 and December 2008, and involving 41 patients on peritoneal dialysis, 20 haemodialysis patients and 20 healthy controls. Fasting visfatin level was measured with enzyme-linked immunosorpent assay (ELISA) method, and patients on peritoneal dialysis were separated into two groups according to the visfatin levels - high and low. The groups were compared in terms of some clinical (height, weight, body mass index, waist circumference, hip circumference, waist/hip ratio, heart rate, systolic and diastolic blood pressure and the kt/V and CrCI (creatanine clearance) parameters which are indicative of the dialysis adequacy) and biochemical parameters (glucose, triglycerides, cholesterol, low density lipoprotein, high density lipoprotein, aspartate aminotransferase, alanine transminase, blood urea nitrogen, creatinine, total protein, albumin, globulin, sodium, potassium, magnesium, calcium, phosphorus, ferritin, venous blood gas, parathyroid hormone and insulin). SPSS 15 was used for statistcal analysis. RESULTS: No statistically significant difference in the visfatin levels was found between the patients and controls (7.71 +/- 4.04, 7.36 +/- 3.71, 7.70 +/- 1.61, respectively, p = 0.63). The triglyceride level of the high-visfatin group was significantly higher than that of the low-visfatin group (243.8 +/- 133.2, 150.8 +/- 65.8, respectively, p<0.05). However, there was no correlation between visfatin and triglyceride levels. No difference in the other clinical and biochemical parametres was observed between the two groups of peritoneal dialysis patients. CONCLUSIONS: No significant difference in the serum visfatin levels of peritoneal dialysis patients compared to haemodialysis patients or healthy individuals was noticed. Further studies are needed to confirm the effect of visfatin on triglyceride levels, and, if confirmed, the mechanism of this relation.