Medical Oncology or Surgical Oncology: Which Branch Should Be Started in Esophageal Cancer Diagnostic Evaluation?

Objective We evaluated the effect of the branch of the cancer specialist (medical oncologist versus surgical oncologist) who initially examines a patient on treatment delay. The objective was to evaluate whether surgical oncology and medical oncology clinics, which have different operating styles, impact the timeliness of treatment. Additionally, we investigated the prognostic impact of the clinical and treatment-related factors in patients with esophageal cancer treated at our center. Methods This was a retrospective single-center study. The prognostic impact of resection type (R0 or R1-2), multimodal treatment, lymphovascular invasion (LVI), perineural invasion (PNI), lymph node metastases, cachexia at the time of diagnosis, smoking, and diagnostic application of endoscopic ultrasound was evaluated. Patients were stratified according to whether the orientation and management processes were based on a multimodal approach and whether they were first examined by a surgical oncologist or a medical oncologist for diagnostic workup and management. The impact of the management approach on progression-free survival (PFS) was evaluated. Results Use of a multimodal approach in patients with esophageal cancer was associated with longer PFS (26.7 vs 13.9 months, p = 0.002). LVI and cachexia were associated with shorter PFS (16.1 vs 29.4 months, p = 0.044 and 14.6 vs 29.0, p = 0.019, respectively). The first appointment of the patients in the medical oncology department was associated with shorter treatment delay (54 [IQR: 36-71] vs 31 [IQR: 24-48] days, p < 0.001). Conclusions Our findings suggest that the first appointment of patients in the medical oncology department may lead to a more systematic workup and treatment progress. We believe that systematic use of multimodal approaches for esophageal cancer may confer prognostic benefits.

Roles of metabolic tumor volume and total lesion glycolysis on 18F-FDG PET/CT, CA19-9 levels, and complete blood count parameters in predicting survival in patients with unresectable or metastatic pancreatic cancer.

AIM: In this study, we aimed to investigate the roles of volume based 18F-FDG PET/CT parameters, CA19-9 levels, and complete blood count parameters in predicting survival in patients with unresectable and/or metastatic pancreatic ductal adenocarcinoma. MATERIALS AND METHOD: Fifty-seven pancreatic cancer patients who were followed in University of Health Sciences Gazi Yasargil Training and Research Hospital between January 2017 and June 2020, declined surgical treatment and/or radiation therapy or had medically inoperable, unresectable, or metastatic disease, and received chemotherapy were included in the study. 18F-FDG PET/CT images of patients were evaluated and calculated metabolic tumor volume (MTV) and total lesion glycolysis (TLG) parameters were compared with CA19-9 levels and complete blood count parameters. Patients were assessed in two groups as survivors and non-survivors. RESULTS: Total MTV and total TLG on 18F-FDG PET/CT were significantly higher among non-survivors than survivors (p: 0.023 and 0.034, respectively). Multivariate Cox regression analysis revealed that TLG higher than 46 g/ml.cm3, MTV higher than 11.02 cm3 (OR 0.987, 95%CI 0.976-0.999, p:0.029 and OR 0.246, 95%CI 0.089- 0.685, p: 0.007, respectively) and elevated MPV (OR:0.785, 95% CI 0,574-0.976, p:0.042) were independent prognostic factors for predicting mortality. CONCLUSION: TLG >46 g/ml.cm3 and MTV >11.02 cm3 in 18F-FDG PET/CT and elevated MPV in complete blood count are independent prognostic factors for predicting mortality in patients with unresectable or metastatic pancreatic cancer who are treated with chemotherapy. KEY WORDS: Pancreatic cancer, Metabolic tumor volume, Total lesion glycolysis, Mean platelet volume.

Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma.

OBJECTIVE: In this study, we aimed to evaluate the diagnostic sensitivities of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the primary tumor, and nodal, peritoneal and distant organ metastases of primary and recurrent gastric adenocarcinoma (GAc) with patient and lesion-based comparison. MATERIALS AND METHOD: Twenty-one patients with histopathologically proven newly diagnosed or recurrent GAc who underwent 18F-FDG and 68Ga-FAPI-04 imaging were included in the study. Both imaging techniques were evaluated visually according to the intensity of organ-based uptake. SUVmax and tumor-to-background ratio (TBR) values obtained from primary tumor/relapse and metastatic organs were compared statistically. RESULTS: 68Ga-FAPI-04 uptake was positive in all 15 newly diagnosed patients, while two patients among them who had mucinous and signet ring cell carcinoma did not exhibit 18F-FDG uptake. The sensitivity and specificity of 68Ga-FAPI-04 PET/CT in detecting primary gastric were 100%, while the sensitivity and specificity of 18F-FDG were 86.6 and 100%, respectively. 68Ga-FAPI-04 imaging revealed diffuse stomach uptake in seven patients, while 18F-FDG could only show two of them. The sensitivity and specificity of in-patient-based detection of lymph node metastases were 100 and 95.2%, respectively, while these values were 71.4 and 93.7%, respectively, for 18F-FDG. For peritoneal involvement 68Ga-FAPI-04 had a sensitivity and specificity of 100%, whereas 18F-FDG had a sensitivity of 40% and a specificity of 100%. CONCLUSION: 68Ga-FAPI-04 PET/CT is an imaging modality with the potential of yielding more sensitive and specific findings 18F-FDG PET/CT. This modality may help avoid invasive diagnostic procedures that may be frequently required in GAc.

Nivolumab-Related Dry Mouth and Dry Eye: Cross-Sectional Study.

To evaluate ICIs related dry eye and dry mouth in nivolumab therapy, 24 patients receiving nivolumab (group 1), 30 patients in remission without treatment for 6 months (group 2), 30 healthy participants (group 3) were cross-sectionally examined. Schirmer's 1, 2, TSH blood tests, serological analysis, salivary flow scintigraphy and minor-salivary gland biopsy were performed. Schirmer's tests were performed with anesthetic (1) and without anesthetic (2). Schirmer's scores were lower in group 1 with more frequent reduced tear production (p < 0.001). TSH levels negatively correlated with Schirmer's scores. Functional insufficiency was detected by salivary flow scintigraphy in 7 out of 10 patients with Schirmer's test positivity. In Schirmer's positive patients, lymphocytic sialadenitis was confirmed in 4 patients (focus score > 1) and CD4 T lymphocyte precipitation was observed in 6 patients. Nivolumab therapy may be associated with ICIs related immune sicca.

The role of inflammatory parameters in predicting disease recurrence in patients with stage IIA colon cancer with no high-risk features.

OBJECTIVE: We aimed to investigate the roles of inflammatory parameters, including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and C-reactive protein/albumin ratio (CAR), in predicting disease recurrence in patients with stage IIA (T3N0M0) high microsatellite instability and microsatellite-stable colon cancer who had no risk factors associated with relapse. MATERIALS AND METHODS: We evaluated 155 patients with colon cancer followed in 3 hospitals in Turkey between February 2009 and March 2020. These patients had stage IIA disease and had no risk factors associated with relapse. None of the patients received adjuvant chemotherapy. NLR, PLR, LMR, and CAR parameters were retrospectively obtained from laboratory results at the time of diagnosis, and their associations with disease recurrence were assessed. RESULTS: Over a median follow-up period of 38 months (range: 4-98 months), 11 of the 155 patients experienced relapse or developed metastases. Multivariate Cox analyses revealed that NLRs of ≥3.12 (hazard ratio [HR]: 0.041, 95% confidence interval [CI]: 0.048-0.826, p = 0.006) and CARs of ≥0.027 (HR: 0.199, 95% CI: 0.004-0.404, p = 0.026) were independent prognostic markers predicting relapse. The median 5-year recurrence-free survival rate of patients with NLRs of ≥3.12 at the time of diagnosis was 88.0%; this rate was 100% in patients with NLRs of <3.12 (p < 0.001). Similarly, the median 5-year recurrence-free survival rate of patients with CARs of ≥0.027 at the time of diagnosis was 84.7%; this rate was 95.7% in patients with CARs of <0.027 (p = 0.016). CONCLUSION: In this study, NLR and CAR were found to be independent prognostic markers predicting disease recurrence in patients with stage IIA colon cancer who did not receive adjuvant chemotherapy due to low clinical risk.

68Ga-FAPI-04 PET/CT, a new step in breast cancer imaging: a comparative pilot study with the 18F-FDG PET/CT.

AIM: We aimed to compare the roles of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the evaluation of primary tumor and metastases in primary and recurrent breast cancer. MATERIALS AND METHOD: Twenty female patients with histopathologically confirmed primary and recurrent breast cancer were included in the prospective study. All patients underwent FDG and FAPI PET/CT imaging in the same week. The number of primary and metastatic lesions, SUVmax values, and tumor-to-background ratios (TBR) were recorded from both scans. Data obtained were statistically compared. RESULTS: FAPI PET/CT was superior to FDG in detecting breast lesions, as well as hepatic, bone, lymph node, and cerebral metastases in terms of patient- and lesion-based assessments. The sensitivity and specificity of FAPI in detecting primary breast lesions were 100% and 95.6%, respectively, while the sensitivity and specificity of FDG were 78.2% and 100%, respectively. The SUVmax values of primary breast tumors, lymph nodes, lung metastases, and bone metastases were significantly higher on FAPI imaging than FDG imaging (p < 0.05). However, SUVmax values of hepatic metastases did not exhibit a statistically significant difference between two imaging techniques (p > 0.05). Also, FAPI imaging yielded significantly higher TBR in breast lesions as well as hepatic, bone, brain and lung metastases compared to FDG (p < 0.05). CONCLUSION: 68 Ga-FAPI-04 PET/CT is superior to 18F-FDG PET/CT in detecting the primary tumor in patients with breast cancer with its high sensitivity, high SUVmax, and high TBR. 68 Ga-FAPI-04 PET/CT is also superior to 18F-FDG PET/CT in detecting lymph node, hepatic, bone, and cerebral metastases because it has lower background activity and higher uptake in subcentimetric lesions.

Depression and anxiety in cancer patients before and during the SARS-CoV-2 pandemic: association with treatment delays.

PURPOSE: Pandemics can be associated with anxiety and depression in cancer patients who are undergoing treatment. In the present study, we aimed to perform a comparative evaluation of the conditions of cancer patients before and during the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to detect the impact of the pandemic on treatment delays that are associated with anxiety and depression in cancer patients. In addition, the effect of public transport use on treatment delays was examined. METHODS: BDI and BAI were administered to 595 breast, ovarian, colon and gastric cancer patients before and during the pandemic. The questionnaires were administered by the physician blindly, who was unaware of the delay of the patients. The number of days by which the patients delayed their treatment due to the fear of contamination were recorded retrospectively. Correlation analyses were performed between the obtained scores and treatment delays. RESULTS: The depression and anxiety levels in cancer patients were found to increase during the pandemic (p = 0.000), and this increase was positively correlated with the disruption of their treatment (p = 0.000, r = 0.81). Depression and anxiety levels and treatment delays were higher in elderly patients (p = 0.021). Depression and anxiety were more pronounced in female patients (p = 0.000). Moreover, treatment delays were more common in patients who had to use public transportation (p = 0.038). CONCLUSION: SARS-CoV-2 pandemic may increase anxiety and depression in cancer patients. This can cause patients to experience treatment delays due to concerns about becoming infected. At this point, if necessary, assistance should be obtained from psychiatric and public health experts.

Correlations between whole body volumetric parameters of 68Ga-PSMA PET/CT and biochemical-histopathological parameters in castration-naive and resistant prostate cancer patients.

OBJECTIVE: To evaluate the relationship between whole body volumetric (Wbv) results of 68Ga-PSMA PET/CT with biochemical and histopathological parameters. METHODS: One hundred twenty-one prostate cancer patients who underwent 68Ga-PSMA PET/CT between January 2018 and December 2019 were included. Imaging was conducted for staging upon new diagnosis with moderate- and high-risk disease and for confirming the progression of castration resistance. The relationships between the Wbv 68Ga-PSMA PET/CT parameters and prostate-specific antigen (PSA) levels, PSA doubling time and Gleason score (GS) were evaluated. RESULTS: The median GS and mean PSA levels were similar between the castration-naive and resistant patients. The PSA levels were positively correlated with MTVwb (p: 0.009, r: 0.286) and TLPwb (p: 0.002, r: 0.344). Gleason scores were positively correlated with MTVwb (p: 0.050, r: 0.216), TLPwb (p: 0.007, r: 0.296) and highest standard uptake value (HSUV) max (p: 0.047, r: 0.220). In the castration-naive group, Gleason scores (from p < 0.001 to p = 0.04 and r = 0.331 to 0.549) and PSA levels (from p = 0.002 to p = 0.045 and from r = 0.323 to 0.473) correlated with all 68Ga-PSMA-PET/CT parameters. PSA doubling time was negatively correlated with whole-body metabolic tumour volume (MTVwb) (p: 0.050, r: 0.232) and whole-body total lesion PSMA (TLPwb) (p: 0.026, r: 0.262). The MTVwb, TLPwb and HSUVpeak values of the patients with biochemical recurrence (BR) of 0-6 months (n = 18) were higher than those with BR > 2 years (n = 35) (p = 0.046, 0.047 and 0.042, respectively). CONCLUSIONS: Wbv 68Ga-PSMA PET/CT results were correlated with PSA levels and Gleason scores. The correlation was relatively stronger in the castration-naive group. The prognostic accuracy of PSA in the resistant group may be weaker than in the naive group. The difference in volumetric parameters of patients with short BR compared to long BR supports the idea that 68Ga-PSMA PET/CT can distinguish patients with rapid relapse from others.

The effect of iron treatment on adhesion molecules in patients with iron deficiency anemia.

The present study was aimed to determine the effect of iron supplementation on levels of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in patients with iron deficiency anemia (IDA). In this study, 26 female patients diagnosed with iron deficiency were treated approximately 3 months of oral iron supplementation (99 ± 10 days; ferrous glycine sulfate; 100 mg/day of elemental iron). Levels of sICAM-1 and sVCAM-1 were assessed prior to treatment and after approximately 3 months of treatment and compared with 26 healthy female subjects. A significant increase in sVCAM levels was found in the patients with iron deficiency at the end of the treatment relative to pretreatment levels compared to controls, whereas no significant differences were determined in sICAM levels. In the posttreatment period, no significant change was observed in sICAM levels compared to the pretreatment levels, whereas sVCAM levels decreased. However, after the treatment period, the sVCAM, hemoglobin, mean corpuscular volume (MCV), and serum ferritin levels did not return to the normal range compared to the controls. Pretreatment sVCAM-1 levels were inversely correlated with levels of hemoglobin, hemotocrit, MCV, serum iron, and ferritin. After treatment, the sVCAM-1 levels were negatively correlated with ferritin levels. Levels of sVCAM were significantly higher in patients with IDA than controls. After the treatment period, the sVCAM levels were not completely normalized in patients with IDA compared to controls, regardless of the presence of inadequate levels of hemoglobin, MCV, and serum ferritin. Thus, iron supplementation not only ameliorates anemia, but may also reduce the inflammation markers in cases with IDA.