[The possible role of the timing of the first oncological treatment on the survival rate of cancer diseases. A literature overview]. / Az elso onkológiai ellátás idofaktorának szerepe a daganatos betegségek túlélési mutatóiban. Irodalmi áttekintés.

The aim of this study was to survey the effects of the waiting time for the first oncology treatment in cancer diseases. By the analysis of 67 retrospective studies and reviews the numerical effects of treatment initiation time on survival were assessed. The "time factor" has a leading role on cancer types with aggressive biological behaviour, like breast cancer in younger age, testicular cancers, or head and neck tumours. However, a few days and reasonable delay to the first oncology intervention has no negative impact in numerous cancer diseases. The course of the primary check-up could be modified by several medical and psychosocial factors, and many times the treatment of the most advanced cancers are privileged causing an inverse survival effect. The effectiveness of the cancer therapies is determined by the optimal treatment decision, however, further research is necessary for the determination of the exact role of the "time factor" in oncology. Orv Hetil. 2018; 159(14): 535-546.

[Effect of smoking on survival after myocardial infarction - smoker's paradox in Hungary?] / A dohányzás hatása a szívinfarktus utáni túlélésre ­ dohányzási paradoxon Magyarországon?

INTRODUCTION: The strong, positive relationship between smoking and myocardial infarction was proven in the 1960s and 1970s. The prognostic significance of smoking in the acute phase of the infarction, and later in patients who survive the acute phase is, however, not clear. Numerous international studies focus on the phenomenon called the "smoker's paradox", which means that smokers have a lower mortality rate after suffering myocardial infarction than non-smokers. Although in many cases smoking does not have a positive effect on survival after controlling for confounders, an international consensus has not been reached regarding this issue. AIM: The aim of this paper was to investigate whether the paradox effect exists in the case of Hungarian patients after controlling for the patients' risk profiles. METHOD: The database used for the research was based on the 2014-2016 data of the Hungarian Myocardial Infarction Registry (n = 20 811) supervised by the Gottsegen György National Institute of Cardiology. The present analysis uses multivariate methodology to adjust for confounding: logistic regression is used for the short-term survival and survival analysis - with Cox proportional hazards model and Accelerated Failure Time models - is used for the long-term survival. Age, sex, performing of PCI, type of infarction (ST-elevation or not), creatinine abnormality, need for prehospital reanimation, cardiogenic shock and the presence of several comorbidities and medical history data were controlled for in the multivariate analysis. RESULTS: Both the short term - 30 day - mortality (OR = 1.517, 99% confidence interval: 1.229-1.872) and the long term mortality (HR = 1.395, 99% confidence interval: 1.232-1.579) were worse for smokers than non-smokers after adjusting for the abovementioned factors. CONCLUSION: The "smoker's paradox" cannot be observed in the case of Hungarian patients, moreover smoking in itself is associated with worse prognosis. Orv Hetil. 2018; 159(14): 557-565.

[Analysis of mortality and its predictors in patients with contralateral hip fracture after femoral neck fracture]. / Ellenoldali csípotáji törésekkel összefüggo halálozás és kockázati tényezoinek vizsgálata.

INTRODUCTION: There is a high mortality with not well understood risk factors after the second hip fracture. AIM: Analysis of the 30- and 365-day mortality and its risk factors in patients with contralateral hip fracture. METHOD: Patients with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their primary hip fracture in Hungary in 2000. Risk factors as age, sex, concomitant and chronic diseases, type of fracture and surgery, surgical complications, day of admission were analyzed by logistic and Cox regression as well as Kaplan-Meier analysis. RESULTS: There were 312 eligible patients identified with 8.3 % mortality rate at 30 and with 38,4% at 365 days respectively. Significant risk factors for the 30 day mortality were intertrochanteric type of fracture (OR: 4.722; HR: 4.129) and non operative management (OR: 7.357; HR: 6.317) while for the 365 day mortality those were older age (OR:1.070; HR:1.050) and type of surgery (OR: 0.450). CONCLUSION: Age, type of fracture and type of surgery proved to be risk factors. There is a need to identify further risk factors in order to develop an efficacious prevention strategy for the reduction of the mortality after the second hip fractures. Orv Hetil. 2017; 158(20): 783-790.

[Brentuximab vedotin treatment in patients with relapsed or refractory Hodgkin lymphoma. A Hungarian retrospective study]. / Relabáló/refrakter Hodgkin-lymphoma brentuximab vedotin kezelése. Hazai tapasztalatok.

INTRODUCTION: The treatment of relapsed or refractory Hodgkin lymphoma is still a major therapeutic challenge. The use of brentuximab vedotin, an anti-CD30 antibody-drug conjugate, represents a promising approach for these patients, however clinical outcomes have not yet been evaluated in Hungary. AIM: Our aim was to assess the efficacy, safety and outcome of brentuximab vedotin treatment in Hungarian Hodgkin lymphoma patients. METHOD: In this retrospective case note review we enrolled patients at 6 clinical sites countrywide who were diagnosed with Hodgkin lymphoma and received brentuximab vedotin between 1 January 2013 and 31 December 2016. RESULTS: A total of 86 patients were treated with brentuximab vedotin during the examined period. Before therapy initiation 66% of our patients had advanced-stage disease. Overall response rate to brentuximab vedotin, administered before autologous hematopoietic stem cell transplantation (n = 54) was 66.6%, complete remission rate was 42.6%. Thirty patients received brentuximab vedotin after AHSCT, 46.67% responded to treatment, 30% achieved complete remission. Thirty-six patients received the drug as a single-agent therapy, 50 patients were given brentuximab vedotin in combination, 39 of them with bendamustin. Toxicity was observed only in 13.95% of our patients, most common symptom was skin rash. Based on our analysis the estimated 5-year overall survival rate was 78.7%, the estimated progression free survival rate was 23.59 months (95% CI: 19.50-27.68). CONCLUSION: Brentuximab vedotin carries a substantial improvement in the treatment of relapsed or refractory Hodgkin lymphoma. Our results underline prior observations published in the literature. The use of brentuximab vedotin in combination can be beneficial, however further investigation is needed on the subject. Orv Hetil. 2017; 158(41): 1630-1634.

[Evaluation of anatomic and prognostic stages of breast cancer according to the 8th edition of the TNM staging system - Retrospective analysis based on data from deceased patients once diagnosed with breast cancer]. / Emlorákok TNM-8 szerinti anatómiai és prognosztikai stádiumainak retrospektív vizsgálata elhunyt, valaha emlorákos betegek adatai alapján.

INTRODUCTION: The 8th edition of the Tumor-Node-Metastasis (TNM) based staging of breast cancer introduces a prognostic stage influenced by biomarkers along the traditional T, N and M categories. AIM: To retrospectively assess stage influencing prognostic variables; and the anatomic and prognostic stages on the basis of the overall survival (OS) of a cohort of deceased patients once diagnosed with breast cancer. METHOD: We included patients with known causes of death certified at the Bács-Kiskun County Teaching Hospital and having a history of breast cancer diagnosed on a resection specimen at the same institution. Prognostic factors were obtained from the histopathological reports. Statistics included one-way ANOVA, Dunn's post hoc test and Kaplan-Meier curve analyses. RESULTS: The 303 patients grouped as breast cancer related death (n = 168) or unrelated (n = 135) showed significant differences in most stage defining prognostic factors and the anatomic and prognostic stages. Significant differences in 5-year OS were observed between pT and pN categories, histological grades and estrogen receptor statuses. Except for stages I and II, significant differences were found between both different anatomic and prognostic stages (p<0.001). Stage IV is by definition uniform, but we identified survival differences between biomarker based subgroups: triple negative carcinomas had worse OS than estrogen receptor positive and HER2 negative carcinomas. CONCLUSIONS: Our analysis based on real survival data suggests that the prognostic stages separate patients according to OS similarly to the anatomic stages. The results validate the prognostic stages, but also suggest that separating stage IV disease according to biomarkers makes sense. Orv Hetil. 2017; 158(35): 1373-1381.

[Renal transplantations in the Centre for Nephrology in Szombathely, 1976-2016]. / Veseátültetések a szombathelyi nefrológiai centrumban, 1976­2016.

INTRODUCTION: The organized nephrological care in Szombathely commenced its activities in 1976. AIM: Follow-up of our patients who has undergone a kidney transplantation. METHOD: We used the local and national databases. RESULTS: 213 patients (7 preemptive, 206 dialyzed) had 240 renal transplantations. Only 11 of them were living organ donation. Between 69 transplantations (Tx) were carried out between 1976-1995, and 163 Tx were done in the second 20 years. 122 patients (57%) are still alive (the average survival of these patients in renal replacement therapy - RRT - are 11.4 years), and 7 of them had transplantation between 1976-1995. The longest survival time was 35.1 years. Prevalence of patients on RRT at the end of 2016 was 1367 pmp in our county (32.5% living with functioning graft). CONCLUSIONS: Number of transplanted patients has grown in the last decade. Proportion of living organ donation was minimal. Orv Hetil. 2017; 158(25): 984-991.

[Treatment of recurrent glioblastoma with single-agent bevacizumab]. / Rekurrens glioblastomában szenvedo betegek kezelése bevacizumab-monoterápiával.

INTRODUCTION: The prognosis of patients with recurrent glioblastoma is poor, as the median survival does not exceed 6 months. AIM: The aim of this study was to evaluate the efficacy of bevacizumab monotherapy in patients with recurrent glioblastoma multiforme. METHOD: From April, 2012 to June, 2015, 40 patients with recurrent glioblastoma multiforme were treated with bevacizumab in a dose of 10 mg/kg every 2 weeks. RESULTS: The average progression-free survival was 6.4 months (2-22 months), and the 6-month progression-free survival was 42.5%. The six-month overall survival was 82.5%, which corresponds to those published in the literature. CONCLUSIONS: Bevacizumab monotherapy improves progression-free survival in patients with recurrent glioblastoma multiforme.

[First outcomes, since being full member of Eurotransplant. A single center experience of cadaveric kidney transplantation]. / Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai.

INTRODUCTION: The first renal transplantation was completed in 1991 at the University of Debrecen. In 2013 Hungary joined Eurotransplant. AIM: The authors retrospectively compared the trends. METHOD: Comparison between Period A (from January 1, 2008 to August 31, 2013) and Period B (from September 1, 2013 to October 22, 2015). RESULTS: The proportion of living transplants rose from 3.5% to 9.1 %. During period B over 25% of utilized donors were over 60 years of age. Recipients with body mass index above 30 kg/m(2) increased from 12% to 31%. Prevalence of diabetes among recipients rose twofold. Uretero-neocystostomy was used during period A (99%) while in period B end to side uretero-ureteral anastomosis has also gained popularity (68%). In 2013 the authors introduced routine use of induction treatment. Acute rejection rate decreased from 34% to 8%. The rate of surgical complications did not change. Acute bacterial infections decreased from 41% to 33%. Cumulative renal allograft 1, 3 and 5 year survival rates were 86.6%, 85% and 82.7% in group A vs. projected rates 88%, 84% and 84% in group B, respectively. CONCLUSIONS: Despite the growing proportion of expanded criteria donors, the authors were able to maintain a low incidence of delayed graft function and a favorable graft survival. Since 2013 the authors introduced treatments for acute humoral rejection according to international standards.

[Allograft nephrectomy - a single-center experience]. / Graftectomiák a debreceni vesetranszplantációs programban.

INTRODUCTION: Indication and timing of allograft nephrectomy is still uncertain in some cases. AIM: The aim of the authors was to summarize their experience with graftectomies. METHOD: Data from patients who underwent kidney transplantation between January 1, 2004 and December 31, 2015 were retrospectively analyzed. Frequency, indications, timing, complications as well as early and late allograft nephrectomies were reviewed. RESULTS: From 480 renal transplants, 55 graftectomies were performed (11%). Frequent indications included chronic allograft nephropathy (47%), arterial blood supply complications (13%), ureter complications (9%). 22 cases (40%) of allograft nephrectomies were urgent while 33 cases (60%) were elective. 24% of graftectomies were performed within 30 days after transplantation and 76% thereafter. CONCLUSIONS: The main indications for early graftectomies were arterial complications (31%) and chronic allograft nephropathy (62%) in cases of late graftectomies. The majority of the graftectomies were elective. Leading indication was chronic allograft nephropathy. Early and late graftectomies have different characteristics.

[Changes in the outcome for infants, with birth weight under 500 grams, at our department (First Department of Obstetrics and Gynecology, Semmelweis University, Budapest)]. / Az 500 gramm alatti születési súlyú koraszülöttek túlélésének változása klinikánkon.

INTRODUCTION: The mortality and morbidity of extremely low birth weight infants (birth weight below 1000 grams) are different from low birth weight and term infants. The Centers for Disease Control statistics from the year 2009 shows that the mortality of preterm infants with a birth weight less than 500 grams is 83.4% in the United States. In many cases, serious complications can be expected in survivals. AIM: The aim of this retrospective study was to find prognostic factors which may improve the survival of the group of extremely low birth weight infants (<500 grams). METHOD: Data of extremely low birth weight infants with less than 500 grams born at the 1st Department of Obstetrics and Gynecology, Semmelweis University between January 1, 2006 and June 1, 2012 were analysed, and mortality and morbidity of infants between January 1, 2006 and December 31, 2008 (period I) were compared those found between January 1, 2009 and June 1, 2012 (period II). Statistical analysis was performed with probe-t, -F and -Chi-square. RESULTS: Survival rate of extremely low birth weight infants less than 500 grams in period 1 and II was 26.31% and 55.17%, respectively (p = 0.048), whereas the prevalence of complications were not significantly different between the period examined. The mean gestational age of survived infants (25.57 weeks) was higher than the gestational age of infants who did not survive (24.18 weeks) and the difference was statistically significant (p = 0.0045). CONCLUSIONS: Education of the team of the Neonatal Intensive Care Unit, professional routine and technical conditions may improve the survival chance of preterm infants. The use of treatment protocols, conditions of the Neonatal Intensive Care Unit and steroid prophylaxis may improve the survival rate of extremely low birth weight infants.

[Bacterial infection after orthotopic liver transplantation]. / Bakteriális infekciók májátültetés után.

INTRODUCTION: The authors reviewed the prevalence of postoperative infections, the results of bacterium cultures, and the incidence of multidrug resistance in their liver transplanted patients during a period between 2003 and 2012. AIM: The aim of this study was to analyse risk factors and colonisations of bacterial infections. METHOD: The files of 408 patients (281 bacterium cultures) were reviewed. RESULTS: Of the 408 patients 70 had a postoperative infection (17%); 58 patients (14.2%) had positive and 12 patients (2.9%) negative bacterial culture results. Cholangitis was found in 7 cases (12.1%), abdominal infection in 17 cases (29.3%), and pulmonary infection in 28 cases (48.3%). Postoperative infection was more frequent in patients with initial poor graft function, acute renal insufficiency, biliary complication, and in those with intraabdominal bleeding. The 1-, 3- and 5-year cumulative survival of patients who had infection was 70%, 56% and 56%, respectively, whereas the cumulative survival data of patients without infection was 94%, 87% and 85%, respectively (p<0.001). Multidrug resistance was found in 56% of the positive cultures, however, the one-year survival was not different in patients who had multidrug resistance positive and negative bacterial infection (both 70.2%). CONCLUSIONS: Infection control must target the management of multidrug resistance microbes through encouraging prevention, hygienic, and isolation rules, improving the operative, transfusion, and antimicrobial policy in a teamwork setting.

[Prognostic value of absolute monocyte count in chronic lymphocytic leukaemia]. / Az abszolút monocytaszám prognosztikus értéke krónikus lymphoid leukaemiában.

INTRODUCTION: The low peripheral absolute lymphocyte and high monocyte count have been reported to correlate with poor clinical outcome in various lymphomas and other cancers. However, a few data known about the prognostic value of absolute monocyte count in chronic lymphocytic leukaemia. AIM: The aim of the authors was to investigate the impact of absolute monocyte count measured at the time of diagnosis in patients with chronic lymphocytic leukaemia on the time to treatment and overal survival. METHOD: Between January 1, 2005 and December 31, 2012, 223 patients with newly-diagnosed chronic lymphocytic leukaemia were included. The rate of patients needing treatment, time to treatment, overal survival and causes of mortality based on Rai stages, CD38, ZAP-70 positivity and absolute monocyte count were analyzed. RESULTS: Therapy was necessary in 21.1%, 57.4%, 88.9%, 88.9% and 100% of patients in Rai stage 0, I, II, III an IV, respectively; in 61.9% and 60.8% of patients exhibiting CD38 and ZAP-70 positivity, respectively; and in 76.9%, 21.2% and 66.2% of patients if the absolute monocyte count was <0.25 G/l, between 0.25-0.75 G/l and >0.75 G/l, respectively. The median time to treatment and the median overal survival were 19.5, 65, and 35.5 months; and 41.5, 65, and 49.5 months according to the three groups of monocyte counts. The relative risk of beginning the therapy was 1.62 (p<0.01) in patients with absolute monocyte count <0.25 G/l or >0.75 G/l, as compared to those with 0.25-0.75 G/l, and the risk of overal survival was 2.41 (p<0.01) in patients with absolute monocyte count lower than 0.25 G/l as compared to those with higher than 0.25 G/l. The relative risks remained significant in Rai 0 patients, too. The leading causes of mortality were infections (41.7%) and the chronic lymphocytic leukaemia (58.3%) in patients with low monocyte count, while tumours (25.9-35.3%) and other events (48.1 and 11.8%) occurred in patients with medium or high monocyte counts. CONCLUSIONS: Patients with low and high monocyte counts had a shorter time to treatment compared to patients who belonged to the intermediate monocyte count group. The low absolute monocyte count was associated with increased mortality caused by infectious complications and chronic lymphocytic leukaemia. The absolute monocyte count may give additional prognostic information in Rai stage 0, too.

Hetven évnél idosebb betegek tüdorák miatt végzett mutéteinek értéke.

OBJECTIVE: The significance of surgery in elderly patients with lung cancer is debated. The age is a predisposing risk factor for developing cancer thereby the possibilities of surgical procedure is increasing in the elderly patients. To clarify the benefit of surgery in patients with lung cancer aged 70 years and over we reviewed our cohort of 206 patients. METHODS: Data of elderly patients out of 4022 lung cancer cases were analysed. 124 patients with lung tumours presented symptomatically and imaging suggested the presence of lung malignancies in 82 patients. 155 tumours were located peripherally, while 51 were central. All patients underwent detailed lung function test and cardiovascular examinations prior to surgery; significant comorbidities were optimised, too. RESULTS: One patient's data was lost during follow-up. In 122 cases lobectomy was the choice of surgery, 49 patients underwent atypical resection, 16 had pneumonectomies, and 18 explorations were performed. Postoperative mortality rate was 1%. Histology revealed adenocarcinoma in 121 patients, squamous cell carcinoma in 73 patients, small cell carcinoma nine and large cell carcinoma three patients. As far as postoperative staging 100 patients had stage I, 54 had stage II, 38 had stage III (III/a: 34, III/b: 4) and 13 had stage IV disease. 5-year survival was 40%. Survival by histology was 40% for adenocarcinoma and 45% for squamous cell carcinoma at five years. Survival rate for patients with stage I was 58% (st I/a: 75%), with stage II 29%, with stage III 14% (st III/a: 17%), with stage IV no five-year survivor was observed. Lymph node involvement was significantly associated with outcome (5-year survival rate in N0 was 49% in N2: 8%). CONCLUSIONS: Our results confirmed an acceptable perioperative risk and benefit of surgery for elderly patients with lung cancer. The age alone is not a contraindication for lung resection with meticulous patient's selection and active postoperative rehabilitation. More patients had adenocarcinoma than squamous cell carcinoma, similarly to all patients. In the elderly patients limited parenchymal resection is an acceptable alternative. Surgery offers good outcome in early stage disease, but surgery should not be the choice of treatment for advanced cancers (st III/b and st IV especially N2).

[Primary Spinal Tumor Registry at the National Centre for Spinal Disorders]. / Primer Gerinctumor Regiszter az Országos Gerincgyógyászati Központban.

Primary spinal tumors are rare diseases. Primary spinal tumor registry would be useful to help decision making in this complex field of spine surgery. In this article the authors present the latest findings from the Primary Spinal Tumor Registry at the National Centre for Spinal Disorders, Hungary. The registry is based on a novel database management software, the REDCap electronic data capture system. It contains data of 323 patients treated surgically during an 18-year period. Among the 126 malignant tumors, the most frequent was chordoma (61 cases). In the case of benign tumors schwannoma showed the largest prevalence (45 cases). The authors conclude that due to the rarity of the disease and the complexity of the management, multicenter, prospective registries are required to provide high level of evidence. The structure of the Primary Spinal Tumor Registry in the National Centre for Spinal Disorders in Hungary is optimal for user-friendly, fast and secure data collection providing a prospective database for scientific researches and clinical follow-up.

[Vitamin D supply of patients with hip fracture]. / A csípotáji csonttörést szenvedett betegek D-vitamin-ellátottsága.

INTRODUCTION: Vitamin D deficiency is an important risk factor for fractures. However, there are few data available only on the relationship between serum 25-hydroxyvitamin D levels and recovery after surgery for hip fracture. AIM: The authors investigate the vitamin D supply of patients with hip fractures. METHOD: Between February and September 2013, serum 25-hydroxyvitamin D and parathyroid hormone levels were determined in 203 patients with hip fracture (74.8±11.5 ys; 67 men and 136 women) and in 74 control subjects. RESULTS: Vitamin D deficiency and secondary hyperparathyroidism occurred significantly more frequently in patients with hip fracture than in control subjects (72% vs. 45%, and 33% vs. 17%, respectively). Patients with better condition after surgery showed higher 25-hydroxyvitamin D levels (p<0.001) than those with poor condition. Serum 25-hydroxyvitamin D were lower in the 31 patients who died [median of survival time: 19 (5-52) days] compared to those who survived [22.6 (9.5-45.0) vs. 33.0 (16.5-56.6) nmol/l]. CONCLUSIONS: The association between vitamin-D deficiency and mortality as well as the positive correlation between serum 25-hydroxyvitamin D levels and better postoperative condition confirm the importance of proper vitamin D supply in the prevention and cure of hip fractures, what is more in the increase of the chance of survival.

[Treatment outcome in primary testicular non-Hodgkin lymphoma]. / Primer herelymphomás betegek kezelésével szerzett tapasztalatok.

INTRODUCTION: Primary testicular lymphoma constitutes a rare subgroup among extranodal non-Hodgkin's lymphomas. Because of its aggressive clinical behaviour due to high grade histological features developing mainly in older population, patients with this disease usually have a poor prognosis. Orchidectomy followed by combination immunochemotherapy is a traditional treatment method with a rather inferior outcome. AIM: In this retrospective survey the authors analysed the clinical presentation, pathological features and treatment results of patients with primary testicular lymphoma diagnosed and treated in their haematology centre between 2000-2012 METHOD: During this period 334 patients with aggressive non-Hodgkin's lymphomas were treated, of whom 8 patients (2.39%; age between 23 and 86 years; median, 60 years) underwent semicastration for primary testicular lymphoma (7 patients had diffuse, large B-cell lymphoma and one patient had Burkitt-like lymphoma). According to the Ann Arbor staging system a limited stage I-IIE was diagnosed in 7 patients and advanced stage was found in one patient. All but one patients were treated with rituximab added to CHOP regimen (6 or 8 cycles in every 21 or 28 days), whereas one patient received radiotherapy only. Central nervous system intrathecal prophylaxis was used in one case and no preventive irradiation of the contralateral testis was used. RESULTS: With a median follow-up of 50 months complete remission was observed in 7 patients. However, two patients died (one due to progression and one in remission from pulmonary solid tumour). Complete remission rate proved to be 87.5%, disease-free survival was between 13 and 152 months (median 38 months) and overall survival rates were between 17 and 156 months (median 43 months). The 5-year disease-free and overall survival rates were 37.5 %. CONCLUSIONS: The relatively favourable treatment outcome could be mainly explained by the high number of patients with early-stage of the disease, early surgical removal of testicular lymphomas and the use if immunochemotherapy. This therapeutic regimen was effective to prevent localized and distant relapses. Despite omission of regular prophylaxis of the central nervous system, no relapse was detected.

[Evaluation of thrombocytosis as predictive factor in colorectal cancer]. / A thrombocytosis mint prediktív faktor értékelése colorectalis tumorokban.

UNLABELLED: INTRODUCTION/AIM OF THE STUDY: Preoperative thrombocytosis proved to be a negative prognostic factor in several solid tumor. However, there is still debate in the literature regarding colorectal cancer. The aim of our study was to examine whether thrombocytosis is an independent risk factor for metastasis development and predictor of survival in colorectal cancer. MATERIALS AND METHODS: Clinicopathological data of 336 patients with colorectal cancer (CRC) and 118 patients with liver metastasis of colorectal cancer (mCRC) who had operation between 2001 and 2011 were collected retrospectively. Thrombocytosis was defined as 400 G/L < platelet count. Disease-free survival (DFS) and overall survival (OS) were determined with Kaplan-Meier method supported by log-rank test. RESULTS: Both in the CRC and the mCRC group OS was significantly shorter in patients who had elevated platelet count (HR = 2.2, p < 0.001 and HR = 2.9, p = 0.018, respectively). Multivariate analysis confirmed that elevated platelet count was an independent prognostic factor of both CRC (HR = 1.7, p = 0.035) and mCRC (HR = 3.1, p = 0.017). DFS was significantly shorter in patients with elevated platelet count in the CRC group (HR = 2.0, p = 0.011). DISCUSSION: The platelet count is a valuable and cheap prognostic marker for the prediction of survival in patients both with CRC and mCRC.

[Long-term survival after lung-sparing central bronchoplastic procedures [CBPs] for malignant tumors]. / Hosszú túléléssel járó malignus tumor miatti tüdomegtartó centrális fohörgoplasztikáink.

BACKGROUND: Bronchial malignancies are leading tumour-related cause of death. Prolonged survival can only be expected after radical resections. Central bronchoplastic procedures, which save the whole lung parenchyma, however, may play a role. AIM: These bronchoplastic procedures can be good alternatives for pulmonectomies. The value of these operations can be evaluated by postoperative mortality complication, and the survival rate. MATERIAL AND METHODS: In the period of 1985-2012 we operated 7130 bronchial carcinomas. Of these, 7 cases of 80 central broncoplastics we preserved the whole lung (in one case as an alternative for inoperability, in 6 patients as an option instead of pulmonectomy). The indications were carcinoid in four cases, epidermoid carcinoma, mucoepidermoid carcinoma and main carina SCLC after induction chemo-radiotherapy. The average age of the 4 male and of the 3 female patients were 28.5 (14-58) years. In 5 cases the right main bronchus, while in one case the left main bronchus was resected and the bronchial tree was reconstructed. In one case (SCLC patient) we made a complete carina resection and end-to-end anastomosis between the trachea and the rebuilt neocarina to preserve both lungs. The anastomosis was made with 3-4/0 PDS interrupted sutures above a sterile tube (6 cases) and in one case due to a jet catheter which were positioned through the operation field into the distal part of the main healthy bronchus. RESULTS: There was no operative mortality nor bronchopleural fistula. In the early postoperative period we applied repeated bronchoscopic suctions. In the patient with carina SCLC anastomosis stenosis developed. The main bronchi were temporarily stented. This patient is fit 174 months after the intervention, the Karnofsky index mesures to 90%. Other 5 patients are alive without any consequences of recurrence nor metastasis. The patient with epidermoid carcinoma died 83 months later because of distant metastases of a SCLC, originating from the contralateral lung. The mean survival is 118 (7-233) months. CONCLUSION: In case of some properly selected localised mainstem bronchial malignancies, such as young age and low grade malignancy, radical surgical interventions can be performed with long term survival preserving the whole lung due to special CBPs. Some such successful series and case reports (under 200 cases) can be found in the literature but the long-term survival data was not demonstrated in most publications. In Hungary there has not been any publications yet on such a successful series with long term survival. These results are remarkable within international standards.

[How did the survival of acute myeloid leukemia change over the last ten years in our unit?] / Hogyan változott az akut myeloid leukaemiás betegek túlélése a terápiás lehetoségek bovülésével az elmúlt 10 évben klinikánkon?

INTRODUCTION: Acute myeloid leukemia (AML) is a hematological malignancy with high mortality rate. The treatment is especially challenging in patients older than 65 years, which is the large majority of those. For patients unfit for intensive chemotherapy regimens, only palliative cytoreduction and basic supportive care used to be the options in our unit. However, from 2018, the azacitidine-venetoclax combination has been a new therapeutic alternative. This treatment resulted in marked survival benefit in clinical trials, however, its impact on the daily clinical practice and the entire patient population is unclear. OBJECTIVE: Our goal was to evaluate how the application of azacitidine-venetoclax changed the treatment and survival of AML patients in our practice. METHOD: We retrospectively analyzed the available clinical data of all AML patients treated consecutively between January 1, 2011 and December 31, 2021 at the 3rd Department of Internal Medicine (from 2020 onward called Department of Internal Medicine and Hematology), examining their treatment depending on the time period of therapy (2011-2017 and 2018-2021). Patients with acute promyelocytic leukemia were excluded. RESULTS: 423 patients were diagnosed during this period. The number of cases showed a marked increase: in the first 7 years of our study, 184 patients were diagnosed, while this rose to 239 during the subsequent 4 years. The median age of patients was 67.6 years, with more than 60% of patients aged over 65. An improving trend can be observed in the overall survival: between 2011 and 2017, the median overall survival was 4.8 ± 0.9 months, while between 2018 and 2021, it was 8.3 ± 1.4 months (p = 0.051). Moreover, in the case of patients over 65 there was a significant overall survival improvement: 3.1 ± 0.5 vs. 4.9 ± 0.6 months (p = 0,01). The main factor behind this improvement could be that a large proportion of over 65 patients previously only fit for supportive care could now be treated with azacitidine-venetoclax: the percentage of actively treated patients grew from 57.1% to 75.3% in the second period. CONCLUSION: The survival of patients unfit for curative therapy and older than 65 showed a steady increase which can be attributed to the introduction of new therapeutic alternatives. Orv Hetil. 2023; 164(45): 1787-1794.

Literature review of evidence-based follow-up strategies of cancer patients / Daganatos betegek evidencia alapú gondozási stratégiáinak irodalmi áttekintése

An increasing proportion of cancer patients remains permanently tumorfree after primary care due to modern curative treatments. However, the life expectancy and quality of life deteriorate significantly in most relapsed cases in spite of different palliative therapies. To detect the early relapse in asymptomatic stage, patients undergo a preplanned care process, targeting primarily their improved survival. Several studies and reviews have been conducted in recent decades to determine the optimal and rational frequency and methods of control examinations. The data of different followup strategies were analyzed from several perspectives. Recommended followup protocols differ significantly based on the origin, histological characteristics, stage, prognostic factors and typical sites of recurrences, such as local, "oligometastatic" or systemic relapse of tumors. In addition to the detection of recurrence, the importance of qual ity of life, monitoring of psychological status and psychosomatic complaints as well as the costeffectiveness of protocols also came to the focus. Involving family doctors or qualified nurses in routine oncology followup may function as an alternative option to reducing the workload of specialists. The COVID­19 pandemic resulted in the use of telemedicine methods in the evaluation of examinations and followup strategies coming to the fore, while at the same time this made the reevaluation of control care algorithms even more important. In this paper, we review the results of studies comparing the different followup strategies, highlighting which protocols help to optimize the use of health care capacity while preserving the survival chance of cancer patients in relapse.