Sürdürülebilir Kalkınma Amaçları
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- MakaleAçık Erişim2025Efficacy of Second-Line Treatments After Atezolizumab and Bevacizumab in Advanced Hepatocellular Carcinoma and Related Prognostic Factors: A Multicenter Study by the Turkish Oncology Group (TOG)
Majidova, Nargiz; Yaslikaya, Sendag; Mildanoglu, Maral Martin; Coskun, Alper; Uzundal, Duygu Ercan; Sahin, Taha Koray; Akyildiz, Arif; Akbas, Sinem; Camanli, Ufuk; Sahin, Elif
Background/Aims: The treatment of hepatocellular carcinoma (HCC), which accounts for 90% of all liver cancers, is highly varied. The use of second-line treatments following progression on first-line atezolizumab and bevacizumab (Atez/Bev) for advanced HCC remains controversial. The aim of this study was to analyze the real-world clinical results of second-line treatments in progression after Atez/Bev and to determine the factors affecting prognosis. Materials and Methods: Fifty-eight patients treated with second-line sorafenib, regorafenib, and cabozantinib for progression after first-line Atez/Bev for advanced/metastatic HCC from 20 centers in T & uuml;rkiye between October 2020 and June 2024 were retrospectively analyzed. Responses were evaluated by Response criteria, specifically Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria. Median overall survival (OS) and progression-free survival (PFS) were computed with the Kaplan-Meier method. The Cox regression model was utilized to analyze multivariate analyses. Results: About 82.8% of the patients were male and the median age of the whole group was 62 (range, 18-78) years. All patients progressed after first-line Atez/Bev and were given second-line treatment. The most commonly used second-line treatment option was sorafenib (70.7%), followed by regorafenib (12.1%) and cabozantinib (10.3%). Both median PFS (4.1 months) and median OS (7.8 months) were longer in patients treated with sorafenib compared to other treatments. In univariate analyses, Child-Pugh score B, high alpha-fetoprotein (AFP) levels (>200 ng/mL), extrahepatic spread, and Prognostic Nutritional Index (PNI) < 47.6 substantially raised the risk of overall mortality. Multivariate analysis showed that extrahepatic spread (HR (Hazard ratio): 0.41, P = .012), PNI level (HR: 0.24, P = .005), and AFP level (HR:1.97, P = .049) were independent predictors of OS. Conclusion: Although second-line therapies after Atez/Bev show different degrees of efficacy, survival rates are consistent with the literature. Extrahepatic spread, AFP level, and PNI level are the main prognostic factors. In light of this information, personalized treatment strategies may improve outcomes for this challenging patient group.
- MakaleYalnız künye2012The importance of multifocal/multicentric tumor on the disease-free survival of breast cancer patients: Single center experience
Ustaalioglu, Basak Oven; Bilici, Ahmet; Kefeli, Umut; Şeker, Mesut; Oncel, Mustafa; Gezen, Cem; Gumus, Mahmut; Demirelli, Fuat
OBJECTIVES:: Multifocal/multicentric breast cancers have been comprehensively studied and their outcomes have been compared with unifocal tumors. We evaluated the impact of multifocality and multicentricity on the disease-free survival (DFS) and overall survival of breast cancer patients and tried to analyze the correlation between multifocality/multicentricity (M/M) and other prognostic factors. MATERIAL AND METHODS:: Between 1994 and 2009, we analyzed retrospectively 697 breast cancer patients. Multicentric and multifocal breast cancer were defined as the presence of 2 or more invasive tumor foci within the different quadrants of the same breast or within a same quadrant of the breast, respectively. M/M and other prognostic factors were evaluated using univariate and multivariate analyses. RESULTS:: Multifocal/multicentric tumors were seen in 107 (15.4%) of the 697 breast cancer patients. pT and pN stage were related with the presence of multifocal/multicentric tumors. As tumor size increased and the number of axillary lymph nodes metastasis increased, the incidence of M/M increased significantly (P=0.003 vs. P=0.02, respectively). Overall, the median DFS time of patients with multifocal/multicentric tumors was significantly worse than that of the unifocal tumors (55 vs. 137 mo, P<0.001). Multivariate analysis showed that the presence of M/M was the most important prognostic factor for DFS (P=0.001, hazard ratio (HR): 0.33; 95% confidence interval (CI), 0.18-0.58), as were pN stage and extracapsular extension of the tumor (P=0.01, HR: 1.74; 95% CI, 1.13-2.69) (P=0.03, HR: 1.9; 95% CI, 1.04-3.47, respectively). M/M were not also statistically significant prognostic factors in breast cancer for overall survival (P=0.06). CONCLUSIONS:: M/M imparts an unfavorable prognosis on the DFS of breast cancer patients in comparison to unifocal tumors and the presence of multifocal/multicentric tumors were associated with advanced pT and pN stages.
- MakaleAçık Erişim2011Breast Conserving Surgery and Modified Radical Mastectomy in Turkish Women with Breast Cancer: A Prospective Analysis of Quality of Life
Kement, Metin; Gezen, Cem; Asik, Ayla; Karaöz, Alev; Ustaalioglu, Basak Oven; Bilici, Ahmet; Öncel, Mustafa
Objective: The aim of this study is to compare the postoperative quality of life of the patients who underwent breast conserving surgery followed by radiotherapy (BCT) and the patients who underwent modified radical mastectomy (MRM) in our clinic. Material and Methods: The patients who were operated on with diagnosis of breast cancer in our clinic between January 2006 and January 2008 were included in the study. Those who received neoadjuvant therapy and who required radiotherapy after modified radical mastectomy and those in ASA classes 3 and 4 were excluded. The patients who were treated with modified radical mastectomy were included in the first group (Group MRM) and the patients who were treated with breast conserving therapy and radiotherapy thereafter were included in the second group (Group BCT). Quality of life of the patients were assessed using Medical Outcome Syudy-Short Form 36 (MOS SF-36) form six months after their treatment (surgery, radiotherapy, chemotherapy) was completed. Results: There were no significant differences between two groups in terms of age, evaluated socioeconomic parameters (education, income, marital status) and clinical parameters (stage, complications, adjuvant chemotherapy). Quality of life of the patients who underwent BCT (n=27) was worse than that of general Turkish population in six of eight (except vitality and social function) SF-36 scale and worse than mean values of normal individuals in NSABP BCPT trial in seven of eight (except vitality) scales. Besides, while physical component score was worse than that of general population (45.3 vs 52.6), mental component score (MCS) was relatively similar to general population (53.4 vs 51.7). When quality of life of the patients who underwent MRM (n=23) and BCT were compared, mean values of BCT group were found to be better in all scales and the difference was found to be statistically significant in six out of eight (except vitality and social function) scales (p<0.05). Conclusion: It can be stated that quality of life of the patient who underwent BCT due to breast cancer is impaired in terms of physical status, however did not change in terms of mental status. It can also be stated that quality of life of the patients who underwent breast conserving therapy were better than the ones who underwent modified radical mastectomy in terms of both physical and mental status.
- MakaleYalnız künye2011Laparoscopic abdominoperineal resections for mid or low rectal adenocarcinomas: A retrospective, comparative study
Gezen, Cem; Altuntas, Yunus E.; Kement, Metin; Okkabaz, Nuri; Bilici, Ahmet; Vural, Selahattin; Gumus, Mahmut; Oncel, Mustafa
BACKGROUND: Laparoscopic abdominoperineal resection (APR) has been seldom studied apart from low anterior resections, and deserves to be separately analyzed. This study aims to compare perioperative and oncological outcomes of laparoscopic and conventional APRs performed for the treatment of mid and low rectal adenocarcinomas. MATERIALS AND METHODS: Patients operated for primary mid or low rectal adenocarcinoma between 2001 and 2009 in our institution were retrospectively investigated. These data were abstracted and compared within conventional and laparoscopic resection groups: demographics, tumor and procedure-related parameters, perioperative results, early oncological outcomes, and survival. RESULTS: Demographics and tumor and procedure-related parameters were similar within the laparoscopic (n=31) and conventional (n=36) groups, except intraoperative bleeding and requirement for transfusion, which were significantly lower after laparoscopic APRs. Perioperative results including complication, reoperation, and 30-day mortality rates were identical. Early oncological results and 3-year survival rates were alike. CONCLUSIONS: The perioperative results and oncological outcomes are similar after laparoscopic and conventional APRs. As current data include limited number of patients in a retrospective design, further studies comparing laparoscopic and conventional APR techniques are required.
- MakaleYalnız künye2010Prognostic significance of perineural invasion in patients with gastric cancer who underwent curative resection
Bilici, Ahmet; Seker, Mesut; Ustaalioglu, Bala Basak Oven; Kefeli, Umut; Yildirim, Emre; Yavuzer, Dilek; Aydin, Fatih Muhammed; Salepci, Taflan; Oncel, Mustafa; Gumus, Mahmut
Background: The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection. Materials and Methods: We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis. Results: PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P =.001 and P <.001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P =.001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P =.02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12-3.13) as were classical clinicopathological features. Conclusion: Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.
- MakaleYalnız künye2010Does the metastatic lymph node ratio influence the disease-free survival of patients with breast cancer: Single-center experiences
Oven Ustaalioglu, Bala Basak; Bilici, Ahmet; Kefeli, Umut; Şeker, Mesut; Yildirim, Emre; Salepci, Taflan; Oncel, Mustafa; Kement, Metin; Gumus, Mahmut
Background: Axillary lymph nodes (ALNs) are the most important prognostic factor for survival in breast cancer. Pathological evaluation can affect the number of involved lymph nodes. In the current study, we evaluated whether the metastatic lymph node ratio (n ratio) is important in predicting disease-free survival (DFS) for breast cancer patients. Material and Methods: From 802 breast cancer cases, 427 patients with ALN metastasis were analyzed retrospectively. The n ratio was categorized as n ratio 1 (1-10%), n ratio 2 (10.01-50%) and n ratio 3 (>50%). DFS was established according to the Kaplan-Meier method. Predicting risk factors for relapse were analyzed using the Cox proportional hazards model. Results: The n ratio was significantly higher in breast cancer patients with advanced pathologic pT, pN and clinical stage, undifferentiated histology, lymphovascular and extracapsular invasion, more resected ALNs and positive progesterone receptor. In the univariate analysis, multicentricity, necrosis, grade, pN stage, estrogen receptor and progesterone receptor positivity, trastuzumab and neoadjuvant chemotherapy usage, the presence of inflammatory breast cancer and n ratio were found to be important factors in predicting DFS. Multivariate analysis indicated that multicentricity, neoadjuvant chemotherapy, trastuzumab usage and n ratio were significantly associated with prognosis. Conclusions: The n ratio is inexpensive, easily available and a simple prognostic factor for breast cancer patients with positive ALNs.