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Öğe Association between specific KRAS mutations and the clinicopathological characteristics of colorectal tumors(Spandidos Publ Ltd, 2015) Kodaz, Hilmi; Hacibekiroglu, Ilhan; Erdogan, Bulent; Turkmen, Esma; Tozkir, Hilmi; Albayrak, Dogan; Uzunoglu, SernazThe aim of this study was to investigate the clinicopathological characteristics and distribution by tumor localization of KRAS point mutations in metastatic colorectal cancer. A total of 189 patients diagnosed with colorectal cancer between 2007 and 2014, who were either metastatic at the time of diagnosis or developed metastasis subsequently, were included in this study. KRAS mutation analysis was performed in the primary tumor tissues and KRAS mutations were identified in 47.6% of the patients. There was a high frequency of the p.G13D point mutation in left-colon tumors (P=0.011), while the p.G12D point mutation was more frequent in right-colon tumors (P=0.004). KRAS wild-type frequency (P=0.02) was higher among patients aged <40 years. A comparison of codon 12 and 13 mutations revealed that codon 12 mutations were more common in the >50-year-old group (P=0.03) and codon 13 mutations were more common in the <70-year-old group (P=0.04). KRAS wild-type tumors were localized in the right colon (P=0.005) and tumors with the p.G13D point mutation (P=0.018) were diagnosed at non-metastatic stages. In conclusion, KRAS point mutations in colorectal cancer exhibited a heterogeneous distribution in terms of tumor localization. In addition, the p.G13D point mutation was found to differ from other mutations in several aspects.Öğe A case of Guillain-Barre syndrome in a patient with small cell lung cancer treated with chemotherapy(Kare Publ, 2014) Turkmen, Esma; Erdogan, Bulent; Hacibekiroglu, Ilhan; Kodaz, Hilmi; Uzunoglu, Sernaz; Celik, Yahya; Cicin, IrfanGuillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy characterized by bilateral progressive symmetrical paralysis. GBS is rarely seen neuropathy in cancer patients. In the literature some cases of GBS associated with anticancer chemotherapy. In this case; the guillain-barre syndrome developed after the treatment of a 59-year-old male patient with metastatic small cell lung carcinoma who admitted to hospital with neutropenic fever after cisplatin/etoposide chemoteraphy regime is presented. The patients complained of bilteral progressive symmetrical paralysis in upper and lower limbs with depressed deep tendon reflexes and hypoesthesia. There was no pathological findings on electromyography. There was no a sign at radiological imaging that explained cranial and spinal mestastasis. The cerebrospinal fluid had albuminocytologic dissociation. Decline in tumoral lesions were detected on chest radiography. Accompanied by clinical and laboratory findings, a diagnosis of Guillain-Barre syndrome was considered. Semptoms completely disapperared after intravenous immunoglobulin for five days. Recurrence did not during follow-up. The patients was administered a total of 4 cycles of cisplatin/etoposide chemotherapy. The patient died due to disease progression six months later. We think that, in this case GBS was not a paraneoplatic syndrome because there was more than 50% tumor shrinkage. We propose GBS was induced by infection and chemotherapy rather than malignancy.Öğe Clinical features of the patient with multiple primary tumors: Single center experience(Kare Publ, 2017) Gokyer, Ali; Kostek, Osman; Hacioglu, Muhammet Bekir; Erdogan, Bulent; Kodaz, Hilmi; Turkmen, Esma; Hacibekiroglu, IlhanOBJECTIVE: Multiple primary tumors are the ones that develop in the same patient at the same or different times. They are usually examined under two groups. If the second tumor is diagnosed 6 months after the first tumor is diagnosed, it is named as metachronous tumor. If it is diagnosed in 6 months after the first diagnosis, it is called as synchronous tumor. The malignancy of tumors should be proved histologically. At least 2 cm of solid tissue should be present between two tumors. If they are at localized at the same place, a gap of at least 5 years should be present between them. Metastatic disease should be eliminated. This study aimedto review the clinical, demographic, and pathological features of multiple primary tumors, detect the prevalence, compare the results with literature findings, and evaluate and improve the approach to multiple primary tumors. METHODS: A total of 170 patients diagnosed with multiple primary tumors were included in this study. Patient data were obtained from pathology and medical reports of the patients. RESULTS: Most of the multiple primary tumors were metachronous. The number of male patients was more than that of female patients. The median time between double tumors was 3 monthsforsynchronous tumorsand 26 months for metachronous tumors. Synchronous tumors with the highest prevalence of comorbidity were lung-larynx and lung-colon, whereas metachronous tumors with the highest prevalence of comorbidity were lung-bladder, lung-larynx, breast-endometrium, and breast-colon. The history of smoking and alcohol was found to be higher in male patients andsynchronous tumors. CONCLUSION: The detection of the first tumor in the metastatic stage and an accompanying synchronous secondary tumor was found to be a poor prognostic factor. The treatment of the first tumor, smoking, squamous cell histology, and male gender were among the other factors negatively affecting survival, although they were not statistically significant.Öğe Clinicopathological Characteristics and Prognosis of Patients According to Recurrence Time After Curative Resection for Colorectal Cancer(Asian Pacific Organization Cancer Prevention, 2014) Bozkurt, Oktay; Inanc, Mevlude; Turkmen, Esma; Karaca, Halit; Berk, Veli; Duran, Ayse Ocak; Ozaslan, ErsinPurpose: To investigate clinicopathological features in patients with recurrent colorectal cancer within 1 year and more than 1 year after curative resection. Materials and Methods: We retrospectively evaluated 103 patients with disease recurrence before versus after 1 year of resection. Thirty-two patients (31%) were diagnosed with recurrence less than 1 year after curative resection for colorectal cancer (early recurrence) and 71 (69%) after more than 1 year (non-early recurrence). Results: The early recurrence group displayed a significantly lower overall survival rate for both colon cancer (p=0,01) and rectal cancer (p<0.001). Inadequate lymph node dissection was a significant predictor for early relapse. There were no statistically significant differences in clinicopathological variables such as age, sex, primary tumor localization, stage, depth of invasion, lymphovascular invasion and perineural invasion between the early and non-early recurrence groups. However, a K-ras mutation subgroup was significantly associated with early recurrence (p<0.001). Conclusions: Poor survival is associated with early recurrence for patients undergoing resection for non-metastatic colorectal cancer, as well as K-ras mutation.Öğe Comparative analysis of the efficacy and safety of modified FOLFOX-6 and DCF regimens as first-line treatment in advanced gastric cancer(Spandidos Publ Ltd, 2015) Hacibekiroglu, Ilhan; Kodaz, Hilmi; Erdogan, Bulent; Turkmen, Esma; Esenkaya, Asim; Onal, Yilmaz; Uzunoglu, SernazThe aim of this study was to retrospectively compare the efficacy and toxicity of the oxaliplatin + 5-fluorouracil (5-FU) + leucovorin (LV) regimen [modified (m) FOLFOX-6] with that of the docetaxel + cisplatin + 5-FU regimen (DCF) in patients with advanced gastric cancer (AGC). A total of 72 patients received DCF (75 mg/m(2) docetaxel and 75 mg/m(2) cisplatin on day 1 and 750 mg/m(2) 5-FU on days 1-5) every 21 days, whereas 54 patients received mFOLFOX-6 (85 mg/m(2) oxaliplatin and 400 mg/m(2) LV as a 2-h infusion, followed by a 5-FU bolus of 400 mg/m(2) and 2,400 mg/m(2) 5-FU as a 46-h continuous infusion) every 14 days. In the DCF arm, 55 (76.4%) of the patients received prophylactic granulocyte colony-stimulating factor (G-CSF), 48-72 h following completion of chemotherapy. The median follow-up of the study was 12.1 months. The overall response rate (ORR) was 37.0% for mFOLFOX-6 and 40.3% for DCF (P=0.72). The median time to progression was 6.5 and 6.2 months in the mFOLFOX-6 and DCF arms, respectively (P=0.70). The median overall survival was 11.4 and 13.5 months in the mFOLFOX-6 and DCF arms, respectively (P=0.72). The rates of hematological toxicity did not differ between the two arms. However, in the subgroup analysis, grade 3-4 neutropenia and febrile neutropenia were significantly more common among patients who had not received G-CSF prophylaxis in the DCF arm. The incidence of grade 3-4 nausea/vomiting and diarrhea were significantly higher in the DCF arm. In conclusion, the present study demon-strated that the efficacy of the mFOLFOX-6 regimen was comparable to that of the DCF regimen in AGC patients. In addition, the benefit of G-CSF prophylaxis in conjunction with the DCF regimen was demonstrated.Öğe Frequency of RAS Mutations (KRAS, NRAS, HRAS) in Human Solid Cancer(Kare Publ, 2017) Kodaz, Hilmi; Kostek, Osman; Hacioglu, Muhammet Bekir; Erdogan, Bulent; Kodaz, Cagnur Elpen; Hacibekiroglu, Ilhan; Turkmen, EsmaRAS oncogene affects numerous cellular functions including growth, proliferation, apoptosis, migration, division and differentiation of the cells. It has 3 known isoforms as Harvey- RAS (HRAS), Kirsten - RAS (KRAS) and Neuroblastoma-RAS (NRAS). RAS has an intrinsic GTPase activity. It encodes proteins binding the guanine nucleotides. KRAS and HRAS were discovered in studies carried out on viruses leading to cancer. Retroviral oncogenes related to murine sarcoma virus genes (Kristen Rat Sarcoma Virus and Murine Sarcoma Virus) were discovered in 1982. These two oncogenes are similar to human KRAS. Approximately 30% of all human cancers have ras genes. Mutations in KRAS account for about 85% for all RAS mutations in human tumors, NRAS is about 11-15%, and HRAS is about 1%.Öğe Hormonal therapy in advenced stage prostate cancer(Kare Publ, 2015) Hacibekiroglu, Ilhan; Kodaz, Hilmi; Turkmen, EsmaProstat cancer is the most common type of cancer in men. At the time of diagnosis, only 5% of prostat cancer patients have the disease in advanced stage. While the 5 year overall survival rate of the patients with locoregional disease is close to 100%, this ratio in patients with advanced disease decreases to 28%. Prostat cancer cells depend on androgens for development, proliferation and physiological function. The purpose of the standard hormone therapy is to keep testesteron levels in castrate levels. Androgen deprivation therapy (ADT) is the standard treatment approach in prostat cancer patients with advanced stage. Although this treatment possesses many clinical benefits, it has also side effects affecting many systems in the body. This article evaluated the types and mechanisms of action of ADT, the management of this treatment's side effects, and the controversial situations commonly encountered in daily oncology practice in the light of current literature.Öğe Impact of bevacizumab on survival outcomes in primary tumor resected metastatic colorectal cancer(Humana Press Inc, 2015) Kodaz, Hilmi; Erdogan, Bulent; Hacibekiroglu, Ilhan; Turkmen, Esma; Gurkan, Hakan; Albayrak, Dogan; Tastekin, EbruWe have studied the efficacy of bevacizumab in colorectal cancer with unresectable metastasis patients who had undergone resection of primary tumor. The patients with unresectable metastasis during diagnosis who had undergone resection of primary tumor without chemotherapy and the patients without resection of primary tumor were included. Among patients who had met the inclusion criteria, 46 patients with resection of primary tumor and 47 without resection of primary tumor were included in the study. A total of 93 unresectable metastatic colorectal cancer patients were included in the study. Median PFS was 9 months (95 % CI 7.37-10.62) in patients with resected primary tumor and bevacizumab containing first-line chemotherapy combination. Median PFS was 10 months (95 % CI 8.06-11.93) in patients without bevacizumab (P = 0.66) Median OS was 25 months (95 % CI 17.92-32.07) in patients with resected primary tumor and bevacizumab containing first-line chemotherapy combination. Median OS was 16 months (95 % CI 9.71-22.28) in patients without bevacizumab (P = 0.36) Median OS was 16 months (95 % CI 13.06-8.939) in patients without resected primary tumor and bevacizumab containing first-line chemotherapy combination. Median OS was 9 months (95 % CI 1.48-16.51) in patients without bevacizumab (P = 0.012). Bevacizumab seems ineffective in mCRC patients with resected primary tumor. An increase in number of retrospective literature data and randomized, prospective studies is required about this subject.Öğe Importance of Ki-67 in human epidermal growth factor receptor 2 positive breast cancer(Imprimatur Publications, 2015) Erdogan, Bulent; Turkmen, Esma; Yalta, Tulin Deniz; Usta, Ufuk; Kodaz, Hilmi; Hacibekiroglu, Ilhan; Tanriverdi, OzgurPurpose: The aim of this study was to evaluate the importance of Ki-67 in Human Epidermal Growth Factor Receptor 2 (Her-2) positive breast cancer patients. Methods: We reviewed the records of patients diagnosed with Her-2-positive non-metastatic breast cancer between 2005 and 2011. Paraffin-embedded tissue samples were stained with MIB-1 mouse monoclonal antibody to find Ki-67 levels. Patients were grouped as low Ki-67 <20% and high Ki-67 >= 20%. Demographic and clinical features were compared. Results: One hundred and six patients were included in the study. Median follow up time was 41 months (range 15-100). Median age was 49.5 years (range 29-79). Twenty-nine patients (27.4%) were in the Ki-67 low group. Demographic features were similar in both groups. Lymphovascular invasion was more frequent in the Ki-67 high group, and hormone receptor (HR) positivity was more frequent in the Ki-67 low group (p=0.03, p=0.03, respectively). Recurrence rate was not significantly different in both groups (p=0.36). T stage (p=0.02), stage (p<0.01), lymphovascular invasion (p=0.02), ER status (p=0.02), and HR status (p<0.01) were related with recurrence. In multivariate analysis, stage and HR negativity were independent factors for recurrence (p<0.01, p=0.01, respectively). Recurrence sites were also similar in both groups. Survival rates at the third year for Ki-67 low group and Ki-67 high group were 94% and 92%, respectively. Conclusion: Her-2 positive patients with low Ki-67 and high Ki-67 had similar demographic and pathologic features except lymphovascular invasion and HR status. HR status was an important factor for disease course. Clinical course was determined by HR status rather than Ki-67.Öğe Incidence of contrast-induced nephropathy in hospitalised patients with cancer(Springer, 2014) Cicin, Irfan; Erdogan, Bulent; Gulsen, Emrah; Uzunoglu, Sernaz; Sut, Necdet; Turkmen, Esma; Kodaz, HilmiObjectives To determine the frequency of and possible factors related to contrast-induced nephropathy (CIN) in hospitalised patients with cancer. Methods Ninety adult patients were enrolled. Patients with risk factors for acute renal failure were excluded. Blood samples were examined the day before contrast-enhanced computed tomography (CT) and serially for 3 days thereafter. CIN was defined as an increase in serum creatinine (Cr) of 0.5 mg/dl or more, or elevation of Cr to 25 % over baseline. Relationships between CIN and possible risk factors were investigated. Results CIN was detected in 18/90 (20 %) patients. CIN developed in 25.5 % patients who underwent chemotherapy and in 11 % patients who did not (P=0.1). CIN more frequently developed in patients who had undergone CT within 45 days after the last chemotherapy (P=0.005); it was also an independent risk factor (P=0.017). CIN was significantly more after treatment with bevacizumab/irinotecan (P=0.021) and in patients with hypertension (P=0.044). Conclusions The incidence of CIN after CT in hospitalised oncological patients was 20 %. CIN developed 4.5-times more frequently in patients with cancer who had undergone recent chemotherapy. Hypertension and the combination of bevacizumab/irinotecan may be additional risk factors for CIN development. Key Points Contrast-induced nephropathy (CIN) is a concern for oncological patients undergoing CT. CIN occurs more often when CT is performed <45 days after chemotherapy. Hypertension and treatment with bevacizumab appear to be additional risk factors.Öğe Increased dose single-agent gemcitabine in platinum-taxane resistant metastatic ovarian cancer(Sage Publications Ltd, 2015) Kodaz, Hilmi; Hacibekiroglu, Ilhan; Turkmen, Esma; Erdogan, Bulent; Elpen, Cagnur; Uzunoglu, Sernaz; Cicin, IrfanBackground: In platinum-taxane resistant epithelial ovarian cancer (EOC), we aimed to determine the effectiveness. Patients and Methods: Between 2004 and 2013, patients afflicted with platinum-taxane resistant EOC and who were administered a 30-minute i.v. infusion of single-agent gemcitabine at a dose of 1,250 mg/m(2) on the 1st, 8th and 15th days, every 28 days, were examined retrospectively. Results: Twenty-six patients with platinum-taxane resistant EOC were included in the study. The overall survival (OS) was 48 months. The median survival after becoming platinum-taxane resistant was 16 months for the study population. Median time to progression (TTP) and median survival after becoming platinum-taxane resistant for patients who received second-line treatment were 3.3 months and 16 months, respectively; for patients who received third-line treatment with gemcitabine, these were 3.7 months and 19 months, respectively. Administration of gemcitabine as second- and third-line chemotherapy in platinum-taxane resistant EOC, provides similar TTP and OS outcomes (p = 0.4, p = 0.9) with a similar response and toxicity rate. Conclusions: Second- and third-line gemcitabine at a dose of 1,250 mg/m(2) on days 1 , 8 and 15 every 28 days as a 30-minute i.v. infusion in platinum-taxane resistant EOC is an effective treatment option with a tolerable and manageable toxicity.Öğe K-RAS and N-RAS mutations in testicular germ cell tumors(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2017) Hacioglu, Bekir Muhammet; Kodaz, Hilmi; Erdogan, Bulent; Cinkaya, Ahmet; Tastekin, Ebru; Hacibekiroglu, Ilhan; Turkmen, EsmaTesticular cancer is a relatively rare tumor type, accounting for approximately 1% of all cancers in men. However, among men aged between 15 and 40 years, testicular cancer is the most commonly diagnosed malignancy. Testicular germ cell tumors (TGCTs) are classified as seminoma and non-seminoma. The RAS oncogene controls several cellular functions, including cell proliferation, apoptosis, migration, and differentiation. Thus, RAS signaling is important for normal germ cell development. Mutations of the Kirsten RAS (K-RAS) gene are present in over 20% of all cancers. RAS gene mutations have also been reported in TGCTs. We investigated K-RAS and N-RAS mutations in seminoma and non-seminoma TGCT patients. A total of 24 (55%) pure seminoma cases and 19 (45%) non-seminoma cases were included in the study. K-RAS and N-RAS analyses were performed in our molecular pathology laboratory, using K-RAS and N-RAS Pyro Kit 24 V1 (Qiagen). In total, a RAS mutation was present in 12 patients (27%): 7 seminoma (29%) and 5 non-seminoma cases (26%) [p = 0.55]. AK-RAS mutation was present in 4 pure seminoma tumors (16%) and 3 non-seminoma tumors (15%) [p = 0.63], and an N-RAS mutation was observed in 4 seminoma tumors (16%) and 3 non-seminoma tumors (15%) [p = 0.63]. Both, K-RAS and N-RAS mutations were present in two patients: One with seminoma tumor and the other with non-seminoma tumor. To date, no approved targeted therapy is available for the treatment of TGCTs. The analysis of K-RAS and N-RAS mutations in these tumors may provide more treatment options, especially in platinum-resistant tumors.Öğe Performance Status is an Important Prognostic Factor in Second Line Treatment of Pancreaticobiliary Adenocarcinoma(H G E Update Medical Publishing S A, 2013) Erdogan, Bulent; Turkmen, Esma; Uzunoglu, Sernaz; Tanriverdi, Ozgur; Cicin, IrfanBackground/Aims: To define the factors related with disease control and survival in patients with pancreaticobiliary adenocarcinoma treated with second-line therapy. Methodology: We retropectively reviewed the data of 39 pancreaticobiliary adenocarcinoma patients treated with second-line chemotherapy between 2000 and 2012. Age, gender, origin of tumor, location of tumor, stage at diagnosis, Eastern Cooperative Oncology Group (ECOG) performance status, progression site, progression free survival (PFS) for first-line therapy, disease control at first-line therapy and chemotherapy protocols are analyzed for disease control rate, PFS and overall survival (OS). Results: Disease control was recorded in 21 (53.8%) patients (20 stable disease, 1 partial response). Disease control rate was higher in patients with good performance status (p=0.03). Disease control at first-line therapy was not a predictor of disease control at second-line (p=0.6). Response to first-line therapy and other prognostic factors was not related with disease control. Progression free survival and OS was significantly longer in patients with good ECOG performance status (0-1) (p=0.01, p=0.006). Choice of chemotherapy (single agent or combination) and other factors did not have any impact on PFS and OS. In multivariate analysis; disease control was independent prognostic factor for both PFS and OS (p<0.001), (p<0.001). Conclusions: Disease control and performance status are two important prognostic factors. Chemotherapy regimen has no impact on disease control and survival. Salvage chemotherapy can be considered for patients with good performance status whether they are resistant to first-line therapy or not.Öğe Post progression survival analysis of metastatic gastric and gastroesophageal junction cancer patients after second-line treatment(Univ Catholique Louvain-Ucl, 2016) Turkmen, Esma; Erdogan, Bulent; Kodaz, Hilmi; Hacibekiroglu, Ilhan; Onal, Yilmaz; Uzunoglu, Sernaz; Kilic, NiluferPurpose : The aim of this study was to define the factors that affect response and post-progression survival of metastatic gastric cancer (MGC) and gastroesophageal junction cancer (GEJ) patients treated with second-line chemotherapy. Methods : We retrospectively reviewed the data of 59 patients with MGC or GEJ adenocarcinoma who received second-line treatment. Results : The median age was 54 years old (26-77). Response to second-line treatment was strongly associated with disease control with first-line treatment (p < 0.01). Median progression-free survival (PFS), overall survival (OS) and post-progression survival (PPS) were 3.2 (95% CI : 2.63-3.80), 6.5 (95% CI : 3.78-9.35) and 2.7 months (95% CI : 1.89-3.68), respectively. PFS (r = 0.55, p < 0.01) and PPS (r = 0.89, p < 0.01) were correlated with OS. Response to second-line treatment was independently related to PFS (HR : 0.12 95% CI : 0.53-0.26, p < 0.001). Having an ECOG 0 performance status (HR : 0.42; 95% CI : 0.21-0.86, p = 0.02) and response to second-line therapy (HR : 0.47; 95% CI : 0.25-0.85, p = 0.01) were independently associated with OS. Conclusion : PPS and PFS were correlated with OS after second-line treatment of MGC. Response to second-line treatment prolonged OS by increasing PFS, and having an ECOG 0 PS prolonged OS by increasing PPS.Öğe Single-agent bevacizumab is an effective treatment in recurrent glioblastoma(Humana Press Inc, 2015) Hacibekiroglu, Ilhan; Kodaz, Hilmi; Erdogan, Bulent; Turkmen, Esma; Ozcelik, Melike; Esenkaya, Asim; Saygi, Haci MehmetThe aim of this study was to evaluate the efficiency and safety of single-agent bevacizumab therapy for recurrent glioblastoma multiforme (GBM). We identified patients with histologically confirmed glioblastoma and World Health Organization Grade III glioma who were previously treated with temozolomide plus radiotherapy and received 10 mg/kg bevacizumab intravenous infusion every 2 weeks until disease progression for recurrent disease. A total 24 patients included to this study. Twenty-two patients had GBM, and two patients had WHO grade III glioma. No complete response was observed, five patients (20.8 %) had partial response, nine patients (37.5 %) had stable diseases, and ten patients (41.7 %) had progressive diseases. The overall response rate was 20.8 %. The 6-month PFS rate (PFS6) and median PFS were determined as 37.5 % and 4.1 months, respectively. Median OS was 6.4 months. Performance status of 17 (70.8 %) patients was improved following bevacizumab regimen. Univariate analysis showed that improvement in performance status (IPS) following bevacizumab therapy was a significant predictor of both PFS (p < 0.001) and OS (p < 0.020). Bevacizumab-related adverse effects were observed in 13 (54.1 %) patients. Grade 3-4 toxicity was observed in 4 (16.6 %) patients. Therapy interruptions were experienced in two patients due to adverse effects. Single-agent bevacizumab is an effective and safe treatment alternative in recurrent GBM. IPS following bevacizumab therapy was a significant predictor of both PFS and OS.Öğe Single-agent bevacizumab is an effective treatment in recurrent glioblastoma (vol 32, 12, 2015)(Humana Press Inc, 2015) Hacibekiroglu, Ilhan; Kodaz, Hilmi; Erdogan, Bulent; Turkmen, Esma; Ozcelik, Melike; Esenkaya, Asim; Saygi, Haci Mehmet[Abstract Not Available]Öğe Treatment preferences in stage IA and IB testicular seminoma: multicenter study of Anatolian Society of Medical Oncology(Springer, 2015) Bilici, Ahmet; Ozturk, Turkan; Turkmen, Esma; Odabas, Hatice; Cihan, Sener; Selcukbiricik, Fatih; Erdogan, BulentApproximately 75 % of patients with testicular seminoma present with stage I disease, and the probability of long-term survival approaches 100 %. However, the standard adjuvant treatment for stage I seminoma patients remains controversial, and there is no uniform consensus in the literature. The present study was performed to evaluate treatment preference and outcomes for men with stage I testicular seminoma. From 1997 to 2013, 282 patients with histologically confirmed stage IA and IB testicular seminoma who underwent orchiectomy were included. The outcomes of three management options and survivals were retrospectively analyzed. The prognostic significance of risk factors for relapse on survival was evaluated by univariate and multivariate analysis; in addition, the factors predicting relapse were also evaluated by logistic regression analysis. Of the 282 patients with stage I seminoma, 130 (46.1) received adjuvant radiotherapy (RT), 80 (28.4 %) were treated with adjuvant carboplatin, while the remaining 72 patients (25.5 %) underwent surveillance. At the time of analysis, the median follow-up period of 38.5 months; relapses were observed in 16 patients (22.3 %) on surveillance, in one patient (1.2 %) treated with adjuvant carboplatin and in ten patients (%7.7) who received adjuvant RT. The 5-year disease-free survival (DFS) rate for patients who underwent surveillance was worse than those of patients treated with adjuvant carboplatin and RT (64.2 vs. 97.7 vs. 91.9 %, respectively; p < 0.001). However, the 5-year overall survival (OS) rate for patients on surveillance was similar compared with the adjuvant treatment groups (100 vs. 92.3 vs. 97.4 %, respectively; p = 0.44). Univariate analysis showed that only the treatment approach (surveillance vs. adjuvant carboplatin vs. adjuvant RT) for DFS (p < 0.001), invasion of the rete testis (p = 0.041) and the presence of relapse (p < 0.001) for OS were important prognostic indicators. Multivariate analysis indicated that the treatment strategy for DFS (p < 0.001, HR 0.34) was an independent prognostic factor. Furthermore, a logistic regression analysis showed that adjuvant treatment was found to be an independent factor for predicting relapse (p = 0.004, odds ratio: 0.39). Our results indicate that adjuvant treatment with carboplatin or RT is associated with improved DFS compared with surveillance for men with stage I testicular seminoma after orchiectomy. Moreover, the treatment strategy is an important prognostic indicator for DFS and a predictive factor for relapse. Although adjuvant treatment, especially carboplatin, seems to be a suitable treatment for patients with risk factors for relapse, surveillance is still feasible and the preferred management option after radical orchiectomy in men with stage I seminoma. More reliable predictive factors are needed to make treatment decisions.Öğe Unknown primary adenocarcinomas: A single-center experience(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2016) Uzunoglu, Sernaz; Erdogan, Bulent; Kodaz, Hilmi; Cinkaya, Ahmet; Turkmen, Esma; Hacibekiroglu, Ilhan; Sari, AliThis study aimed to elucidate the clinical and prognostic characteristics of a homogeneous group of patients with cancer of unknown primary (CUP). Between 1999 and 2014, CUP was diagnosed in 159 (1.3%) of 11,742 cancer patients at Trakya University Hospital (Edirne, Turkey). Ninety-seven (61%) of the 159 patients were retrospectively reviewed. Among these, 61 (62.8%) patients with adenocarcinoma were included in this study. The most frequently predicted primary tumor site was the lung (37.7%), and 59% of the patients were smokers. There was a significant relationship between smoking and the lung as a potential primary cancer site (p = 0.042). The most frequent site of metastasis was the liver (60.7%). The median number of metastases per patient was two, but patients with liver metastases had a median of five metastases. The overall median survival time was 7 months. Median survival was significantly longer in patients with a predicted primary site than in patients without the predicted site (7 vs. 6 months, respectively; p = 0.038). When the patients with predicted ovarian and peritoneal tumors were excluded from the comparison, the statistical p value was still close to significant (p = 0.07). Multivariate analysis revealed that smoking, liver metastasis, serum alkaline phosphatase = 92 U/L, and progression in response to chemotherapy were independent predictors of a poor prognosis. The present study identified several independent prognostic factors in patients with unknown primary adenocarcinomas who received chemotherapy. Smoking, the presence of liver metastasis, and response to chemotherapy were independent risk factors for both progression-free and overall survival.