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18F-FDG PET/CT parameters for prediction of response to neoadjuvant therapy and prognosis in rectal cancer
(Wolters Kluwer Health, 2023) Ebinç, Senar; Güzel, Yunus; Oruç, Zeynep; Kömek, Halil; Kalkan, Ziya; Can, Canan; Taşdemir, Bekir; Urakçı, Zuhat; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, Abdurrahman
Objective This study aims to investigate the role of F-18 fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) parameters in the prediction of treatment response and the prognosis in locally advanced rectal cancer. Methods We investigated the relationship of 18F-FDG PET/CT parameters [rectal metabolic tumor volume (MTV), rectal total lesion glycolysis (TLG), rectal standard uptake value (SUV) max, rectal highest peak SUV, lymph node MTV, lymph node TLG, lymph node highest peak SUV] with the pathological response and disease-free survival (DFS) in 60 patients who received neoadjuvant therapy for a diagnosis of locally advanced rectal cancer. Patients with a total score of 0 were assigned to the low-risk group, patients with a score of 1 were assigned to the intermediate-risk group and patients with a score of 2 were assigned to the high-risk group. Results The multivariate analysis revealed that, from baseline PET CT parameters, lymph node highest peak SUV strongly predicted the pathological response at a cutoff value of 2.23. DFS was predicted by the lymph node highest peak SUV at a cutoff value of 3.13 and by the MTV value at a cutoff value of 27 cm3. The risk scoring performed with regard to rectal MTV and lymph node highest peak SUV values determined a median DFS of 19 months in patients with a risk score of 2, whereas the median DFS was not reached in patients with risk scores of 0 and 1 (P < 0.001). Conclusion This study determined that rectal MTV and lymph node highest peak SUV predicted the response to neoadjuvant therapy and DFS.
Causes of liver test abnormalities in newly diagnosed cancer patients and the investigation of etiological factors
(Taylor & Francis Ltd, 2024) Urakçı, Zuhat; Ebinç, Senar; Oruç, Zeynep; Kalkan, Ziya; Kaplan, Muhammet Ali; Küçükköner, Mehmet; Işıkdoğan, Abdurrahman
Objectives: In this study, we aimed to investigate the causes of liver test abnormalities in newly diagnosed patients naive to anti-tumoral therapy. Method: This study included a total of 490 patients with ALT levels > 5X ULN on liver function tests at the initial presentation to our clinic. Data from 247 (50.4%) patients diagnosed with cancer (cohort A) and 243 (49.6%) patients without cancer (cohort B) were compared with regard to the etiology of liver test abnormalities and the risk factors. Results: The most common etiological factor in cohort A was presence of liver metastasis (31.2%, n = 77). In the comparison of the two groups with regard to etiological factors; the rates of liver metastasis [31.2% vs 0%, (p < 0.001)], drug-induced liver toxicity [30/4% vs 19.8%, (p = 0.007)], pancreaticobiliary pathology [21.5% vs 14%, (p = 0.03)] and chronic viral hepatitis [14.2% vs 7.4%, (p = 0.02)] were higher in the cohort A. The rate of NAFLD was higher in the cohort B [6.9% vs 42.2% (p < 0.001). Conclusion: In our study, the most common cause of liver test abnormalities was the presence of liver metastasis in cohort A and NAFLD in cohort B.
Clinical characteristics and outcomes of cancer cases among syrian refugees from Southern Turkey
(NLM (Medline), 2023) Kutluk, Tezer; Şahin, Berksoy; Kirazlı, Meral; Ahmed, Fahad; Aydın, Sinem; Çınkır, Havva Yeşil; Ebinç, Senar; Işıkdoğan, Abdurrahman; Ayyıldız, Mehmet Orhan; Üzel, Veysiye Hülya
Importance: Cancer was a common noncommunicable disease in Syria before the present conflict and is now a major disease burden among 3.6 million Syrian refugees in Turkey. Data to inform health care practice are needed. Objective: To explore sociodemographic characteristics, clinical characteristics, and treatment outcomes of Syrian patients with cancer residing in the southern border provinces of Turkey hosting more than 50% of refugees. Design, Setting, and Participants: This was a retrospective hospital-based cross-sectional study. The study sample consisted of all adult and children Syrian refugees diagnosed and/or treated for cancer between January 1, 2011, and December 31, 2020, in hematology-oncology departments of 8 university hospitals in the Southern province of Turkey. Data were analyzed from May 1, 2022, to September 30, 2022. Main Outcomes and Measures: Demographic characteristics (date of birth, sex, and residence), date of first cancer-related symptom, date and place of diagnosis, disease status at first presentation, treatment modalities, date and status at last hospital visit, and date of death. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision and International Classification of Childhood Cancers, Third Edition, were used for the classification of cancer. The Surveillance, Epidemiology, and End Results system was applied for staging. The diagnostic interval was defined as the number of days from first symptoms until the diagnosis. Treatment abandonment was documented if the patient did not attend the clinic within 4 weeks of a prescribed appointment throughout the treatment. Results: A total of 1114 Syrian adult and 421 Syrian children with cancer were included. The median age at diagnosis was 48.2 (IQR, 34.2-59.4) years for adults and 5.7 (IQR, 3.1-10.7) years for children. The median diagnostic interval was 66 (IQR, 26.5-114.3) days for adults and 28 (IQR, 14.0-69.0) days for children. Breast cancer (154 [13.8%]), leukemia and multiple myeloma (147 [13.2%]), and lymphoma (141 [12.7%]) were common among adults, and leukemias (180 [42.8%]), lymphomas (66 [15.7%]), and central nervous system neoplasms (40 [9.5%]) were common among children. The median follow-up time was 37.5 (IQR, 32.6-42.3) months for adults and 25.4 (IQR, 20.9-29.9) months for children. The 5-year survival rate was 17.5% in adults and 29.7% in children. Conclusions and Relevance: Despite universal health coverage and investment in the health care system, low survival rates were reported in this study for both adults and children with cancer. These findings suggest that cancer care in refugees requires novel planning within national cancer control programs with global cooperation.
COVİD-19 ve kanser yönetimi
(Dicle Üniversitesi Tıp Fakültesi, 2021) Urakçı, Zuhat; Kalkan, Ziya; Ebinç, Senar
Coronavirüs hastalığı 2019 (COVID-19) şiddetli akut solunum sendromu coronavirüs 2'nin (SARS-CoV-2) neden olduğu bulaşıcı bir hastalıktır. Dünya Sağlık Örgütü (DSÖ) Mart 2020’de COVID-19 salgınını küresel bir salgın olarak ilan etmiştir. Kanser hastalığının kendisi ve kanser tedavisinde kullanılan yöntem ve tedavilerin immünsupresyona neden olabilmelerinden dolayı bu hastalarda COVİD-19 hastalığına yakalanma riski artmaktadır. Ayrıca kanser hastalarında normal popülasyona göre COVİD-19’a bağlı mortalite oranları daha yüksektir. COVİD-19 pandemisi sürecinde birçok ülkenin sağlık sisteminde problemler baş göstermiş ve bu problemlerden dolayı çoğu alanda değişiklikler yapılma yoluna gidilmiştir. Bu bağlamda günlük onkolojik pratikte de değişik modifikasyonlar yapılmış, mevcut koşullara adaptasyon sağlanmaya çalışılmıştır. Rutin kanser taramaları geçici olarak durdurulmuş, rutin takiplerde bazı koşullarda takip aralıkları uzatılmıştır. Sağlık sistemlerindeki yüklenmelerden dolayı tanı aşamasında bazı farklılıklar yaşanmıştır. COVİD-19 pandemi sürecinde immünoterapi, hedefe yönelik ilaçlar ve hormonal ilaçlar COVİD-19 bulaş ve mortalite riskini arttırmadığından bu ilaçların kullanımı ile ilgili standart yaklaşımda belirgin bir farklılık görülmemektedir. Bununla birlikte hastane vizitlerini azaltma amacıyla immünoterapi kür aralıklarının uzatılabileceği önerilmiştir. Kemoterapi alan hastalarda immünsupresyon oluşturma ve enfeksiyon riski nedeni ile uluslararası kılavuzlar çerçevesinde bazı değişikliklere gidilmiştir. Küratif yaklaşımlarda ve kemoterapiye iyi yanıt alınabilecek tümörlerin tedavisinde standart yaklaşım önerilirken, metastatik evre palyatif tedavi alan ve kemoterapi etkinliği belirgin olmayan hastalarda hastayla birlikte tedaviye karar verilmesi önerilmiştir. Sağlık otoriteleri aşılama programlarında kanser tanılı hastalara öncelik tanımış, aşının kanser hastalarında COVİD-19 bulaşını önleme ve COVİD-19’a bağlı mortaliteyi azaltmada etkili olduğu gözlenmiştir.
Effect of Helicobacter pylori infection on the first-line treatment outcomes in patients with immune thrombocytopenic purpura
(Verduci Editore s.r.l, 2022) Doǧan, Ali Alp; Ekinci, Ömer; Ebinç, Senar
OBJECTIVE: Helicobacter pylori (H. pylori) eradication therapy is known to increase the platelet count, but in immune thrombocytopenic purpura (ITP), the effect of H. pylori infection on the response to treatment is not clear. This study aims to determine whether the response to the first-line treatment is affected by the states of H. pylori-positivity and -negativity in ITP patients. PATIENTS AND METHODS: Adult newly diagnosed or chronic ITP patients who had not received eradication therapy for H. pylori infection were included. Characteristics of the patients, presence and severity of bleeding, initial platelet count, administered treatments, and treatment response rates were inspected. RESULTS: Of 119 total patients, 66 (55.5%) were female, 32 (26.9%) were H. pylori-positive, 87 (73.1%) were H. pylori-negative. H. pylori-positive and H. pylori-negative groups were not significantly different in terms of age (p=0.127), gender (p=0.078), diagnosis status (p=0.094) and the distribution of bleeding symptoms (p=0.712). The most common treatment was standard-dose steroid in both groups (62.5% vs. 68.9%, p=0.524). Rates of complete response, partial response, no response were comparable for the two groups (respectively, 75% vs. 73.6%, and 18.8% vs. 19.5%, and 6.2% vs. 6.9%), and there was no significant difference between the groups (p=0.283). CONCLUSIONS: It can be stated, according to the present study, that in ITP patients in whom treatment is indicated, the response to the firstline treatment without the administration of H. pylori eradication therapy is similar between H. pylori-positive and H. pylori-negative patients.
Effectiveness of current first-line treatments and evaluation of prognostic factors related to survival in castration-resistant prostate cancer with isolated bone metastasis
(Türkiye Klinikleri Yayınevi, 2023) Urakçı, Zuhat; Ebinç, Senar; Oruç, Zeynep; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, Abdurrahman
Objective: This study aimed to investigate the effectiveness of first-line treatments and survival-related prognostic factors in castration- resistant prostate cancer (CRPC) with isolated bone metastasis. Material and Methods: Clinicopathological characteristics of patients diagnosed with CRPC and isolated bone metastasis presenting to the Medical Oncology Clinic of Dicle University between January 2010 and December 2020, as well as the treatments received by them, were retrospectively evaluated. Results: Our study included 91 prostate cancer patients that were in the castration-resistant stage and had isolated bone metastases. As the first-line treatment, 43 (47.2%) of our patients received docetaxel (DOC), 27 (29.6%) received abiraterone acetate (AA), and 21 (23.2%) received enzalutamide (ENZA). The median progression- free survival (PFS) periods for the DOC, AA, and ENZA groups were 9 months [95% confidence interval (CI): 6.52-11.47], 8 months (95% CI: 3.54-12.45), and 13 months (95% CI: 8.09-17.90), respectively (p=0.047). The median overall survival (OS) periods among patients receiving DOC, AA, and ENZA during the hormone-refractory period were 13 months (95% CI: 8.48-17.51), 12 months (95% CI: 8.58- 15.41), and 20 months (95% CI: 2.90-37.09), respectively (p=0.13). Multivariate analyses indicated that the choice of first-line treatment received by the patients was an independent prognostic factor for PFS, whereas lymph node metastasis was an important prognostic variable for OS. Conclusion: Our study involving CRPC patients with isolated bone metastases demonstrates similar OS among patients receiving DOC, ENZA, or AA as the first-line treatment for prostate cancer, although ENZA is associated with a better PFS.
Efficacy and tolerability of current treatments for hormone-refractory prostate cancer patients with visceral metastases
(Future Medicine LTD., 2021) Oruç, Zeynep; Kaplan, M. Ali; Karaağac, Mustafa; Özyurt, Neslihan; Tatlı, Ali Murat; Kaya, Ali Osman; Menekşe, Serkan; Kut, Engin; Koca, Sinan; Sever, Özlem Nuray; Yasin, İrem; Ebinç, Senar; Zeynelgil, Esra; Sakin, Abdullah; Turhal, Nazım Serdar; Işıkdoğan, Abdurrahman
Aim: To assess the efficacy and tolerability of the first-line treatment options for hormone-refractory prostate cancer patients with visceral metastases. Materials and methods: The records of 191 patients diagnosed with hormone-refractory prostate cancer with visceral metastases were analyzed retrospectively. Results: Docetaxel was administered to 61.2% (n = 117), abiraterone to 14.2% (n = 27) and enzalutamide to 9.4% (n = 18) as the first-line treatment. The median survival of the patients receiving docetaxel, abiraterone and enzalutamide as the first-line treatment during the hormone-refractory period was 15 (95% Cl: 12.9-17) months, 6 (95% Cl: 1.8-10.1) months and 11 (95% Cl: 0.9-23.1) months (p = 0.038), respectively. Conclusion: The present study established a statistically significant difference in favor of docetaxel in terms of overall survival and progression-free survival. Lay abstract The optimal therapeutic option for castration-resistant prostate cancer (CRPC) patients with visceral metastases is unknown. We assessed the efficacy and tolerability of the first-line treatment options for CRPC patients with visceral metastasis. One hundred ninety-one patients diagnosed with CRPC with visceral metastases were included in the study. The present study established a statistically significant difference in favor of docetaxel in terms of overall survival and progression-free survival between first-line docetaxel, abiraterone and enzalutamide treatments in CRPC patients with visceral metastases. For patients who cannot undergo chemotherapy, enzalutamide, among novel androgen pathway inhibitors, may be the most appropriate option, given its numerical, although statistically insignificant, difference in overall survival and its fewer side effects compared with abiraterone.
Efficacy of Ga-68-PSMA PET/CT-derived whole-body volumetric parameters in predicting response to second-generation androgen receptor axis-targeted therapy, and the prognosis in metastatic hormone-refractory prostate cancer patients
(Lippincott William & Wilkins, 2021) Oruç, Zeynep; Güzel, Yunus; Ebinç, Senar; Kömek, Halil; Küçüköner, Mehmet; Kaplan, Muhammet Ali; Oruç, İdris; Urakçı, Zuhat; Işıkdoğan, Abdurrahman
Introduction The present study investigates the role of Ga-68-PSMA PET/CT-derived whole-body metabolic and volumetric parameters in the prediction of treatment response and prognosis among metastatic hormone-refractory prostate cancer patients undergoing second-generation androgen receptor axis-targeted therapy (abiraterone or enzalutamide). Materials and methods This retrospective study included 44 metastatic hormone-refractory prostate cancer patients undergoing Ga-68-PSMA PET/CT, including 29 enzalutamide-treated and 15 abiraterone-treated patients. Results Of the 44 patients included in the study, 29 received enzalutamide and 15 received abiraterone. During treatment, the changes in PET parameters were correlated with the PSA (biochemical) response. More specifically, a positive correlation was noted between PSA response and percent change in TLP (Delta TLP) response, and there was concordance between the results (r = 0.652, k = 0.42, P < 0.001). Baseline PSA (P =0.05), high MTVw (P = 0.005), the increase in Delta PSA (P = 0.036), Delta TLP (P = 0.039) and percent change in MTV (Delta MTV) (P = 0.049) values were identified as factors associated with mortality risk.Multivariate analysis showed that PSA1 [odds ratio (OR): 1.005, 95% confidence interval (CI) 1.002-1.008, P = 0.004], Delta PSA (OR: 14.7, 95% CI 1.50-143.7, P = 0.02) and MTVw1 (OR: 11.4, 95% CI 1.11-116, 6, P = 0.04) were independent prognostic factors associated with mortality risk. Conclusion A statistically significant concordance and correlation was noted between Ga-68-PSMA PET/CT-derived whole-body metabolic parameters (Delta TLP and Delta MTV) and Delta PSA. In addition, the baseline PSA, Delta PSA, Delta TLP, Delta MTV and TMTV were identified as predictive factors for mortality risk.
Efficacy of pemetrexed plus a platinum rechallenge in the treatment of pleural mesothelioma
(Via Medica, 2023) Urakçı, Zuhat; Ebinç, Senar; Oruç, Zeynep; Kalkan, Ziya; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, Abdurrahman
Introduction. Pemetrexed-based rechallenge therapies can be used as an option in the treatment of pleural mesothelioma. We aimed to investigate the efficacy of pemetrexed-based rechallenge in mesothelioma. Material and methods. A total of 132 patients who received chemotherapy for unresectable or metastatic pleural mesothelioma in the Medical Oncology Clinic of Dicle University Medical Faculty between 2005 and 2020 were included in our study. Pemetrexed plus platinum rechallenge treatments were compared with other chemotherapy regimens in terms of survival. Results. In our study, 31 (23.4%) of a total of 132 patients received rechallenge pemetrexed plus platinum treatment. There was no statistically significant difference between median progression-free survival of patients who received pemetrexed plus cisplatin or gemcitabine plus cisplatin in the first-line therapy [5 months vs. 8 months (HR = 1.43; 95% CI 0.59–3.45; p = 0.376)]. In the second-line treatment, patients who received rechallenge pemetrexed plus platinum therapy had statistically significantly higher median PFS than those who received gemcitabine plus platinum [6 months vs. 4 months (HR = 0.46; 95% CI 0.22–0.94; p = 0.011)] due to a previous good response. In the second-line treatment, median overall survival was 15 months with gemcitabine plus platinum and 29 months with pemetrexed plus platinum rechallenge (p = 0.007). Conclusions. This study demonstrated that the pemetrexed plus platinum regimen was more effective than gemcitabine plus platinum in the second-line treatment in terms of both progression-free and overall survival in patients who had previously benefited from pemetrexed-based chemotherapy and had not progressed up to 6 months after first-line treatment.
ERKEN EVRE SEMİNOM HASTALARINDA PROGNOZU ETKİLEYEN FAKTÖRLER
(Ramazan AKDEMİR, 2020) Sezgin, Yasin; Ebinç, Senar; Urakçı, Zuhat
ÖzetGiriş: Cerrahi olarak orşiektomi yapılmış erken evre seminom hastalarında mükemmel bir prognoz gözlenir. Seminom hastaları metastatik evrede olsa bile yaklaşık olarak %50 kür şansı mevcuttur. Bu nedenle özellikle risk faktörü taşımayan erken evre seminom hastaları aktif izlem ile takip edilebilir. Aktif izlemdeki temel amaç; cerrahi orşiektomi sonrası hiçbir şekilde nüks etmeyecek olan %85 hastayı doğru olarak tespit etmek ve o hastaları gereksiz tedaviden ve kemoterapinin yan etkilerinden korumaktır. Biz bu çalışmamızda seminom hastalarında rekürrens riskini arttırabilecek faktörleri araştırdık. Materyal-Metod: Tek merkezli retrospektif olan bu çalışmaya erken evre seminom hastaları dahil edildi. Çalışmaya 18 yaş üstü olan çalışmaya dahil eilme kriterlerine uygun 70 hasta alındı. Çalışmadaki amacımız erken evre seminom hastalarında prognoz üzerinde etkili olan faktörler, nüksü gösteren bir prediktif değer olup olmadığının araştırılması olarak belirlendi. Hasta sayısının az olması nedeni ile ölüm ve nüks için regresyon modeli oluşturulamadı. Ancak hipotez testi olarak univariable Cox regresyon ve Logrank testi uygulandı.Bulgular:. Hastaların median yaşı 35,7 (27,24-38,09) yıl idi. Hastaların 61’i (%87,1) evre I ve 9’u (%12,9) evre II hastalığa sahip idi. Yapılan istatistiksel analizde hastalığın evresi ile rekürrens arasında anlamlı ilişki mevcut idi. Toplamda nüks eden 10 yastanın 4’ü (%40) evre II’de olup bu durum istatistiksel olarak anlamlı idi (p:0.019) (Şekil-I). Diğer parametreler ve rekürrens arasında anlamlı ilişki izlenmedi.Tartışma ve sonuç: Lenfovasküler invazyon, spermatik kord tutulumu, tunika albuginea tutulumu ve rete testis tutulumu gibi faktörlerin rekürrens riski ile ilişkisi izlenmezken, evrenin rekürrens riski üzerinde etkisi olduğunu gözledik (p=0,019).
Evaluation Of Cancer And Non-Cancer Patients Receiving Palliative Care Service İn Terms Of Hospitalization Times And Overall Survival During Hospitalization: A Single-Center Experience
(Veysi AKPOLAT, 2021) Kalkan, Ziya; Ebinç, Senar; Kalkan, Tuğba Tezer; Urakçı, Zuhat; Oruç, Zeynep
Objective: In the last 20 years, palliative care has gained a place within the health system worldwide. Our aim is to review the demographic characteristics of patients hospitalized in palliative care centers, to investigate the factors influencing hospitalization times of patients with cancer and non-cancer diagnoses and the median in-hospital survival. Results: A total of 428 patients, comprising 237 (55.4%) males and 191 (44.6%) females were included in the study. Median patient age was 75 (18-105) years. In terms of hospitalization times, there were no significant differences between genders (p=0.79) and diagnoses (malignant/non-malignant); however, there was a statistically significant difference between survival statuses (died/discharged) and patients who died had longer hospitalization times (16 days versus 12 days) (p=0.008). When age, gender, hospitalization type and diagnosis were compared with regard to median in-hospital survival in multivariate analysis, the diagnosis (non-malignant/malignant) was an independent factor indicating median in-hospital survival (HR:2.08, 95% CI:(1.47-2.94), p
Evaluation of factors predicting the effectiveness of regorafenib in the treatment of metastatic colorectal cancer
(Aves Yayıncılık, 2022) Ebinç, Senar; Oruç, Zeynep; Urakçı, Zuhat; Kalkan, Ziya; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, Abdurrahman
Objective: Regorafenib is a multikinase inhibitor, the effectiveness of which was demonstrated in metastatic colorectal cancer. This study aimed to investigate the factors that could predict the effectiveness of regorafenib. Materials and Methods: This study retrospectively reviewed the clinical characteristics, tumor characteristics, and previous therapies in 62 patients who presented to our center between 2016 and 2020 and used regorafenib for metastatic colorectal cancer. The effects of the investigated variables on the response obtained with regorafenib use were evaluated. Results: This study included a total of 62 patients diagnosed with metastatic colorectal cancer, of whom 30 (48.4%) were males and 32 (51.6%) were females. Patients' median age at diagnosis was 49 years (1868). Regorafenib therapy yielded a disease control rate of 64% [complete response = 0, partial response= 14 (28%), and stable disease = 18 (36%)]. Objective response was obtained in 28% of patients [complete response = 0 and partial response = 14 (28%)]. Progression-free survival was 4 months. The evaluation of the effects of patients' age, sex, performance status, previous treatments, metastatic sites, and RAS mutation status on the disease control rate and progression-free survival did not determine any positive or negative effects on progression-free survival. However, left-sided tumors had a positive effect on disease control rate (69.8% vs. 28.6%, P =.029). and previous use of cetuximab had a negative effect on disease control rate [76.5% vs. 37.5% (P =.007)]. Conclusion: In our study, tumor localization and previous cetuximab use were found to be correlated with the disease control rate in patients on regorafenib. However, the need for novel biomarkers that will predict the effectiveness of regorafenib in metastatic colorectal cancer treatment persists.
Factors predicting pathological complete response to neoadjuvant chemotherapy in patients diagnosed with non- metastatic muscle invasive urothelial bladder cancer
(2023) Urakçı, Zuhat; Ebinç, Senar; Tunç, Sezai; Oruç, Zeynep; Küçüköner, Mehmet; Kaplan, Muhammet Ali; Işıkdoğan, Abdurrahman
Aim: In this study, we aimed to investigate the factors that may have the potential to predict pathological complete response (pCR) with platinum-based neoadjuvant chemotherapy (NAC) in non-metastatic muscle-invasive bladder cancer (MIBC). Methods: Our study included 46 patients diagnosed with non-metastatic MIBC, who applied to Dicle University Medical Oncology Clinic between 2016-2019 years and received NAC. Age, gender, ECOG performance score, tumor grade, pathological tumor (pT) stage, clinical lymph node (cN) status, localization of the primary tumor in the bladder, presence of comorbid diseases, renal failure status, hydronephrosis, and NAC regimens were analyzed. Results: Of the total 46 patients included in the study, 42 (81.3%) were male and 4 (8.7%) were female. The median age at diagnosis was 61.5 (34-77) years. In the group of patients aged <65 years, pCR was achieved in 9 patients (33.3%) and pCR was not achieved in 18 patients. The rate of pCR after NAC in the patient group aged <65 years was higher than in the age ≥65 group, which was statistically significant (p: 0.03). While the median disease-free survival (DFS) was not reached in the pCR arm, the median DFS was calculated as 26 months (95% CI: 4.6-47.3) in the non-pCR arm (Log Rank p=0.23). The mean overall survival (OS) value in the pCR arm was 126 months (95% CI: 106.5- 145.4) and the mean OS value in the non-pCR arm was 53.5 months (95% CI: 44.2-62.9) (Log Rank p=0.05). Conclusion: In our study, age <65 years was found to be an independent prognostic factor for pCR in the neoadjuvant treatment of non-metastatic MIBC. Mean OS was better in patients who achieved pCR.
Hungry Bone Syndrome in Patients with End-Stage Renal Disease Receiving Hemodialysis
(Veysi AKPOLAT, 2021) Erdem, Mehmet; Ebinç, Senar; Duman, Azad; Oruç, İdris; İliklerden, Ümit Haluk; Soyoral, Yasemin
Objective: Hyperparathyroidism develops in the majority of patients with end-stage renal disease receiving hemodialysis. Parathyroidectomy can be performed in cases who cannot be managed with medical therapy and a portion of the patients develop hungry bone syndrome (HBS) in the postoperative period. In this study, we investigated the factors that influence the development of HBS and the hospitalization times in hemodialysis patients who underwent parathyroidectomy. Method: This study included 49 patients. Demographic, clinical and laboratory parameters of these patients were retrospectively evaluated. Results: Patients’ median age was 46 years (22-62). The parathyroid gland that showed hyperplasia the most frequently was the left inferior 79.6% (n=39), followed by the right inferior 77.6% (n=38) gland. Rate of four-gland hyperplasia was 32.7% (n=16). Of the 49 operated patients, 34 (69.4%) developed HBS. In patients with postoperative PTH 4 ampules during the first 24 hours, hospitalization times were prolonged and the need for parenteral calcium infusion was elevated. Conclusion: The need for parenteral calcium replacement during the first 24 hours, postoperative PTH and calcium levels during the first 24 hours were determined to be factors indicating the severity of HBS in the postoperative period.
ICE Regimen in Adult Advanced/Relapsed Soft TissueSarcoma Patients; is it More Effective in Early Use?Retrospective Analysis of Single Center Study
(2021) Sezgin, Yasin; Ebinç, Senar; Işıkdoğan, Abdurrahman; Küçüköner, Mehmet; Kaplan, Muhammet Ali; Oruç, Idris; Urakci, Zuhat
Objectives: To analyze the efficacy and tolerability of the ICE regimen and prognostic factors for survival in patientswith advanced or relapsed soft tissue sarcomas treated with the ICE regimen (ifosfamide, carboplatin and etoposide). Methods: The records of 28 patients diagnosed with advanced or relapsed soft tissue sarcoma who were treated withthe ICE regimen at our center between 2008 and 2020, were evaluated retrospectively. Results: The most common histopathological subtype were pleomorphic sarcoma (9/32.1%). After a median follow-upduration of 8 months, the median PFS and OS were 6 months (95% confidence interval (CI), 3.6–8.3) and 9.3 months(95% CI, 4.7–13.9), respectively. A multivariate analysis for overall survival revealed the ICE treatment line (HR:4.8, 95%Cl 1.7–12.8, p: 0.002), tumor site (HR: 0.12, 95% Cl 0.03–0.4, p: 0.001) and response to ICE regimen (HR: 0.09, 95% Cl0.01–0.49, p: 0.005) to be independent prognostic factors. The group that received 1–2 chemotherapy regimens priorto the ICE regimen recorded better OS than the group received more than two chemotherapy regimens (22.8 monthsvs 5 months, p: 0.006). Conclusion: The ICE regimen may be particularly effective when used for early treatment after doxorubicin-basedtherapy in patients with advanced or relapsed soft tissue sarcomas.
Laboratory and clinical characteristics of patients diagnosed with hellp syndrome due to microangiopathic hemolytic anemia and/or thrombocytopenia
(Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, 2020) Ekinci, Ömer; Ebinç, Senar
Objective: We aimed to present the pregnant patientswho were consulted with hematologists formicroangiopathic hemolytic anemia and/orthrombocytopenia and were diagnosed HELLPsyndrome.Materials and Methods: A total of 32 patients, whowere diagnosed with HELLP syndrome, were included inthis study. Patients with other microangiopathichemolytic anemia, including pre-eclampsia, eclampsia,thrombotic thrombocytopenic purpura, hemolytic uremicsyndrome, disseminated intravascular coagulation etc.were excluded.Results: The median age of all patients was 30.45 ±16.22 (18-52) years. According to the Mississippiclassification; 12 patients (37.5%) were in class 1 while 15patients (46.9%) were in class 2, and there was acuterenal failure in 4 patients (33.3%) in class 1 and 3patients (20%) in class 2. There was no acute renal failurepresent in the class 3 including a total of 5 patients(15.6%). There was renal failure in 6 (42.9%) of 14patients (43.7%) with HELLP syndrome, whosehemoglobin value was less than or equal to 8 gr/dl. Inpatients with HELLP syndrome, the renal failure risk ofthose whose hemoglobin value was less than or equal to8 gr/dl was significantly higher than those whosehemoglobin value was greater than 8 gr/dl (OR: 12.75, p= 0.0285).Conclusion: The mechanism of occurrence of HELLPsyndrome is not clear and have many overlapping clinicalaspects with the other thrombotic microangiopathicsyndromes. Renal failure is a complication of HELLPsyndrome. The most associated cases with renal failureare the presence of DIC and severe anemia in HELLPsyndrome. The hemoglobin value of less than 8 gr/dl is asignificant risk factor for renal failure in HELLPsyndrome.
Meme kanserli hastalarda Pet - BT ile tümör özellikleri arasındaki ilişki
(Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, 2022) Sezgin, Yasin; Karhan, Oğur; İleri, Serdar; Ebinç, Senar; Bilen, Erkan; Ürün, Muslih; Yerlikaya, Halis
Amaç: Meme kanseri dünya çapında kadınlarda en sık görülen ve en sık ölüme yol açan kanserdir. Pozitron emisyon tomografisi (PET) - bilgisayarlı tomografinin (BT) onkolojide kullanımı giderek artan öneme sahip olmaktadır. Çalışmamızda tümörün bazı özelliklerine göre 18 F-floro-2-deoksi-D-glukoz ( 18 F-FDG) tutulum yoğunluğu arasındaki ilişkiyi araştırmayı planladık. Gereç ve Yöntem: Çalışmamızda onkoloji kliniğimize meme kanseri teşhisi ile başvuran ve PET-BT çekimi yapılan 414 hastanın dosyası retrospektif incelendi. Çalışmaya 18-90 yaş aralığında olan meme kanserli hastalar dahil edildi. İkincil malignitesi olan, akli dengesi yerinde olmayan, 18 yaşından küçük ve 90 yaşından büyük hastalar çalışma dışı bırakıldı. Moleküler alt tiplere, tümör boyutlarına, vücut kitle indeksine ve proliferasyon indekslerine göre FDG tutulumları araştırıldı. Bulgular: Çalışmaya dahil edilen 414 hastanın yaş ortalaması 48.8 yıldı. Hastaların büyük çoğunluğunun alt tipi; invaziv duktal karsinom idi. Tanı anında 86 hasta metastatik evrede iken, 327 hasta lokal veya lokal ileri evredeydi. Çalışmada Ki-67 artışı ile FDG tutulumunun artışı arasında korelasyon saptandı ve istatiksel olarak anlamlı bulundu. Sonuç: Çalışmada tümör boyutu büyük olanlarda daha fazla FDG tulumu mevcut idi. Aynı şekilde proliferasyon indeksi artışında ve invaziv duktal karsinomda daha yüksek FDG tutulumu mevcut idi. Tümör özellikleri ile FDG tutulumları arasındaki ilişki gelecekte bireyselleştirilmiş tedavi için prediktif bir belirteç olarak kullanılabilir.
Prognostic factors and the prognostic role of inflammation indices in malignant pleural mesothelioma
(Bayçınar Tıbbi Yayıncılık, 2023) Ebinç, Senar; Oruç, Zeynep; Kalkan, Ziya; Karhan, Oğur; Urakçı, Zuhat; Küçüköner, Mehmet; Kaplan, Muhammet Ali; Işıkdoğan, Abdurrahman
Background: In this study, we aimed to investigate the prognostic factors of malignant pleural mesothelioma and the prognostic value of inflammation indices in malignant pleural mesothelioma. Methods: Between January 2002 and December 2019, a total of 132 patients (74 males, 58 females; mean age: 55 years; range, 31 to 79 years) diagnosed with malignant pleural mesothelioma were retrospectively analyzed. Patients’ demographic data and laboratory results were recorded. The prognostic value of the following five inflammation indices was evaluated: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, advanced lung cancer inflammation index, C-reactive protein/albumin ratio, and prognostic nutritional index. Results: Of all patients, 81% (n=107) were aged 65 or older and 61.4% (n=81) had an epithelioid histology. Of 12 variables examined in the multivariate analysis for their relationship with survival, age ≥65 years, non-epithelioid subtype, and prognostic nutritional index <40 were found to be poor prognostic factors. Based on the score constructed from these factors, the good prognostic group (score 0-1) had a median overall survival of 21 months and a one-year survival rate of 77.9%, while the poor prognostic group (score 2-3) had a median overall survival of nine months and a one-year survival rate of 29.7%. Conclusion: Our study results indicate that age ≥65 years, prognostic nutritional index <40, and non-epithelioid histological subtype are poor prognostic factors of malignant pleural mesothelioma.
Prognostic importance of primary tumor location in RAS mutant metastatic colorectal cancer
(Dicle Üniversitesi Tıp Fakültesi, 2019) Akdeniz, Nadiye; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Urakçı, Zuhat; Sezgin, Yasin; Ebinç, Senar; Bilen, Erkan; Karhan, Oğur; Laçin, Şahin; Büyükbayram, Hüseyin; Işıkdoğan, Abdurrahman
Objective: The prognostic value of tumor location in patients with metastatic colorectal cancer (mCRC) was reported by recent analyses in RAS wild-type patients. However, there is no enough specific data regarding prognostic value of primary tumor location in RAS mutated mCRC patients. We aimed to find if there is any relation between tumor prognosis and primary tumor location in patients with RAS mutated mCRC. Method: This retrospective study included 57 patients with mCRC who were diagnosed and treated in our hospital between January 2011 and December 2017. Characteristics features of the patients were obtained from our institution patient medical records. Patients were included to the present study if KRAS or NRAS mutation was detected in tumor tissues.Results: Twenty-nine (50.9%) of patients were female and the median age of all patients was 52 (18-80) years. Forty (70.2%) of 57 patients were defined as left side (LS) and 17 (29.8%) of patients were located in the right side (RS). As first line systemic treatment, twenty-five (43.9%) patients had received oxaliplatin-based chemotherapy while 32 (56.1%) patients had received irinotecan-based chemotherapy. Tumor sidedness did not affect on progression-free survival (PFS) (mPFS, 10.9 months for LS vs 8.1 months for RS, p=0.400) and overall survival (OS) (mOS, 20.9 months for LS vs 20.8 months for RS, p=0.930).The patients who had oxaliplatin based chemotherapy regimens showed better OS rate than irinotecan based regimens (28.7months vs16.3 months, p=0.017, respectively). Conclusion: Our study results support the thought that claims the sidedness of primary CRC in metastatic setting does not have effect on PFS and OS in patients with RAS mutant mCRC. However, our findings also underline the necessity of studies with larger patient populations and subgroup analyzes to evaluate potential prognostic and molecular features to determine the standart approach to this specific subgroup of the disease.
Rare tumours of the testis: twelve years of experience
(Universitas Carolina Pragensis, 2020) Oruç, Zeynep; Ebinç, Senar; Kaplan, Muhammet Ali
Rare tumours of the testis includes a wide variety of tumours. We aim to present clinical and histological characteristics of our patients with rare tumours of the testis. The medical records of 33 patients who were treated and followed-up for testicular rare tumours in our center between 2007 and 2020 were retrospectively reviewed. Of all the 243 testicular tumours, 222 cases (91.4%) were germ cell tumours and 21 cases (8.6%) were non-germ cell tumours. Thirty-three rare tumours of the testis including rare germ cell tumours and non-germ cell tumours were detected. The mean age of the patients at diagnosis was 34 years (range 18-68 years). The histological types of rare testicular tumours were as follows: teratoma 4.5% (n=11), sex-cord stromal tumours 4.5% (n=11), paratesticular tumours 3.2% (n=8), and the others [lymphoma 0.4% (n=1), mesothelioma 0.4% (n=1) and choriocarcinoma 0.4% (n=1)]. The median duration of follow-up was 32 months (range 1 to 256 months). None of the patients with non-metastatic disease stage developed recurrence after having received appropriate therapy. Metastatic disease was documented in 9 cases at the time of diagnosis (five patients with teratomas, two patients with Leydig cell tumour, one patient with choriocarcinoma and rhabdomyosarcoma). The most common subtypes of testicular rare tumours in our center was teratoma and sex-cord stromal tumours. Because of testicular rare tumours have different biological features and different clinical outcomes, the management of each tumour requires a different approach.

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