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Öğe 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, AbdurrahmanObjective 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.Öğe A case of primary pancreatic lymphoma followed in remision in the 9th year(Harran Üniversitesi, 2018) Oruç, İdris; Oruç, Zeynep; Küçüköner, Mehmet; Soylu, Berat Evran; Kaplan, Muhammet AliPrimary pancreatic lymphoma (PPL) is a rare form of ekstranodal, lymphomas, comprising 0.2-4.9% of pancreatic masses and <1% of all malignant lymphomas. Due to the rarity of PPL and nonspecific clinical symptoms and imaging, differentiation of PPL from adenocarcinoma is difficult without histopathologic diagnosis. Many patients with primary pancreatic lymphoma are diagnosed after radical surgery due to difficulties in diagnosis. Many patients with primary pancreatic lymphoma can be diagnosed after radical surgical treatments due to diagnostic difficulties. A 70-year-old patient presenting with abdominal pain was detected to have pancreatic mass. The post-operative pathologic outcome was reported as T-rich B-cell lymphoma. The patient was followed with complete remission after receiving six cycles of chemotherapy. This case report emphasizes the importance of distinguishing between pancreatic lymphoma and adenocarcinoma because of the different treatment strategies and prognoses.Öğe Approach to hypersplenism due to splenic metastasis of breast cancer: A case report(Dicle Üniversitesi Tıp Fakültesi, 2012) Küçüköner, Mehmet; Kaplan, M. Ali; İnal, Ali; Işıkdoğan, Abdurrahman; Fırat, Uğur; Önder, Akın; Uçmak, Feyzullah; Önder, Hakan; Akdoğan, M. RecaiThe most common sites for breast cancer metastasis include the bones, lungs, liver, lymph nodes, and brain. However, splenic metastasis of breast cancer is extremely rare. Hypersplenism occurs as a cause of severe hemolytic anemia in carcinomas or with marked splenic enlargement related to splenic metastasis. We presented a rare case of breast cancer with splenic metastasis that was undergone splenectomy to correct cytopenia related to hypersplenism. In the light of this case, splenectomy can be beneficial in the patients with hypersplenism.Öğe Are abdominal pain and distention symptoms of breast cancer?(2012) Kapan, Murat; Önder, Akın; Arıkanoğlu, Zülfü; Girgin, Sadullah; Fırat, Uğur; Küçüköner, MehmetMeme kanseri genellikle kemik, akciğer, karaciğer ve santral sinir sistemine metastaz yapar. İzole peritoneal meme kanseri metastazı oldukça nadir görülür. Kliniğimize karınağrısı şikayeti ile baş vuran hastanın sistemik muayenesinde, abdominal distanssiyon, asit ve memede kitle tespit edildi. Memeden alınan bşyopsi invazif duktal karsinom ve laparoskopik peritoneal biyopsi sonucu ise meme kanseri metastazı olarak değerlendirildi. palyatif kemoteripi plannanan hasta tedaviyi kabul etmedi. Altı ay takip edilen hastada başka bir metastaz gelişmedi.Öğe The comparison of FOLFOX regimens with different doses of 5-FU for the adjuvant treatment of colorectal cancer: a multicenter study(Springer, 2021) Akdeniz, Nadiye; Kaplan, Muhammet Ali; Uncu, Doğan; İnanç, Mevlüde; Kaya, Serap; Dane, Faysal; Küçüköner, Mehmet; Demirci, Ayşe; Bilici, Mehmet; Durnalı, Ayse Gök; Koral, Lokman; Şendur, Mehmet Ali Nahit; Erol, Cihan; Türkmen, Esma; Ölmez, Ömer Fatih; Açıkgöz, Özgür; Laçin, Şahin; Şahinli, Hayriye; Urakçı, Zuhat; Işıkdoğan, AbdurrahmanPurpose We aim to compare the efficiency and toxicity of three different 5-fluorouracil (5-FU) administration types in 5-FU, leucovorin, and oxaliplatin (FOLFOX) combination treatment for adjuvant therapy in colorectal cancer (CRC). Methods Five hundred and seventy patients with stage III colorectal carcinoma who received different FOLFOX regimens after curative resection were included. Patients were divided into three groups as FOLFOX-4, modified FOLFOX-6 (mFOLFOX-6), and mFOLFOX-4 for comparison of toxicity and disease-free survival (DFS) and overall survival (OS) times. Results Three-year DFS rates for FOLFOX-4, mFOLFOX-6, and mFOLFOX-4 groups were 65%, 72%, and 72%, respectively. Five-year OS rates for FOLFOX-4, mFOLFOX-6, and mFOLFOX-4 groups were 69%, 75%, and 67%, respectively. There was no statistically significant difference between the three treatment groups in terms of DFS and OS (p = 0.079, and p = 0.147, respectively). Among grade 1-2 adverse events (AE), thrombocytopenia, neuropathy, and stomatitis were more common in the mFOLFOX-6-treated group. The frequency of grade 1-2 nausea and vomiting were similar in mFOLFOX-6 (36.3% and 24%, respectively) and mFOLFOX-4 (32.4% and 24.7%, respectively) groups but were higher than that in the FOLFOX-4 (19.5% and 11.3%, respectively) group. Among the most common grade 3-4 AE, neutropenia (53.4%, 9%, and 13.5%, respectively) and diarrhea (10.5%, 2.2%, and 2.4, respectively) were more common in FOLFOX-4. The rate of anemia and febrile neutropenia was similar in treatment groups (p = 0.063, and p = 0.210, respectively). Conclusion In the adjuvant treatment of stage III CRC patients, three different 5-FU administration types in FOLFOX combination treatment can be used with similar efficiency and manageable toxicity.Öğe 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, AbdurrahmanObjective: 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.Öğe 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, AbdurrahmanIntroduction 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.Öğe 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, AbdurrahmanIntroduction. 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.Öğe 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, AbdurrahmanObjective: 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.Öğe Evaluation of pulmonary function after radiotherapy using helical tomotherapy for breast cancer treatment: Prospective study(KARE yayıncılık, 2016) Teke, Fatma; Demir, Melike; Bucaktepe, Pakize Gamze Erten; Kaya, Mehmet Ali; Doğan, Mehmet Hakan; Küçüköner, Mehmet; Zincircioğlu, Seyit Burhanedtin; Teke, MemikPurpose of the present study was to investigate acute pulmonary changes using pulmonary function tests (PFTs) after breast cancer irradiation with helical tomotherapy (HT). METHODS Forty patients were included in this study. Pretreatment and 3 months after completion of radiotherapy (RT), values of forced vital capacity (FVC), forced expiratory volume in first second (FEV1), and FEV1/ FVC ratio were measured and recorded. RESULTS Restrictive pattern was seen in 4 patients in baseline PFTs and moderate deterioration was observed in their measurements of PFT at 3 months after RT. Obstructive pattern was defined in only 1 patient in baseline PFTs and it remained unchanged after RT. Mild obstructive pattern in 4 patients and mild restrictive pattern in 3 patients had developed at 3 months after RT. CONCLUSION Minimal changes that result in mild restrictive and obstructive pattern in PFTs can be seen in acute phase after RT with HT.Öğe 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, AbdurrahmanAim: 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.Öğe Göğüs duvarı yerleşimli, nadir bir yumuşak doku sarkomu: Berrak hücreli sarkom(Dicle Üniversitesi Tıp Fakültesi, 2013) Alabalık, Ulaş; Keleş, Ayşe Nur; Büyükbayram, Hüseyin; Fırat, Uğur; Küçüköner, Mehmet; Hamidi, ArifYumuşak dokunun berrak hücreli sarkomları, nöral krest hücrelerinden köken alan, kötü prognozlu ender tümörlerdir. Histolojik özelliklerinin malign melanoma benzemesi sebebiyle (S-100 ve HMB- 45 pozitifliği, ultrastrüktürel melanozomların varlığı gibi) yumuşak dokuların malign melanomu olarak da dlandırılmıştır. Ancak berrak hücreli sarkom kutanöz melanomdan farklı olarak hemen her zaman derin yerleşimlidir ve davranışı farklıdır. Desmoplastik veya iğsi hücreli malign melanomun, dermis yerleşimli oluşu nedeniyle ayırıcı tanıları daha zor olabilmektedir. Vakamızda, geniş nekroz alanları yanısıra, gevşek stroma içinde, uniform görünümlü, veziküler nükleuslu, belirgin nükleollü, dar ve soluk-eozinofilik, kısmen şeffaf sitoplazmalı hücrelerden oluşan infiltratif tümör izlendi. İmmünohistokimyasal çalışmada tümörün vimentin, S-100, HMB45 ve SMA eksprese ettiği, CD34, PanCK, EMA, LCA, CD99 ve desmin ile immünreaksiyon göstermediği Ki-67 proliferasyon indeksinin ise %50 civarında olduğu tespit edildi. Derin yerleşim özelliği ve morfolojik-immünohistokimyasal bulguları bir araya getirildiğinde vaka ‘’berrak hücreli sarkom’’ olarak değerlendirildi. Hastanın 1 ay sonra gönderilen vertebra biyopsisinde benzer morfolojide tümör izlendi ve tümörün vertebraya metastazı şeklinde yorumlandı.Öğe Helicobacter pylori in primary gastric lymphoma and gastric cancer: A clinicopathologic and prognostic assessment(2013) Dal, Mehmet Sinan; Urakçı, Zuhat; Yıldız, Yılmaz; Alabalık, Ulaş; Küçüköner, Mehmet; İnal, Ali; Balakan, OzanAmaç: Helicobacter pylori mide lenfoması ve adenokarsinom için risk faktörüdür. Bu çalışmada H. pylori'nin primer mide lenfoma ve mide kanserinde prognostik faktör olup olmadığı incelendi.Yöntemler: Primer mide lenfoma ve mide kanserli 255 hastanın rezeksiyon veya biyopsi materyalleri H. pylori açısından incelendi. Patoloji spesmenlerinde H. pylori varlığını değerlendirmek için hematoksilen ve eozin boyası kullanıldı.Bulgular: Primer mide lenfomalı 140 hastanın 34'ünde (%24,3) H. pylori saptanırken mide kanserli 115 hastanın 62'sinde (%53,9) H. pylori saptandı. H. pylori varlığı mide kanserli hastalarda, mide lenfomalardan daha sık görüldü (p< 0.001). H. pylori pozitifliği, mide lenfoma içinde mukoza ilişkili lenfoid doku tip lenfomada (MALT) %53,5 oranında, diffüz büyük B hücreli lenfomadan farklı olarak %18,7 oranında görüldü (p< 0,001). Primer mide lenfoma da H. pylori'nin varlığı hastalıksız sağkalım ve genel sağkalım açısından anlamlılık oluşturmuyordu (p=0,833, p= 0,503). Bununla beraber mide kanserli hastalarda da H. pylori varlığı ile hastalıksız sağkalım ve genel sağkalımda da anlamlılık oluşturmuyordu (p=0,392, p= 0,357). Sonuç: Çalışmamızda mide kanserli ve primer mide lenfoma arasında H. pylori varlığı bakımından anlamlı farklılık vardı. Ancak H. pylori varlığı, hem hastalıksız sağkalım hem de genel sağkalım açısından prognostik anlamlılık oluşturmuyordu.Öğe 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, ZuhatObjectives: 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.Öğe The importance of serum and pleural fluid level of vascular endothelial growth factor (VEGF) and VEGF fluid/serum ratio in the differential diagnosis of malignant mesothelioma-related pleural effusion(Termedia Publishing House Ltd., 2017) Düzköprü, Yakup; Oruç, Zeynep; Kaplan, Muhammet Ali; Ülkü, Refik; Tanrıkulu, Çetin; Esmer, Derya; Bırak, Ali; Küçüköner, Mehmet; Urakçı, Zuhat; Işıkdoğan, AbdurrahmanAim of the study: Vascular endothelial growth factor (VEGF) is one of the parameters that has been studied in differential diagnosis of malignant fluids. This study is aimed at evaluate applicability of serum, fluid VEGF level and fluid to serum VEGF ratio in the diagnosis of malignant pleural mesothelioma (MPM). Material and methods: The patients with pleural effusion over age of 18, between 2011 and 2015 were included in the study. They were divided into three groups: Group 1 - mesothelioma patients; group 2 - other malignancies; and group 3 - benign aetiologies. Group 1 and 2 were termed as the malignant group. Fluid, serum VEGF levels, and the ratio of fluid/serum VEGF level were studied to evaluate the fluid/ serum VEGF ratio in all groups. Results: Twenty cases with mesothelioma, 44 cases with other malignancies, and 20 cases with benign aetiologies were included in this study. No statistically significant difference was found according to serum VEGF levels for all groups, (group 1: 437 ±324 pg/ ml, group 2: 354 ±223 pg/ml, group 3: 373 ±217 pg/ml, p = 0.836), while fluid VEGF levels showed a statistically significant difference (group 1: 3359 ±700 pg/ml, group 2: 2175 ±435 pg/ml, group 3: 1092 ±435 pg/ml, p = 0.041). The ratio of fluid to serum VEGF levels showed a difference, at the significance limit, between the malignant (group 1 and group 2) and benign (group 3) groups (8.83 ±1.29 vs. 4.57 ±1.07, p = 0.059) but showed a statistically significant difference between the mesothelioma and benign groups (12.11 ±1.68 vs. 4.57 ±1.07, p = 0.044). Conclusions: The VEGF fluid/serum ratio may be an applicable parameter in the differential diagnosis of malignant fluids, especially MPM.Öğe Investigation of the Clinicopathological Characteristics and Survival Outcomes of Patients Refusing Surgery Post-Neoadjuvant Therapy in Rectal Cancer(2022) Topuk, Savas; Kaplan, Muhammet Ali; Urakçı, Zuhat; Kalkan, Ziya; Küçüköner, Mehmet; Işıkdoğan, Abdurrahman; Oruç, ZeynepObjectives: In locally advanced rectal cancer, the standard treatment approach consists of post-neoadjuvant surgery and adjuvant chemotherapy. In this study, we aimed to evaluate the clinicopathological characteristics of patients receiving neoadjuvant therapy for a diagnosis of rectal cancer and to compare the survival outcomes of patients who underwent surgery and patients who refused the surgical approach after neoadjuvant therapy, regardless of response status. Methods: Our study included patients who presented to our clinic and underwent neoadjuvant therapy for locally advanced or oligometastatic rectal carcinoma between 2011 and 2021. Patients who did not complete neoadjuvant therapy or progressed on treatment were excluded. Patient data were retrospectively reviewed using the hospital records system. Results: Our study analyzed data from a total of 123 patients, consisting of 98 (79.7%) patients in the surgery arm and 25 (20.3%) patients in the refusal arm. In our study, 65 (52.8%) patients were female and 58 (47.2%) patients were male. Median age at diagnosis was 53 years (20-86). Most of the patients (75.6%) had stage-III disease. Regarding response to neoadjuvant therapy; complete response was obtained in 16.3% (n=20), partial response was obtained in 71.5% (n=88), stable disease was obtained in 12.2% (n=15) of the patients. After neoadjuvant therapy, 20.3% of the patients had refused surgery and started follow-up. Of the 98 (79.7%) operated patients, 77 (26.6%) had been treated with a low anterior resection and 21 (17.1%) with an abdominoperineal resection. During follow-up, 29.3% (n=36) of the patients showed recurrence or progression. While progression-free survival could not be reached for operated patients, patients refusing surgery had a median recurrence free survival of 32 months (6.3-57.6) (Log-rank p=0.003). Median overall survival was 144 months (46.3-241.6) in operated patients as opposed to 41 (23.0-58.9) months in those refusing surgery (Log-rank p<0.001). Operated patients and patients refusing surgery had three-year survival rates of 64.9% vs 40% (p=0.023) and five-year survival rates of 45.4% vs 16% (p=0.007), respectively. Conclusion: We determined that, in rectal cancer, both the overall survival and progression/recurrence-free survival outcomes of patients refusing surgery were poorer than those in the surgery arm, regardless of response status.Öğe İrritabl bağırsak sendromunda mukozal mast hücre artışı(2015) Küçüköner, Mehmetİrritabl barsak sendromu (IBS), kronik ve tekrarlayıcı karın ağrısı, diyare, kabızlık ve/veya karında şişkinlik ile seyreden fonksiyonel bir gastrointestinal bozukluktur. Kabızlık baskın (IBS-C), diyare baskın (IBS-D), karma tip (IBS-M) ve alt sınıfı olmayan şeklinde alt grupları tanımlanmıştır. Tanıyı kolaylaştırmak ve standardize etmek için semptoma dayalı Roma kriterleri geliştirilmiştir. İBS önemli biyolojik ve psikososyal faktörlerin etkileşimidir. Motilite değişikliği, visseral hiperaljezi, beyin barsak etkileşiminin bozulması, anormal merkezi işlem, otonom ve hormonal olaylar, genetik ve çevresel faktörler, postenfeksiyöz sekeller ve psikososyal bozuklukların bireye göre farklı katılımları olur. Sistemik mastositozun GİS ve GİS dışı semptomlarının IBS ile benzerliği, kolonik mukozal mast hücrelerinin sorumlu olup olmayacağı hipotezini gündeme getirmiştir. Bu hipotezden hareketle yapılan çok sayıda araştırmalarda IBS' lu hastaların kolon mukozasında mast hücre infiltrasyonu saptanmıştır. Çalışmamızda yapılmış araştırmaların işaret ettiği gibi IBS' nun düşük dereceli organik bir hastalık olup olmadığını belirlemeyi amaçladık. Bu amaç için yaş ve cinsiyet uyumlu, Roma-III kriterlerini karşılayan 72 İBS hastası ( IBS-D grup 40 kişi,İBS-K 32) ve 50 kontrol grubu oluşturuldu. Vakaların barsak temizliği lavman ile yapılıp, fleksibil kolonoskopi cihazı ile rektum ve çekum mukozasından forcepsle biopsiler alındı. Alınan biopsi materyeli Giemza ve Hematoksilen-Eozin ile boyandı. Biobsi kesitlerinin histolojik değerlendirmesi, ışık mikroskopisinde 10 odakta mast hücresi sayılıp, ortalaması alınarak 4 basamaklı skala (yok, az, orta, çok) ile yapıldı. Yine her üç grubun serum sitokinleri çalışılıp analizleri yapıldı. Çalışmamızın sonucunda IBS-D gruptaki hastalarımızın rektum ve çekum mukozasında mast hücre artışı ile inflamatuvar sitokinlerden de sIL-2R düzeyinde artış saptandı Çalışmamız IBS'nin fizyopatolojisinde düşük dereceli inflamasyonun olduğunu göstermektedir. IBS' nin patogenezinden sorumlu tutulan inflamasyonda ve visseral hipersensitivitede mukozal mast hücre infiltrasyonun rolu olduğunu desteklemektedir. Anahtar Kelimeler: BS, mast hücreÖğe Kanser tedavisinde mTOR sinyal yolağı ve mTOR inhibitörleri(Dicle Üniversitesi Tıp Fakültesi, 2013) Küçüköner, Mehmet; Işıkdoğan, AbdurrahmanmTOR (Rapamisin protein kompleksinin memeli hedefi) hücre büyümesi ve metabolizmasında önemli role sahiptir. Kanserde önemli olduğu saptanan üç temel sinyalizasyon yolu; (PI3K)/AKT kinaz zinciri, protein kinaz C ailesi (PKC) ve mitojenle aktive olan protein kinaz (MAPK)/Ras vardır. mTOR; PI3K/AKT sinyal yolağının akış aşağı aktivasyonunda anahtar bir kinazdır. Bu yolaklar sıklıkla kanserde bozulur ve bu yüzden de mTOR önemli bir antitümör hedeftir. Antikanser ajanlar olarak mTOR inhibitörleri rapamisin ve ondan türetilmiş temsirolimus, everolimus ve ridaforolimus sonradan deforolimus oluşturmaktadır. mTOR inhibitörleri birçok kanser tipinde önemli bir hedeftirÖğe Kolorektal kanserler: Tek merkez 12 yıllık sonuçları(2013) Önder, Akın; Küçüköner, Mehmet; Büyükbayram, Hüseyin; Kaplan, M.Ali; Nas, Necip; Urakçı, Zuhat; Keleş, AyşenurAmaç: Bu çalışmamızda kliniğimizde takibi yapılmış olankolorektal kanserli hastaların demografik, epidemiyolojik, klinik özellikleri ve sağkalımını etkileyen faktörlerin retros-pektif olarak belirlenmesi amaçlanmıştır.Yöntemler: Dicle Üniversitesi Tıp Fakültesi Tıbbi Onko-loji Bilim Dalı’nda 2000- 2012 tarihleri arasında takip edil-miş 767 kolorektal kanser tanılı hasta retrospektif olarakdeğerlendirildi.Bulgular: Çalışmada hastaların 432’si (%56,3) erkek, 335’i( %43,7) kadın olup ortanca yaş 54 (11-94) idi. Ev- resine bakılan 725 hastanın 57’si (%7,9) evre I, 230’u (%31,7) evre II, 248’i (%34,2) evre III ve 190’u (%26,2) evre IV olarak tespit edildi. Tüm hastaların ortanca takip süresi 24.8 (1.5-154.1) aydı. Hastaların 275’inde (%35.9) nüks veya progresyon, 184’ünde (%24) ölüm gözlendi. Hastalıksız sağkalım oranları (HSK) %1,3 ve 5 yıllık %81, %62 ve %29 iken, genel sağkalım (GSK) oranları 1,3 ve 5 yıllık %88, %74 ve %49 idi. Yaş grubuna göre değer- lendirildiğinde 60 yaş ve altında olan hasta grubunda 60 yaş üstü gruba kıyasla hem HSK hem de GSK daha iyiydi (p=0.053 ve p=0.024). Evre ile HSK ve GSK arasında- da anlamlı farklılıklar görüldü (p<0.001 ve p<0.001). Tü- mör diferansiyasyon derecesi de HSK üzerinde etkilydi (p=0.027). Yapılan multivaryant cox regresyon analizde evrenin hem HSK hem de GSK açısından bağımsız prog- nostik faktör olduğu görüldü (p<0,001, p<0,001). Sonuç: Bölgemizde başvuran hastaların çoğunluğu %60,4 ile lokal ileri ve metastatik evredeydi. Evre, histo- lojik grade ve ileri yaş, hem hastalıksız sağkalım hem de genel sağkalım üzerine etkili prognostik faktörler olarak bulundu. Multivariyant analizde evre hem genel sağkalım hem de hastalıksız sağkalım açısından bağımsız prog- nostik faktör olduğu görüldü.Öğe A Low body fat mass ratio predicts poor prognosis in patients with advanced non-small cell lung cancer(Routledge Journals Taylor & Francis Ltd., 2022) Oruç, Zeynep; Akbay, Ahmet; Kaplan, M. Ali; Oruç, İdris; Urakçı, Zuhat; Küçüköner, Mehmet; Işıkdoğan, AbdurrahmanPurpose The aim of this study was to investigate the effect of the body fat mass ratio on survival and prognosis in advanced non-small-cell lung cancer patients. Methods The study includes 200 patients who were diagnosed with advanced non-small-cell lung cancer between 2014 and 2018 and whose body fat mass percentage and body mass index (BMI) were determined using the Tanita Body Composition Analyzer during admission. Results All patients had advanced incurable non-small-cell lung cancer (30% had locally advanced disease, 70% were stage IV). In the univariate and multivariate analyses, age, gender, histopathological type, smoking history, comorbidities, weight loss in the last six months and body mass index had no statistically significant effect on survival (p > 0.05). However, the performance status (p = 0.008), metastatic status (p = 0.003) and body fat mass ratio (p = 0.01) were found to have a significant effect on overall survival (OS): the median OS was 16.4 mo, in patients with the BFM ratio <= 22% and 29.2 mo, in those with > 22% (p = 0.01). Conclusion In this study, it was found that the body fat mass ratio was an important prognostic factor in patients with advanced non-small-cell lung cancer.
