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    Classic Kaposi's sarcoma: A review of 156 cases
    (Elsevier Ltd, 2018) Çetin, Bülent; Aktaş, Bilge; Bal, Oznur; Algin, Efnan; Akman, Tülay; Koral, Lokman; Kaplan, Mehmet Ali; Uncu, Doğan; Özet, Ahmet
    Background: Kaposi's sarcoma (KS) is a reactive, multifocal, multicentric, angiogenic neoplastic proliferation that is thought to originate from endothelial cells that are infected with human herpesvirus-8 (HHV-8). This report examines a cohort of patients with classic Kaposi's sarcoma (KS) evaluated at the national institute of oncology over the 13-year period. Methods: A retrospective analysis of 156 patients with classic KS, between January 2000 and November 2013, was performed. This study focused on the clinical presentation, staging, diagnosis, and treatment of classic KS. Results: One hundred fifty-six patients (median age 69 and 115 male) were enrolled into the study. Median age at diagnosis was 69 (range: 32–95 years). Male/female ratio was 2.80. The most common location was the lower limbs. There were 75 stage I patients (48.1%), 8 stage II patients (22.4%), 31 stage III patients (19.9%) and 15 stage IV patients (9.6%). Surgery was the most common local treatment method (43%). 44 patients (28.2%) received radiotherapy (RT) at diagnosis. Cytotoxic treatment with chemotherapy or interferon-α was administered in 57 patients. Visceral involvement was observed in 10 patients (lung: nine patients, liver: one patient) and bone metastasis occurred in two patients at relapse. Conclusion: This study is one of the largest reported series. Further studies are required and it will be important to standardize the assessment of disease activity and clinical response.
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    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, Abdurrahman
    Purpose 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.
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    A multicentre, multinational study of clinical characteristics and prognosis of hepatocellular carcinoma
    (World Health Organization, 2023) Dirican, Ahmet; Uncu, Doğan; Sekacheva, Marina; Artaç, Mehmet; Aladashvil, Archil; Erdoğan, Atike; Kaplan, Muhammet
    Background: Hepatocellular carcinoma (HCC) is a significant health problem, and the associated mortality rate is increasing. Aim: We aimed to determine the clinical characteristics and prognosis for HCC in member countries of the OncoBridge Study Group. Methods: We recruited 630 patients diagnosed with HCC between 2013 and 2019 from 4 countries (Türkiye, Russia, Georgia, and Greece). Univariate and multivariate analyses were conducted to investigate clinical and laboratory prognostic factors. Receiver operating characteristic (ROC) analysis was used to determine the prognostic value of the neutrophil to lymphocyte ratio (NLR) and alpha-fetoprotein (AFP) value. Results: The 3 most common etiological factors were hepatitis B infection (39.7%), hepatitis C virus infection (17.0%) and non-alcoholic fatty liver disease (9.0%). Median overall survival for the whole group was 25 [95% confidence interval (CI): 15.7–34.2] months. Cut-off values for AFP and NLR were accepted as 200 ng/mL and 3.45, respectively. The area under the ROC curve values for AFP, NLR and NLR+AFP were 0.625 (95% CI: 0.547–0.704), 0.589 (95% CI: 0.512–0.667) and 0.657 (95% CI: 0.583–0.731). From the multivariate analysis, advanced tumour size, lymph node involvement and metastasis (TNM) stage, presence of cirrhosis, high AFP, and high NLR values were associated with poor survival. Conclusion: AFP, NLR, advanced TNM, and presence of cirrhosis may predict prognosis in patients with HCC. Studies involving more countries are needed to corroborate these findings.
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    Predictive and Prognostic Value of ABO Blood Group in Patients Using Immune Checkpoint Inhibitor for Advanced Renal Cell Carcinoma
    (2022) Ergün, Yakup; Urakçı, Zuhat; Yazıcı, Ozan; İmamoğlu, Gökşen İnanç; Kahraman, Seda; Açıkgöz, Yusuf; Uncu, Doğan
    Objective: We investigated the prognostic and predictive effects of the ABO blood group system on patients receiving immune checkpoint inhibitors for advanced renal cell carcinoma (RCC). Material and Methods: In this retrospective observational study, the data on the patients with known ABO blood group, who were administered nivolumab for mRCC, were reviewed. The tumor response rates and survival were analyzed based on the ABO blood group. Results: A total of 89 patients were included in the study. The median age of the patients was 57 (range: 24-83 years) years, and 67% (n=60) of the patients were male. Moreover, 43%, 18%, 9%, and 30% of the patients had blood groups A, B, AB, and O, respectively. Our study had a median follow-up time of 11 months. Although the groups did not differ significantly in progression-free survival (PFS) and overall survival (OS) according to the blood groups, patients who had the B blood type survived longer. For patients with blood types A, B, AB, and O, the median PFS was 5.3 months, 8.4 months, 3.7 months, and 7.8 months, respectively (p=0.8), and the median OS was 14.5 months, 20.3 months, 12.0 months, and 16.5 months, respectively (p=0.8). Conclusion: Although the groups did not differ significantly according to the ABO blood group, the patients with the B blood group survived relatively longer. These results suggested that further studies with more patients should be conducted.
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    Sunitinib or pazopanib: Is there any difference between tyrosine kinase inhibitors in the pre-nivolumab setting in metastatic renal cell carcinoma?
    (Cureus Inc., 2020) Uçar, Gökhan; Açıkgöz, Yusuf; Ergun, Yakup; Bal, Öznur; Yılmaz, Mesut; Karakaya, Serdar; Akdeniz, Nadiye; Köstek, Osman; Isak, Özlem Aydın; Şener, Görkem Yazıcı; Dirikoç, Merve; Esen, Selin Aktürk; Doğan, Mutlu; Uncu, Doğan
    Introduction Treatment options for metastatic renal cell carcinoma disease have been improved in recent years. However, there is still no optimal treatment sequence or combination for metastatic disease. We aimed to investigate whether patients differed in terms of disease outcomes regarding pre-nivolumab tyrosine kinase inhibitors (TKIs). Material and methods The analysis of patients was performed after all cohorts were sub-grouped into two groups according to pre-nivolumab TKIs as following the sunitinib arm and the pazopanib arm. Result A total of 75 patients were included in this study. The median follow-up time was eight months for all cohorts. The objective response rate was statistically significantly higher in the pazopanib arm as compared to the sunitinib arm (56% vs 30%, p=0.02). Progression-free survival was significantly higher in pazopanib than sunitinib (10.3 months vs 5.3 months, p=0.02). Multivariate analysis revealed that pazopanib treatment was associated with better progression-free survival (HR: 0.44, 95 CI; 0.22-0.91, p=0.02). While the median overall survival for patients who had received sunitinib was 11.0 months, it has not been reached the median in the pazopanib arm (11.0 months vs NR, p=0.051). Discussion We demonstrated significantly better progression-free survival and a higher objective response rate with nivolumab treatment in patients who had received pazopanib as compared with patients who received sunitinib in the pre-nivolumab period.
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    Superiority of Pathologic Lymph Node Ratio over Positive Lymph Node Count in Operated Early-Stage Breast Cancer
    (Edizioni Luigi Pozzi, 2024) Urakçı, Zuhat; Ali Kaplan, Muhammet; Oruç, Zeynep; Gümüş, Mahmut; Uncu, Doğan; Ebinç, Senar; Özkan, Metin
    AIM: In early-stage breast cancer, the axillary lymph nodes play a crucial role in determining the prognosis of the disease. The rate of lymph node involvement might be a more valuable prognostic factor than the number of positive lymph nodes. Therefore, we aimed to evaluate whether the lymph node ratio (LNR) is a superior prognostic indicator compared to the pathologic lymph node count in early-stage disease. METHODS: We included 3053 non-metastatic, lymph node-positive breast cancer patients who were treated and followed at 6 medical oncology centers in Türkiye between 2004–2018. Based on LNR, patients were classified into three risk groups: high (>0.65), intermediate (0.21–0.65), and low (≤0.20). RESULTS: Classification of patients according to the TNM8 system based on the number of positive lymph nodes revealed that pathologic lymph node count (pN)1 accounted for 49.0% (n = 1495), pN2 for 30.0% (n = 917), and pN3 for 21.0% (n = 641). Based on the LNR risk group, the low-risk group accounted for 45.4% (n = 1385), intermediate for 36.2% (n = 1105), and high for 18.4% (n = 563) of the total patients. For the entire patient cohort, the 5-and 10-year disease-free survival (DFS) were 93% and 67%, respectively, while overall survival (OS) rates were 95% and 75%, respectively. The median DFS for patients with N1, N2, and N3 disease was 149 months (94.2–203.7), 120.1 months (108.2–132.0), and 81.8 months (68.4–131.1), respectively (p < 0.001). The median DFS for the three LNR risk groups (low, intermediate, and high risk) was 148.9 months (95.3–202.6), 118.7 months (99.9–137.7), and 81.8 months (68.2– 95.3) respectively. Increasing LNR rate was an independent prognostic factor for DFS, according to multivariate analysis (p < 0.001). Furthermore, the median DFS was 133 months for pathologic N1 patients in the LNR intermediate-high risk group, while the median DFS was not reached in patients with LNR and the pN2 low risk group (p = 0.034). CONCLUSIONS: This study confirms the significance of LNR as a prognostic factor for DFS. The results show that in certain specific subgroups, LNR provides more information than pathologic lymph node counts. © 2024 The Author(s).
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    Third-line Therapy for Metastatic Renal Cell Carcinoma and Its Effect on Quality of Life and Overall Survival: A National, Multicenter, Observational Study
    (2020) Öztop, İlhan; Özkan, Metin; Alacacıoğlu, Ahmet; Dane, Faysal; Uncu, Doğan; Elkıran, Emin; Öksüzoğlu, Ömür
    Objective: The study aimed to evaluate the efficacy of targeted therapies used as the third-line treatment after first-line cytokineand second-line tyrosine kinase inhibitor (TKI) therapies in metastatic renal cell carcinoma (mRCC) patients and assess the quality of life (QoL)of patients. Material and Methods: This national, multicenter, non-interventional study included patients aged ?18 years with histologicallyconfirmed mRCC, receiving targeted therapies as the third-line treatment for the last one month. Overall survival (OS), progression-free survival (PFS), adverse events (AEs), and QoL were evaluated. Results: The study included 102 mRCC patients (74 males) (median age of 61years). The median disease duration since diagnosis was 27.5 months (ranging 4-201 months). Of all the patients, 75.5% and 24.5% were receiving Axitinib and Everolimus, respectively, as third-line therapy. In all patients, the one-year PFS and OS rates were 62.9% and 79.9%,respectively. Seventy-one AEs (mostly mild) developed in 29 (28.4%) patients, fatigue being the most common (9.8%) AE. As compared tothe baseline, no significant change was observed in the QoL scores of patients in the 12th month. The Axitinib and Everolimus groups did notdiffer significantly as regards to PFS and OS. Of the 11 patients with grade III-IV AEs, four were from the Everolimus group, and seven belonged to the Axitinib group. The QoL scores did not show a significant difference between the two groups except for that in the 12th month.Conclusion: Third-line therapy in mRCC patients was found to be effective and tolerable. Prolonged survival in mRCC patients receiving anincreasing number of therapy lines requires further evaluation of QoL, considering it to be a part of treatment assessment.