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    Clinical, Laboratory and Radiologic Course and Prognosis of COVID-19 in Cancer Patients and Comparison with General Population: A Single-Center Experience
    (Akad Doktorlar Yayinevi, 2021) Erdur, Erkan; Yildirim, Ozgen Ahmet; Poyraz, Kerem; Can, Canan; Komek, Halil
    In this study, we aimed to investigate the clinical findings and follow-up data of patients with COVID-19 and had a history of cancer, and compare these data with other COVID-19 patients. We included 2349 COVID-19 inpatients between March 2020 and July 2020. 82 of these patients were found to have a cancer diagnosis (Group 1). Patients undergoing chemotherapy were assigned to group 1A, patients receiving non-chemotherapy treatment were assigned to group 1B, cancer patients without any treatment to group 1C and non-cancer patients to group 2. These groups were compared in terms of basic demographic characteristics, symptoms, comorbidities, laboratory and imaging findings, intensive care unit (ICU) admission rate and death. The median age of the patients in group 1 was statistically higher than group 2 (61 and 52, p< 0.001). The most common cancer diagnosis was breast cancer (n= 16, 19.5%). Inflammatory parameters such as CRP and D-dimer were found to be higher in patients in group 1 than group 2 (p= 0.005 and p= 0.003, respectively). The mortality rate of the patients in group 1 was 15.8%, while the mortality rate in group 2 was 5.1% and this was statistically significantly higher (p< 0.001). Being in group 1 and group 1A were determined as the predictive parameters for death (r= 0.087, p< 0.001 and r: 0.254, p= 0.021 respectively). Our data suggests that history of cancer and active chemotherapy treatment are independent prognostic factors for severe disease and mortality in COVID-19.
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    Correlations between whole body volumetric parameters of 68Ga-PSMA PET/CT and biochemical-histopathological parameters in castration-naive and resistant prostate cancer patients
    (Springer, 2021) Yildirim, Ozgen Ahmet; Gundogan, Cihan; Can, Canan; Poyraz, Kerem; Erdur, Erkan; Komek, Halil
    Objective To evaluate the relationship between whole body volumetric (Wbv) results of Ga-68-PSMA PET/CT with biochemical and histopathological parameters. Methods One hundred twenty-one prostate cancer patients who underwent Ga-68-PSMA PET/CT between January 2018 and December 2019 were included. Imaging was conducted for staging upon new diagnosis with moderate- and high-risk disease and for confirming the progression of castration resistance. The relationships between the Wbv Ga-68-PSMA PET/CT parameters and prostate-specific antigen (PSA) levels, PSA doubling time and Gleason score (GS) were evaluated. Results The median GS and mean PSA levels were similar between the castration-naive and resistant patients. The PSA levels were positively correlated with MTVwb (p: 0.009, r: 0.286) and TLPwb (p: 0.002, r: 0.344). Gleason scores were positively correlated with MTVwb (p: 0.050, r: 0.216), TLPwb (p: 0.007, r: 0.296) and highest standard uptake value (HSUV) max (p: 0.047, r: 0.220). In the castration-naive group, Gleason scores (from p < 0.001 to p = 0.04 and r = 0.331 to 0.549) and PSA levels (from p = 0.002 to p = 0.045 and from r = 0.323 to 0.473) correlated with all Ga-68-PSMA-PET/CT parameters. PSA doubling time was negatively correlated with whole-body metabolic tumour volume (MTVwb) (p: 0.050, r: 0.232) and whole-body total lesion PSMA (TLPwb) (p: 0.026, r: 0.262). The MTVwb, TLPwb and HSUVpeak values of the patients with biochemical recurrence (BR) of 0-6 months (n = 18) were higher than those with BR > 2 years (n = 35) (p = 0.046, 0.047 and 0.042, respectively). Conclusions Wbv Ga-68-PSMA PET/CT results were correlated with PSA levels and Gleason scores. The correlation was relatively stronger in the castration-naive group. The prognostic accuracy of PSA in the resistant group may be weaker than in the naive group. The difference in volumetric parameters of patients with short BR compared to long BR supports the idea that Ga-68-PSMA PET/CT can distinguish patients with rapid relapse from others.
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    Depression and anxiety in cancer patients before and during the SARS-CoV-2 pandemic: association with treatment delays
    (Springer, 2021) Yildirim, Ozgen Ahmet; Poyraz, Kerem; Erdur, Erkan
    Purpose Pandemics can be associated with anxiety and depression in cancer patients who are undergoing treatment. In the present study, we aimed to perform a comparative evaluation of the conditions of cancer patients before and during the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to detect the impact of the pandemic on treatment delays that are associated with anxiety and depression in cancer patients. In addition, the effect of public transport use on treatment delays was examined. Methods BDI and BAI were administered to 595 breast, ovarian, colon and gastric cancer patients before and during the pandemic. The questionnaires were administered by the physician blindly, who was unaware of the delay of the patients. The number of days by which the patients delayed their treatment due to the fear of contamination were recorded retrospectively. Correlation analyses were performed between the obtained scores and treatment delays. Results The depression and anxiety levels in cancer patients were found to increase during the pandemic (p = 0.000), and this increase was positively correlated with the disruption of their treatment (p = 0.000, r = 0.81). Depression and anxiety levels and treatment delays were higher in elderly patients (p = 0.021). Depression and anxiety were more pronounced in female patients (p = 0.000). Moreover, treatment delays were more common in patients who had to use public transportation (p = 0.038). Conclusion SARS-CoV-2 pandemic may increase anxiety and depression in cancer patients. This can cause patients to experience treatment delays due to concerns about becoming infected. At this point, if necessary, assistance should be obtained from psychiatric and public health experts.
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    Nivolumab-Related Dry Mouth and Dry Eye: Cross-Sectional Study
    (Taylor & Francis Inc, 2021) Yildirim, Ozgen Ahmet; Poyraz, Kerem; Erdur, Erkan; Can, Canan; Gundogan, Cihan; Guzel, Yunus; Etem, Hulya
    To evaluate ICIs related dry eye and dry mouth in nivolumab therapy, 24 patients receiving nivolumab (group 1), 30 patients in remission without treatment for 6 months (group 2), 30 healthy participants (group 3) were cross-sectionally examined. Schirmer's 1, 2, TSH blood tests, serological analysis, salivary flow scintigraphy and minor-salivary gland biopsy were performed. Schirmer's tests were performed with anesthetic (1) and without anesthetic (2). Schirmer's scores were lower in group 1 with more frequent reduced tear production (p < 0.001). TSH levels negatively correlated with Schirmer's scores. Functional insufficiency was detected by salivary flow scintigraphy in 7 out of 10 patients with Schirmer's test positivity. In Schirmer's positive patients, lymphocytic sialadenitis was confirmed in 4 patients (focus score > 1) and CD4 T lymphocyte precipitation was observed in 6 patients. Nivolumab therapy may be associated with ICIs related immune sicca.
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    Perioperative Docetaxel, Oxaliplatin, Fluorouracil, and Leucovorin (FLOT) in Patients with Gastric or Esophagogastric Junction Adenocarcinoma; Real-Life Experience
    (Akad Doktorlar Yayinevi, 2020) Yildiz, Fatih; Eraslan, Emrah; Ilhan, Aysegul; Demir, Hacer; Demir, Nazan; Erdur, Erkan; Yildirim, Ozgen Ahmet
    In patients with gastic cancer, five-year survival is poor in the locally advanced stage. Docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) combination regimen has been shown to provide a survival advantage in the locally advanced stage. In this study, we aimed to evaluate the efficacy and tolerability of FLOT with real-life data in patients with locally advanced gastric/esophagogastric junction cancers. This retrospective study was conducted between June 2016 - March 2020 and included 106 patients' data from six centers in Turkey. Median age was 60 (33-82). Primary tumor localization was stomach in 76 (71.7%) patients. Seventy-six (71.7%) patients were operated after median 4 (1-8 cycles) cycles of preoperative FLOT. Pathological complete regression (pCR)was obtained in 10 (13.1%) of the operated patients. Median follow-up was 9.1 (1.4-45.7) months. One-year DFS was 63.2% and the two-year OS was 65.1%. Three (2.8%) patients had chemotherapy-related deaths. Due to chemotherapy-related toxicity and intoleration, 19 (17.9%) patients had dose reduction. The pCR obtained by FLOT appears higher than other regimens. This study is one of the rare mufticentric real-life data showing the efficacy and tolerability of the FLOT regimen in the perioperative treatment in GC and EJC.
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    Role of 68Ga-PSMA PET/CT parameters in treatment evaluation and survival prediction in prostate cancer patients compared with biochemical response assessment
    (Hellenic Soc Nuclear Medicine, 2021) Can, Canan; Gundogan, Cihan; Yildirim, Ozgen Ahmet; Poyraz, Kerem; Guzel, Yunus; Komek, Halil
    Objective: In this study, we aimed to evaluate the concordance of biochemical treatment response with gallium-68-prostate specific membrane antigen (Ga-68-PSMA) positron emission tomography/computed tomography (PET/CT) treatment response in prostate cancer (PCa) and investigate their prognostic effects on survival. Materials and Methods: One hundred and fifty-one patients with PCa, who underwent Ga-68-PSMA PET/CT imaging in our clinic between May 2016 and December 2019, were on treatment, and had pre-treatment and post-treatment imaging studies were included in our study. The treatment patients received and prostate-specific antigen (PSA) levels at the time of PET/CT imaging were recorded. Pre- and post-treatment whole-body metabolic tumor volume (MTVw), whole-body total lesion PSMA (TLPw), percent change in PSA (Delta PSA), Delta MTV, and Delta TLP values were calculated in all patients. Survival time of all patients was measured from the time of initial PET imaging. Results: Median age of patients included in our study was 71 years (range: 51-88). When Delta PSA response and Delta TLP response were evaluated together (r:0.71, P<0.001 and k:0.541, P<0.001), statistically significance strong correlation and moderate concordance was observed. Delta PSA response and Delta MTV treatment response had statistically significant moderate correlation and moderate concordance (r: 0.66, P<0.01 and k: 0.454, P<0.001, significantly). Between Delta PSA response and Delta TLP and Delta MTV response had stronger correlation and higher concordance when PSA levels were above 10. Multivariate analyses using multiple Cox regression analysis revealed MTVw1 and Delta MTV parameters to be independent prognostic factors for mortality (P:0.003 and P:0.001, respectively). Conclusion: We observed that biochemical response and whole-body volumetric Ga-68-PSMA PET/CT parameter response showed correlation and concordance in all groups with PCa, which was more significant when PSA level was >= 10ng/mL. MTVw1 and Delta MTV parameters obtained via Ga-68-PSMA PET/CT were independent prognostic factors for mortality in Pca. Gallium-68-PSMA PET/CT is a valuable imaging technique for diagnostic purposes as well as follow-up and prognostic evaluation.
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    The role of inflammatory parameters in predicting disease recurrence in patients with stage IIA colon cancer with no high-risk features
    (Taylor & Francis Ltd, 2021) Erdur, Erkan; Yildirim, Ozgen Ahmet; Poyraz, Kerem; Aslan, Ferit; Yildiz, Fatih; Komek, Halil
    Objective: We aimed to investigate the roles of inflammatory parameters, including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and C-reactive protein/albumin ratio (CAR), in predicting disease recurrence in patients with stage IIA (T3N0M0) high microsatellite instability and microsatellite-stable colon cancer who had no risk factors associated with relapse. Materials and methods: We evaluated 155 patients with colon cancer followed in 3 hospitals in Turkey between February 2009 and March 2020. These patients had stage IIA disease and had no risk factors associated with relapse. None of the patients received adjuvant chemotherapy. NLR, PLR, LMR, and CAR parameters were retrospectively obtained from laboratory results at the time of diagnosis, and their associations with disease recurrence were assessed. Results: Over a median follow-up period of 38 months (range: 4-98 months), 11 of the 155 patients experienced relapse or developed metastases. Multivariate Cox analyses revealed that NLRs of >= 3.12 (hazard ratio [HR]: 0.041, 95% confidence interval [CI]: 0.048-0.826, p = 0.006) and CARs of >= 0.027 (HR: 0.199, 95% CI: 0.004-0.404, p = 0.026) were independent prognostic markers predicting relapse. The median 5-year recurrence-free survival rate of patients with NLRs of >= 3.12 at the time of diagnosis was 88.0%; this rate was 100% in patients with NLRs of <3.12 (p < 0.001). Similarly, the median 5-year recurrence-free survival rate of patients with CARs of >= 0.027 at the time of diagnosis was 84.7%; this rate was 95.7% in patients with CARs of <0.027 (p = 0.016). Conclusion: In this study, NLR and CAR were found to be independent prognostic markers predicting disease recurrence in patients with stage IIA colon cancer who did not receive adjuvant chemotherapy due to low clinical risk.
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    Roles of metabolic tumor volume and total lesion glycolysis on 18F-FDG PET/CT, CA19-9 levels, and complete blood parameters in predicting survival in patients with unresectable or metastatic pancreatic cancer
    (Edizioni Luigi Pozzi, 2022) Erdur, Erkan; Guzel, Yunus; Yildirim, Ozgen Ahmet; Poyraz, Kerem; Yildirim, Mehmet Serdar; Kaplan, Ilsan
    AIM: In this study, we aimed to investigate the roles of volume based F-18-FDG PET/CT parameters, CA19-9 levels, and complete blood count parameters in predicting survival in patients with unresectable and/or metastatic pancreatic ductal adenocarcinoma. MATERIALS AND METHOD: Fifty-seven pancreatic cancer patients who were followed in University of Health Sciences Gazi Yasargil Training and Research Hospital between January 2017 and June 2020, declined surgical treatment and/or radiation therapy or had medically inoperable, unresectable, or metastatic disease, and received chemotherapy were included in the study. F-18-FDG PET/CT images of patients were evaluated and calculated metabolic tumor volume (MTV) and total lesion glycolysis (TLG) parameters were compared with CA19-9 levels and complete blood count parameters. Patients were assessed in two groups as survivors and non-survivors. RESULTS: Total MTV and total TLG on F-18-FDG PET/CT were significantly higher among non-survivors than survivors (p: 0.023 and 0.034, respectively). Multivariate Cox regression analysis revealed that TLG higher than 46 g/ml.cm(3), MTV higher than 11.02 cm(3) (OR 0.987, 95%CI 0.976-0.999, p:0.029 and OR 0.246, 95%CI 0.089-0.685, p: 0.007, respectively) and elevated MPV (OR:0.785, 95% CI 0,574-0.976, p:0.042) were independent prognostic factors for predicting mortality. CONCLUSION: TLG >46 g/ml.cm(3) and MTV >11.02 cm(3) in F-18-FDG PET/CT and elevated MPV in complete blood count are independent prognostic factors for predicting mortality in patients with unresectable or metastatic pancreatic cancer who are treated with chemotherapy.