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Publication Metadata only The effect of progressive muscle relaxation exercises on sleep quality in cancer patients undergoing chemotherapy: a randomized controlled study(Elsevier Inc., 2024) Sarı, Ebru; Gündogdu, Fatma; Semerci, Remziye; School of NursingObjectives: This study aimed to evaluate the effect of progressive muscle relaxation exercises (PMRE) on sleep quality in patients undergoing chemotherapy treatment and experiencing disturbed sleep. Methods: The prospective randomized controlled study was conducted between March and September 2022 with 69 patients (intervention group: 34 patients, control group: 35 patients) in a hospital chemotherapy unit. During the data collection process, the “Personal Information Form” and “Pittsburgh Sleep Quality Index (PSQI)” were utilized. Patients in the intervention group performed PMRE twice a day for 8 weeks. Patients in the control group received routine care at the clinic without additional intervention. For data analysis, Student's t-test, Mann–Whitney U test, Fisher's exact test, and chi-square test were used. Results: The sociodemographic attributes of patients within both the intervention and control groups exhibited comparability. However, notable distinctions emerged in the PSQI Global sleep score and PSQI subdimension scores, encompassing sleep latency and duration, subjective sleep quality, habitual sleep efficiency, sleep disturbance, and daytime dysfunction between the two groups. The study found a notable difference in scores between the patients in the intervention group and those in the control group. The patients who received the intervention had significantly lower scores (P <.001). Conclusion: The study revealed that PMRE was beneficial in improving sleep quality in cancer patients undergoing chemotherapy who had poor sleep quality. Implications for Nursing Practice: Oncology nurses may consider using PMRE to improve the sleep quality of cancer patients receiving chemotherapy.Publication Metadata only Adrenocortical cancer in the real world: a comprehensive analysis of clinical features and management from the Turkish Oncology Group (TOG)(Elsevier Inc., 2024) Yasar,H.; Aktas,B.Y.; Ucar,G.; Goksu,S.S.; Bilgetekin,I.; Cakar,B.; Sakin,A.; Ates,O.; Basoglu,T.; Arslan,C.; Demiray,A.G.; Paydas,S.; Cicin,I.; Sendur,M.A.N.; Karadurmus,N.; Kosku,H.; Uner,A.; Utkan,G.; Kefeli,U.; Tanriverdi,O.; Cinkir,H.; Gumusay,O.; Turhal,N.S.; Menekse,S.; Kut,E.; Beypinar,I.; Sakalar,T.; Demir,H.; Yekeduz,E.; Kilickap,S.; Erman,M.; Urun,Y.; Yumuk, Perran Fulden; School of MedicineIntroduction: Adrenocortical carcinoma (ACC) is a rare yet highly malignant tumor associated with significant morbidity and mortality. This study aims to delineate the clinical features, survival patterns, and treatment modalities of ACC, providing insights into the disease's prognosis. Materials and Methods: A retrospective analysis of 157 ACC patients was performed to assess treatment methodologies, demographic patterns, pathological and clinical attributes, and laboratory results. The data were extracted from the hospital's database. Survival analyses were conducted using the Kaplan–Meier method, with univariate and multivariate analyses being performed through the log-rank test and Cox regression analyses. Results: The median age was 45, and 89.4% had symptoms at the time of diagnosis. The median tumor size was 12 cm. A total of 117 (79.6%) patients underwent surgery. A positive surgical border was detected in 26 (24.1%) patients. Adjuvant therapy was administered to 44.4% of patients. The median overall survival for the entire cohort was 44.3 months. Median OS was found to be 87.3 months (95% confidence interval [CI] 74.4-100.2) in stage 2, 25.8 (95% CI 6.5-45.1) months in stage 3, and 13.3 (95% CI 7.0-19.6) months in stage 4 disease. Cox regression analysis identified age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as significant factors associated with survival in patients with nonmetastatic disease. In metastatic disease, only patients who underwent surgery exhibited significantly improved overall survival in univariate analyses. Conclusion: ACC is an uncommon tumor with a generally poor prognosis. Understanding the defining prognostic factors in both localized and metastatic diseases is vital. This study underscores age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as key prognostic determinants for localized disease, offering critical insights into the complexities of ACC management and potential avenues for targeted therapeutic interventions.Publication Metadata only Collecting duct carcinoma: epidemiology, clinical characteristics and survival(Elsevier Science Inc, 2023) Panunzio, Andrea; Tappero, Stefano; Hohenhorst, Lukas; Garcia, Cristina Cano; Piccinelli, Mattia; Barletta, Francesco; Tian, Zhe; Tafuri, Alessandro; Briganti, Alberto; De Cobelli, Ottavio; Chun, Felix K. H.; Terrone, Carlo; Kapoor, Anil; Saad, Fred; Shariat, Shahrokh F.; Cerruto, Maria Angela; Antonelli, Alessandro; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalIntroduction: Collecting duct carcinoma (CDC) is a rare renal malignancy. We relied on a large population-based cohort to address epidemiology, clinical characteristics, and treatment of CDC patients. We also tested survival in the overall cohort, as well as in stage-specific fashion. Materials and methods: Within Surveillance, Epidemiology, and End Results (2004- 2018) database, we identified 399 CDC patients. Based on Kaplan-Meier plots survival estimates, conditional survival rates were derived according to disease stage. Cox regression models tested for predictors of cancer specific mortality (CSM). Results: Overall, 273 (68.4%) patients were male, 236 (59.2%) had T3-4 stages, 148 (37.1%) had lymph node invasion, and 156 (39.1%) had distant metastases at initial diagnosis. Nephrectomy alone was commonest in stage I-II (n = 91/99, 92%) and III (n = 94/116, 81%). Combination of both nephrectomy and systemic therapy was commonest in stage IV (n = 62/172, 36%). In the overall cohort, median cancer specific survival was 18 months. Provided a disease-free interval of 24 months, five-year Kaplan-Meier estimated survival at diagnosis increased from 74.2 to 91.0% in stage I-II, from 31.1 to 65.3% in stage III, and from 6.3 to 34.1% in stage IV. In multivariable Cox regression models addressing CSM, systemic therapy (Hazard Ratio [HR]: 0.47, P = 0.020), nephrectomy (HR: 0.37, P < 0.001) and combination of both (HR: 0.28, P < 0.001) exhibited a strong protective effect. Conclusion: Despite its highly aggressive phenotype and dismal survival, CDC is sensitive to nephrectomy and/or systemic therapy. Moreover, even for advanced stage, a more favorable prognosis can be achieved in patients, who benefit of disease-free interval after diagnosis and initial treatment.Publication Metadata only Conditional survival after radical cystectomy for non-metastatic muscle-invasive squamous cell carcinoma of the urinary bladder: a population-based analysis(Elsevier Science Inc, 2023) Barletta, Francesco; Tappero, Stefano; Panunzio, Andrea; Incesu, Reha-Baris; Garcia, Cristina Cano; Piccinelli, Mattia Luca; Tian, The; Gandaglia, Giorgio; Moschini, Marco; Terrone, Carlo; Antonelli, Alessandro; Chun, Felix K. H.; De Cobelli, Ottavio; Saad, Fred; Shariat, Shahrokh F.; Montorsi, Francesco; Briganti, Alberto; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalPurpose: To assess the effect of event-free survival duration on cancer-specific mortality (CSM) after radical cystectomy (RC) in nonmetastatic muscle-invasive squamous cell carcinoma of the urinary bladder. Methods: RC patients treated for non-metastatic muscle-invasive squamous cell carcinoma of the urinary bladder were identified within the Surveillance, Epidemiology, and End Results database (2000-2018). Independent predictor status for CSM of T and N stage groupings (i.e., T2N0, T3N0, T4N0, and TanyN1-3) was tested in multivariable Cox-regression models. Conditional 5-year CSM-free estimates were assessed at baseline and at 4 specific event-free survival times (i.e. 6, 12, 18 and 24 months), within each of the 4 examined stage groups. Results: Of 981 RC patients, 206 (21%), 416 (42%), 152 (16%), and 207 (21%) were T2N0, T3N0, T4N0, and TanyN1-3, respectively. In multivariable Cox-regression models T3N0 (HR 1.94), T4N0 (HR 5.22), and TanyN1-3 (HR 6.62) were independent predictors of CSM, relative to T2N0. In conditional survival analyses based on 24 months event-free status, survival estimates were: 89% for T2N0 vs. 76% at baseline (Delta = 13%), 84% for T3N0 vs. 58% at baseline (Delta = 26%), 69% for T4N0 vs. 25% at baseline (Delta = 44%), 69% for TanyN1-3 vs. 22% at baseline (Delta = 47%). Conclusions: Event-free status at 24 months of follow-up is associated with substantially higher CSM-free survival than when CSM-free survival is predicted at baseline. The magnitude of this effect is most pronounced in TanyN1-3 and T4N0 patients, intermediate in T3N0 and more modest, nonetheless important, in T2N0.Publication Metadata only Regional differences in total hospital costs for radical cystectomy in the United States(Elsevier Sci Ltd, 2023) Hoeh, Benedikt; Flammia, Rocco Simone; Hohenhorst, Lukas; Sorce, Gabriele; Chierigo, Francesco; Panunzio, Andrea; Tian, Zhe; Saad, Fred; Gallucci, Michele; Briganti, Alberto; Terrone, Carlo; Shariat, Shahrokh F.; Graefen, Markus; Antonelli, Alessandro; Kluth, Luis A.; Becker, Andreas; Chun, Felix K. H.; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalObjectives: To test for regional differences in total hospital costs (THC) across the United States in bladder cancer patients treated with open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RARC). Materials: We relied on the National Inpatient Sample (NIS) database (2016-2019) and stratified RC patients according to census region (Midwest, Northeast, South, West). Primary statistical analyses consisted of THC-trend analyses and multivariable log-link linear regression models, after adjustment for hospital clustering (Generalized Estimating Equation function) and discharge disposition weighting. Finally, sensitivity analysis, relying on most favorable patient cohort, was performed. Results: Of 5280 eligible patients, 1441 (27%), 1031 (20%), 1854 (35%) and 954 (18%) underwent RC in the Midwest, Northeast, South and West, respectively. Median THC was 28,915$ and differed significantly between regions (Midwest: 28,105$; Northeast: 28,886$; South: 26,096$; West: 38,809$; p < 0.001). After stratification between ORC and RARC, highest THC was invariably recorded in the West: ORC 36,137$ vs 23,941-28,850$ and RARC 43,119$ vs 28,425-29,952$ (both p < 0.05). In multivariable log-link linear regression models, surgery in the West was independently associated with higher THC: ORC (Exponent beta (Exp(beta]]: 1.39; 95%-CI: 1.32-1.47; p < 0.001) and RARC (Exp(beta]: 1.46; 95%-CI: 1.38-1.55; p < 0.001). Results remained unchanged when analyses were refitted in most favorable patient subgroup. Conclusions: Important regional differences in ORC and RARC THC distinguish the West from other United States regions. The THC discrepancy clearly requires closer examination to identify underlying processes that contribute to inflated costs in the West.Publication Metadata only Prognostic significance of radiographic lymph node invasion in contemporary metastatic renal cell carcinoma patients(Elsevier Inc., 2023) Scheipner, Lukas; Incesu, Reha-Baris; Morra, Simone; Baudo, Andrea; Assad, Anis; Jannello, Letizia Maria Ippolita; Siech, Carolin; de Angelis, Mario; Tian, Zhe; Saad, Fred; Shariat, Shahrokh F.; Briganti, Alberto; Chun, Felix K.H.; Longo, Nicola; Carmignani, Luca; De Cobelli, Ottavio; Pichler, Martin; Ahyai, Sascha; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalPurpose: To test the prognostic significance of radiographic cN-stage in metastatic renal cell carcinoma (mRCC) patients with low metastatic burden (1 site of metastasis), relying on the Surveillance, Epidemiology, and End Results database (SEER 2010-2020). Methods: Included were mRCC patients with 1 site of metastasis, treated with systemic therapy without cytoreductive nephrectomy (CN). Kaplan-Meier plots and multivariable Cox-regression models addressed cancer-specific mortality (CSM) according to radiographic cN-stage (ccN1 vs. ccN0). Separate subgroup analyses were performed, addressing radiographic N-stage in patients with distinct histology (clear-cell vs. RCC not otherwise specified [RCC NOS]). Results: Of 1756 mRCC patients, 545 (31%) were radiographic cN1. Overall, the median CSM-free survival of the cohort was 11 months. Median CSM-free survival was 8 vs. 14 months in radiographic cN1 vs. cN0 mRCC patients (HR 1.49, P < .0001). In multivariable Cox regression analyses, radiographic cN1 status was an independent predictor of higher CSM (HR 1.39; P = .01). In subgroup analyses, addressing patients with clear-cell histology and patients with RCC NOS separately, radiographic cN1 status remained independently associated with a higher CSM in both groups (clear-cell: HR 1.36; P = .03; RCC NOS: HR 2.06; P = .009). Conclusion: In mRCC patients with low metastatic burden, presence or absence of radiographic lymph node invasion results in a clinically meaningful discrimination between those with poor prognosis and others. In consequence, consideration of radiographic lymph node invasion might be of great value in this specific population of mRCC patients.Publication Metadata only Regional differences in penile cancer patient characteristics and treatment rates across the United States(Elsevier Sci Ltd, 2023) Scheipner, Lukas; Garcia, Cristina Cano; Barletta, Francesco; Incesu, Reha-Baris; Morra, Simone; Baudo, Andrea; Assad, Anis; Tian, Zhe; Saad, Fred; Shariat, Shahrokh F.; Chun, Felix K. H.; Briganti, Alberto; Longo, Nicola; Carmignani, Luca; Leitsmann, Marianne; Ahyai, Sascha; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalIntroduction: We tested for regional-specific differences in patient, tumor and treatment characteristics as well as cancer-specific mortality (CSM) of squamous cell carcinoma of the penis (SCCP) patients, across the Surveillance, Epidemiology, and End Results (SEER) registries.Methods: The SEER database (2000-2018) was used to tabulate patient (age at diagnosis, race/ethnicity), tumor (stage, grade, N-stage) and treatment characteristics (proportions of primary tumor surgery, local lymph node surgery, systemic therapy), according to 12 SEER registries. Multinomial regression models, as well as multi -variable Cox regression models tested for CSM differences, adjusting for patient, tumor and treatment characteristics.Results: In 5395 SCCP patients, registry-specific patient counts ranged from 2060 (38 %) to 64 (1 %). Differences across registries existed for race/ethnicity, stage, grade and N-stage. Additionally, in stage I-II SCCP patients, proportions of local tumor destruction (LTD) ranged from 19 % to 39 % and from 33 % to 61 % for partial penectomy. In stage III-IV SCCP patients, proportions of partial penectomy ranged from 40 % to 59 % and from 17 % to 50 % for radical penectomy. Local lymph node surgery ranged from 8 % to 24 % and proportions of systemic therapy ranged from 3 % to 14 %. Significant inter-registry differences remained, after adjustment for treatment proportions. Unadjusted five-year CSM ranged from 19 % to 32 %. In multivariable analyses, one registry exhibited significantly higher CSM (SEER registry 10, Hazard Ratio [HR] 1.48), relative to the largest reference registry (SEER registry 1, n = 2060).Conclusion: Important regional differences including patient, tumor and treatment characteristics exist for SCCP patients across SEER registries. After multivariable adjustment, no differences in CSM were recorded, with the exception of one registry.Publication Metadata only Differences in survival of clear cell metastatic renal cell carcinoma according to partial vs. radical cytoreductive nephrectomy(Elsevier Inc., 2023) Cano Garcia, Cristina; Flammia, Rocco S.; Piccinelli, Mattia; Panunzio, Andrea; Tappero, Stefano; Barletta, Francesco; Incesu, Reha-Baris; Law, Kyle W.; Morra, Simone; Tian, Zhe; Saad, Fred; Kapoor, Anil; Shariat, Shahrokh F.; Longo, Nicola; Briganti, Alberto; Terrone, Carlo; Antonelli, Alessandro; De Cobelli, Ottavio; Hoeh, Benedikt; Kluth, Luis A.; Chun, Felix K.H.; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalBackground: It is unknown whether previously reported other-cause mortality (OCM) advantage of partial cytoreductive nephrectomy (PCN) vs. radical cytoreductive nephrectomy (RCN) still applies to contemporary clear cell metastatic renal cell carcinoma (ccmRCC) patients. Materials and Methods: We relied on the Surveillance, Epidemiology and End Results (SEER) database (2004-2019) to identify ccmRCC patients treated with PCN and RCN. Temporal trends of PCN rates within the SEER database were tabulated. After propensity score matching (PSM), cumulative incidence plots depicted 5-year OCM and cancer-specific mortality (CSM) of PCN and RCN patients. Multivariable Cox regression models tested for differences between PCN vs. RCN. Results: Of 5149 study patients, 237 (5%) underwent PCN vs. 4912 (95%) RCN. In the SEER database 2004 to 2019, rates of PCN in ccmRCC patients increased from 3.0% to 8.0% (estimated annual percent change [EAPC]: 3.0%; P = .04). After PSM, 5-year OCM rates were 2.4 vs. 7.5% for respectively PCN vs. RCN patients (P = .036). 5-year CSM rates were 50.8 vs. 53.6% for respectively PCN and RCN patients (P = .57). In multivariable Cox regression models, PCN was associated with lower OCM (Hazard Ratio (HR): 0.39; 95% confidence interval (CI): 0.18-0.84; P = .02) but did not affect CSM rates (HR: 0.99; 95% CI: 0.76-1.29; P = .96). Conclusions: We confirm the existence of OCM advantage after PCN vs. RCN in contemporary ccmRCC patients.Publication Metadata only Conditional survival of stage III non-seminoma testis cancer patients(Elsevier Inc., 2023) Incesu, Reha-Baris; Barletta, Francesco; Tappero, Stefano; Morra, Simone; Garcia, Cristina Cano; Scheipner, Lukas; Piccinelli, Mattia Luca; Tian, Zhe; Saad, Fred; Shariat, Shahrokh F.; de Cobelli, Ottavio; Ahyai, Sascha; Chun, Felix K.H.; Longo, Nicola; Terrone, Carlo; Briganti, Alberto; Graefen, Markus; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalPurpose: In many primaries other than non-seminoma testis cancer, the risk of death due to cancer decreases with increasing disease-free interval duration after initial diagnosis and treatment. This effect is known as conditional survival and is relatively unexplored in stage III non-seminoma patients, where it may matter most in clinical decision-making. We examined the effect of disease-free interval duration on overall survival in stage III non-seminoma patients. Materials and Methods: Within the Surveillance, Epidemiology, and End Results Database (2004–2018), stage III non-seminoma patients were identified. Multivariable Cox regression analyses and conditional survival models were applied. Results: Of 2,092 surgically treated stage III non-seminoma patients, 385 (18%) exhibited good vs. 558 (27%) intermediate vs. 1,149 (55%) poor prognosis. In multivariable Cox regression models, poor prognosis group independently predicted overall mortality (HR 3.3, P < 0.001). In conditional survival analyses based on 36 months’ disease-free interval duration, 5-year overall survival estimates were as follows: good prognosis patients 96 vs. 89% at initial diagnosis without accounting for disease-free interval duration (Δ=+7); intermediate prognosis patients 94 vs. 85% at initial diagnosis without accounting for disease-free interval duration (Δ=+9); poor prognosis patients 94 vs. 65% at initial diagnosis without accounting for disease-free interval duration (Δ=+29). Conclusions: Conditional survival estimates based on 36 months’ disease-free interval duration provide a more accurate and more optimistic outlook for stage III non-seminoma patients than predictions defined at initial diagnosis, without accounting for disease-free interval duration.Publication Metadata only Other-cause mortality, according to partial vs. radical nephrectomy: age and stage analyses(Elsevier Inc., 2023) Baudo, Andrea; Incesu, Reha-Baris; Morra, Simone; Scheipner, Lukas; Jannello, Letizia Maria Ippolita; de Angelis, Mario; Siech, Carolin; Tian, Zhe; Acquati, Pietro; Longo, Nicola; Ahyai, Sascha; de Cobelli, Ottavio; Briganti, Alberto; Chun, Felix K.H.; Saad, Fred; Shariat, Shahrokh F.; Carmignani, Luca; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalIntroduction: We tested the association between other-cause mortality and partial vs. radical nephrectomy in patients with T1a, T1b, and T2 renal cell carcinoma, across all patient ages. Material and Methods: Within the Surveillance, Epidemiology, and End Results database (2010-2020), patients with localized renal cell carcinoma stages (T1a-T1b-T2, N0, M0), who underwent partial or radical nephrectomy were identified. Only patients with tumor size 2 to 10 cm were included. Cumulative incidence plots and multivariable competing risks regression models were used. Results: Of 68,195 patients, 28,845 (42%) underwent partial nephrectomy vs. 39,350 (58%) radical nephrectomy. In T1a patients, 5-year other-cause mortality rates were 6% for partial nephrectomy vs. 11% for radical nephrectomy (Δ=5%). In T1a patients, partial nephrectomy independently predicted lower other-cause mortality, across all ages (HR: 0.73, P < .001). In age category subgroup analyses addressing T1a patients, in all age categories, partial nephrectomy invariably predicted lower other-cause mortality than radical nephrectomy: ≤59 years (HR: 0.67, P < .001); 60 to 69 years (HR: 0.70, P < .001); and ≥70 years (HR: 0.79, P < .001). Finally, in T1b patients, as well as in T2 patients, no other-cause mortality advantage was recorded for partial vs. radical nephrectomy: T1b (8 vs. 10%, Δ=2%); T2 (8 vs. 9%, Δ=1%). Conclusions: Relative to radical nephrectomy, partial nephrectomy is associated with lower other-cause mortality in stage T1a renal cell carcinoma patients across all age categories, including the oldest patients. Conversely, no clinically meaningful other-cause mortality benefit was associated with partial nephrectomy in stages T1b or T2, regardless of age, including youngest patients.