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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 A case of pathologic complete response after neoadjuvant triplet chemotherapy for locally advanced colon cancer with mismatch repair enzyme proficiency(Via Medica, 2023) Kocak, Mehmet Zahid; Cakir, Murat; Kerimoglu, Ulku; Araz, Murat; Eryilmaz, Melek Karakurt; Artac, Mehmet; Yumuk, Perran Fulden; School of MedicinePatients with potentially resectable colon cancer and expected to have negative margins should undergo resection rather than neoadjuvant chemotherapy. Recent studies have suggested that neoadjuvant immunotherapy may be an option for tumors with mismatch repair enzyme deficiency (dMMR), but standard treatment for locally advanced colon cancer with mismatch repair enzyme proficiency (pMMR) is still unclear. A 37-year-old male patient was diagnosed with clinical stage IIIC (T4b N1a M0) transverse colon cancer. Mismatch repair proteins were proficient. After 3 cycles of oxaliplatin (85 mg/m(2), day 1), irinotecan (150 mg/m2, IV, day 1), leucovorin (200 mg/m(2), IV, day 1), and 5-fluorouracil (3000 mg/m(2), 46 hours of continuous infusion initiating from day 1), there was a remarkable reduction in the tumoral mass on the abdominal computed tomography. A right hemicolectomy was performed. A pathologic complete response was obtained. Although there is no consensus on which patients are suitable for neoadjuvant therapy in pMMR locally advanced colon cancer, triplet chemotherapy may be a reasonable option in selected patients.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 The percentage of ALK-positive cells and the efficacy of first-line alectinib in advanced non-small cell lung cancer: is it a novel factor for stratification? (Turkish Oncology Group Study)(Springer Science and Business Media Deutschland Gmbh, 2023) Hizal,M.; Bilgin,B.; Paksoy,N.; Atcı,M.M.; Kahraman,S.; Kılıçkap,S.; Güven,D.C.; Keskinkılıç,M.; Ayhan,M.; Eren,O.; Mustafayev,F.N.A.; Yaman,Ş.; Bayram,E.; Ertürk,İ.; Özcan,E.; Korkmaz,M.; Akagündüz,B.; Erdem,D.; Telli,T.A.; Aksoy,A.; Üskent,N.; Baytemür,N.K.; Gülmez,A.; Aydın,D.; Şakalar,T.; Arak,H.; Tatlı,A.M.; Ergün,Y.; Ak,N.; Ünal,Ç.; Özgün,M.A.; Yalçın,B.; Öztop,İ.; Algın,E.; Sakin,A.; Aydıner,A.; Şendur,M.A.N.; Yumuk, Perran Fulden; School of MedicineIntroduction: Alectinib is an effective second-generation ALK tyrosine kinase inhibitor (TKI) used in the first-line treatment of patients with advanced ALK-positive NSCLC. Recent studies demonstrated that the percentage of ALK-positive tumor cells in patient groups receiving crizotinib might affect outcomes. This study aimed to investigate whether the percentage of ALK-positive cells had a predictive effect in patients with advanced NSCLC who received first-line Alectinib as ALK-TKI. Materials and methods: This retrospective study included patients with advanced-stage NSCLC who received alectinib as a first-line ALK-TKI and whose percentage of ALK-positive cells was determined by FISH at 27 different centers. Patients who received any ALK-TKI before alectinib were not included in the study. Patients were separated into two groups according to the median (40%) value of the percentage of ALK-positive cells (high-positive group ≥ 40% and low-positive group < 40%). The primary endpoint was PFS, and the secondary endpoints were OS, ORR, and PFS of the subgroups based on different threshold values for the percentage of ALK-positive cells. Results: 211 patients were enrolled (48.3% female, 51.7% male) to study. 37% (n = 78) of the patients had received chemotherapy previously. After a median of 19.4 months of follow-up, the median PFS was not reached in the high-positive group (n = 113), but it was 10.8 months in the low-positive group (n = 98) (HR 0.39; 95% CI 0.25–0.60, p < 0.001). The median OS in the high-positive group was not reached, whereas it was 22.8 months in the low-positive group (HR 0.37; 95% CI 0.22–0.63, p < 0.001). ORR was significantly higher in the high-positive group (87.2 vs. 68.5%; p = 0.002). According to the cut-off values of < 20%, 20–39%, 40–59%, and ≥ 60%, the median PFS was 4.5, 17.1, and 26 months, respectively, and could not be reached in the ≥ 60% group. Conclusion: Our study demonstrated that the efficacy of alectinib varies significantly across patient subgroups with different percentages of ALK-positive cells. If these findings are prospectively validated, the percentage of ALK-positive cells may be used as a stratification factor in randomized trials comparing different ALK-TKIs.Publication Metadata only Prognostic significance of mucinous histology in left‑sided metastatic colorectal cancers with wild‑type RAS and evaluation of backbone chemotherapy regimens(Spandidos Publ Ltd, 2023) Arikan, Rukiye; Atci, Muhammed Mustafa; Ay, Seval; Ayhan, Murat; Demircan, Nazim Can; Telli, Tugba Akin; Celebi, Abdussamet; Yasar, Alper; Isik, Selver; Celikel, Cigdem; Balvan, Ozlem; Bayoglu, Ibrahim Vedat; Kostek, Osman; Dane, Faysal; Yumuk, Perran Fulden; School of MedicineMucinous colorectal adenocarcinoma (MCAC) is a distinct subtype of colorectal carcinoma (CRC). The prognostic and predictive significance of mucinous histology remains controversial. It was aimed to investigate the prognostic and/or predictive role of mucinous histology in left-sided metastatic CRC (mCRC) with wild-type RAS. This is a retrospective multicenter study of mCRC treated with first line anti-EGFR combined 5-fluorouracil based chemotherapy (CT). Patients were stratified according to presence (>50% extracellular mucin) or absence of mucinous histology. Survival analyses were performed firstly regardless of treatment options and then performed as separating according to CT regimens. Additional analyses were performed for MCAC patients considering backbone CT regimens. A total of 125 patients were included, consisting of 40 (32.0%) patients with MCAC and 85 (68.0%) patients with non-MCAC. Median follow-up time was 19.7 months. Median progression-free survival (PFS) was 10.7 months in all patients, and PFS was lower in MCAC than non-MCAC (9.9 vs. 12.0 months, respectively, P=0.005). Median overall survival (OS) was 25.7 months in all patients. OS was lower in MCAC than non-MCAC (22.8 vs. 29.7 months, respectively, P=0.005). When considering backbone CT regimens, in multivariate analyses, mucinous histology was an independent prognostic factor for OS in both for mFOLFOX6 (HR: 1.92, P=0.04) and FOLFIRI (HR: 2.04, P=0.04) groups and was associated with poor PFS in only mFOLFOX6 (HR: 3.86, P<0.001) group. When outcomes were analyzed for the MCAC group, median OS of MCAC patients receiving mFOLFOX6 and FOLFIRI was 22.47 and 14.22 months, respectively (P=0.41). Median PFS of MCAC patients receiving mFOLFOX6 and FOLFIRI was 10.15 and 8.11 months, respectively (P=0.73). The study revealed poor prognosis of mucinous histology, both in whole study population and in backbone CT groups. Moreover, lower PFS of MCAC patients was revealed in only mFOLFOX6 group and this finding may be a valuable issue for the future research. However, considering all analyses, the present results did not indicate a special benefit of any backbone CT regimen for MCAC patients.Publication Metadata only The risk of recurrence in endometrial cancer patients with low-volume metastasis in the sentinel lymph nodes: a retrospective multi-institutional study(MDPI, 2023) Buda, Alessandro; Paniga, Cristiana; Taskin, Salih; Mueller, Michael; Zapardiel, Ignacio; Fanfani, Francesco; Puppo, Andrea; Casarin, Jvan; Papadia, Andrea; De Ponti, Elena; Grassi, Tommaso; Mauro, Jessica; Turan, Hasan; Gungor, Mete; Ortag, Firat; Imboden, Sara; Garcia-Pineda, Virginia; Mohr, Stefan; Siegenthaler, Franziska; Perotto, Stefania; Landoni, Fabio; Ghezzi, Fabio; Scambia, Giovanni; Fruscio, Robert; Vatansever, Doğan; Taşkıran, Çağatay; School of MedicineThe surgical management of apparent early-stage endometrial cancer is still unclear. Nodal involvement is prognostic, but the role of retroperitoneal staging is still debated. Sentinel node mapping has been introduced and accepted as a valid alternative to full lymphadenectomy. Furthermore, ultrastaging provides a more accurate analysis of the excised lymph nodes by detecting a higher rate of low-volume metastasis. The aim of this study was to evaluate the impact of low-volume metastasis on recurrence-free survival in women with apparent early-stage endometrial cancer in a large retrospective multi-institutional collaboration.The aim of this study was to assess the impact of low-volume metastasis (LVM) on disease-free survival (DFS) in women with apparent early-stage endometrial cancer (EC) who underwent sentinel lymph node (SLN) mapping. Patients with pre-operative early-stage EC were retrospectively collected from an international collaboration including 13 referring institutions. A total of 1428 patients were included in this analysis. One hundred and eighty-six patients (13%) had lymph node involvement. Fifty-nine percent of positive SLN exhibited micrometastases, 26.9% micrometastases, and 14% isolated tumor cells. Seventeen patients with positive lymph nodes did not receive any adjuvant therapy. At a median follow-up of 33.3 months, the disease had recurred in 114 women (8%). Patients with micrometastases in the lymph nodes had a worse prognosis of disease-free survival compared to patients with negative nodes or LVM. The rate of recurrence was significantly higher for women with micrometastases than those with low-volume metastases (HR = 2.61; p = 0.01). The administration of adjuvant treatment in patients with LVM, without uterine risk factors, remains a matter of debate and requires further evaluation.Publication Metadata only Impact of persistent PSA after salvage radical prostatectomy: a multicenter study(Springernature, 2023) Preisser, Felix; Incesu, Reha-Baris; Rajwa, Pawel; Chlosta, Marcin; Nohe, Florian; Ahmed, Mohamed; Abreu, Andre Luis; Cacciamani, Giovanni; Ribeiro, Luis; Kretschmer, Alexander; Westhofen, Thilo; Smith, Joseph A.; Steuber, Thomas; Calleris, Giorgio; Raskin, Yannic; Gontero, Paolo; Joniau, Steven; Sanchez-Salas, Rafael; Shariat, Shahrokh F.; Gill, Inderbir; Karnes, R. Jeffrey; Cathcart, Paul; Van Der Poel, Henk; Marra, Giancarlo; Tilki, Derya; School of Medicine; Koç University HospitalBackground and Objective: Persistent prostatic specific antigen (PSA) represents a poor prognostic factor for recurrence after radical prostatectomy (RP). However, the impact of persistent PSA on oncologic outcomes in patients undergoing salvage RP is unknown. To investigate the impact of persistent PSA after salvage RP on long-term oncologic outcomes. Material and Methods: Patients who underwent salvage RP for recurrent prostate cancer between 2000 and 2021 were identified from twelve high-volume centers. Only patients with available PSA after salvage RP were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of persistent PSA on biochemical recurrence (BCR), metastasis and any death after salvage RP. Persistent PSA was defined as a PSA-value >= 0.1 ng/ml, at first PSA-measurement after salvage RP. Results: Overall, 580 patients were identified. Of those, 42% (n = 242) harbored persistent PSA. Median follow-up after salvage RP was 38 months, median time to salvage RP was 64 months and median time to first PSA after salvage RP was 2.2 months. At 84 months after salvage RP, BCR-free, metastasis-free, and overall survival was 6.6 vs. 59%, 71 vs. 88% and 77 vs. 94% for patients with persistent vs. undetectable PSA after salvage RP (all p < 0.01). In multivariable Cox models persistent PSA was an independent predictor for BCR (HR: 5.47, p < 0.001) and death (HR: 3.07, p < 0.01). Conclusion: Persistent PSA is common after salvage RP and represents an independent predictor for worse oncologic outcomes. Patients undergoing salvage RP should be closely monitored after surgery to identify those with persistent PSA.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 Characteristics of incidental prostate cancer in the United States(Springernature, 2023) Scheipner, Lukas; Incesu, Reha-Baris; Morra, Simone; Baudo, Andrea; Assad, Anis; Jannello, Letizia Maria Ippolita; Siech, Carolin; de Angelis, Mario; Barletta, Francesco; Tian, Zhe; Saad, Fred; Shariat, Shahrokh F.; Briganti, Alberto; Chun, Felix K. H.; Longo, Nicola; Carmignani, Luca; De Cobelli, Ottavio; Ahyai, Sascha; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalBackground: Data regarding North-American incidental (cT1a/b) prostate cancer (PCa) patients is scarce. To address this, incidental PCa characteristics (age, PSA values at diagnosis, Gleason score [GS]), subsequent treatment and cancer-specific survival (CSS) rates were explored. Methods: Incidental PCa patients were identified within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Descriptive statistics, annual percentage changes (EAPC), Kaplan-Meier estimates, as well as Cox regression models were used. Bootstrapping technique was used to generate 95% confidence intervals for CSS at 6 years. Results: Of all 344,031 newly diagnosed non metastatic PCa patients, 5155 harbored incidental PCa. Annual rates of incidental PCa increased from 1.9% (2004) to 2.5 % (2015; p = 0.02). PSA values at diagnosis were 0-4 ng/ml in 48% vs. 4-10 ng/ml in 31% vs. > 10 ng/ml in 21%. Of all incidental PCa patients, 64% harbored GS 6 vs. 25% GS 7 vs. 11% GS >= 8. Of all incidental PCa patients, 47% were aged < 70, 35% were between 70 and 79 and 18% were >= 80 years. Subsequently, 71% underwent no local treatment (NLT) vs. 16% radical prostatectomy (RP) vs. 14% radiotherapy (RT). Proportions of patients with NLT increased from 65 to 81% (p = 0.0001) over the study period (2004-2015). CSS at six years ranged from 58% in GS >= 8 patients with NLT to 100% in patients who harbored GS 6 and underwent either RP or RT. Conclusion: Incidental PCa in the United States is rare. Most incidental PCa patients are diagnosed in men aged less than 80 years of age. The majority of incidental PCa patients undergo NLT and enjoy excellent CSS.Publication Metadata only Prognostic significance of pathologic lymph node invasion in metastatic renal cell carcinoma in the immunotherapy era(Springer, 2023) Scheipner, Lukas; Barletta, Francesco; Garcia, Cristina Cano; Incesu, Reha-Baris; Morra, Simone; Baudo, Andrea; Assad, Anis; Tian, Zhe; Saad, Fred; Shariat, Shahrokh F.; Briganti, Alberto; Chun, Felix K. H.; Longo, Nicola; Carmignani, Luca; Pichler, Martin; Ahyai, Sascha; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalBackground: This study aimed to test the prognostic significance of pathologically confirmed lymph node invasion in metastatic renal cell carcinoma (mRCC) patients in this immunotherapy era. Methods: Surgically treated mRCC patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018. Kaplan-Meier plots and multivariable Cox-regression models were fitted to test for differences in cancer-specific mortality (CSM) and overall mortality (OM) according to N stage (pN0 vs pN1 vs. pNx). Subgroup analyses addressing pN1 patients tested for CSM and OM differences according to postoperative systemic therapy status.Results: Overall, 3149 surgically treated mRCC patients were identified. Of these patients, 443 (14%) were labeled as pN1, 812 (26%) as pN0, and 1894 (60%) as pNx. In Kaplan-Meier analyses, the median CSM-free survival was 15 months for pN1 versus 40 months for pN0 versus 35 months for pNx (P < 0.001). In multivariable Cox regression analyses, pN1 independently predicted higher CSM (hazard ratio [HR], 1.88; P < 0.01) and OM (HR, 1.95; P < 0.01) relative to pN0. In sensitivity analyses addressing pN1 patients, postoperative systemic therapy use independently predicted lower CSM (HR, 0.73; P < 0.01) and OM (HR, 0.71; P < 0.01). Conclusion: Pathologically confirmed lymph node invasion independently predicted higher CSM and OM for surgically treated mRCC patients. For pN1 mRCC patients, use of postoperative systemic therapy was associated with lower CSM and OM. Consequently, N stage should be considered for individual patient counseling and clinical decision-making.