Small cell lung cancer (SCLC) is a common cancer among the world’s lung cancers. Despite advances in diagnosis and treatment, the prognosis is still poor. There is no effective biomarker other than stage in daily practice. However, in daily practice, patients may have different features and survival times even though they have the same stage. Previously, albumin–bilirubin (ALBI) grade, platelet–albumin–bilirubin (PALBI) grade were used to determine the prognosis of acute-chronic liver failure and acute upper gastrointestinal bleeding in liver cirrhosis. In subsequent studies, they were found to be associated with prognosis in hepatocellular carcinoma (HCC) and other solid cancers. However, the prognostic relationship between ALBI grade, PALBI grade, and SCLC is unknown. Therefore, we conducted this study to examine the relationship between ALBI grade and PALBI grade and prognosis in SCLC patients. Data of 138 patients with advanced SCLC at diagnosis between 2009 and 2020 were analyzed retrospectively. The results of the multivariate analysis were as follows: ALBI grade 1 vs 2, hazard ratio (HR) = 1.608, p = 0.002 for OS and HR = 1.575, p = 0.002 for PFS; ALBI grade 1 vs 3, HR = 2.035, p < 0.001 for OS and HR = 2.675, p < 0.001 for PFS; PALBI grade 1 vs 2, HR = 1.302, p = 0.006 for OS and HR = 1.674, p = 0.002 for PFS; and PALBI grade 1 vs 3, HR = 1.725, p < 0.001 for OS and HR = 2.675, p < 0.001 for PFS. In conclusion, the ALBI and PALBI grades were determined to be associated with the prognosis of SCLC, and they can be used as easy, inexpensive, and practical markers in determining the follow-up treatment and prognosis of SCLC patients.

Background: We aimed to investigate the effect of hemoglobin/prognostic nutritional index and hemoglobin/red blood cell distribution, which are indicators of inflammation and nutrition, on prognosis and survival in patients with rectal cancer. Methods: The retrospective study reviewed medical records of 138 patients with rectal cancer who were followed up between 2010 and 2021. The effects of hemoglobin/red blood cell distribution, hemoglobin/prognostic nutritional index, tumor stage, and lymph node status on survival and prognosis were evaluated using univariate and multivariate analyses. Overall survival and disease-free survival were calculated for both groups. Results: Survival and prognosis were found to be significantly better in nonanemic patients with the hemoglobin/prognostic nutritional index higher than the cut-off value than in anemic patients with a normal or lower hemoglobin/prognostic nutritional index. Similarly, survival and prognosis were found to be significantly better in nonanemic patients with a hemoglobin/red blood cell distribution higher than the cut-off value than in anemic patients with a normal or lower hemoglobin/red blood cell distribution. Conclusion: The results indicated that nutrition and inflammatory markers have independent prognostic significance in rectal cancer. These markers are simple, inexpensive, and useful biomarkers commonly used in clinical practice, and they were found to predict overall survival and disease-free survival independently. Cite this article as: Tuncel ET, Parvizi M, Kut E, Aydın M, Kasap E. Prognostic significance of hemoglobin/prognostic nutritional index and hemoglobin/red blood cell distribution in rectal cancer. Turk J Gastroenterol. 2023;34(2):128-134.

Background: Increasing use of ¹⁸F-FDG PET/CT in cancer patients, has led to more common detection of ¹⁸F-FDG uptake in the gastrointestinal tract (GIT). Aims: The objective of this study was to assess ¹⁸F-FDG uptake in incidental and known GIT malignancy. Methods: A total of 6500 patients followed-up in a single and tertiary center between January 2010 and September 2016 were retrospectively reviewed. Of 2850 patients assessed with ¹⁸FDG-PET/CT, known GIT malignancy and ¹⁸F-FDG uptake cases during follow-up were included in the study. Results: Of 658 patients with ¹⁸F-FDG uptake, 150 patients who underwent endoscopy were included in the study. Seventy-seven of these patients had known GIT malignancy and 73 had incidental ¹⁸F-FDG uptake. Among these 73 patients; 7 (9.6%) had malignancy, 20 (27,2%) adenoma and 24 (32.9%) inflammation that were confirmed. Endoscopy was normal in 22 (30.2%) patients. One hundred forty-three (95.3%) patients had focal and 7 (4.7%) had diffuse uptake. While no malignancy was detected in patients with diffuse uptake, 58.7% (84/143) of the patients with focal uptake presented malignancy. Mean the standardized uptake value (SUV) max values were found as 15.0 ± 10.6 (range, 3.8–56.5) in malignant disease, 10.2 ± 4.3 (range, 2.4-19.7) in adenoma, 7.3 ± 3.6 (range, 3.6–18.7) in inflammation, and 9.8 ± 4.2 (range, 3.8–19.9) in normal endoscopy groups (p < 0.001, rho = 0.378). Conclusion: Although this study demonstrated high probability of malignant disease with increased ¹⁸F-FDG uptake in the GIT, it would be a more appropriate approach to confirm all patients with ¹⁸F-FDG uptake through endoscopy as SUVmax values vary in a wide range.

This study primarily aimed to assess whether baseline [(18)F] fluorodeoxyglucose (FDG) PET/CT metabolic parameters—including SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG)—can predict tumor regression grade (TRG) and survival in patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiotherapy (nCRT). In addition, secondary analyses were performed to identify other clinical and pathological variables associated with treatment response and prognosis. This retrospective study included patients diagnosed with LARC who underwent nCRT followed by surgical resection between 2014 and 2023. Pre-treatment staging with F-18 FDG PET/CT was performed for all patients. Postoperative pathological response was assessed using the TRG system. Patients were categorized into two groups: complete responders (TRG1) and incomplete responders (TRG2–5). Demographic characteristics, PET/CT metabolic parameters (SUVmax, MTV, TLG), Carcinoembryonic antigen (CEA), Carbohydrate antigen 19 − 9 (CA19-9), and histopathological features (perforation, lymphovascular invasion [LVI], and perineural invasion [PNI]) were compared between the groups. Statistical analyses included chi-square tests, Mann–Whitney U tests, logistic regression models with odds ratios (ORs), and Kaplan–Meier survival analysis. A total of 151 patients were included. A statistically significant difference was found between TRG1 and TRG2-5 groups regarding family history (p = 0.034), CEA at diagnosis (p = 0.002), Ca19.9 after radiotherapy (p = 0.045), and presence of concurrent chemotherapy (CC) (p = 0.004). Significant differences were also observed in postoperative pathological features, including perforation (p = 0.045), LVI (p = 0.023), PNI (p = 0.031), and post-operative CEA levels (p = 0.001). In terms of outcomes, TRG1 was associated with better survival (p = 0.001), longer disease-free survival (p = 0.001), and overall survival (p = 0.001). Logistic regression identified independent predictors of complete response (TRG1): family history (OR: 5.08, p = 0.027), post-RT CEA (OR: 0.61, p = 0.015), post-op CEA (OR: 1.13, p = 0.012), perforation (OR: 20.93, p = 0.033), LVI (OR: 0.33, p = 0.042), and PNI (OR: 0.49, p = 0.045). Kaplan–Meier analysis demonstrated significantly longer overall survival in patients with TRG1 compared to TRG2–5 (log-rank p = 0.001). Similarly, disease-free survival was significantly better in the TRG1 group (log-rank p = 0.001). In the multivariate Cox regression model, TRG1 (HR: 0.41; 95% CI: 0.26–0.66; p = 0.001), CC (HR: 0.62; 95% CI: 0.39–0.98; p = 0.039), and absence of perforation (HR: 0.51; 95% CI: 0.28–0.95; p = 0.034) were found to be independent predictors of improved survival. Baseline F-18 FDG PET/CT parameters, including SUVmax, MTV, and TLG, were not predictive of TRG or survival in patients with LARC undergoing neoadjuvant chemoradiotherapy. However, clinical and pathological variables such as family history, post-treatment CEA levels, perforation, lymphovascular invasion, and perineural invasion were significantly associated with TRG1. TRG1, histopathological subtype, perforation, and CC were also found to be independent predictors of survival. These findings suggest that while FDG-PET/CT may have limited utility in predicting treatment response, certain clinical and pathological features remain critical for outcome assessment.

Aim: Fulvestrant is a drug used in the treatment of metastatic hormone receptor-positive breast cancer (mHRPBC). Although clinical trials have shown the efficacy of fulvestrant, real-life data are limited and data from clinical trials and real-life settings sometimes may be seen differently. Therefore, we retrospectively reviewed mHRPBC patients followed in our center and taking fulvestrant to evaluate the efficacy and clinical outcomes of the drug and also to identify factors affecting the efficacy and clinical outcomes of fulvestrant. Materials and methods: Patients who were followed up with the diagnosis of metastatic breast cancer between 2010 and 2022 and using fulvestrant were retrospectively analyzed. Results: The median progression-free survival (PFS) time was 9 [95% confidence interval (CI): 7.13-10.18] months and the median overall survival time was 28 (95% CI: 22.53-34.93) months. According to multivariate analyses, PFS was associated with age (p=0.041), body mass index (BMI) (p=0.043), brain metastasis (p=0.033), fulvestrant line (p=0.002), and use of pre-fulvestrant chemotherapy (p=0.032). Conclusion: Fulvestrant is an effective drug in mHRPBC. Fulvestrant is more effective in patients whose BMI index is under 30, without brain metastases, without prior chemotherapy, under 65 years of age, and used fulvestrant in the early treatment line. The efficacy of fulvestrant may vary according to age and BMI.