Background and Objectives: Lung cancer is the leading cause of cancer-related deaths. Spread through air spaces (STAS) is an adverse prognostic factor that has become increasingly known in recent years. This study aims to investigate the impact of STAS presence on overall survival (OS) and disease-free survival (DFS) in patients with surgically resected stage IA-IIIA lung cancer and to identify clinicopathological features associated with STAS. Materials and Methods: This research involved 311 lung cancer surgery patients. The relationship between the presence of STAS in the patients’ surgical pathology and OS and DFS values was examined. Clinicopathological features associated with the presence of STAS were determined. Results: There were 103 (33%) STAS-positive patients. Adenocarcinoma histological subtype, perineural invasion (PNI), and lymphovascular invasion (LVI) were significantly correlated with being STAS positive. STAS significantly predicted DFS and OS. One-year and five-year DFS rates were significantly lower in the STAS-positive group compared to the STAS-negative group (65% vs. 88%, 29% vs. 62%, respectively, p ≤ 0.001). Similarly, one-year and five-year OS rates were significantly lower in the STAS-positive group compared to the STAS-negative group (92% vs. 94%, 54% vs. 88%, respectively, p ≤ 0.001). In multivariate analysis, STAS was found to be an independent prognostic factor for both DFS and OS (HR: 3.2 (95%CI: 2.1–4.8) and 3.1 (95%CI: 1.7–5.5), p < 0.001 and <0.001, respectively). Conclusions: In our study, STAS was found to be an independent prognostic biomarker in operated stage IA-IIIA lung cancer patients. It may be a beneficial pathological biomarker in predicting the survival of patients and managing their treatments.

Introduction: This study aimed to assess the role of the adjusted PNI-IMDC risk scoring system in stratifying the intermediate group of metastatic RCC patients who received TKIS in the first-line setting. Methods: A total of 185 patients were included. The adjusted PNI and IMDC model was used to divide the intermediate group into two groups: intermediate PNI-high and intermediate PNI-low groups. The statistical data were analyzed using Kaplan–Meier and Cox regression analysis. Results: The results showed that the adjusted PNI-IMDC risk score, classic IMDC, and PNI had similar prognostic values. Adjusted PNI-IMDC risk score might be used for a more homogeneous differentiation of the classic intermediate group. On the other hand, multivariate analysis revealed that the presence of nephrectomy, adjusted favorable/intermediate (PNI-high) group, ECOG performance score, and presence of bone metastasis were independent predictors of OS. Conclusions: Pre-treatment PNI, as a valuable and potential add-on biomarker to the adjusted PNI-IMDC classification model, can be helpful for establishing an improved prognostic model for intermediate group mRCC patients treated with first-line TKISs. Further validation studies are needed to clarify these findings.

Aim: Hormone receptor (HR)-positive, human epidermal growth factor 2 (HER2)-negative breast cancer which represents the most common subgroup of metastatic breast cancer (MBC). Recently, further subclassification for HER2-negative tumors has emerged as HER2-low. There is limited knowledge regarding the effect of HER2-low expression on outcomes of patients with HR-positive and HER2-negative MBC treated with CDK 4/6 inhibitors plus hormonal therapy. Therefore, we evaluated survival parameters according to HER2-low status for this patient group in this study. Material and Methods: As the Turkish Oncology Group (TOG) Project, retrospectively collected data from 423 patients with HR-positive/HER2-negative MBC treated with ribociclib and palbociclib plus letrozole therapy was assessed. Included patients had metastatic first-line therapy and endocrine-sensitive disease. Survival outcomes were compared between HER2-negative and HER2-low patient groups. Conclusion: HER2-low status had no statistically significant impact on survival in patients treated with palbociclib or ribociclib plus letrozole.

Many developing countries lack access to recommended first-line treatments for metastatic renal cell carcinoma (mRCC), such as immune checkpoint inhibitors (ICIs) or ICI-tyrosine kinase inhibitor (TKI) combinations. As a result, predictive markers are necessary to identify patients who may benefit from single-agent TKIs for long-term response. This study aims to identify such parameters. This was a multi-centre, retrospective study of patients with mRCC who were undergoing first-line treatment with sunitinib or pazopanib. Patients who had been diagnosed with mRCC and had not experienced disease progression for 36 months or more were deemed to have achieved a long-term response. Predictive clinical and pathological characteristics of patients who did not experience long-term disease progression were investigated. A total of 320 patients from four hospitals were included in the study. The median age of the patients was 60 years (range 20-89 years). According to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk classification, 109 patients were classified as having favourable risk and 211 were in the intermediate-poor risk group. The median progression-free survival (PFS) and overall survival (OS) for all patients were 12.5 months and 76.4 months, respectively. In the long-term responder’s group, the median PFS was 78.4 months. Among all patients, prior nephrectomy, the Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) <1, and the absence of brain metastasis were predictive factors for long-term response. For patients in the favourable risk group, the lack of brain metastasis was a predictor of long-term response. In the intermediate-poor risk group, prior nephrectomy and ECOG PS <1 were predictive factors for long-term response. Some individuals with mRCC may experience a durable response to TKIs. The likelihood of a long-term response can be determined by factors such as nephrectomy, ECOG PS < 1, and the absence of brain metastases.

Background and Objectives: Positron emission tomography with 18F-FDG (PET-CT) provides a quantitative measure of tumor metabolic activity through the maximum standardized uptake value (SUVmax) of lung tumors—a measure of metabolic activity that may have prognostic value in non-small cell lung cancer (NSCLC). This study evaluated whether preoperative tumor SUVmax predicts outcomes in resected NSCLC. Materials and Methods: This single-center retrospective study included 209 consecutive patients with resected NSCLC who had preoperative FDG PET-CT. SUVmax of the primary tumor was recorded, and patients were stratified into low- and high-SUVmax groups to evaluate survival outcomes. Results: Median age was 62 years and 77% were male. Histologic subtypes were adenocarcinoma (44%), squamous carcinoma (43%), and others (13%), with stage I–III distribution of 39.7%, 33.5%, and 26.8%, respectively. SUVmax demonstrated moderate discrimination for mortality (AUC = 0.652), with an optimal cutoff of 11.14. Patients with SUVmax ≥ 11.14 had significantly worse OS and DFS. However, on multivariate analysis, SUVmax was not an independent predictor of outcomes, while extracapsular invasion (OS) and adjuvant chemotherapy (DFS) remained significant. Conclusions: In this cohort of resected NSCLC, high preoperative SUVmax (≥11.14) was associated with more advanced tumor stage and worse OS/DFS but was not an independent prognostic factor after accounting for other variables. Tumor invasiveness and use of adjuvant therapy were stronger outcome predictors. Preoperative SUVmax may help identify high-risk patients when considered alongside established clinicopathologic factors.

Miyelodisplastik sendrom tanısı alan hastaların genellikle ileri yaş grubunda yer alması nedeniyle bu hastalarda osteopeni veya osteoporoz görülmesi beklenmektedir. Ancak, literatürde MDS hastalarında osteoporoz veya kemik yoğunluğu ile ilgili yapılmış nitelikli çalışma bulunmamaktadır. MDS tanılı hastaların bir kısmında prognozun kötü seyretmesi ve agresif gidiş nedeniyle osteoporoz gibi yan hastalık sayılabilecek hayati olmayan klinik durumlara yeterince önem verilmemesi bunun nedeni olabilir. Ayrıca, MDS’nin kendi komplikasyonları dışında ileri yaşa bağlı DM, hipertansiyon, iskemik kalp hastalığı gibi ek hastalıkların azalmış kemik yoğunluğundan daha ön planda bulgu vermesi nedeniyle osteoporoz bu hasta grubunda dikkat çeken bir hastalık olmamıştır. Buradan yola çıkarak Cerrahpaşa Tıp Fakültesi İç Hastalıkları AD, Hematoloji BD Polikliniğinde takipli MDS hastalarından osteoporoz açısından tetkik edilmiş olanları geriye dönük taramayı amaçladık. Dosyasına ulaşılabilen 105 MDS tanılı hastanın sadece 11’inde ön planda kemik ağrısı ve iskelet sistemine ait yakınmalar nedeniyle kemik sağlığına yönelik tetkik yapılmış olduğu, söz konusu 11 hastadaki kemik yoğunluğu ölçümleri, vitamin D düzeyleri ile transfüzyon, prognostik skor ve yaş arasında bir ilişki olup olmadığını değerlendirmeyi amaçladık. Çalışmaya alınan hastalardan 9'unda osteopeni veya osteoporoz düzeyinde kemik yoğunluğunda azalma saptandı. DXA tetkiki normal görülen 2 hastadan biri 69 diğeri 72 yaşında idi, bu iki hastanın D vitamin düzeyleri sırasıyla 14.9 ng/ml ve 37,5 ng/ml olarak görüldü. D vitamin düzeyi düşük olan hasta R-IPSS’e göre yüksek riskli olup yaklaşık 2,5 yıldır MDS tanısı ile toplam 21 ünite eritrosit süspansiyonu kullanmıştı. Söz konusu hasta RAEB-II endikasyonu ile başlanan azasitidinden fayda görmekteydi. D vitamin düzeyi >30 ng/ml olan hasta ise azasitidine refrakterdi. Hastanın R-IPSS skoru orta dereceliydi, ön planda transfüzyon gerektiren trombositopeni ile seyrediyordu. Osteopeni veya osteoporoz saptanan 9 hastanın verileri ile DXA tetkikinde normal kemik yoğunluğu gözlenen 2 hastanın verileri karşılaştırıldığında yaş ve izlem süreleri açısından bir fark gözlenmedi. Hasta sayısının azlığı nedeniyle istatistiksel analiz yapılmadı. R-IPSS ortanca değerlerinin osteoporozu olmayan 2 hastada olan 9 hastaya nazaran daha yüksek olduğu görüldü ve bu hastalarda eritrosit transfüzyon gereksinimi daha fazla idi. Osteoporoz veya osteopenisi olan hastalarla normal kemik yoğunluğu bulunan hastalar transfüzyon gereksinimi, vitamin D düzeyleri, R-IPSS skorları açısından karşılaştırıldığında istatistiksel olarak anlamlı bir fark saptanmadı. Ancak, bu değerlendirmede hasta sayısının az oluşu göz önüne alınmalıdır. DXA değerlerinin dolayısı ile kemik yoğunluğunun transfüzyon, yaş, vitamin D düzeyleri, R-IPSS ile bir bağıntısı olup olmadığı araştırıldığında beklenildiği üzere osteoporoz varlığı ile DXA değerleri arasında istatistiksel olarak anlamlı bir korelasyon saptanırken sadece R-IPSS ile lomber DXA değeri arasında sınırda anlamlı bir doğrusal bağıntı gösterilebilmiştir. Çalışmamız ileriye dönük tasarlanmış bir araştırma olmadığından MDS’de osteoporozun sıklığı konusunda bir çıkarım yapmamız mümkün olmamıştır. Bunun için yeterli sayıda hasta ve kontrol içeren cinsiyet ve yaş uyumlu grupların karşılaştırıldığı prospektif çalışmalara gereksinim duyulmaktadır. Çalışmamızda sadece yüksek R-IPSS’li hastalarda lomber kemik yoğunluğunun da arttığını düşündüren sınırda anlamlı bir sonuç elde ettik; ancak hasta sayısının az olması nedeniyle bu sonucun anlamlılığını değerlendirmek güçtür. Dolaylı olarak değerlendirilirse osteoporozun daha çok düşük riskli MDS hastalarında görüldüğü yorumu yapılabilir. Bu durum düşük riskli MDS hastalarında hastalığın daha yavaş seyretmesine bağlı izlem süresinin uzun olması ile açıklanabilirse de kendi çalışmamızda yer alan düşük ve orta riskli 2 grup arasında izlem süresi açısından fark tespit edilmemiştir. Sonuç olarak, MDS gerek ileri yaş hastalığı olması sebebiyle gerek kemik...