Background and Objectives: Sarcopenia is frequently observed in cancer patients and is associated with short survival. In this study, the aim was to research the sarcopenia risk factors, the correlation of sarcopenia with inflammatory biomarkers, and the prognostic significance of sarcopenia and inflammation markers in patients with metastatic gastric cancer. Material and Method: The study included 177 patients diagnosed with metastatic gastric cancer attending Dokuz Eylül University Faculty of Medicine (DEUFM) Medical Oncology clinic from 2016 to 2022. The skeletal muscle area at L3 vertebral level was identified on abdominal computed tomography (CT) images, and the skeletal muscle index (SMI, cm²/m²) was calculated. Additionally, PLR, MLR, NLR, dNLR, SIRI, SII, PIV, PNI, CAR, and LAR were assessed among systemic inflammatory biomarkers. Cut-off values were determined with ROC curve analysis. Survival analyses were performed with the Kaplan–Meier method, and risk factors were investigated with Cox regression analysis. For all statistical analyses, p < 0.05 was accepted as significant. Results: Among patients, 71.8% were identified to have sarcopenia. Significant levels of difference were identified for median SIRI, NLR, MLR, PLR, SII, PNI, and dNLR values between patients with and without sarcopenia (p < 0.05). The sarcopenia risk was assessed between groups created according to the cut-off values for inflammation markers. Univariate regression analysis found that SIRI, PIV, NLR, MLR, PLR, SII, PNI, and dNLR were statistically significant (p < 0.05). Multivariate analysis identified SIRI and PNI as independent risk factors. For all patients, median overall survival was identified to be 12.4 ± 0.8 months (CI 95%, 10.8–13.9). For patients with sarcopenia, overall survival duration was 11.5 ± 0.8 months, while survival duration for patients without sarcopenia was 17.5 ± 4.6 months (p = 0.010). Elevation in the inflammatory biomarkers of SIRI, NLR, SII, LAR, and CAR and low PNI values appear to be associated with short survival (p < 0.05). Conclusions: In this study, sarcopenia was frequently observed in patients with metastatic gastric cancer and sarcopenia was associated with shorter survival. A significant correlation was observed between sarcopenia and inflammatory biomarkers, with SIRI and PNI identified to be independent risk factors for sarcopenia. Our study emphasizes the prognostic importance of sarcopenia and inflammatory markers for the management of patients with metastatic gastric cancer.

Two-Week Combination Chemotherapy with Gemcitabine, High-Dose Folinic Acid and 5 Fluorouracil (GEMFUFOL) as First-Line Treatment of Metastatic Biliary Tract Cancers Metastatic biliary tract cancer;gemcitabine;5-fluorouracil;high-dose folinic acid; Background: The aim of this study was to evaluate the efficacy and tolerability of a gemcitabine, 5-fluorouracil and leucovorin (GEMFUFOL) chemotherapy regimen as first line treatment of metastatic biliary tract cancer. Materials and Methods: All patients received folinic acid $400mg/m^2$ on day 1, 5-fluorouracil bolus $400mg/m^2$ on day 1, IV infusion of 5-fluorouracil $2400mg/m^2$ over 46 hours, and gemcitabine $1250mg/m^2$ on day 1. Results: A total of 29 patients with metastatic biliary tract cancer received GEMFUFOL regimen as the firstline treatment. The mean follow-up was 22.1 months (95%CI, 12.5-31.8). One patient (3.4%) achieved complete response, 5 (17.2%) had partial response, and 4 (13.8%) had stable disease. The median progression-free survival was 3.3 months (95%CI, 2.9-3.7), and the median overall survival was 8.8 months (95%CI, 3.5-14). The 1-year and 2-year survival rates were 58.6% and 30%, respectively. Grade 3 and 4 toxicity included neutropenia in 4 patients (13.7%), thrombocytopenia in 2 (6.8%), anemia2 (6.8%), and alopecia in 1 (3.4%). Two patients (6.8%) developed febrile neutropenia. A dose reduction was achieved in 8 patients (27.6%) while 5 patients had extended-interval dosage (17.2%) for toxicity. Conclusions: The GEMFUFOL chemotherapy regimen was generally efficacious and tolerable as a first-line treatment of metastatic biliary tract cancer.

Background and Objectives: KRAS genes are among the most prominent oncogenes that trigger tumor formation in colorectal cancer (CRC) and serve as predictive biomarkers for resistance to anti-EGFR therapies in metastatic colorectal cancer (mCRC) patients. However, the prevalence and mutation spectrum of the KRAS gene family in mCRC patients in Turkey have not been sufficiently analyzed. This study investigates the frequency and distribution of mutations in the KRAS gene family across different regions of Turkey and examines gender-related variations. Materials and Methods: This multicenter observational study included 2458 histologically confirmed mCRC patients collected from 52 centers across Turkey. In a central laboratory, KRAS mutations in codons 12 and 13 were analyzed using polymerase chain reaction (PCR). Statistical analyses were performed using chi-square tests and Monte Carlo simulations, with a significance threshold set at p < 0.05. Results: Depending on the region, KRAS mutations were detected in 45% of patients, ranging from 39.6% to 47.5%. The mutation rate was significantly higher in female patients (48.8%) compared to male patients (42.6%) (p = 0.002). Codon 12 mutations were more frequent than codon 13 mutations. G12D, G12V, and G13D mutations accounted for 80% of all detected mutations. The G12V mutation was prevalent in female patients (p = 0.007). Based on region, mutation diversity was similar, and no statistically significant difference was found (p > 0.05). Conclusions: This large-scale, multicenter study provides the most comprehensive dataset of KRAS mutations in mCRC patients in Turkey. This study revealed regional trends, as well as gender differences. The findings highlight the importance of routine KRAS genotyping in guiding personalized treatment strategies, especially regarding candidate selection for anti-EGFR therapies. Further research is required to elucidate the prognostic and therapeutic implications of specific KRAS mutations.

Background and Objectives: HER-2 expression plays a critical role in the biological behavior and treatment of gastric cancer. With the emergence of HER-2-targeted therapies, classification into negative, low, and positive groups has gained clinical importance. The present study focused on assessing the link between HER-2 status and clinical–pathological variables, metastatic involvement, and overall survival (OS) among advanced gastric cancer patients. Materials and Methods: A total of 300 patients with advanced gastric adenocarcinoma were retrospectively analyzed. The mean age of the 300 patients included in the study was 61.8 years, and 70% of them were male. Based on immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), patients were classified as HER-2-negative (IHC 0), HER-2-low (IHC 1+ or 2+/FISH-negative), or HER-2-positive (IHC 3+ or 2+/FISH-positive). Clinicopathological variables, metastatic sites, and OS were compared among groups using Pearson’s Chi-square, Fisher’s exact test, ANOVA, and Kaplan–Meier survival analysis. Results: Significant differences were observed among HER-2 subgroups in pathological subtype (p = 0.006), liver metastasis (p = 0.009), lung metastasis (p = 0.006), and other metastatic sites (p = 0.001). HER-2-positive patients demonstrated higher rates of adenocarcinoma histology and increased liver and lung metastases. In female patients, HER-2 status was significantly associated with lung (p = 0.001) and other metastases (p < 0.001). Median OS for the entire cohort was 9.83 months (95% CI: 8.29–11.36). HER-2-positive patients had a significantly longer OS (15.06 months) compared with HER-2-negative patients (8.73 months; p = 0.039). Conclusions: HER-2 status is an important predictor of metastatic behavior and survival in advanced gastric cancer. HER-2-positive patients display distinct metastatic patterns and improved outcomes, supporting the value of HER-2-targeted therapies. The HER-2-low group may represent a biologically and clinically relevant intermediate subtype requiring further investigation.