Background: In this study, we aimed to investigate the frequency, prognostic effect of codon, and amino acid specific KRAS mutations in patients with metastatic colorectal cancer (mCRC) and their predictive effect on irinotecan and oxaliplatin during first-line treatment. Methods: The data of 304 mCRC patients were retrospectively evaluated between 2010 and 2018. Patients were categorized according to the most prominent codon and amino acid mutation and their prognostic features were analyzed. Results: In total, 274 patients were included in the study and 128 patients (47%) revealed KRAS mutation. Median follow-up time was 19.8 months (range; 1.6–96). The median overall survival rates for patients with codons 12 and 13 mutations were 25.4 and 22.2 months, respectively (p = 0.4). Moreover, the median overall survival for the codon 12 mutant patients who received irinotecan-based chemotherapy in the first-line treatment was 42.7 months, whereas for the codon 13 mutant and KRAS wild-type patients, it was 18.3 and 23.9 months, respectively (codon 12 vs. codon 13; HR: 0.31, p = 0.03, codon 12 vs. wild-type; HR: 0.45, p = 0.03). Conclusion: The significant survival advantage was observed in patients with codon 12 mutations who received irinotecan-based chemotherapy as a first-line treatment.

Neoadjuvant chemotherapy (NAC) is well-established for locally advanced breast cancer, even in the early stages, especially in HER2-positive and triple-negative cases. However, the effect of chronologic age on NAC response remains controversial. This study investigates the efficacy and outcomes of NAC in older patients with breast cancer, compared to a younger cohort, to address the current knowledge gap. 535 patients who received NAC followed by curative surgery from 2010 to 2021 were retrospectively analyzed. We evaluated breast and axillary downstaging, pathologic complete response (pCR), and post-treatment toxicities. Data were stratified by age, with patients aged 65 years and older representing the older group. Anthracycline-based chemotherapy was prevalent (97.6%) and favored younger patients who received a dose-dense anthracycline regimen (71.7% vs. 38.5%, p < 0.001). Surgical outcomes, breast and axillary downstaging, and the pathologic complete response showed no age-related differences. Grade 3–4 toxicity was higher in older patients (71% vs. 46.4%, p < 0.01). Older patients treated with NAC achieve comparable outcomes to younger patients, supporting personalized treatment. Chronologic age should not dictate treatment decisions, emphasizing the need for comprehensive evaluation for optimal geriatric patient care.

Purpose: N3 gastric cancer is characterized by a fairly high lymph node metastasis burden and poor outcome despite optimal therapy. Given the limitations of TNM classification, a comprehensive evaluation tool is necessary to predict the prognosis of patients with N3 gastric cancer who underwent curative surgery. This study aims to explore the outcomes and clinicopathologic prognostic factors affecting the overall survival (OS) of patients with N3 gastric cancer after surgery. Methods: Data on patients with N3 gastric cancer who underwent (sub)total gastrectomy and regional lymph node dissection between November 2005 and September 2018 (n = 169) were analyzed by Cox regression to determine the independent prognostic factors for OS. Results: The multivariable analysis established that gender, patient performance status, metastatic lymph node ratio (MLNR), tumor grade, and adjuvant chemotherapy are significantly associated with OS. The five-year OS of the study population was 15%. Adjuvant chemoradiotherapy was applied to 72% of the patients, which resulted in an improvement in recurrence-free survival but not OS. Recurrence occurred in 103 (75%) patients, in which the most frequent recurrence site was distant metastasis. Conclusion: Male gender, poor performance status, grade 3 tumor, MLNR > 0.37, and not receiving adjuvant chemotherapy are predictors of poor prognosis in N3 gastric cancer after curative resection. Considering the high recurrence rates of this group, prospective studies are needed to optimize treatment strategies.

Background and objectives: Early recurrence (ER) following curative-intent surgery for pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis. Identifying preoperative risk factors for ER is essential for optimizing perioperative strategies. This study aimed to investigate perioperative predictors of ER, with a specific focus on tumor localization. Methods: We retrospectively analyzed 163 patients who underwent R0 or R1 resection for PDAC. ER was defined as recurrence within 6 months postoperatively. Two separate multivariate logistic regression analyses were conducted: one including only preoperative variables, and one including both pre- and postoperative factors. Results: ER occurred in 35.6% of patients and was associated with significantly worse overall survival (median 9 vs. 21 months, p < 0.001) and post-recurrence survival (5 vs. 8 months, p = 0.008). Preoperative ECOG performance status > 0 (OR 3.31, p = 0.013) and CA 19-9 > 208 U/mL (OR 3.18, p = 0.022) were identified as independent predictors of ER. In the postoperative model, tumor localization in the body/tail (OR 3.23, p = 0.035), tumor size > 3.25 cm, lymph node ratio > 0.13, and absence of adjuvant therapy were also significant. Notably, tumor location did not influence overall survival. Conclusions: Tumor localization in the body/tail of the pancreas is independently associated with early recurrence but not overall survival. These findings highlight the importance of incorporating tumor site into preoperative risk stratification and support the consideration of neoadjuvant therapy in select anatomically resectable patients, particularly those with left-sided tumors.

Background/Objectives: The precise role of volumetric body composition (VBC) parameters, visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and skeletal muscle index (SMI) on the survival of metastatic renal cell carcinoma (mRCC) is not fully elucidated. Herein, the present study investigated the clinical significance of baseline VBC parameters and their changes after 3–4 months from treatment initiation in patients with mRCC treated with first-line targeted therapy. Methods: A total of 108 patients were enrolled. VBC parameters were depicted from computerized tomography (CT) images at the third lumbar vertebra level. Kaplan–Meier curves were used to estimate survival probability, and the differences between prognostic subgroups were compared with the log-rank test. The association of baseline VBC variables and their change values (First CT value minus baseline CT value) with progression-free survival (PFS) and overall survival (OS) was evaluated in univariate and multivariate analyses. Results: The median PFS and OS of the whole patients were 11 and 46 months, respectively. Patients with increased VATI and SATI change values had poorer OS than those with decreased values. However, patients with higher SMI change values had superior OS than those with lower values. Among VBC variables, the independent predictors of worse OS were high VATI change (HR 5.10, p = 0.001) and low SMI change values (HR 2.66, p = 0.007), in addition to International Metastatic Renal Cell Carcinoma Database Consortium prognostic stratification (p = 0.001). Conclusions: Our findings showed that high VATI and low SMI changes were associated with worse OS in mRCC patients treated with first-line targeted therapy.

Amaç: Yeni nesil pek çok tedaviye rağmen oldukça kötü prognoza sahip metastatik renal hücreli karsinom (mRHK) tanılı hastalarda günümüze kadar kullanılan prognostik belirteçlerin her hastada prognozu doğru tayin edemediği bilinmektedir. Bu nedenle prognostik biyobelirteç arayışı sürmektedir. Bu çalışmada mRHK hastalarında tedavi öncesi biyokimyasal parametrelerin onkolojik sonuçlara etkisini araştırmak amaçlandı. Gereç ve Yöntemler: Kliniğimizde 2007-2020 tarihleri arasında tanı anında metastatik (Evre 4) veya lokal evrede (Evre 1-3) olup radikal nefrektomi yapılmış ve takipte nüks gelişen 90 mRHK hastasının klinik, patolojik, sağ kalım özellikleri ve sağ kalım üzerinde etkili olan faktörleri retrospektif olarak değerlendirildi. Hastaların demografik, klinikopatolojik ve tedavi özellikleri ile ilgili tanımlayıcı istatistiksel analizler yapıldı. Bulgular: Hastaların %21,2’i kadın, %78,8’si erkekti. Kadınlarla erkekler arasında medyan GS (genel sağkalım) açısından fark yoktu. Tanı anında metastazı olan hastalarda medyan GS süresi istatistiksel olarak anlamlı farkla daha düşüktü(p=0,001). Tanı anında metastatik hastalarda medyan GS 36,2 ay iken, takipte nüks olan hastalarda medyan GS 90,4 ay idi. Alkalenfosfataz/Albümin (ALP/ALB) oranı arttıkça sağkalım azalmaktaydı (p=0,038). CRP/ALB oranı 0.072 olanlarda bu süre 51 ay ile kısıtlıydı (AUC.630 p=0.046 cut off:0.072). Sonuç: CRP/ALB oranının prognozu belirleyen bir biyobelirteç olduğu saptanmıştır. Birinci sıra hedef tedavi sonrası progrese olan hastalarda immünoterapi önermekteyiz. Günümüzde özellikle mRHK'nin tedavi kararında prognoz önemli hâle gelmiştir ve yeni prognostik belirteçlerin araştırılmasına çalışmamızın ışık tutacağını düşünüyoruz.