Background: Age- and cancer-related sarcopenia and malnutrition are common in older patients with colorectal cancer (CRC) and may negatively influence treatment tolerance and prognosis. However, the comparative prognostic value of post-chemotherapy changes in CT-based body composition parameters at the third lumbar vertebra (L3) and the twelfth thoracic vertebra (T12) levels, and their associations with nutritional indices, remain unclear. This study aimed to examine and compare the prognostic relevance of post-chemotherapy body composition changes at L3 and T12 and to assess their relationship with nutritional indices in older patients with metastatic CRC (mCRC). Methods: This retrospective study included 87 older patients with mCRC. Baseline and ~3-month follow-up CT scans were analyzed at L3 and T12 using 3D Slicer to quantify skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), visceral-to-subcutaneous fat ratio (VSR), and intramuscular adipose tissue index (IMATI). Changes (Δ) in CT-derived body composition after chemotherapy were calculated as percentage change using ((follow-up − baseline)/baseline) × 100. Prognostic Nutritional Index (PNI) and Geriatric Nutritional Index (GNRI), which are established nutritional assessment tools, were calculated from baseline laboratory/anthropometric data. Agreement between T12 and L3 was assessed, and associations with grade ≥ 3 toxicity, progression-free survival (PFS), and overall survival (OS) were evaluated using multivariable models and ROC analyses. Results: Mean age was 69.0 ± 4.5 years (59 male/28 female), and 26.4% developed grade ≥ 3 adverse events. Over 3 months, mean SMI declined significantly at both L3 (46.7 ± 8.8 → 42.8 ± 9.8 cm²/m²) and T12 (34.6 ± 8.2 → 31.6 ± 8.1 cm²/m²) (p < 0.001 for both), accompanied by decreases in VATI and VSR; T12-IMATI increased significantly. Baseline PNI showed a weak positive correlation with L3-SMI (r = 0.302, p = 0.033), whereas GNRI showed moderate correlations with SMI at L3 (r = 0.502, p < 0.001) and T12 (r = 0.317, p = 0.025) and was associated with longitudinal changes in muscle metrics. T12-SMI consistently yielded lower values than L3-SMI, and agreement varied by compartment (best for SATI; weakest for VSR). Lower GNRI and greater L3-SMI loss were independently associated with grade ≥ 3 toxicity; ΔL3-SMI showed the highest discrimination (AUC = 0.79, 95% CI = 0.69–0.87, p < 0.001; cut-off >5.1% loss). All patients progressed (median PFS 7.6 months); mortality was 82.8% (median follow-up: 25 months). In multivariable analysis, PFS, CRP, GNRI, and ΔL3-SMI remained independently associated with OS. ΔL3-SMI provided the strongest mortality discrimination (AUC = 0.85, 95% CI = 0.74–0.94, p < 0.001; cut-off >10.4% loss), while ΔIMATI was also informative (AUC = 0.71, 95% CI = 0.59–0.82, p = 0.023). Conclusions: In older patients with mCRC, early post-chemotherapy skeletal muscle loss—particularly at the L3 level—showed the strongest prognostic association with severe toxicity and mortality. GNRI provided complementary prognostic information as a marker of baseline immunonutritional reserve. Although T12-derived measurements were correlated with L3-derived values, systematic bias suggests that they should not be interpreted interchangeably for longitudinal risk stratification.

Objective: This study primarily aimed to identify baseline clinical and laboratory predictors of hematologic toxicity during first-line platinum-based chemotherapy in BRCA-mutated ovarian cancer patients. Secondary objectives included describing toxicity patterns and evaluating the association between hematologic toxicity and survival outcomes. Methods: This retrospective study included 64 patients with BRCA-mutated ovarian cancer who received platinum-taxane-based chemotherapy and were followed up at the İstanbul University Institute of Oncology between January 2009 and September 2024. Hematological toxicity was assessed using complete blood count before each chemotherapy cycle. Clinical data, factors associated with toxicity, and survival outcomes were compared between groups. Results: Hematologic toxicity occurred in 29.7% of the patients. The baseline leukocyte, neutrophil, and platelet counts were significantly lower in patients with toxicity. Additionally, patients with toxicities had more comorbidities at the baseline. Although the rate of dose modification was higher in the hematologic toxicity group, there were no significant differences between the groups in terms of treatment response or survival outcomes. Conclusion: Although hematologic toxicity was associated with more frequent dose modifications, no statistically significant differences in survival outcomes were observed between the groups. Baseline hematologic values and comorbidities should be considered in individualized planning of chemotherapy. Large-scale prospective studies are warranted to enhance the understanding of this topic. Cite this article as: Çokgezer S, Senkal M, Safaraliyeva A, Bozbey HU, Taştekin D. Hematologic toxicity during first-line platinum-based chemotherapy in BRCA-mutated ovarian cancer: predictors and survival impact. Cerrahpaşa Med J 2026; 50, 0033, doi: 10.5152/cjm.2026.26033.

To investigate whether pretreatment serum endocan, platelet-derived growth factor (PDGF)-CC, and -DD levels are elevated in metastatic colorectal cancer (mCRC) patients compared to healthy controls, and to assess their independent associations with chemotherapy response and survival, along with their comparative predictive performance. Adult patients with mCRC receiving systemic chemotherapy combined with an anti-angiogenic agent (bevacizumab or aflibercept) were prospectively enrolled, along with healthy controls. Pretreatment serum samples were collected prior to therapy initiation. Endocan, PDGF-CC, and PDGF-DD levels were measured in duplicate using enzyme-linked immunosorbent assay. Treatment response was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and categorized as responders (complete or partial response) and non-responders (stable or progressive disease). Progression-free survival (PFS) and overall survival (OS) were recorded. Median serum levels of endocan (405.5 vs. 269.0 pg/mL), PDGF-DD (499.9 vs. 315.1 pg/mL), and PDGF-CC (2330 vs. 1118 pg/mL) were significantly higher in the mCRC group compared to controls (p < 0.001). In multivariable logistic regression, all three biomarkers were independently associated with non-response to chemotherapy [Odds ratio (ORs): 1.10 for endocan, 1.05 for PDGF-DD, 1.05 for PDGF-CC; all p < 0.05]. For disease progression, Cox regression showed that higher levels of endocan [Hazard ratio (HR) = 1.04], PDGF-DD (HR = 1.03), and PDGF-CC (HR = 1.04) were significant predictors (all p < 0.01). Similar associations were observed for overall mortality (HR = 1.04, 1.02, and 1.02, respectively; all p < 0.05). Endocan, PDGF-DD, and PDGF-CC are elevated in mCRC and independently predict poor treatment response and adverse survival outcomes, highlighting their potential as prognostic biomarkers.

Background and Objectives: This study aimed to comparatively evaluate the association of commonly used comorbidity scores with survival, mortality, and recurrence in ovarian cancer patients aged 50 years and above. Materials and Methods: In this single-center, retrospective study, 130 female patients diagnosed between 2017 and 2024 who had received systemic therapy and had complete medical records were included. Comorbidity scores—including the Charlson Comorbidity Index (CCI), Cumulative Illness Rating Scale-Geriatric (CIRS-G), Adult Comorbidity Evaluation-27 (ACE-27), Elixhauser Comorbidity Index, Index of Coexistent Disease (ICED), and Functional Comorbidity Index (FCI)—were calculated for each patient. Survival analyses were conducted using the Kaplan–Meier method and Cox regression modeling. The prognostic accuracy of comorbidity scores was assessed via receiver operating characteristic (ROC) curve analysis. Results: Patients with higher CCI scores had significantly shorter survival, and CCI was identified as an independent prognostic factor in multivariate analysis. While other comorbidity scores were associated with overall survival in univariate analyses, they lost statistical significance in multivariate models. Patients with a higher comorbidity burden experienced more frequent disease recurrence and shorter time to recurrence. Conclusions: Comorbidity burden is a key clinical determinant of survival and disease trajectory in older patients with ovarian cancer. The CCI demonstrated the highest prognostic accuracy in this population and may serve as a valuable tool in individualized treatment planning. Integration of comorbidity-based assessments into standard decision-making processes is recommended in geriatric oncology practice.

Background: Reliable prognostic stratification is essential in metastatic colorectal cancer (mCRC), yet current inflammation-based scores do not fully integrate systemic inflammation, tumor burden, and clinical characteristics. Objective: This study aimed to develop a novel prognostic score integrating clinical, tumor burden, and inflammatory parameters in patients with mCRC and to compare its performance with the Glasgow Prognostic Score (GPS) and Gustave Roussy Immune Score (GRIm). Materials and Methods: This retrospective single-center study included 310 patients with mCRC treated between 2015 and 2025. GPS and GRIm were calculated. The novel prognostic score was constructed using seven equally weighted prognostic variables encompassing clinical characteristics, tumor burden, and laboratory parameters. Survival analyses were performed using Kaplan–Meier and Cox regression. Model performance was assessed using AUC, reclassification, calibration, and decision curve analysis. Results: Most patients had ECOG PS 0–1 (96.1%), left-sided tumors (76.1%) and synchronous metastases (79.0%). The median follow-up was 23.6 months. Both GPS and GRIm were independent prognostic factors for OS. GPS demonstrated superior discriminative performance compared with GRIm (AUC for 24-month OS: 0.697 vs. 0.620; p = 0.005). The novel score stratified median OS into low-, intermediate-, and high-risk groups as 40.9, 25.4, and 11.5 months, respectively (p < 0.001). The novel model outperformed GPS and GRIm (AUC: 0.768) and improved reclassification. Bootstrap-based internal validation demonstrated low optimism and good calibration. Conclusions: The novel prognostic score integrating clinical, inflammatory, and tumor burden parameters demonstrated superior prognostic performance compared with GPS and GRIm in mCRC. This score may serve as tool for individualized risk stratification.