Objective: Extragonadal germ cell tumours have a more unfavourable prognosis than gonadal germ cell tumours. We aimed to evaluate the survival analysis, response rates, and factors affecting responses to high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) in patients with relapsed/refractory extragonadal germ cell tumours. Methods: This study included patients diagnosed with extragonadal germ cell tumours who underwent HDCT + ASCT between November 2016 and January 2023 at Gülhane Training and Research Hospital. Clinical characteristics and follow-up data from patient records and the hospital’s electronic system were retrospectively analysed. Patients under 18 years of age and those without medical records were excluded. Patient characteristics, post-HDCT progression-free survival (PFS), overall survival (OS) data, and factors affecting survival were examined. The relationship between clinical factors and OS/PFS was analysed. Results: Twenty-five patients were included in this study. Complete response (CR) was observed in seven patients (28%), partial response (PR) was observed in nine patients (36%), stable disease (SD) was observed in one patient, and progressive disease (PD) was observed in eight patients (32%) after HDCT + ASCT. The median follow-up period was 25.4 months. The median PFS and OS after HDCT + ASCT were calculated as 6.1 months and 12.2 months, respectively. Conclusions: Salvage HDCT + ASCT is an option in the treatment of extragonadal germ cell tumours, offering the potential for prolonged survival and curing.

The C‑reactive protein‑triglyceride‑glucose index (CTI), integrating C‑reactive protein and the triglyceride‑glucose index, is a pragmatic biomarker reflecting systemic inflammation and metabolic stress in cancer. Although its prognostic value has been validated in heterogeneous cancer cohorts, data in homogeneous perioperative settings remain limited. The present study retrospectively evaluated 131 patients with locally advanced gastric or gastroesophageal junction adenocarcinoma who received perioperative fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy between November 2018 and June 2024 (67 months). CTI was calculated at diagnosis, and patients were stratified using the 4.78 cut‑off value previously validated in oncology populations. Associations between CTI and clinicopathological variables, pathological response, progression‑free survival (PFS) and overall survival (OS) were analyzed. The results demonstrated that among the 131 patients who underwent curative‑intent surgery after neoadjuvant FLOT, 113 (86.3%) had low CTI (<4.78) and 18 (13.7%) had high CTI (≥4.78). Patients with high CTI had significantly shorter PFS compared with those with low CTI (median, 12.2 vs. 25.5 months; P=0.006). OS was also markedly inferior in the high CTI group [median, 23.1 months vs. not reached (NR) in the low CTI group; P=0.001]. In the multivariable analysis, high CTI independently predicted poor PFS [hazard ratio (HR), 2.18; 95% confidence interval (CI), 1.21‑3.95; P=0.010]. Regarding treatment response, the pathological complete response rate was 11.5% (13/113) in the low CTI group and 22.2% (4/18) in the high CTI group (P=0.221), indicating no significant association between CTI and pathological complete response. In conclusion, pretreatment CTI is an independent prognostic marker in patients with locally advanced gastric or gastroesophageal junction adenocarcinoma treated with perioperative FLOT, identifying individuals at higher risk of relapse and inferior survival. The simplicity, low cost and pretherapeutic availability of pretreatment CTI support its use as a promising tool for risk stratification that warrants prospective, multicenter validation.

Background: Frailty has emerged as a critical determinant of postoperative morbidity, mortality, and survival in elderly cancer patients. However, evidence focusing specifically on octogenarian patients undergoing major gastrointestinal cancer surgery remains limited. Methods: This retrospective cohort study included 274 patients aged ≥ 80 years who underwent curative-intent colorectal or gastric cancer surgery at Erzurum City Hospital between 2015 and 2025. Patients were stratified into Low (0–1), Medium (2), and High (≥ 3) frailty groups using the modified Frailty Index-5 (mFI-5). Perioperative outcomes, adjuvant therapy feasibility, overall survival (OS), and recurrence-free survival (RFS) were evaluated and compared across frailty categories. Results: Of the 274 patients, 153 (55.8%) were classified as low frailty, 81 (29.6%) as medium frailty, and 40 (14.6%) as high frailty. Increasing frailty severity was associated with higher rates of major postoperative complications (12.5%, 27.8%, and 46.9%) and higher observed 90-day mortality (13.7%, 14.8%, and 37.5%). Median length of hospital stay differed across frailty groups and was 9.0 (IQR 6.0–12.0) days in Low frailty, 8.0 (IQR 6.0–12.0) days in Medium frailty, and 12.0 (IQR 8.0–15.0) days in High frailty patients. In multivariable analyses, high frailty was independently associated with higher 90-day major morbidity (adjusted OR 8.92, 95% CI 2.09–38.12; p = 0.003) and poorer OS (adjusted HR 3.70, 95% CI 1.88–7.28; p < 0.001). High frailty was also associated with poorer RFS in adjusted analyses (adjusted HR 3.85, 95% CI 1.41–10.50; p = 0.008). Conclusion: Preoperative frailty, as assessed by the mFI-5, is associated with increased perioperative morbidity and worse survival outcomes in octogenarian patients undergoing colorectal or gastric cancer surgery. Routine frailty assessment may support risk stratification and shared decision-making in this vulnerable population.

Background Relapsed or refractory Germ cell tumors are commonly treated with HDCT/ASCT, yet robust predictors of hematopoietic recovery are limited. Quantitative CT-based body-composition metrics are readily available in practice, but their prognostic value for post-transplant engraftment remains uncertain. We investigated whether muscle and fat indices derived from routine CT scans are associated with the pace of hematologic recovery after HDCT/ASCT Methods Retrospective single-center cohort (n=43) with relapsed/refractory GCT undergoing HDCT/ASCT. CT within ±6 months of ASCT was analyzed at L3 to derive SMI, PMI, SFA, VFA, TFA, and VFA/SFA. Primary endpoint: engraftment time post-ASCT. Univariable associations used Spearman ρ; multivariable linear regression adjusted for age, Hb, weight, and BSA evaluated independent effects. Significance: p< 0.05 Results Median hematologic engraftment duration was 12.0 days . Engraftment duration correlated positively with age and negatively with hemoglobin. In multivariable analysis, older age and lower hemoglobin independently predicted longer engraftment; body weight and BSA were not significant. Among morphometrics, only VFA/SFA associated with delayed engraftment. SMI, PMI, and TFA were not significant. As expected after HDCT, grade 4 neutropenia and thrombocytopenia occurred in all patients. Conclusions In relapsed/refractory GCT treated with HDCT/ASCT, older age and lower post-transplant hemoglobin independently predict prolonged engraftment. Beyond traditional muscle/fat areas, a higher VFA/SFA ratio—reflecting visceral adiposity—also associates with delayed recovery, suggesting fat distribution may influence hematopoietic regeneration. These variables may support pre-transplant risk stratification and individualized supportive care.

Background: The role of high-dose chemotherapy followed by autologous stem-cell transplantation (HDCT–ASCT) in advanced Ewing sarcoma remains uncertain, with mixed prospective data and heterogeneous retrospective findings. Materials and Methods: We performed a single-center, retrospective cohort study of consecutive patients with histologically confirmed ES who received HDCT–ASCT after ≥1 prior systemic therapy line (N=46). Conditioning was ICE. Prespecified endpoints were overall survival (OS; diagnosis → death), post-transplant overall survival OS-2 (ASCT → death), and progression-free survival PFS (ASCT → progression/death). Survival was estimated by Kaplan – Meier and compared by log-rank. Prognostic factors (age at diagnosis, primary tumor site, metastatic organ involvement) were evaluated using Cox models. Results: Median age at diagnosis was 23.5 years (14–55); 69.6% were male and 21.7% had metastatic disease at presentation. Median OS was 42.0 months, median PFS and OS-2 after HDCT–ASCT were 5.0 months and 8.0 months, respectively. Younger age (≤23 years) was associated with longer OS (50.0 vs 34.0 months; p=0.027). Primary tumor site was not independently associated with PFS, OS-2, or OS. Metastatic site showed endpoint-specific effects: liver metastasis independently predicted worse OS (HR 5.411; p=0.006), while lung metastasis was associated with shorter PFS (HR 6.037; p=0.016) and OS-2 (HR 2.672; p=0.025). Post-transplant best responses were CR 8.7%, PR 17.4%, SD 15.2%, and PD 58.7%. Grade 3–4 hematologic toxicities were universal (febrile neutropenia, neutropenia, thrombocytopenia 100%; anemia 86.9%); common non-hematologic events included nausea/vomiting (82.6%), diarrhea (78.2%), and mucositis/stomatitis (65.2%). Treatment-related mortality was 2.1% (1/46). Conclusions: In this young-adult–predominant cohort, HDCT–ASCT achieved limited disease control with substantial but manageable toxicity. Prognosis was driven more by age and metastatic organ involvement than by primary site, with liver metastasis portending inferior OS and lung metastasis adversely affecting PFS/OS-2. These data support risk-adapted patient selection and exploration of post-transplant maintenance strategies in future prospective studies.

Background: Ewing sarcoma (ES) is a highly aggressive malignant tumor that predominantly affects children and young adults. Despite advances in multimodal therapy, relapse and refractory disease remain the leading causes of treatment failure. High-dose chemotherapy followed by autologous stem cell transplantation (HDCT-ASCT) has been proposed as a consolidation strategy for high-risk or relapsed ES; however, its clinical value remains controversial. Methods: We retrospectively analyzed 46 consecutive patients with locally advanced or metastatic ES who underwent HDCT-ASCT after at least one prior systemic therapy line. Clinical, pathological, and transplant-related variables were evaluated for associations with overall survival (OS), post-transplant OS (OS-2), and progression-free survival (PFS). Survival was estimated using the Kaplan–Meier method, and prognostic factors were assessed by Cox proportional hazards modeling. Results: The median age at diagnosis was 23 years (range: 14–55). Median OS from diagnosis was 42 months, while post-transplant OS-2 and PFS were 8 and 5 months, respectively. Younger patients (≤23 years) had significantly longer OS (50 vs. 34 months; p = 0.027). Liver metastasis predicted inferior OS (HR = 5.411; p = 0.006), whereas lung metastasis was associated with shorter OS-2 (HR = 2.672; p = 0.025) and PFS (HR = 6.037; p = 0.016). Treatment-related mortality was low (2.1%), though hematologic toxicity was universal. Overall, HDCT-ASCT provided transient disease control, with modest benefit confined to younger, chemosensitive, and medically fit patients. Conclusions: In this real-world cohort, HDCT-ASCT was feasible and safe but offered limited survival advantage in heavily pretreated Ewing sarcoma. Prognosis was primarily influenced by age and metastatic distribution, particularly hepatic and pulmonary involvement. These findings support a risk-adapted, biology-driven approach reserving HDCT-ASCT for selected patients and highlight the need for post-transplant maintenance strategies integrating targeted or immunotherapeutic modalities.