Background: Pancreatic cancer is most often diagnosed at an advanced stage because it develops silently, and its early symptoms are vague and nonspecific. Grouping patients by their primary symptom clusters could provide valuable prognostic insights, enabling more accurate predictions of the stage at diagnosis, the likelihood of surgical resection, and expected survival. Methods: Single-center retrospective cohort study of 164 adults with histologically confirmed pancreatic adenocarcinoma. Patients were grouped by primary symptom cluster: obstructive (jaundice/dark urine/pruritus/steatorrhea), systemic (anorexia, fatigue, weight loss, or dyspnea/neurologic), pain-predominant (abdominal/back/epigastric pain or acute pancreatitis), or control (asymptomatic/incidental). Results: The study included 164 patients with a median age of 69 years (range 57– 81); 56.7% were male. At diagnosis, the overall stage distribution was as follows: stage I, 11%; stage II, 15.9%; stage III, 24.4%; and stage IV, 48.8%. Patients in the obstructive, systemic, and pain-predominant groups were more likely to present with advanced disease than those in the control group (p< 0.05). Among the symptomatic groups, the systemic cluster had a higher proportion of advanced-stage cases compared with both the obstructive and pain-predominant groups (p< 0.05). In contrast, no difference was found between the obstructive and pain-predominant groups (p> 0.05). In Cox proportional hazards analysis, symptom cluster category, stage at diagnosis, surgical resection status, treatment rate, treatment type, and localization were identified as independent predictors of overall survival (p< 0.05). Median survival was longest in the control group (37.6 months), followed by the obstructive (16.0 months), pain-predominant (11.8 months), and systemic (7.8 months) groups, with all between-group comparisons reaching significance (p< 0.05). Conclusion: Presenting symptom clusters are strongly associated with disease stage, surgical resectability, and survival outcomes in pancreatic cancer. Early recognition of high-risk symptom profiles may improve surgical opportunities and outcomes.

Objective: This study aimed to investigate the prognostic value of the preoperative monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and clinicopathological parameters for predicting survival outcomes in patients undergoing curative-intent gastrectomy for gastric adenocarcinoma. Methods: This retrospective cohort study analyzed data from 304 patients with histopathologically confirmed gastric adenocarcinoma who underwent curative-intent gastrectomy with standardized D1+ or D2 lymphadenectomy. The MHR was calculated using preoperative monocyte counts and HDL cholesterol levels. Patients were dichotomized based on the optimal MHR cutoff determined via receiver operating characteristic curve analysis with the Youden index. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were assessed using Kaplan–Meier analysis and compared with log-rank tests. Results: ROC analysis determined an optimal MHR cutoff of ≥11.02 (AUC: 0.654; 95% CI: 0.59–0.718), yielding sensitivities and specificities of 62.6% and 62.4%, respectively. Patients with an elevated MHR (≥11.02) had worse 5-year OS (51.4 vs. 72.2%; p < 0.001) and PFS (65.2 vs. 80.5%; p = 0.003). In the multivariate Cox regression model, elevated MHR emerged as an independent predictor of disease progression (HR: 1.93; 95% CI: 1.17–3.18; p = 0.010), while parameters such as signet ring cell histology, lymphovascular invasion, and perineural invasion were significant in univariate analyses but not in the adjusted multivariate model. Conclusions: MHR should not be regarded as a definitive predictor in isolation but rather as a cost-effective, readily obtainable adjunct within a broader preoperative risk assessment framework. Integration with other inflammation-based and clinicopathological factors may enhance predictive performance and clinical applicability.

BACKGROUND Microscopically positive margins (R1) after gastrectomy are uncommon but are associated with poor outcomes. Whether R1 reflects inadequate surgery or aggressive tumor biology remains unclear. MATERIAL AND METHODS We retrospectively analyzed 28 patients who underwent R1 resection for gastric adenocarcinoma between 2010 and 2023. Clinicopathologic features, recurrence patterns, and overall survival (OS) were evaluated. Prognostic factors were identified using univariate and multivariate Cox regression. RESULTS After a median follow-up of 82 months, the 5-year OS was 21.4%. Recurrence occurred in 50% of patients, all of whom subsequently died. On univariate analysis, HER2 negativity (HR 0.60, 95% CI 0.41-0.87, P=0.007), high Ki-67 index (HR 1.03, 95% CI 1.01-1.05, P=0.004), poor differentiation (HR 2.40, 95% CI 1.26-4.55, P=0.008), advanced pathological stage (HR 15.87, 95% CI 3.79-66.40, P<0.001), high lymph node ratio (HR 245.63, 95% CI 20.60-2929.13, P<0.001), and signet ring histology (HR 5.29, 95% CI 1.94-14.43, P=0.001) were associated with inferior OS. Multivariate analysis confirmed signet ring histology (HR 6.00, 95% CI 1.32-27.22, P=0.020) and advanced pathological stage (HR 13.28, 95% CI 2.76-63.89, P=0.001) as independent adverse prognostic factors, whereas lymph node ratio demonstrated borderline significance (HR 35.77, 95% CI 0.98-1308.06, P=0.051). CONCLUSIONS Survival after R1 resection is determined mainly by tumor biology - particularly signet ring features and advanced stage - rather than surgical technique. These findings call for risk-adapted adjuvant strategies and refined prognostic models in this high-risk subgroup.

Immune checkpoint inhibitors such as nivolumab have brought meaningful benefits to patients with advanced non-small cell lung cancer (NSCLC), yet many patients still experience limited responses. Vitamin D is a key modulator of immune function, and deficiency is common in individuals with cancer. Given its potential role in shaping immunotherapy response, we retrospectively assessed whether baseline vitamin D levels were associated with clinical outcomes in advanced NSCLC patients treated with nivolumab. We retrospectively analyzed patients with stage IV NSCLC treated with nivolumab across multiple centers, predominantly as second-line therapy. Prior to nivolumab initiation, all patients were confirmed to be negative for common driver mutations, including EGFR, ALK, ROS1, and other actionable genomic alterations. Baseline serum 25-hydroxyvitamin D levels were measured prior to nivolumab initiation, and patients were categorized as having severe deficiency (< 10 ng/mL), deficiency (10–20 ng/mL), or sufficient levels (≥ 20 ng/mL). The presence of liver metastases was recorded at baseline. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared with log-rank tests. Multivariable Cox proportional hazards models adjusted for age, sex, ECOG performance status, liver metastasis, and other metastatic sites were used to evaluate the independent prognostic value of vitamin D status. Objective response rates (ORR) were assessed in patients with available radiologic data. A total of 890 patients were screened, and after excluding those with missing baseline vitamin D data, 305 patients were included in the analysis. The median age was 64 years (range 34–85), and 68% of patients were male. Vitamin D levels were < 10 ng/mL in 30%, 10–20 ng/mL in 44%, and ≥ 20 ng/mL in 26% of patients. Patients with severe vitamin D deficiency were numerically older (median age 65 vs. 63 years) and had higher rates of ECOG PS ≥ 2 (15.1% vs. 7.5%) and squamous histology (37.6% vs. 27.5%), though these differences were not statistically significant (p > 0.05 for all). Liver metastases were present in 54 patients (17.7%), and the distribution was similar across vitamin D groups (p = 0.92). Median PFS was shortest in patients with severe vitamin D deficiency (3.4 months), intermediate in the 10–20 ng/mL group (5.2 months), and longest in patients with sufficient levels (8.1 months). Median OS ranged from 8.6 months in the < 10 ng/mL group to 15.8 months in the ≥ 20 ng/mL group. Patients with liver metastases had significantly shorter OS compared to those without (median OS 9.8 vs. 13.6 months, HR 1.48, p = 0.006). Vitamin D deficiency was associated with significantly worse PFS and OS on univariate analysis. In multivariable analysis, vitamin D levels < 20 ng/mL remained independently associated with poorer OS. ORR was numerically higher in patients with sufficient vitamin D levels (30% vs. 14%). Lower baseline vitamin D levels were associated with inferior clinical outcomes in advanced NSCLC patients treated with nivolumab. Patients with vitamin D levels ≥ 20 ng/mL demonstrated longer PFS and OS and a trend toward higher response rates. These findings support a prognostic role for vitamin D status in immunotherapy-treated NSCLC; however, prospective studies are required to determine whether vitamin D optimization can causally enhance immunotherapy efficacy.

Aim: To investigate into the age, gender as well as the etiology of portal vein thrombosis in patients diagnosed with the illness. Material and methods: The medical records of patients with portal vein thrombus (PVT), who referred to the internal medicine and gastroenterology policlinic at Dursun Odabaş Education and Research Hospital at the Faculty of Medicine in Yuzuncu Yil University between 01.01.2011 and 31.12.2013 were retrospectively analyzed. Results: As a result of the screening within the context of various parameters, a mild dominance of males was observed (M/F = 39/31), The average diagnosis of the illness in males was found to be 47 within the context of the age; this score was 41 in females. More than one thrombophilic factors were determined in 26 patients and there was a known history of liver cirrhosis in 15 patients, as well as myeloprolifirative disease found in 16 patients. Besides these, 13 of the patients were diagnosed to have idiopathic PVT. Conclusion: PVT should be taken into consideration in the middle and later age patients in the differential diagnosis of abdominal pain, and any underlying disease like liver cirrhosis or thrombophilia should certainly be investigated.

Aims: The aim of this study was to evaluate the impact of anemia at the time of recurrence on survival and prognosis in patients with esophageal squamous cell carcinoma (ESCC) who developed relapse during follow-up after definitive treatment. Methods: The data of 105 patients who had received definitive treatment for ESCC and subsequently developed recurrence were retrospectively reviewed. The mean age of the patients was 62.1±5.9 years (median 62), and 68.6% were male. Based on hemoglobin levels at the time of recurrence, patients were categorized into anemia and non-anemia groups according to laboratory reference ranges. Clinical characteristics, recurrence patterns, and treatments administered for recurrence were compared between the groups. Survival analyses were performed using the Kaplan–Meier method and the log-rank test; factors affecting post-recurrence mortality were evaluated with Cox regression analysis. Results: Anemia was detected in 60.0% of patients at the time of recurrence. Patients with anemia were significantly older than those without anemia (64.7±4.9 vs. 58.3±5.5 years, p