Background: Osteosarcoma is a rare but aggressive bone malignancy. Despite advances in multimodal therapy, survival remains suboptimal, highlighting the need for prognostic markers to guide treatment. Methods: This study included 162 osteosarcoma patients who received neoadjuvant chemotherapy followed by surgery between January 2009 and March 2024. Patients received either double (cisplatin + doxorubicin) or triple (MAP or PEI) chemotherapy. Survival analyses were conducted using Kaplan–Meier curves, log-rank tests, and Cox proportional hazards models. Results: The median age was 20 years (IQR: 18–29), and 53.1% were male. Patients who received triple chemotherapy regimens demonstrated significantly longer overall survival (OS) compared to those on doublet regimens. High tumor necrosis rates (>90%) and negative surgical margins were strongly associated with improved OS, while metastatic disease at diagnosis, elevated alkaline phosphatase (ALP), and male gender were linked to poorer survival. Multivariate analysis identified adjuvant therapy, age under 18, high necrosis rate, negative margins, and normal ALP as significant OS predictors. Conclusions: Triple-agent chemotherapy, necrosis rate ≥90 and negative surgical margins are strongly associated with prolonged survival in osteosarcoma. The key prognostic indicators such as ALP levels, surgical margins and age at diagnosis should guide personalized treatment strategies to improve outcomes in curable patients.

Objective To investigate the impact of cumulative cisplatin dose on clinical outcomes in locally advanced cervical cancer patients undergoing definitive chemoradiotherapy. Methods A retrospective analysis was conducted on 654 patients with stage IB3–IVA disease treated with definitive chemoradiotherapy. Radiotherapy was applied as external beam pelvic with or without para-aortic radiotherapy and brachytherapy. Concomitant chemotherapy was in the form of weekly or 3 weekly cisplatin. Data on demographics, treatment protocols, cumulative cisplatin dose, adverse effects, and survival outcomes were collected. Statistical analyses, including univariate and multivariate Cox regression models, were used to assess factors influencing progression free survival and overall survival. Results The median cumulative cisplatin dose was 210 mg (range 40–320), and ≥200 mg in 503 (76.9%) patients. Median follow-up was 35 months (range 1–150). The 5 year progression free survival and overall survival rates were 66.9% and 77.1%, respectively. Multivariate analysis identified poor performance status, non-squamous cell histology, presence of lymph node metastases, and hemoglobin <10 g/dL before chemoradiotherapy as poor prognostic factors for both progression free survival and overall survival in the whole group. When stage III cases were evaluated separately, the cumulative cisplatin dose 200 mg, particularly in patients with lymph node metastases, significantly improved overall survival. Factors such as anemia, toxicity related challenges, and comorbidities were identified as critical considerations in treatment planning. These findings emphasize the balance between maximizing therapeutic efficacy and managing toxicity, guiding personalized treatment approaches for locally advanced cervical cancer.

Background: Dynamic assessment of cardiac output (CO) with passive leg raise (PLR), stroke volume variation (SVV), and pulse pressure variation (PPV) offer effective and safe methods to predict fluid responsiveness in patients with shock. The primary aim of this study was to evaluate the reliability of CO and SVV readings with the ultrasonic cardiac output monitor (USCOM) 1A device compared to PPV measurements in determining fluid responsiveness of patients in shock. Materials and Method: Intubated and mechanically ventilated patients aged 18–95 with shock admitted to the medical intensive care unit from June 2019 to December 2020 were included in the study. Fluid responsiveness was assessed using PPV from arterial monitoring and CO/SVV using the USCOM 1A device. CO, PPV, and SVV data were recorded before and after PLR. Results: Out of 145 shock patients, 92 were included. Before the PLR maneuver, 67 patients had PPV values above 12% and were stated as fluid responsive. The SVV index measured by the USCOM device demonstrated good sensitivity (85%) and specificity (96%) in identifying fluid responsiveness. The agreement with PPV was substantial (Cronbach’s alpha reliability: 0.718 [P < 0.001]), and the index was internally consistent (kappa agreement: 0.707 [P < 0.001]). The SVV index moderately correlated with PPV (R: 0.588 [P = 0.001]). Regarding fluid responsiveness determined by PPV, the AUC value of SVV was 0.797 (0.701–0.894) (p: 0.001). Conclusion: SVV measured by the USCOM device is a reliable and practical tool for hemodynamic assessment in clinical practice, particularly when invasive methods are unsuitable.

Background and Objectives: To evaluate the prognostic value of the Clinical–Pathologic Stage–Estrogen receptor status and Grade (CPS+EG) staging system, which combines clinical staging, pathological staging, oestrogen receptor (ER) status, and tumour grade in predicting survival outcomes in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer receiving neoadjuvant therapy (NACT). Materials and Methods: A retrospective review was performed on 245 female breast cancer patients who received anti-HER2 therapy alongside NACT at the Medical Oncology Department of Kartal Dr Lütfi Kırdar City Hospital, University of Health Sciences, from April 2012 to June 2024. The CPS+EG score was calculated using the MD Anderson Cancer Centre neoadjuvant treatment response calculator. Patients were categorised into two groups based on their CPS+EG score < 3 and ≥3. The primary outcomes assessed were disease-free survival (DFS) and overall survival (OS). Kaplan–Meier and log-rank tests were utilised for time-to-event analysis; Cox regression was used for multivariate analysis. A significance level of ≤0.05 was considered. Results: The median age of the patient cohort was 51 years (range: 27–82 years). Among these patients, 183 (74.6%) had a CPS+EG score less than 3, while 62 (25.3%) exhibited a score of 3 or higher. The median follow-up duration was 37.6 months. The pathological complete response (pCR) rate across the entire cohort was 51.8%. Specifically, the pCR rate was 56.3% in the group with CPS+EG scores below 3, and 38.7% in those with scores of 3 or higher (p = 0.017). Patients with CPS+EG scores less than 3 demonstrated superior overall survival (OS), which reached statistical significance in univariate analysis. Multivariate analysis identified the CPS+EG score as an independent prognostic factor for both overall survival and disease-free survival (DFS), with hazard ratios of 0.048 (95% CI: 0.004–0.577, p = 0.017) and 0.35 (95% CI: 0.14–0.86, p = 0.023), respectively. Conclusions: The CPS+EG score is an independent and practical prognostic marker, particularly for overall survival, in patients with HER2-positive breast cancer who have received neoadjuvant therapy. Patients with a CPS+EG score < 3 have higher pCR rates and survival rates. When used in conjunction with pCR, it can improve risk categorisation and contribute to the individualisation of adjuvant strategies in the post-neoadjuvant period. Due to its ease of calculation and lack of additional costs, this score can be instrumental in clinical practice for identifying high-risk patients. Our findings support the integration of the CPS+EG score into routine clinical decision-making processes, although prospective validation studies are necessary.

Objective: The role of adjuvant chemoradiotherapy (CRT) following curative gastrectomy remains controversial, especially in the context of D2 dissection. This research evaluated survival indicators through an analysis of previous observational studies and it evaluated treatment outcomes between patients who underwent CRT and those who received CT as their sole therapy. Methods: The researchers performed a non-randomized retrospective cohort study which analyzed 206 patients who underwent R0–R1 resection for gastric adenocarcinoma and received either adjuvant CRT (n = 107) or CT alone (n = 99). A Kaplan–Meier analysis together with Cox regression methods were used to evaluate survival outcomes of patients. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences between groups at the beginning of the study. The median follow-up was 52.0 months. Results: The baseline characteristics differed markedly between groups, with CRT patients showing higher rates of T4 tumors (34.6% vs. 22.2%), N3 disease (47.7% vs. 26.3%), vascular invasion (72.9% vs. 50.5%), and R1 resection (10.3% vs. 1.0%). Unadjusted survival favored CT alone (median DFS 81.7 vs. 103.9 months; median OS 86.2 months vs. not reached). These differences lost significance after IPTW adjustment (DFS: HR 1.18, p = 0.428; OS: HR 1.24, p = 0.336). T3–T4 stage, N2–N3 nodal status, vascular invasion, and positive margins emerged as independent prognostic factors. Subgroup analyses revealed no treatment interactions (all p > 0.05). Conclusions: The research used a retrospective study design which showed substantial differences between treatment groups at the beginning of the study. The survival results that showed better outcomes for CT alone became attenuated after the researchers applied propensity score adjustment to adjust for confounding from treatment selection. The study established that advanced T–N stage, vascular invasion, and positive margins were identified as independent prognostic factors. The research results are hypothesis-generating and require randomized controlled trials to establish the exact difference in effectiveness between different treatments.

Objective: Metastatic gastric cancer is a biologically heterogeneous disease with a poor prognosis. Although the presence of distant metastasis defines advanced disease, the prognostic impact of specific metastatic patterns remains unclear. This study aimed to evaluate the association between metastatic patterns and overall survival in patients with metastatic gastric cancer. Methods: In this retrospective single-centre study, 292 patients with histopathologically confirmed metastatic gastric cancer were included. Metastatic sites were evaluated using computed tomography, magnetic resonance imaging, and/or positron emission tomography. Overall survival (OS) was analysed using the Kaplan–Meier method and compared using the log-rank test. Prognostic factors were assessed through univariate and multivariate Cox proportional hazards regression models. Results: The median OS for the entire cohort was 10 months (95% CI, 9.3–12.0). The most common sites of metastasis were non-regional lymph nodes (78.8%), liver (49.7%), and peritoneum (30.8%). Peritoneal metastasis was associated with significantly worse survival in unadjusted Kaplan–Meier analysis (9.5 vs 11 months, P<0.001), whereas other metastatic sites were not significantly associated with OS. No significant difference in OS was observed between patients with single-site and multiple-site metastases (P=0.31). In multivariate analysis, Eastern Cooperative Oncology Group performance status (ECOG) and prior gastrectomy were identified as independent prognostic factors, while the impact of metastatic site did not remain statistically significant. Conclusion: Metastatic gastric cancer exhibits substantial heterogeneity in survival outcomes according to the distribution of metastatic sites. Peritoneal involvement was associated with worse survival in unadjusted analyses and may represent a clinically relevant marker of adverse prognosis. Including site-specific metastatic information in prognostic assessments may contribute to improved risk stratification in addition to the conventional staging system.