Background: Unplanned hospitalizations in patients with cancer are associated with adverse outcomes, including intensive care unit (ICU) transfer and in-hospital mortality. This study aimed to evaluate the predictive role of the prognostic nutritional index (PNI) and albumin-to-globulin ratio (AGR) for these outcomes in patients with unplanned hospitalization in a medical oncology ward. Methods: This retrospective, single-center study included patients aged ≥18 years with malignancy who had unplanned hospitalization between 1 January and 30 April 2025. PNI and AGR were calculated at admission. The primary outcome was ICU transfer or in-hospital mortality. Univariable and multivariable logistic regression analyses were performed, with AGR and PNI evaluated in separate models to avoid collinearity. Predictive performance was assessed using ROC analysis. Results: A total of 418 patients were included, with adverse clinical outcomes in 26.8%. Metastatic disease was present in 73.7%, and gastrointestinal (41.6%) and lung cancers (21.5%) were most common. In univariable analysis, metastatic disease (p < 0.001), Eastern Cooperative Oncology Group (ECOG) performance status (p < 0.001), cancer type (p = 0.030), reason for hospitalization (p = 0.001), AGR (p < 0.001), and PNI (p < 0.001) were significantly associated with adverse clinical outcomes. In multivariable analyses performed in separate models, ECOG ≥ 2 emerged as the strongest independent predictor of adverse clinical outcomes (AGR model: OR: 9.93; PNI model: OR: 11.14; both p < 0.001). Metastatic disease remained an independent risk factor, while higher AGR and PNI values were independently associated with a reduced risk (all p < 0.05). Among hospitalization reasons, only electrolyte imbalance/transfusion was associated with a lower risk, whereas most cancer type subgroups were not independently significant. Both indices showed moderate predictive performance, with PNI performing slightly better than AGR (AUC: 0.729 vs. 0.707). Conclusions: ECOG performance status, together with PNI and AGR, were identified as practical and accessible predictors of adverse clinical outcomes in patients with unplanned hospitalization in a medical oncology ward.

Background: Immune checkpoint inhibitors (ICIs) targeting the PD-1 axis represent standard second-line therapy for metastatic non-small cell lung cancer (NSCLC). Emerging data suggest that SARS-CoV-2 mRNA vaccines may enhance antitumor immunity through innate immune activation and type I interferon signaling, potentially sensitizing tumors to PD-1 blockade. The clinical impact of patients initiating second-line nivolumab remains unclear. Methods: In this retrospective single-center cohort study, 88 patients with recurrent stage IV NSCLC who received second-line nivolumab between 1 January 2023 and 1 January 2026 were analyzed. Vaccination exposure was defined using a 6-month pre-treatment window prior to nivolumab initiation (T0). Patients were stratified according to receipt of ≥2 versus 0–1 mRNA COVID-19 vaccine doses within the 6 months preceding T0 (n = 45 and n = 43, respectively). The primary endpoint was progression-free survival from nivolumab initiation (PFS2). Survival outcomes were estimated using the Kaplan–Meier method and evaluated using Cox regression models. Results: With a median follow-up of 22.4 months, median PFS2 for the overall cohort was 11.1 months (95% CI, 9.4–15.1). Patients receiving ≥2 mRNA doses had significantly longer PFS2 than those receiving 0–1 dose (14.0 vs. 9.6 months; p = 0.04). In multivariable analysis, ≥2 doses were independently associated with reduced risk of progression or death (aHR 0.52, 95% CI 0.31–0.88; p = 0.01). Non-adenocarcinoma histology and baseline brain metastasis were independently associated with shorter PFS2. Conclusions: Receipt of ≥2 mRNA vaccine doses within 6 months before nivolumab initiation was independently associated with prolonged PFS2 in metastatic NSCLC. Prospective multicenter validation is warranted.

Background and Objectives: Immune checkpoint inhibitors (ICIs) improve survival in advanced non-small-cell lung cancer (NSCLC), yet treatment responses vary. The potential influence of proton pump inhibitors (PPIs), metformin, statins, and nonsteroidal anti-inflammatory drugs (NSAIDs) on immunotherapy efficacy has gained increasing attention. This study aimed to evaluate the associations of these medications with survival outcomes. Materials and Methods: This retrospective cohort study included 179 patients with advanced NSCLC who received second-line nivolumab. The use of PPIs, metformin, statins, and NSAIDs was assessed within a ±30-day exposure window around nivolumab initiation. Sensitivity analyses were performed including all four studied medications. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox regression models. Results: Median follow-up was 19 months, and 52.5% of patients used PPIs. In univariable analysis, PPI use was significantly associated with worse PFS (HR = 2.01; p < 0.001), while PD-L1 ≥ 50% expression was associated with improved PFS (HR = 0.57; p = 0.034). In multivariable analysis, PPI use remained independently associated with worse PFS (HR = 2.22; p < 0.001), and male sex was associated with improved PFS (HR = 0.56; p = 0.013). For OS, PPI use (HR = 1.53; p = 0.043), ECOG ≥ 2 (HR = 2.09; p = 0.001), and male sex (HR = 0.53; p = 0.008) were significant factors in univariable analysis. In multivariable analysis, PPI use (HR = 2.01; p = 0.002) and ECOG ≥ 2 (HR = 2.21; p = 0.001) were independent adverse prognostic factors, while male sex was independently associated with improved OS (HR = 0.41; p = 0.001). Median PFS was 5 months in PPI users versus 9 months in non-users (p < 0.001); median OS was 9 versus 14 months (p = 0.036). The use of metformin, statins, and NSAIDs showed no significant relationship with PFS or OS. Sensitivity analyses supported an association between PPI use and worse outcomes. Conclusions: PPI use was associated with worse PFS and OS in patients with advanced NSCLC receiving second-line nivolumab. These findings suggest that unnecessary PPI use should be carefully reassessed during immunotherapy.

Aims: Sepsis is a life-threatening organ dysfunction resulting from an excessive inflammatory response in the host due to infection. Due to the activation of the coagulation system in sepsis, the search for treatment has shifted in this direction and therapeutic plasma exchange (TPE). This study, it was aimed to compare the hemogram and biochemical values and inflammatory markers of patients who underwent TPE before and after TPE. Methods: The research data were obtained retrospectively from the records on the hospital system of the patients who were hospitalized in Malatya İnönü University Faculty of Medicine Intensive Care Clinic and were treated with TPE. Results: A total of 25 patients were included. It was observed that platelet count (p=0.427), hemoglobulin (p=0.545), leukocyte (p=0.527) and neutrophil (p=0.657) counts decreased statistically after TPE. It was observed that C-reactive protein (p=0.065) and procalcitonin (p=0.267) values also decreased after TPE procedure. Among the direct bilirubin (p=0.326), total bilirubin (p=0.397), AST (p=0.840) and alanine transferase(ALT) (p=0.122) values, it was determined that the aspartate transferase (AST) value increased after the TPE procedure and the others decreased. It was observed that the blood urea nitrogen (p=0.326) value increased after TPE procedure, while creatinine (p=0.677) value decreased. Conclusion: TPE process can reduce harmful components in plasma. Since it is of vital importance to reduce harmful components in the plasma in sepsis, TPE can be applied by evaluating patient-specifically. Our study is important in terms of showing that TPE can be an alternative treatment modality in patients with sepsis and septic shock.

Background and Objectives: The effect of bevacizumab on the morphology of non-tumoral organs remains unclear. We evaluated computed tomography (CT)- derived treatment-emergent pancreatic volume loss and examined its association with progression-free survival (PFS) and overall survival (OS) in patients with metastatic colorectal cancer receiving bevacizumab. Materials and Methods: This single-center retrospective study included 105 patients treated at Ankara Etlik City Hospital who had evaluable paired contrast-enhanced CT scans obtained before and during therapy. Pancreatic volume was measured on CT, and percentage volume loss was calculated. Clinical, laboratory, radiological, and survival data were retrospectively reviewed. Results: Mean pancreatic volume declined from 89.9 ± 6.1 mL before treatment to 83.6 ± 5.1 mL during therapy (p < 0.001). Albumin levels and platelet counts also decreased, whereas amylase, hemoglobin, and the neutrophil-to-lymphocyte ratio remained largely unchanged. In the main multivariable models, each 1% increase in pancreatic volume loss was associated with worse bevacizumab-line PFS (HR 1.06, 95% CI 1.02–1.10; p = 0.032) and OS (HR 1.08, 95% CI 1.01–1.15; p = 0.041). Percentage change in albumin was independently associated with both endpoints. Sensitivity analyses supported a more consistent association of pancreatic volume loss with PFS than with OS. Conclusions: Pancreatic volume decreased during bevacizumab-containing therapy. Greater pancreatic volume loss was associated with shorter PFS and OS; however, the association was more consistent for PFS. Prospective studies are needed to validate these findings and determine their clinical relevance.

Background/Objectives: This study was conducted to prospectively evaluate quality of life (QoL), patient-reported outcomes, and geriatric domains during the first 3 months of first-line systemic therapy in older patients with de novo metastatic gastrointestinal cancers. Methods: This prospective longitudinal study included 90 patients aged ≥65 years receiving first-line chemotherapy-based systemic therapy. Assessments were performed at baseline, Month 1, and Month 3 using validated QoL, sleep, anxiety, cognitive, and nutritional instruments. The primary endpoint was change in EORTC QLQ-C30 Global Health Status/QoL from baseline to Month 3. Treatment tolerability, initial radiologic response, and exploratory survival outcomes were also assessed. Results: Mean Global Health Status/QoL increased from 68.1 at baseline to 71.0 at Month 3; the model-estimated mean change was +3.0 points (95% CI, −0.3 to 6.2; p = 0.071). Fatigue and appetite loss improved significantly, and normal nutritional status increased from 31.1% to 62.2% (p < 0.001). Clinically meaningful QoL improvement and deterioration occurred in 38.9% and 18.9%, respectively. Treatment intolerance occurred in 46.7%. Disease control was associated with more favorable QoL change than progressive disease (difference, 17.8 points; 95% CI, 6.0–29.7; FDR-adjusted p = 0.008). Baseline nutritional impairment (adjusted HR, 3.58) and poor sleep quality (adjusted HR, 3.30) were associated with shorter progression-free survival. Conclusions: Mean global QoL did not change significantly during the first 3 months, while several symptom and nutritional domains improved. More favorable QoL trajectories were observed with disease control, and baseline nutritional impairment and poor sleep quality were associated with shorter progression-free survival.