Objectives: Inflammation plays an important role in cancer development, and various inflammation parameters are used as potential prognostic markers. This study aimed to evaluate the effectiveness of the combined use of HALP and H index in predicting pathological response to neoadjuvant therapy in patients with HER2-positive early-stage breast cancer. Method: This retrospective cohort study was conducted on 146 HER2-positive breast cancer patients treated in two centers. To stratify patients by their predicted probability of pathological response, HALP and H index values were combined into a composite biomarker score called the combined response score (CRS). Patients were classified into three groups based on biomarker levels: 0 = low CRS (low predictive score), 1 = intermediate CRS, and 2 = high CRS (high predictive score). These groups reflect predicted response likelihood and do not represent actual pathological outcomes. Pathological response results were evaluated according to the combined response score. Pathological complete response (pCR) was defined as residual cancer burden (RCB) 0, indicating no residual invasive tumor in breast or lymph nodes. Results: The mean age of 146 early-stage breast cancer patients included in our study was 52.3 ± 11.3 (min: 29-max: 83). In the ROC analysis, the optimum cut-off value for the HALP score in pathological response classification was found to be 36 (AUC = 0.608, sensitivity = 76.29%, specificity = 44.9%, PPV = 73%, NPV = 47.89%) and 2.3 for the H index (AUC = 0.641, sensitivity = 65.98%, specificity = 51.02%, PPV = 72.73%, NPV = 43.1%). While the pathological complete response rate was 66.4% in all patients, it was 81.8% in those with a combined score of 2, 51% in those with a score of 1, and 58.6% in those with a score of 0 (p < 0.001). In the logistic regression analysis, the probability of pathological response in patients in the combined score = 2 group is 3.77 times higher than in group 0. In the Fagan nomogram, the pretest probability of pathological response is 66%, while the post-test probability for combined response score group 2 is 81.5%, and for the low-H index < 2.3 and the high-HALP ≥ 36 patient group, our estimate for pathological complete response increases to 82%. Conclusions: The HALP-H index combined score is an important predictor of pathological response in early-stage HER2-positive breast cancer patients, independent of histological type and stage. This new score may enable personalized approaches in treatment planning.

Background and Objectives: Perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard of care for resectable gastric and gastroesophageal junction adenocarcinoma; however, up to 50% of patients develop metastatic recurrence. These patients have prior exposure to platinum and taxane agents, and optimal first-line treatment in the metastatic setting remains undefined. This study aimed to characterize real-world treatment patterns and outcomes in patients progressing after perioperative FLOT, focusing on relapse timing and HER2 status. Materials and Methods: This retrospective, multicenter cohort study included 296 patients from 31 centers across Türkiye, stratified into early relapse (≤6 months, n = 114) and late relapse (>6 months, n = 182) groups. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazards regression. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Results: Median PFS and OS for the entire cohort were 6 and 9 months, respectively. Early relapsers had significantly shorter median PFS (4 vs. 6 months, p = 0.029) and OS (8 vs. 12 months, p = 0.047); however, early relapse timing did not retain independent prognostic significance on multivariable analysis. No significant difference in PFS or OS was observed between cytotoxic chemotherapy regimens in either relapse group. HER2 positivity was the only independent predictor of improved PFS on multivariable Cox analysis (HR 0.48, 95% CI 0.29–0.81; p = 0.006). In the late relapse group, trastuzumab-based chemotherapy achieved a median PFS of 14 months and OS of 18 months, significantly superior to all cytotoxic regimens (PFS p = 0.007; OS p = 0.029). Conclusions: In patients progressing after perioperative FLOT, cytotoxic chemotherapy regimen selection did not demonstrate a statistically significant survival difference in this retrospective cohort, regardless of relapse timing. HER2 positivity is the dominant predictive biomarker, and trastuzumab-based therapy suggests a potential survival benefit that warrants prospective validation. Comprehensive biomarker profiling at metastatic diagnosis and prospective trials designed for this post-FLOT population are needed to establish evidence-based treatment standards.

Background/Objectives: Gastric cancer remains a leading cause of cancer-related mortality worldwide, with a significant number of patients diagnosed at locally advanced stages. While perioperative chemotherapy and surgical resection are the standard treatments, patient outcomes remain heterogeneous. This study aimed to investigate the prognostic and predictive effects of Body Mass Index (BMI) on pathological response, progression-free survival (PFS), and overall survival (OS) in patients receiving neoadjuvant chemotherapy. Methods: This retrospective, observational cohort study included 192 patients with locally advanced gastric cancer who underwent curative gastrectomy and neoadjuvant chemotherapy between 2018 and 2023. Patients were categorized based on an optimal BMI cutoff value of 24.9 kg/m². Results: Patients with a BMI ≥ 24.9 kg/m² demonstrated a 41% lower 5-year mortality risk compared to those with a lower BMI (HR = 0.59; 95% CI: 0.35–0.99; p = 0.044). The high BMI group had a significantly longer average PFS (54.1 months) compared to the low BMI group (41.4 months). High BMI was associated with a significantly reduced risk of progression (HR: 0.61; 95%CI: 0.38–0.97; p = 0.038. Log-linear regression confirmed that the complete response rate was 73.7% lower in patients with low BMI. Conclusions: BMI threshold of ≥24.9 kg/m² is associated with improved pathological response and long-term survival in patients with locally advanced gastric cancer receiving neoadjuvant chemotherapy. These findings suggest that BMI potentially reflects the impact of nutritional status on treatment tolerability and oncological outcomes.

Background and Objectives: Neoadjuvant chemotherapy (NAC) followed by radical cystectomy is the standard of care for eligible patients with locally advanced bladder cancer (LABC). However, adjuvant chemotherapy (AC) remains widely used in real-world practice. Host-related inflammatory and nutritional biomarkers may also influence survival outcomes. This study aimed to compare survival outcomes between NAC and AC and to identify independent prognostic factors for overall survival (OS) and progression-free survival (PFS), with particular emphasis on the Prognostic Nutritional Index (PNI). Methods: This multicenter retrospective study included 262 patients with locally advanced bladder cancer. The median age was 66 years, and 84% of patients were male. Patients were treated with neoadjuvant chemotherapy followed by radical cystectomy or adjuvant chemotherapy after surgery between August 2021 and March 2025. The Prognostic Nutritional Index (PNI) was calculated using pretreatment laboratory values. ROC analysis was used to determine the optimal PNI cut-off for predicting mortality, and the derived threshold (49.97) was applied for stratification in all survival analyses. Survival outcomes were evaluated using the Kaplan–Meier method and compared using the log-rank test. Multivariate Cox proportional hazards regression was used to identify independent prognostic factors. Results: Among 262 patients, 138 (52.7%) received NAC, and 124 (47.3%) received AC. Median follow-up was 33.6 months (95% CI: 29.4–37.8). No statistically significant differences in OS (p = 0.388) or PFS (p = 0.499) were observed between treatment groups. In univariate analyses, nodal stage, pathological complete response (pCR), and PNI were significantly associated with both OS and PFS. In multivariate analysis, low PNI (≤49.97) remained an independent predictor of mortality (HR 1.78, 95% CI 1.04–3.38; p = 0.044), while N3 nodal stage independently predicted disease progression (HR 5.92, 95% CI 1.06–32.84; p = 0.042). Conclusions: In this multicenter real-world cohort, nodal stage and systemic inflammatory-nutritional status were key determinants of prognosis in patients with locally advanced bladder cancer receiving perioperative chemotherapy. PNI emerged as an independent predictor of overall survival, suggesting that host-related biomarkers may improve prognostic stratification beyond traditional clinicopathological factors.