Browsing by Author "Altiok, Merih"

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    Clinical Impact of Sarcopenia on Gastric Cancer and the Effect of Neoadjuvant Chemotherapy on Sarcopenia
    (2022) Parsak, Cem Kaan; Gumus, Serdar; Gul, Mehmet Onur; Altiok, Merih; Unal, Ayse Gizem; Yalav, Orcun; Bali, Cagla
    Background: Sarcopenia may adversely affect treatment responses and oncological outcomes in cancer patients. However, the importance of pretreatment nutritional assessment as an indicator of treatment response and outcome in patients with gastric cancer undergoing neoadjuvant chemotherapy remains unclear. Objectives: This study aims to investigate the clinical impact of sarcopenia on gastric cancer and to determine the effect of neoadjuvant chemotherapy (NC) on sarcopenia, as well as body mass index (BMI), psoas muscle index (PMI), and prognostic nutrition index (PNI). Methods: A retrospective review was performed on patients with gastric adenocarcinoma who were operated on after the NC therapy between January 2016 and December 2019. Weight, BMI-, PMI-, and PNI-dependent variables were compared before and after the NC treatment. Sarcopenia was defined according to PMI at the level of the third lumbar vertebra based on computed tomography. Results: Forty-five patients (64.4% women) with a mean age of 56.9 +/- 11.2 years were included in the study. After the NC treatment, the mean BMI of the cohort decreased from 26.1 +/- 4.3 kg/m(2) to 25.1 +/- 4.2 kg/m(2), the mean PMI decreased from 5.69 +/- 1.39 cm(2)/m(2) to 5.16 +/- 1.50 cm(2)/m(2), and the mean PNI decreased from 46.6 +/- 6.5 to 40.0 +/- 7.0 (All, P<0.001). The NC treatment increased the frequency of sarcopenia from 48.9% to 64.5% (P<0.001). According to the Clavien-Dindo (CD) scoring, grade >3 CD complications were more common in the sarcopenic group (27.2%), compared to the non-sarcopenic group (8.7%) (P=0.049). The one-year and three-years overall survival rates were lower in the sarcopenic group (91.7% and 38.2%, respectively), compared to the non-sarcopenic group (93.8% and 45.8%, respectively). However, it was not statistically significant (P=0.509). Conclusion: Sarcopenia is associated with severe postoperative complications in gastric cancer. In addition, the NC treatment reduces PMI, BMI, as well as PNI, and increases sarcopenia frequency. Therefore, patients should be examined in terms of sarcopenia at the time of diagnosis.
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    "Factors Associated with Mediastinal Lymph Node Positivity in Proximal Gastric Tumor Patients Undergoing Curative Surgery"
    (2023) Parsak, Cem Kaan; Topal, Ugur; Altiok, Merih; Capkinoglu, Emir; Bali, Cagla; Yalav, Orcun; Rencuzogullari, Ahmet; Sakman, Gurhan
    Background: Gastric cancer is the fifth most common cancer worldwide. Objectives: This study investigated the risk factors associated with mediastinal lymph node metastases due to proximal gastric cancer. Methods: The study included patients with curative surgical resection and transcural lymphadenectomy for proximal gastric tumors between January 2012 and January 2020. The patients (n=88) were divided into Group 1 (n=54, negative) and Group 2 (n=34, positive) according to the positivity of mediastinal lymph nodes. The diagnostic value of composite immunonutritional and inflammatory indices in predicting lymph node positivity was examined. Results: It was found that only C-reactive protein (CRP) (P=0.044), the rate of postoperative respiratory complications (P=0.002), tumor size (P=0.0001), the total number of lymph nodes, and the number of metastatic lymph nodes were higher in Group 2. Moreover, pT stage (P=0.008) and pN stage (P<0.001) were more advanced in Group 2. Among the composite indices, only the neutrophil-to-lymphocyte ratio (NLR) had a diagnostic value, with a sensitivity of 67.65% and a specificity of 55.56% at a cut-off point of > 2.19. According to the multivariate analysis, a tumor size of > 3 cm, a CRP value of > 7, and tumor localization were independent risk factors. Conclusion: Our study found that mediastinal lymph node positivity was associated with elevated CRP and that these patients had more advanced tumors and poor histopathological characteristics. Mediastinal lymph node positivity was also associated with increased postoperative respiratory complications. We established the diagnostic value of the NLR in predicting lymph node positivity. It is helpful to establish the relationship between clinicopathological characteristics and mediastinal lymph node positivity in proximal gastric tumors since it can be useful in determining the surgical strategy for esophagogastric junction tumors.