Browsing by Author "Yaycioglu, Ozgur"

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Cytoreductive Nephrectomy in the Targeted Treatment Era
(2015) Yaycioglu, Ozgur
To evaluate the role of cytoreductive nephrectomy (CRN) in the treatment of metastatic renal cell carcinoma in targeted therapy era in the light of contemporary data reported in the literature. Recent findings reported in retrospective studies indicate that although the CRN rates are lower than before, the procedure is related with improved survival. Several objective criteria have been proposed for proper patient selection. Results of ongoing prospective studies will help to clarify the role of CRN in the targeted therapy era. Level one evidence is lacking for the role of CRN in the targeted treatment era. However, current data show that the procedure has an essential part in the multidisciplinary treatment of metastatic renal cell carcinoma. Individualization of the treatment decisions is important since not all patients benefit from the operation.
An Independent Validation of 2010 Tumor-Node-Metastasis Classification for Renal Cell Carcinoma: A Multi-center Study by the Urooncology Association of Turkey Renal Cancer-Study Group
(2017) Dirim, Ayhan; Ozkan, Tayyar Alp; Eskicorapci, Sadettin; Yaycioglu, Ozgur; Akdogan, Bulent; Gogus, Cagatay; Can, Cavit; Yildirim, Asif; Ozen, Haluk; Tukeri, Levent
Objective: The American Joint Committee on Cancer tumor-node-metastasis (TNM) classification has been updated by the 7th edition in 2010. The objective of the study was to evaluate cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC) and assess the concordance of 2002 and novel 2010 TNM primary tumor classifications. Materials and Methods: A retrospective analysis of RCC registries from 25 institutions of the Urooncology Association of Turkey Renal CancerStudy Group was performed. Patients with RCC had a radical or partial nephrectomy. The database consisted of 1889 patients. Results: Median follow-up time was 25 months (interquartile range: 11.2-47.8). The 5-year CSS rate for pT1a, pT1b, pT2a, pT2b, pT3a and pT4 tumors were 97% [95% confidence interval (CI): 0.93-0.99], 94% (95% CI: 0.91-0.97), 88% (95% CI: 0.81-0.93), 77% (95% CI: 0.64-0.86) 74% (95% CI: 0.65-0.81) and 66% (95% CI: 0.51-0.77), respectively according to the 2010 TNM classification (p<0.001). CSS comparisons between pT1a-pT1b (p=0.022), pT1b-pT2a (p=0.030), pT3a-pT3b (p<0.001) and pT3b-pT4 (p=0.020) were statistically significant. Conversely, pT2a-pT2b (p=0.070) and pT2b-pT3a (p=0.314) were not statistically significant. Multivariable analyses revealed the pT stage in the 2010 TNM classification as an independent prognostic factor for CSS (p for trend=0.002). C-indexes for 2002 and 2010 TNM classifications were 0.8683 and 0.8706, respectively. Conclusion: Subdividing pT2 does not have a CSS advantage. Moving adrenal involvement to pT4 yielded a more accurate prognosis prediction. T stage and LNI are independent prognostic factors for CSS in RCC. Overall, the novel 2010 TNM classification is slightly improved over the former one. However, shown by C-index values, this improvement is not sufficient to state that 2010 TNM outperforms the 2002 TNM.
Non-Tumoral Factors Affecting The Preference of Nephron-Sparing Surgery in The Treatment of Stage 1 Renal Cell Carcinoma Patients in Turkey
(2021) Kuzgunbay, Baris; Yaycioglu, Ozgur
Objective: Nephron-sparing surgery (NSS) is the first-line treatment for T1N0M0 renal tumors (RT). The aim of this multicentric retrospective study is to investigate the national trends and the effect of non-tumoral factors in the preference of NSS as treatment of T1 RT in Turkey. Materials and Methods: Relevant data for patients operated between 1997 and 2017 was collected from the Urologic Cancer Database-Kidney Urooncology Association, Turkey (UroCaD-K). Results: We included 3195 T1N0M0 RT patients in this study. There was a significant increase in the number of NSS performed with time, 9.26% between 1997-2002 to 54.78% between 2013-2017 (p<0.001). NSS proportion decreased with increasing age (p<0.001); but increased with better hospital facility (p<0.001). From multivariate analysis; younger age, later operation date, larger hospital size with higher nephrectomy centers like university hospitals were independently associated non-tumoral factors favoring NSS over radical nephrectomy (RN). Conclusion: We observed significant disparity in the use of NSS for T1 RT among the elderly (>61 years), small hospital size (<= 500 beds), lower nephrectomy volume (<100 nephrectomies/year), and Non-University Hospitals. This disparity can be resolved by persistent education of the residents and urologists with periodic courses and practical training, increasing the funds and strengthening the technical equipment of centers, thereby favoring the performance of NSS even in smaller centers. This will ensure that suitable patients are treated with NSS rather than RN, regardless of the hospital type.
Prostate Biopsy in the Elderly: Histologic Findings and Treatment Necessity
(2014) Akman, Ramazan Yavuz; Koseoglu, Hikmet; Oguzulgen, Ahmet Ibrahim; Sen, Erhan; Yaycioglu, Ozgur; 25374232
The aim of this study is to determine results of high prostate specific antigen (PSA) or abnormal digital rectal examination driven prostate biopsies performed in our Department in men aged 75 or more and to show the characteristics of pathology results. The hospital records of the patients who had high PSA or abnormal digital rectal examination driven prostate biopsy in two common university based research hospitals have been reviewed retrospectively. Patients aged 75 years or older at the date of biopsy whose records provided pathology results and full medical history were evaluated for the study. A total of 103 patients were evaluated with a mean age of 79.4 +/- 3.4 years. More than half of the patients (55.1%) were in their seventh decade and the rest were in the eighth decade. Median PSA value was 15.0 (range 2.1-4500) ng/ml. In most of the biopsies (67%), PSA levels were lower than 20 ng/ml. In almost half of the patients (48%), digital rectal examination was abnormal. In 68.9% of the patients, there were at least one or more associated co-morbid diseases. Gleason scores were 7 or higher in 73%, and 8 or higher in 37% of the patients with prostate cancer. Four of the 70 (6%) patients had bone metastases. Castrations were applied to most of the patients with prostate adenocarcinoma (% 79). High percentage of high grade (Gleason 7 or more) prostate adenocarcinoma in the elderly refutes the perception of prostate cancer in this age group as clinically insignificant. Therefore, it is to be kept in mind that prostate cancer in the elderly an be clinically significant and prostate biopsies are to be performed when necessary.
The Role of Radical Prostatectomy in the Treatment of Patients with High-Risk Prostate Cancer
(2015) Kuzgunbay, Baris; Yaycioglu, Ozgur
High-risk prostate cancer (PCa), which is defined as PSA > 20 ng/mL or Gleason Score (GS) > 7 or >= cT3a, accounts for up to 40% of newly diagnosed cases and carries a significant risk of progression and death. However, the best management approach for patients with high-risk PCa is still under debate. Recently, radical prostatectomy (RP) with extended lymphadenectomy (LND) has become popular for the treatment of high-risk PCa with good prognosis in selected patients in the context of multimodal approach. However, decision should be made after all treatments have been discussed by a multidisciplinary team and the patient should be informed about the likelihood of a multimodal approach. On the other hand, necessity of sufficient surgical expertise for RP to keep the level of morbidity acceptable in high-risk PCa patients should be kept in mind.