Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item The Prognostic Value of the Novel Global Immune-Nutrition-Inflammation Index (GINI) in Stage IIIC Non-Small Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy(2023) Topkan, Erkan; Selek, Ugur; Pehlivan, Berrin; Kucuk, Ahmet; Ozturk, Duriye; Ozdemir, Beyza Sirin; Besen, Ali Ayberk; Mertsoylu, Huseyin; 0000-0001-8120-7123; 37760482; AAG-2213-2021Simple Summary: We investigated the prognostic significance of the newly created Global Immune-Nutrition-Inflammation Index (GINI) in IIIC non-small cell lung cancer (NSCLC) patients who received definitive concurrent chemoradiotherapy (CCRT). A total of 802 newly diagnosed stage IIIC NSCLC patients were included. The optimal pre-CCRT GINI cutoff was 1562 (area under the curve: 76.1%; sensitivity: 72.4%; specificity: 68.2%; Youden index: 0.406). GINI >= 1562 was associated with significantly shorter median locoregional progression-free (p < 0.001), progression-free (p < 0.001), and overall survival (p < 0.001) than GINI < 1562. For each survival endpoint, the association between GINI and survival outcomes appeared independent of other confounding variables (p < 0.05 for each). The novel GINI index effectively stratified patients with stage IIIC NSCLSC into two distinct subgroups, demonstrating significant differences in both median and long-term survival rates. Background: We sought to determine the prognostic value of the newly developed Global Immune-Nutrition-Inflammation Index (GINI) in patients with stage IIIC non-small cell lung cancer (NSCLC) who underwent definitive concurrent chemoradiotherapy (CCRT). Methods: This study was conducted on a cohort of 802 newly diagnosed stage IIIC NSCLC patients who underwent CCRT. The novel GINI created first here was defined as follows: GINI = [C-reactive protein x Platelets x Monocytes x Neutrophils] divided by [Albumin x Lymphocytes]. The receiver operating characteristic (ROC) curve analysis was used to determine the optimal pre-CCRT GINI cut-off value that substantially interacts with the locoregional progression-free (LRPFS), progression-free (PFS), and overall survival (OS). Results: The optimal pre-CCRT GINI cutoff was 1562 (AUC: 76.1%; sensitivity: 72.4%; specificity: 68.2%; Youden index: 0.406). Patients presenting with a GINI >= 1562 had substantially shorter median LRPFS (13.3 vs. 18.4 months; p < 0.001), PFS (10.2 vs. 14.3 months; p < 0.001), and OS (19.1 vs. 37.8 months; p < 0.001) durations than those with a GINI < 1562. Results of the multivariate analysis revealed that the pre-CCRT GINI >= 1562 (vs. <1562), T4 tumor (vs. T3), and receiving only 1 cycle of concurrent chemotherapy (vs. 2-3 cycles) were the factors independently associated with poorer LRPS (p < 0.05 for each), PFS (p < 0.05 for each), and OS (p < 0.05 for each). Conclusion: The newly developed GINI index efficiently divided the stage IIIC NSCLSC patients into two subgroups with substantially different median and long-term survival outcomes.Item The Clinicopathological and Survival Differences Between Never and Ever Smokers with Non-Small Cell Lung Cancer(2014) Muallaoglu, Sadik; Karadeniz, Cemile; Mertsoylu, Huseyin; Besen, Ali Ayberk; Sezer, Ahmet; Sedef, Ali Murat; Kose, Fatih; Ozyilkan, Ozgur; https://orcid.org/0000-0002-6242-2802; https://orcid.org/0000-0002-1932-9784; https://orcid.org/0000-0002-6445-1439; https://orcid.org/0000-0002-0156-5973; https://orcid.org/0000-0001-8825-4918; 24965406; IVU-7523-2023; M-9530-2014; AAD-2667-2020; G-4827-2016; AAD-2817-2021Purpose: Cigarette smoking was regarded as the most important carcinogenic factor of lung cancer, yet in recent years lung cancer in never-smokers is an increasingly prominent public health issue. The aim of this study was to assess the epidemiological and clinicopathological characteristics of never-smoker patients with non small cell lung cancer (NSCLC), focusing on clinical risk factors and survival. Methods: We retrospectively analyzed 290 NSCLC patients who presented between 2006 and 2011. Differences in clinical features and survival between never- and ever-smoker patients were analyzed. Student's t-test and Mann-Whitney U-test were used to assess the significance of the variables between the groups. Survival curves were calculated using Kaplan-Meier method. Hazard ratio (HR) for death and its 95% confidence interval (CI) were calculated by Cox regression analysis. Results: There were 243 (83.8%) ever-smokers and 47 (16.2%) never-smokers. In never-smokers females predominated (80.9%) as well as patients with adenocarcinomas (78.7%). At the time of analysis 143 (49.3%) patients had died. The 5-year overall survival (OS) rates were not significantly different between never- and ever-smokers (p=0.410). The median OS of all patients was 26 months (95% CI: 16.8-35.2). The median OS was 23 months (95% CI: 11.8-34.2)for never-smokers and 30 months (95% CI: 19.7-40.3) forever-smokers (p=0.410). Never-smokers tended to present with more advanced disease than ever-smokers (p<0.004) and also with more advanced age (p<0.001). The HR for death increased with poorer Eastern Cooperative Oncology Group (ECOG) performance status (PS) (ECOG 2-3), advanced stage (stage 3-4) and untreated patients. Slightly lower risk for death was registered in patients with adenocarcinoma vs those with squamous cell carcinoma (S CC). Conclusion: Although no difference in survival was seen, definite epidemiologic differences do exist between never-smokers and ever-smokers patients with NSCLC. Future efforts should focus on the underlying biological differences, and on identifying potential non-tobacco related risk factors in order to improve treatment strategies for these two groups of NSCLC patients.Item Patient-Reported Outcomes with Cemiplimab Monotherapy for First-Line Treatment of Advanced Non-Small Cell Lung Cancer with PD-L1 Of >= 50%: The EMPOWER-Lung 1 Study(2023) Gumus, Mahmut; Chen, Chieh-, I; Ivanescu, Cristina; Kilickap, Saadettin; Bondarenko, Igor; Ozguroglu, Mustafa; Gogishvili, Miranda; Turk, Haci M.; Cicin, Irfan; Harnett, James; Mastey, Vera; Naumann, Ulrike; Reaney, Matthew; Konidaris, Gerasimos; Sasane, Medha; Brady, Keri J. S.; Li, Siyu; Gullo, Giuseppe; Rietschel, Petra; Sezer, Ahmet; 36308296Background In the EMPOWER-Lung 1 trial (, NCT03088540), cemiplimab conferred longer survival than platinum-doublet chemotherapy for advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) >= 50%. Patient-reported outcomes were evaluated among trial participants. Methods Adults with NSCLC and Eastern Cooperative Oncology Group performance status 0 to 1 were randomly assigned cemiplimab 350 mg every 3 weeks or platinum-doublet chemotherapy. At baseline and day 1 of each treatment cycle, patients were administered the European Organization for Research and Treatment of Cancer Quality of Life-Core 30 (QLQ-C30) and Lung Cancer Module (QLQ-LC13) questionnaires. Mixed-model repeated measures analysis estimated overall change from baseline for PD-L1 >= 50% and intention-to-treat populations. Kaplan-Meier analysis estimated time to definitive deterioration. Results In PD-L1 >= 50% patients (cemiplimab, n = 283; chemotherapy, n = 280), baseline QLQ-C30 and QLQ-LC13 scores showed moderate-to-high functioning and low symptom burden. Change from baseline favored cemiplimab on global health status/quality of life (GHS/QOL), functioning, and most symptom scales. Risk of definitive deterioration across functioning scales was reduced versus chemotherapy; hazard ratios were 0.48 (95% CI, 0.32-0.71) to 0.63 (95% CI, 0.41-0.96). Cemiplimab showed lower risk of definitive deterioration for disease-related (dyspnea, cough, pain in chest, pain in other body parts, fatigue) and treatment-related symptoms (peripheral neuropathy, alopecia, nausea/vomiting, appetite loss, constipation, diarrhea) (nominal p < .05). Results were similar in the intention-to-treat population. Conclusions Results support cemiplimab for first-line therapy of advanced NSCLC from the patient's perspective. Improved survival is accompanied by improvements versus platinum-doublet chemotherapy in GHS/QOL and functioning and reduction in symptom burden.Item Importance of SUVmax Threshold in Positron Emission Tomography-Computed Tomography Assessment of Mediastinal and Hilar Lymph Nodes in Non-Small Cell Lung Cancer(2016) Yildiz, Oya; Cangir, Ayten Kayi; Kilic, Dalokay; Yuksel, Cabir; Enon, Serkan; Kutlay, Hakan; Akal, Murat; Ozdemir, Nezih; Kavukcu, Sevket; Okten, Ilker; H-7700-2019Background: This study aims to determine a new cut-off value for standardized uptake value in positron emission tomography-computed tomography evaluation of mediastinal lymph nodes in non-small cell lung cancer in Turkey. Methods: A total of 207 patients with non-small cell lung cancer who were performed positron emission tomography-computed tomography between November 2006 and February 2010 were prospectively analyzed. Of these patients, 143 patients (125 males, 18 females; mean age 62.1 years; range 39 to 85 years) whose invasive staging was performed after positron emission tomography were included in the study. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates of positron emission tomography were calculated and compared using a maximum standardized uptake value cut-off value of >= 2.5 and the newly determined maximum standardized uptake value cut-off value. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 45.3%, 78.9%, 55.8%, 71%, and 66.4%, respectively, when the maximum standardized uptake value cut-off value was considered 2.5 in mediastinal lymph nodes. The new maximum standardized uptake value cut-off value was determined to be 4.8 in metastatic lymph nodes. These values were 39.6%, 91.1%, 72.4%, 71.9% and 72%, respectively, according to the new maximum standardized uptake value cut-off value of 4.8. There was a significant difference only between specificity rates when the two different maximum standardized uptake value cut-off values were used (p=0.022). Conclusion: In this study, the sensitivity of positron emission tomography in the evaluation of mediastinal lymph nodes was lower than those reported in the literature. This situation may be associated with the frequently observed granulomatous infections such as tuberculosis in our country. Results of positron emission tomography should be evaluated according to countries and a new maximum standardized uptake value cut-off value should be calculated particularly for mediastinal lymph node metastasis in multicenter studies in our country.Item Clinical Benefits of First-Line (1L) Cemiplimab Monotherapy by PD-L1 Expression Levels in Patients With Advanced NSCLC(2021) Kilickap, S.; Sezer, A.; Gumus, M.; Bondarenko, I.; Ozguroglu, M.; Gogishvili, M.; Turk, H. M.; Cicin, I.; Bentsion, D.; Gladkov, O.; Clingan, P.; Sriuranpong, V.; Rizvi, N.; Li, S.; Lee, S.; Makharadze, T.; Paydas, S.; Nechaeva, M.; Seebach, F.; Weinreich, D.M.; Yancopoulos, G.D.; Gullo, G.; Lowy, I.; Rietschel, P.Item Concurrent chemoradiotherapy with weekly carboplatin and paclitaxel may be a feasible option in inoperable stage III non-small cell lung cancer: a single center experience(2019) Calikusu, Zuleyha; Sedef, Ali Murat; Saltaoglu, PinarPurpose: Concurrent chemoradiotherapy (CCRT) is a standard treatment for patients with unresectable stage III non-small cell lung cancer (NSCLC). An optimal chemotherapy regimen with concurrent thoracic radiotherapy is not known. In this study, we investigated the efficacy and toxicity of CCRT with carboplatin [area under curve (AUC) 2] and paclitaxel (80 mg/m(2)) during CCRT. Materials and Methods: We performed a retrospective survival analysis using medical records of 40 patients with inoperable stage III NSCLC that were treated with concurrent chemoradiotherapy with carboplatin-paclitaxel (AUC 2, 60 mg/m2). Results: The most common histopathology was adenocarcinoma, which was diagnosed in 18 patients (45%). There were 12 stage IIIA patients (30%) and 28 stage IIIB patients (70%). The median follow-up time was 22.5 months [95% confidence interval (CI), 2.9-72.2]. Median disease-free survival (DFS) and overall survival (OS) were 22.5 months (95% CI, 18.1-27.0) and 53.5 months (95% CI, 23.5-82.8). Grade 3-4 hematological and non-hematological toxicities were seen in 8 (20%) and 5 (12.5%) patients, respectively. Conclusion: This study showed that CCRT with weekly carboplatin-paclitaxel provides similar outcomes to cases in the literature and the regimen seems to be feasible with a low rate of grade 3-4 toxicity during CCRT of non operable stage III NSCLC. Keywords: Carboplatin, non-small cell lung cancer, chemoradiotherapy, paclitaxel