Browsing by Author "Ekinci, F"
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Item The inflammatory prognostic index as a potential predictor of prognosis in metastatic gastric cancerOzveren, A; Erdogan, AP; Ekinci, FClinical studies aimed at identifying effective and simple prognostic markers for gastric cancer are still being carried out. Inflammatory prognostic index (IPI) is being recognized as a promising prognostic marker in patients with Non-Small Cell Lung Cancer. To evaluate the prognostic utility of IPI in stage 4 gastric cancer. A total of 152 patients with stage 4 gastric cancer, whose laboratory parameters, progression-free survival (PFS) and overall survival (OS) data could be accessed, were evaluated. Kaplan Meier analysis was used for survival analyses. Hazard ratios were expressed with 95% CI values. All methods were performed in accordance with the relevant guidelines and regulations. Study was approved by the Manisa Celal Bayar University's Non-Invasive Clinical Research Ethics Committee (approval No. E-85252386-050.04.04-49119, date: 22.03.2021). We confirm that all methods were performed in accordance with relevant named guidelines and regulations. Median age at diagnosis was 63 years (range: 32-88). The number of patients who received first-line chemotherapy was 129 (84.9%). Median PFS with first-line treatment was 5.3 months, while it was 3.3 months with second-line treatment. Median OS was 9.4 months. Median IPI score was 22.2. We evaluated IPI score for its value in detecting survival status with ROC analysis and identified an IPI cut-off score of 14.6. Low IPI score was significantly associated with longer PFS and OS compared to high IPI (PFS in high vs. low IPI, 3.6 vs. 7 months; p < 0.001) (OS in high vs. low IPI, 6.6 vs. 14.2 months; p < 0.001). IPI score can be an independent prognostic index that is inexpensive, easy to access and evaluate for patients with metastatic gastric cancer, and may be useful in predicting survival in daily practice.Item Factors Predicting Response in Breast Cancer Receiving Neoadjuvant Therapy and the Role of Ki67 Labeling IndexEkinci, F; Uzun, M; Demir, B; Unek, IT; Erdogan, APObjective: To determine the predictive value of Ki67 on pathological complete response (pCR) of breast and axilla regions in breast cancer (BC) patients receiving neoadjuvant therapy (NAT).Study Design: Descriptive study.Place and Duration of the Study: Departments of Medical Oncology, Sirnak State Hospital, Aydin State Hospital, Manisa Celal Bayar University, and Dokuz Eylul University, from November 2010 to July 2022.Methodology: PCR and various histopathological parameters were evaluated for BC patients receiving NAT. The Youden Index method was used to find the cut-off value for the Ki67 variable according to the receiver operating characteristic (ROC) curve. This value was obtained as 77.5. Breast and axillary responses were individually evaluated to assess response to NAT. Univariate and multivariate logistic regression analysis were used to predict both breast and axillary pCR.Results: A total number of 280 females receiving NAT for BC were included in the study. Multivariate analysis for breast pCR to NAT showed that Ki67 index (>77.5 vs <77.5, p=0.047) was statistically significant marker. While Ki67 index was significant for breast pCR in both univariate and multivariate analyses, the same was not observed on axillary response (p=0.387).Conclusion: High Ki67 level was significantly associated with breast pCR in BC patients receiving NAT, but a similar effect was not observed on axillary pCR. These findings suggest that breast and axilla tissues have a biological differences in treatment responses.Item Palliative Biliary Drainage Has No Effect on Survival in Pancreatic Cancer: Medical Oncology PerspectiveErdogan, AP; Ekinci, F; Yildirim, S; Özveren, A; Göksel, GPurpose Removal of obstructive jaundice in metastatic pancreatic cancer is an important part of palliative therapy. However, it is not known whether invasive procedures reduce cancer-related mortality. In this study, the effect of palliative biliary drainage on survival outcomes in pancreatic cancer patients was evaluated. Methods Patients diagnosed with pancreatic cancer and undergoing biliary drainage in two different centers between 2010 and 2019 were evaluated retrospectively. Results Biliary drainage was applied to 73 patients, constituting 20.6% of 355 patients included in the study. The median progression-free survival (PFS) of patients with biliary stent was 5 months, while the median PFS of patients without stenting was 5.5 months and the median overall survival (OS) was 11.1 and 11.5 months, respectively (p: 0.424, p: 0.802). Conclusions A positive effect of palliative biliary drainage on median PFS and OS could not be demonstrated in our study group. In pancreatic cancer, predictive markers are needed to select patients who can derive a survival benefit from biliary drainage.Item Systemic Immune Inflammation Index as a Key Marker of Survival and Immune-related Adverse Events in Immune Checkpoint Inhibitor TherapyEkinci, F; Balcik, OY; Demir, B; Gursoy, P; Ozveren, A; Erdogan, APObjective: To evaluate the prognostic significance of the new index designed by formulating neutrophil, lymphocyte, and platelet counts in patients with metastatic disease receiving immune checkpoint inhibitors (ICI) and its effect on the immune -re-lated adverse events (irAEs). Study Design: Cohort study. Place and Duration of Study: Department of Medical Oncology, University of Manisa Celal Bayar, University of Aydin Adnan Menderes, and University of Ege, and Izmir Kent Hospital, Turkey, from January 2016 to April 2020. Methodology: Patients with metastatic disease receiving ICI sufficient follow-up data were included. Patients, who had received treatment for a minimum of 3 months, were evaluated for the response. Systemic immune-inflammation index (SII) was calcu-lated as neutrophil (/L) x (lymphocyte (/L) / platelet (/L). The cut-off value was determined by examining the area under the receiver operating characteristic (ROC) curve for the SII value. The endpoints of this study included overall survival (OS) and progression-free survival (PFS). Results: A total of 168, patients who received ICI in the metastatic stage, were evaluated. The OS of the patients with low SII scores was 110.8 months (95% CI, 88.2-133.5), while patients with high SII scores were 36.0 months (95% CI, 28.4-43.6) and reached statistical significance (p <0.001). The results of univariate (HR=3.376, 95% CI, 1.986-5.739, p<0.001 and multivariate (HR=2.792, 95% CI, 1.495-5.215, p=0.011) analyses were statistically significant as well. Conclusion: The SII score in patients with metastatic disease receiving ICI was closely related to the prognosis. Patients with a high SII score are associated with a worse prognosis, these patients develop fewer irAEs.Item Biases and Reluctances Causing Cancer Patients in Dilemma for COVID-19 VaccinationEkinci, F; Erdogan, AP; Goeksel, GBackground We have planned this study to determine opinions of this patient group, who are affected negatively both in physical aspect during the treatment process of cancer and who are fragile and sensitive for psycho -social aspects, their opposition level and misimpressions related to vaccine and for eliminating these reluctances if possible. Methods Between February 2021 and 15 April 2021, all cancer patients applying to our oncology clinic have been first asked to fill in the questionnaire, which includes three articles where suggestions expressing their attitude towards vaccination were asked and subsequently nine articles expressing suggestions about vaccine opposition Results According to responses to a decision for vaccination, we have learned that 446 (79,6%) patients thought to have the Covid-19 vaccine, 62 (11.1%) were hesitant, and 52 (9.3%) did not think to have a vaccine. Conclusions The most critical data obtained from this study is that there were severe biases related to adverse effects due to vaccines, although patients have a positive attitude about vaccination. The most important task of health authorities should be to eliminate reluctance without waiting for patients to take a more negative attitude on this subject.Item Factors affecting the serologic response to SARS-CoV-2 vaccination in patients with solid tumors: A prospective studyErdogan, AP; Ekinci, F; Akcali, S; Goksel, GObjective: To evaluate the factors affecting seropositivity and antibody levels after SARS-CoV-2 vaccines in patients with cancer because they were excluded from clinical studies of SARS-CoV-2 vaccines. Methods: This prospective, observational, single-center study included 290 patients with solid tumors followed up in our medical oncology clinic between March 2021 and August 2021. SARS-CoV-2 antibody status was determined before the first dose of vaccine. Fifty-one patients with positive prevaccine baseline antibody tests were excluded from the study, regardless of whether they had previously confirmed SARS-CoV-2 PCR positivity. To determine the quantitative IgG antibody response of the vaccines, blood samples were collected at least 28 days after each dose of vaccine. Quantitative IgG levels against virus spike protein receptor binding domain (RBD) were measured using chemiluminescent enzyme immunoassay (CLIA). Demographic and clinical features affecting seropositivity were analyzed. Results: One hundred and fifty-one (69.3%) patients were vaccinated with two doses of CoronaVac followed by one dose of BNT162b2 (Biontech) (group 1). Sixty-seven (30.7%) patients were vaccinated with three doses of BNT162b2 (group 2). The proportion of patients who developed seropositivity was significantly higher in group 2 (78.6% vs. 54.9%, p < 0.012). Antibody response increased significantly after the second dose of vaccine in both groups. Female sex, being younger than 65 years, and chemotherapy status were significantly related to higher anti-SARS-CoV-2 S antibody levels (p = 0.033, p = 0.036, and p = 0.047, respectively). Antibody levels were significantly higher in patients who had previously received chemotherapy than in patients receiving active chemotherapy (p = 0.042). Conclusions: Our study is the first to evaluate basal SARS-CoV-2 IgG levels before the first dose of vaccine and after three doses in patients with solid tumors. The rate of development of seropositivity with two doses of mRNA vaccine was found to be higher than with two doses of inactivated SARS-CoV-2 vaccine. More attention should be paid to preventive measures in addition to vaccination in patients aged over 65 years and men with cancer diagnoses.Item Level of COVID-19 fear in cancer patientsErdogan, AP; Ekinci, F; Acar, Ö; Göksel, GBackground Cancer patients are in the high-risk group of getting COVID-19 infection and experiencing a severe course. Anxiety of cancer patients about how they pass this pandemic process and how changes in the health system would influence their treatment has increased together with the COVID-19 pandemic. Influence of COVID-19 on psychology of cancer patients is also a subject needed to be investigated as well as its course and prognosis. Thus, it is aimed to measure fear levels of cancer patients by a validated scale. Patients accepting to fill in the validated Fear of COVID-19 (FCV-19S) scale were included in our study. Higher scores obtained from the scale means high level of COVID-19 fear was experienced. Results A total of 66.8% of 486 patients expressed that they are very afraid of coronavirus, and 66.3% expressed that they fear from losing their lives due to coronavirus. The level of fear in the patient group having adjuvant therapy has been found statistically to be significantly higher compared with groups having neoadjuvant and metastatic/palliative therapy (p: 0.004). Conclusions Because the increase of level of fear may lead to vital outcomes such as weakening of immune system, disturbance of treatment compliance, and worsening of prognosis, a psychological approach to cancer patients is compulsory in order to prevent fear of COVID-19 infection.Item HALP Score as a New Prognostic Index in Metastatic Renal Cell CancerEkinci, F; Balcik, OY; Oktay, E; Erdogan, APObjective: To evaluate prognostic significance of the new index, designed by formulating hemoglobin, albumin, lymphocyte, and platelet (HALP) counts in patients with metastatic renal cell carcinoma (RCC). Study Design: Descriptive study. Place and Duration of Study:Department of Medical Oncology, Celal Bayar University, Manisa, Turkey and Adnan Menderes University, Aydin, Turkey, from January 2014 to April 2020. Methodology: Patients with metastatic RCC and sufficient follow-up data were included in the study as a retrospective cohort. HALP score was calculated as hemoglobin (g/L) x albumin (g/L) levels x lymphocyte count (/L)/platelet count (/L). The cut-off value was determined by examining the area under the ROC curve for the HALP value. The endpoints of this study included overall survival (OS) and progression-free survival (PFS). Results: The mean overall survival (OS) of the patients with low HALP score was 17.7 months (95% CI, 2.21 -33.18), while the OS of the patients with high HALP score was 89.7 months (95% CI, 55.62 -123.77) and reached statistical significance (p=0.001). The results of univariate (p = 0.009) and multivariate (p=0.012) analyses were statistically significant as well. Conclusion: The HALP score in metastatic RCC patients was closely related to the prognosis. Worse OS was found in patients with a low HALP score.Item Is CRP/Albumin Ratio (CAR) a New Parameter to be Added to Risk Stratification Systems in Metastatic Renal Cell Carcinoma Patients?Uzun, M; Yildirim, EC; Ekinci, F; Semiz, HSObjective: To evaluate the effect of pretreatment C-reactive protein (CRP)/Albumin ratio (CAR) on prognosis and its association with IMDC (International metastatic renal cell carcinoma database consortium) risk score and overall survival (OS) in metastatic renal cell carcinoma (mRCC) patients. Study Design: Descriptive study. Place and Duration of Study: Department of Medical Oncology, Dokuz Eylul University, Izmir, Turkey, between 2007 and 2020. Methodology: Clinico-pathological and treatment-related data of mRCC patients were retrospectively evaluated and included in the study. CAR was used as a prognostic inflammatory score. CAR threshold value for OS has been obtained by ROC analysis. The prognostic value of CAR was tested using Kaplan-Meier and Cox-regression models. IMDC-CAR model was created by adding CAR to IMDC risk stratification. Results: OS was 91 months in patients with CAR below the threshold value of 0.072 (<0.072), while OS was 51 months in patients with CAR of 0.072 and above (p=0.005). According to IMDC risk stratification, intermediate and poor risk groups showed similar survival times (p>0.05). However, when CAR was added to the IMDC risk score in the intermediate group, it was divided into 3 subgroups with different prognoses (p=0.02). Conclusion: CAR is an independent predictor of OS in mRCC patients. In this study, it has been demonstrated that more accurate prognosis prediction could be made by adding CAR to IMDC indicators in the intermediate risk group, which constitutes a highly heterogeneous group according to IMDC risk stratification.Item Real-Life Efficacy of Palbociclib and Ribociclib in Advanced Breast CancerAvci, T; Sahbazlar, M; Ekinci, F; Erdogan, APBackground: Clinical trials in metastatic hormone receptor-positive (HR+) human epidermal growth factor receptor-2 (HER2)-negative patients have shown that cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors both increase response rates and provide survival benefits. The efficacy of these therapies needs to be supported by real-life data. In this study, we aimed to evaluate treatment response, survival and affecting factors in patients with HR+/HER2- metastatic breast cancer (MBC) who were followed up with CDK 4/6 inhibitors in our center. Materials and methods: A retrospective analysis of 120 patients with HR+/HER2- MBC treated with ribociclib or palbociclib in combination with letrozole or fulvestrant was performed. Results: Median progression-free survival (mPFS) was 24 months in the general population, 27 months in the ribociclib arm and 20 months in the palbociclib arm, with no significant difference in progression-free survival (PFS) in both arms (p = 0.25). The mPFS was longer in the ribociclib + letrozole arm compared to palbociclib + letrozole (27 vs. 20 months, respectively). PFS was also longer in patients receiving ribociclib + fulvestrant compared to palbociclib + fulvestrant but not statistically significant (33 vs. 21 months, respectively). Median overall survival (mOS) was not reached, but 3-year overall survival (OS) was statistically significantly longer in the ribociclib arm (87% vs. 55.5%, respectively, p = 0.03). Conclusion: Palbociclib and ribociclib are first-line treatment options for metastatic HR+/HER2- disease and have similar efficacy. In our study, while the mPFS was not statistically significant in both arms, the 3-year OS rate was higher in the ribociclib arm and statistically significant. Our findings were confirmed in randomized studies comparing both agents head-to-head.Item A Rare Case Report of Skin Metastasis in Gastric CancerSahin, M; Ekinci, F; Çelik, C; Temiz, P; Erdogan, AP; Göksel, GItem The Effect of Palliative Invasive Interventions on Overall Survival in the Last 3 Months of Life in Metastatic Gastric CancerEkinci, F; Erdogan, APPurpose Gastric cancer is one of the biologically aggressive and highly mortal cancers. In addition to limited treatment options, especially in advanced stages, palliative treatment methods are applied to increase patients' quality of life with gastric cancer. This study aims to discuss the effects of paracentesis, thoracentesis, tube thoracostomy, double J catheter nephrostomy, percutaneous transhepatic cholangiography (PTC), and abscess drainage catheter placement procedures applied in the last 3 months for problems requiring palliation, in the light of literature. Method The patient characteristics of the patients and, in addition, the history of any invasive intervention for palliative treatment in the last 3 months were questioned and recorded with the electronic medical record system. The effect of an invasive intervention on survival was examined. The data of patients with metastatic gastric cancer followed in the medical oncology clinic between February 2012 and May 2020 were reviewed retrospectively. Conclusions In this study, in which the effect of palliative invasive intervention (PIG) stories on survival in the last 3 months of life of patients diagnosed with metastatic gastric cancer was examined, no significant difference was found between those who underwent PIG and those who did not, in terms of overall survival. However, since PIG was not included in the design of our study, the effect of PIG in terms of quality of life, mood, motivation of patient relatives, and the cost is unknown. Results In the final analysis, it was noted that 143 (94.1%) of the 152 patients included in the study died and 9 (5.9%) were still alive. Overall survival of all patients was reported as 12.9 months (95% CI, 10.9-14.9). The mean overall survival of 36 patients who underwent palliative invasive intervention (PIG) in the last 3 months was 13.0 months (95% CI, 9.1-17.0), and a similar 13.0 months (95% CI, 10.6-15.3) of 116 patients who did not undergo PIG no significant difference was found (p: 0.887).Item Inflammatory Prognostic Index in Metastatic Renal Carcinoma Treated with NivolumabEkinci, F; Erdogan, AP; Yildirim, S; Bulut, G; Yilmaz, C; Barutca, SObjective: To evaluate the utility of inflammatory prognostic index (IPI), albumin, c-reactive protein (CRP), and lactate dehydrogenase (LDH) as predictive biomarkers of oncologic outcome in metastatic renal cell cancer (mRCC) patients treated with nivolumab. Methodology: Seventy-five mRCC patients treated with nivolumab between January 2017 and June 2020 were enrolled. Several factors were retrospectively investigated, including IPI, CRP, LDH, and albumin level, for their association with progression-free survival (PFS) and overall survival (OS). The IPI was calculated as CRP x NLR/albumin. Univariate and multivariate analyses were performed to assess the prognostic value of relevant factors.Results: When analysed according to the calculated IPI score, it is seen that the group with <2.153 has an OS duration of 96.3 months, while the group with >= 2.153 has a shorter time of 42.9 months (p=0.02). In the analysis performed according to albumin level, it was reported that those with low levels (22.8 months) had worse median OS than those with high levels (92.8 months) (p=0.004). According to the cox regression analysis results, it was determined that those with a high IPI score significantly increased the risk of death compared to those with a low score (HR:2.4, p=0.023). However, this significance could not be confirmed in the multivariate analysis. It was analysed that those with low albumin levels significantly increased the risk of death compared to both Conclusion: Those with high IPI scores and low albumin levels were associated with worse median OS. However, only the multivariate analysis analysed albumin level as an independent prognostic variable. Prospective and more extensive research is needed to consolidate the potential prognostic power of these markers.Item HALP Score as a New Prognostic Factor for Patients with Metastatic Bladder CancerAcar, O; Ayhan, M; Demir, B; Ekinci, F; Aytac, A; Erdogan, APObjective: To investigate the effect of the haemoglobin, albumin, lymphocyte, and platelet (HALP) score (Haemoglobin, Albumin, Lymphocyte, Platelet count) on survival as a new prognostic factor in metastatic bladder cancer. Place and Duration of the Study: Department of Medical Oncology, Celal Bayar University, Manisa, Turkey, and Adnan Menderes Methodology: The medical charts of patients with metastatic bladder cancer were reviewed retrospectively. Prognostic value of the HALP score as a marker of overall survival was examined through a receiver operating characteristic (ROC) curve analysis. Results: The cut-off value for the HALP score in the ROC curve analysis was 29. The median overall survival (OS) was 19 months when the HALP score was less than 29, and the median OS was 40 months when the HALP score was 29 or greater, and this finding was statistically significant (p = 0.003). Conclusion: The HALP score is closely related to prognosis in metastatic bladder cancer. A high HALP score is associated with better survival outcomes.Item Metastatic Pancreatic Cancer Second-Line Treatment Options: Is the Difference Only in Cost?Yildirim, S; Erdogan, AP; Karateke, M; Yilmaz, C; Özveren, A; Bulut, G; Ekinci, F; Almuradova, EIntroduction Although pancreatic cancer ranks seventh in cancer-related deaths, it is an extremely fatal disease, and more than 330,000 people die from this disease worldwide. Although there are many first-line treatment studies in the literature, there are almost no prospective studies regarding second-line therapy. Therefore, there is no standard approach in the second-line treatment of pancreatic cancer. We decided to conduct this study to investigate second-line treatments with problems such as cost, treatment efficacy, and toxicity. Methods Patients older than 18 years old who applied to Ege University Hospital medical oncology department with a diagnosis of metastatic pancreatic cancer, who received first-line chemotherapy due to their illness, and who had progressed afterwards were included in the study. The files of the patients who applied between 2013 and 2017 were examined. Results Our study's primary endpoint was progression-free survival, and it was found that the median progression-free survival was 3.2 months in the Xelox patients, 3.7 months in the gemcitabine-nab paclitaxel patients, and 3.5 months in the other regimens. When the secondary endpoint was evaluated, overall survival, the median overall survival was 5.9 months in the Xelox patients, 5.3 months in the gemcitabine-nab paclitaxel patients, and 4.8 months in the other regimens. Conclusion As a result, second-line treatments were compared, and no statistically significant difference was found between them. For this reason, the side effects of previously used drugs and the side effects of new drugs to be used, as well as their costs, should be evaluated when choosing a treatment.Item Real-Life Data of Neoadjuvant Chemotherapy in Breast Cancer: Aegean Region ExperienceErdogan, AP; Ekinci, F; Özveren, A; Eniseler, EB; Demir, B; Sahbazlar, MObjective: The use of neoadjuvant chemotherapy (NACT) in breast cancer is increasing. However the management of locally advanced breast cancer differs due to the approach of the center to which the patient applied and the approach of the following physician. From this point of view, we aimed to evaluate the real life data of our region. Methods: The study included 106 patients treated with NACT in the medical oncology clinic of two different university hospitals. Association between clinicopathological features and pathological complete response (pCR) were analyzed. Results: The pCR rate was higher in patients with negative hormone receptors and this difference was statistically significant (p:0.000). The rate of obtaining pCR increased as the NACT duration increased, and this increase was statistically significant. The mean NACT duration applied to the patients with pCR was 5.48 +/- 0.22 months, and the mean NACT duration for those who could not obtain pCR was 5.01 +/- 0.1 months (p:0.041). The recurrence rate of patients with pCR was 11.1%, while the recurrence rate of patients who could not obtain pCR was 31.6% (p:0.04). Conclusion: Pathological response to chemotherapy is an important factor in determining prognosis. There appears to be a need for new biomarkers that allow the prediction of pCR and long-term outcomes.Item Molecular Subtypes of Breast Cancer in Women ≤35 years and >35 years: Does Age Matter?Özisik, H; Erdogan, AP; Sürmeli, ZG; Ekinci, F; Durusoy, R; Karaca, BBackground: Women diagnosed with breast cancer at young ages (<= 35 years) have a substantially shorter overall survival durations. According to molecular pathological classification, triple negative and human epidermal growth factor receptor 2 (HER-2) positive breast cancer subgroups are related with poorer prognosis compared to luminal disease. Based on this rational, the primary objective was to evaluate the impact of age on determining molecular subgroups and whether the different outcomes of patients <= 35 years and >35 years of age are caused by the diversity of molecular subgroups. Methods: A total of 216 patients <= 35 years and randomly selected 212 patients of all breast cancer patients >35 years, presented to Ege University Department of Oncology were enrolled in the study. Molecular subtyping was based on estrogen, progesterone receptors (ER, PR), cerb-B2 and Ki-67 proliferation index assessed by immunohistochemistry. Luminal A disease was defined as ER (+), PR (+), cerb-B2 (-), Ki-67 >= 15. Patients with ER/PR (+), cerb-B2 (-)/(+), Ki-67 >= 15 were classified as Luminal B. If all three receptors were negative, it was accepted as triple negative disease and HER-2 positive disease was characterized by lack of hormone receptors and presence of cerb-B2. Results: Fifty-two percent in younger group were Luminal B and 19% were triple negative, which composed the largest proportion of the young group. Among the >35 years group the majority was Luminal B (39%) as similar in very young population, however, this was followed by Luminal A (31%) that has favorable prognostic features. Statistically, there was no significant difference in molecular subtypes between the two age groups. However, triple negative subtype and Ki-67 >= 15% which is associated with poorer prognosis, was numerically higher among <= 35 years of group. Conclusion: Young women diagnosed with breast cancer have poorer prognosis. However, in our study, there was no statistically significant difference in molecular subtypes between two diverse age groups. This could be explained by small size of the study population, but also could be an indication that age is an independent prognostic factor apart from other clinicopathologic features. Yet, since Luminal B and triple negatives were the largest subgroup in very young population, worse prognosis of the disease in this group may be explained by this diversion.Item The real-world outcomes of Lutetium-177 PSMA-617 radioligand therapy in metastatic castration-resistant prostate cancer: Turkish Oncology Group multicenter studyAlmuradova, E; Seyyar, M; Arak, H; Tamer, F; Kefeli, U; Koca, S; Sen, E; Telli, TA; Karatas, F; Gokmen, I; Turhal, NS; Sakalar, T; Ayhan, M; Ekinci, F; Hafizoglu, E; Kahraman, S; Kesen, O; Unal, C; Alan, O; Celik, S; Yekeduz, E; Omur, O; Gokmen, EMetastatic castration-resistant prostate cancer (mCRPC) remains a challenging condition to treat despite recent advancements. This retrospective study aimed to assess the activity and tolerability of Lutetium-177 (Lu-177) PSMA-617 radioligand therapy (RLT) in mCRPC patients across multiple cancer centers in Turkey. The study included 165 patients who received at least one cycle of Lu-177 PSMA-617 RLT, with the majority having bone metastases and undergone prior treatments. Prostate-specific antigen (PSA) levels were assessed before each treatment cycle, and the biochemical response was evaluated in accordance with the Prostate Cancer Work Group 3 Criteria. The PSA decline of >= 50% was classified as a response, while an increase of >= 25% in PSA levels was indicative of progressive disease. Neither response nor progression was considered as stable disease. The Lu-177 PSMA-617 RLT led to a significant PSA response, with 50.6% of patients achieving a >50% decrease in PSA levels. Median overall survival (OS) and progression-free survival were 13.5 and 8.2 months, respectively. Patients receiving Lu-177 PSMA-617 RLT in combination with androgen receptor pathway inhibitors (ARPIs) had a higher OS compared to those receiving Lu-177 PSMA-617 RLT alone (18.2 vs 12.3 months, P = .265). The treatment was generally well-tolerated, with manageable side effects such as anemia and thrombocytopenia. This study provides real-world evidence supporting the effectiveness and safety of Lu-177 PSMA-617 RLT in mCRPC patients, particularly when used in combination with ARPIs. These findings contribute to the growing body of evidence on the potential benefits of PSMA-targeted therapies in advanced prostate cancer.Item The skills of defibrillation practice and certified life-support training in the healthcare providers in TurkeyDerinoz-Guleryuz, O; Uysal-Yazici, M; Udurgucu, M; Karacan, C; Akça, H; Ongun, EA; Ekinci, F; Duman, M; Akça-Çaglar, A; Vatansever, G; Bilen, S; Uysalol, M; Akcan-Yildiz, L; Saz, EU; Bal, A; Piskin, E; Sahin, S; Kurt, F; Anil, M; Besli, E; Alakaya, M; Gültekingil, A; Yilmaz, R; Temel-Koksoy, O; Kesici, S; Akcay, N; Cebisli, E; Emeksiz, S; Kilinc, MA; Köker, A; Çoban, Y; Erkek, N; Gurlu, R; Eksi-Alp, E; Apa, HAim of the study Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. Methods This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. Results A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). Conclusions The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.Item The Confusion Caused by the Fear of COVID 19 in the Future of Cancer PatientsEkinci, F; Ates, GA; Erdogan, AP; Çelik, C; Dirican, A; Göksel, GObjective: The centrality of events scale (CES) was formed to determine to what extent this localisation cancer disease was by fear of COVID-19 in cancer patients or how centralised the cognitive trauma was in this patient group.Materials and Methods: In the first paragraph of the short 7-item CES, it was written, Please think about the most stressful or traumatic event in your life, then 3 options were given. These and C) Other. After marking one of these options, the subjects were instructed to mark their level of agreement with the 7 items as stated by Berntsen and Rubin, and thus this section was the same as the original questionnaire. To be able to evaluate the questionnaire results taking the disease characteristics into account, a record was made of age, gender, treatment history (chemotherapy and radiotherapy), spread, local, metastatic).The questionnaires were administered to all the cancer patients who presented at the oncology clinic between 1 April and 1 October 2020.Results:This study was conducted to seek an answer to this question, and it was seen that of a total of 523 patients diagnosed with cancer, the vast majority (n:368, 70.4%) saw the most traumatic and stressful event of their life as cancer, with the response to option A on the questionnaire. The possibility of contracting COVID-19 was selected by 83 (15.9%) patients as the most stressful or traumatic event in their life. The option of C was marked by 72 (13.8%) patients. This showed that neither cancer nor fear of coronavirus infection was strong enough to replace the traumatic event experienced and centred in the identity of these 72 patients. These traumas of the patients were analyzed with the mean CES points. The highest points were obtained by those who marked option A, at 3.71, which was statistically significantly higher than the 3.29 points for B and 3.29 points for C (p:0.004).Conclusion:A trauma left in the past actually lives on in the cognitive memory and may even be established at the centre of the self and personal identity. Thus, by modifying the short 7-item CES, developed by Berntsen and Rubin to be an objective, measurable format, the results of this study demonstratated both the extent to which the possibility of contracting COVID-19 has started to be established in cancer patients and the unshakable but declining centrality of cancer in the traumatic past.