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Yan Z, Li L, Fu D, Wu W, Qiao N, Huang Y, Jiang L, Wu D, Hu Y, Zhang H, Xu P, Cheng S, Wang L, Lacin S, Muftuoglu M, Zhao W. Immunosuppressive tumor microenvironment contributes to tumor progression in diffuse large B-cell lymphoma upon anti-CD19 chimeric antigen receptor T therapy. Front Med 2023; 17:699-713. [PMID: 37060525 DOI: 10.1007/s11684-022-0972-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/21/2022] [Indexed: 04/16/2023]
Abstract
Anti-CD19 chimeric antigen receptor (CAR)-T cell therapy has achieved 40%-50% long-term complete response in relapsed or refractory diffuse large B-cell lymphoma (DLBCL) patients. However, the underlying mechanism of alterations in the tumor microenvironments resulting in CAR-T cell therapy failure needs further investigation. A multi-center phase I/II trial of anti-CD19 CD28z CAR-T (FKC876, ChiCTR1800019661) was conducted. Among 22 evaluable DLBCL patients, seven achieved complete remission, 10 experienced partial remissions, while four had stable disease by day 29. Single-cell RNA sequencing results were obtained from core needle biopsy tumor samples collected from long-term complete remission and early-progressed patients, and compared at different stages of treatment. M2-subtype macrophages were significantly involved in both in vivo and in vitro anti-tumor functions of CAR-T cells, leading to CAR-T cell therapy failure and disease progression in DLBCL. Immunosuppressive tumor microenvironments persisted before CAR-T cell therapy, during both cell expansion and disease progression, which could not be altered by infiltrating CAR-T cells. Aberrant metabolism profile of M2-subtype macrophages and those of dysfunctional T cells also contributed to the immunosuppressive tumor microenvironments. Thus, our findings provided a clinical rationale for targeting tumor microenvironments and reprogramming immune cell metabolism as effective therapeutic strategies to prevent lymphoma relapse in future designs of CAR-T cell therapy.
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Affiliation(s)
- Zixun Yan
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Li Li
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Di Fu
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wen Wu
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Niu Qiao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yaohui Huang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lu Jiang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Depei Wu
- Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Huilai Zhang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300070, China
| | - Pengpeng Xu
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shu Cheng
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Li Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Sahin Lacin
- University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Muharrem Muftuoglu
- University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Weili Zhao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Laboratory of Molecular Pathology, Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Shanghai, 200025, China.
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Karadurmus N, Paydas S, Esin E, Surmeli ZG, Yildiz B, Erturk I, Nayir E, Dogan M, Sumbul AT, Barista I, Gurkan E, Ocal R, Ferhanoglu B, Ozgur G, Karakas Y, Lacin S, Ozaydin S, Petekkaya HI, Uskent N. Effectiveness of bendamustine in relapsed or refractory lymphoma cases: a Turkish Oncology Group study. Arch Med Sci 2021; 17:920-927. [PMID: 34336021 PMCID: PMC8314394 DOI: 10.5114/aoms.2019.83000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We aimed to investigate the efficacy and side effects of bendamustine in relapsed/refractory lymphoma patients in Turkey. MATERIAL AND METHODS In this retrospective study, we included relapsed/refractory Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients who underwent multiple lines of chemotherapy. The primary endpoint was to determine the objective response and toxicity. RESULTS Ninety-nine patients with a median age of 59.8 years were included in the study. Eighty-one patients had NHL (follicular lymphoma: 10, diffuse large B-cell lymphoma: 27, mantle-cell lymphoma: 18, marginal zone lymphoma: 9, small lymphocytic lymphoma/chronic lymphocytic leukemia: 17) and 18 patients had HL. The patients had previously received a median of three lines of chemotherapy (range: 2-8) except autologous stem cell transplantation (ASCT); 19 patients (HL: 11, NHL: 8) had undergone ASCT. The objective response rate (ORR) was 74.3%, the complete response rate was 57% (= 53), and the partial response rate was 16.6% ( = 19). The overall survival (OS) rate at 1 year was 74.6%. The progression-free survival (PFS) rate at 1 year was 62.5%. The most common side effects were lymphopenia, anemia and neutropenia. Side effects which were observed as grade 3 and higher levels were lymphopenia (14.1%), neutropenia (10.1%) and fatigue (7.1%). CONCLUSIONS Objective response rate of bendamustine was found to be 74.3% in relapsed/refractory HL and NHL patients. It appears to be an effective option as a salvage treatment for patients who have previously received multiple lines of therapy.
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Affiliation(s)
- Nuri Karadurmus
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Semra Paydas
- Department of Medical Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ece Esin
- Department of Medical Oncology, Health Sciences University, Dr. Abdurrahman Yurtaslan Training and Research Hospital, Ankara, Turkey
| | | | - Birol Yildiz
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ismail Erturk
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Erdinc Nayir
- Department of Medical Oncology, Medicalpark Hospital, Ankara, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Health Sciences University, Numune Training and Research Hospital, Ankara, Turkey
| | - Ahmet Taner Sumbul
- Department of Medical Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Ibrahim Barista
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emel Gurkan
- Department of Haematology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ramazan Ocal
- Department of Haematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Burhan Ferhanoglu
- Department of Haematology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Gokhan Ozgur
- Department of Haematology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sahin Lacin
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sukru Ozaydin
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | | | - Necdet Uskent
- Department of Medical Oncology, Anatolian Health Center, Istanbul, Turkey
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Paydas S, Lacin S, Dogan M, Barista I, Yildiz B, Seydaoglu G, Karadurmuş N, Civriz S, Kaplan MA, Yagci M, Gurkan E, Ercolak V. Abstract PO-30: Is it more explanatory to integrate the leukocyte/lymphocyte ratio (LLR) and prognostic nutritional index (PNI) to international prognostic systems (IPS) in cases with Hodgkin lymphoma (HL)? Blood Cancer Discov 2020. [DOI: 10.1158/2643-3249.lymphoma20-po-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Aim: To determine the power of the International Prognostic Scoring systems (IPS-7 and IPS-3) and to obtain more explanatory indexes by integrating LLR and PNI as prognostic indicators to IPS in cases with HL.
Patients and Methods: 1,060 patients with HL were included in this study from 8 centers in Turkey. IPS-7 using seven parameters (age, sex, stage hemoglobin, albumin, lymphocyte count, and white cell count) and the modified IPS-3 score with three parameters (stage, age, and hemoglobin level) were calculated. An alternative IPS-4 score with four parameters (stage, age, hemoglobin level, and LLR or PNI) was also calculated. LLR and PNI were integrated to IPSs.
Statistical Analyses: Chi square test or Student t test was used to compare the groups. The cut-off points of this population for the LLR and PNI were evaluated using AUC (area under ROC curve) statistics and median values of the distributions of the variables. Possible alternative cut-off points for the LLR and PNI were evaluated using AUC statistics and median values of the distributions of the variables. For LLR, 5.7 was detected as cut-off point based on ROC analysis and 5.1 based on median. Cut-off for PNI was 45.2 based on ROC analysis and 47.5 based on median. The Kaplan-Meier method and Cox proportional regression model were used to estimate the mean-median overall survival (OS), failure-free survival (FFS) rates, and hazard ratios (HRs). Log-rank test was used to compare the survival distributions between groups. The prognostic ability of parameters was evaluated for OS and FFS in both univariate and multivariate Cox regression models. p value < 0.05 was considered as significant. The analyses were performed using the statistical package SPSS v 22.0.
Results: Female/male ratio was 396/664; mean age was 37.6±15.8 (15-88). About 75% of the patients had stage II-III disease and two thirds of the patient had nodular sclerosis subtype. All factors of IPS-7 and IPS-3 scoring systems were found to be significant factors that related with OS and FFS according to univariate analyses. PNI and LLR were also found to be prognostic factors for OS and FFS. PNI ≤45.2 and LLR ≥5.8 were found to be poor prognostic indicators. Among 7 factors of IPS-7, gender and albumin were not found to be significant according to multivariate Cox regression model. Hence albumin and gender were excluded from the models and PNI and LLR as prognostic factors were added to obtain easier and more explanatory indexes to the model, respectively. Two different Cox regression models were obtained for OS and FFS. Model 1 showed LLR ≥5.8 as the highest risk for OS (OR: 2.7) and Hb <10.5g/dL as the highest risk for FFS (OR: 2.3). Model 2 showed PNI ≤45.2 as the highest risk for OS (OR: 3.2) and Hb <10.5g/dL as the highest risk for FFS (OR: 2.9). Goodness of fit and agreement between IPS-7, IPS-3 groups and IPS-4 groups were found to be acceptable.
Conclusion: IPS-4 score obtained by integrating LLR or PNI to IPS systems can be used as an explanatory index for prognostic indicator in HL.
Citation Format: Semra Paydas, Sahin Lacin, Mutlu Dogan, Ibrahim Barista, Birol Yildiz, Gulsah Seydaoglu, Nuri Karadurmuş, Sinem Civriz, Muhammed Ali Kaplan, Munci Yagci, Emel Gurkan, Vehbi Ercolak. Is it more explanatory to integrate the leukocyte/lymphocyte ratio (LLR) and prognostic nutritional index (PNI) to international prognostic systems (IPS) in cases with Hodgkin lymphoma (HL)? [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-30.
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Abdel-Wahab R, Hassan MM, George B, Carmagnani Pestana R, Xiao L, Lacin S, Yalcin S, Shalaby AS, Al-Shamsi HO, Raghav K, Wolff RA, Yao JC, Girard L, Haque A, Duda DG, Dima S, Popescu I, Elghazaly HA, Vauthey JN, Aloia TA, Tzeng CW, Chun YS, Rashid A, Morris JS, Amin HM, Kaseb AO. Impact of Integrating Insulin-Like Growth Factor 1 Levels into Model for End-Stage Liver Disease Score for Survival Prediction in Hepatocellular Carcinoma Patients. Oncology 2020; 98:836-846. [PMID: 33027788 PMCID: PMC7704605 DOI: 10.1159/000502482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Liver reserve affects survival in hepatocellular carcinoma (HCC). Model for End-Stage Liver Disease (MELD) score is used to predict overall survival (OS) and to prioritize HCC patients on the transplantation waiting list, but more accurate models are needed. We hypothesized that integrating insulin-like growth factor 1 (IGF-1) levels into MELD score (MELD-IGF-1) improves OS prediction as compared to MELD. METHODS We measured plasma IGF-1 levels in training (n = 310) and validation (n = 155) HCC cohorts and created MELD-IGF-1 score. Cox models were used to determine the association of MELD and MELD-IGF-1 with OS. Harrell's c-index was used to compare the predictive capacity. RESULTS IGF-1 was significantly associated with OS in both cohorts. Patients with an IGF-1 level of ≤26 ng/mL in the training cohort and in the validation cohorts had significantly higher hazard ratios than patients with the same MELD but IGF-1 >26 ng/mL. In both cohorts, MELD-IGF-1 scores had higher c-indices (0.60 and 0.66) than MELD scores (0.58 and 0.60) (p < 0.001 in both cohorts). Overall, 26% of training and 52.9% of validation cohort patients were reclassified into different risk groups by MELD-IGF-1 (p < 0.001). CONCLUSIONS After independent validation, the MELD-IGF-1 could be used to risk-stratify patients in clinical trials and for priority assignment for patients on liver transplantation waiting list.
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Affiliation(s)
- Reham Abdel-Wahab
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Clinical Oncology, Assiut University, Assiut, Egypt
| | - Manal M Hassan
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bhawana George
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roberto Carmagnani Pestana
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sahin Lacin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Hacettepe University Institute of Cancer, Ankara, Turkey
| | - Suayib Yalcin
- Hacettepe University Institute of Cancer, Ankara, Turkey
| | - Ahmed S Shalaby
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Humaid O Al-Shamsi
- Medical Oncology Department, Alzahra Hospital Dubai, Dubai, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Emirates Oncology Society, Dubai, United Arab Emirates
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James C Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lauren Girard
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abedul Haque
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dan G Duda
- Steele Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Simona Dima
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Irinel Popescu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Jean-Nicolas Vauthey
- Department of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Thomas A Aloia
- Department of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ching-Wei Tzeng
- Department of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yun Shin Chun
- Department of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hesham M Amin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA,
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Lacin S, Yalcin S, Karakas Y, Hassan MM, Amin H, Mohamed YI, Rashid A, Morris JS, Xiao L, Qayyum A, Kaseb AO. Prognostic Significance of Serum Insulin-Like Growth Factor-1 in Hepatocellular Cancer Patients: A Validation Study. J Hepatocell Carcinoma 2020; 7:143-153. [PMID: 32984091 PMCID: PMC7502406 DOI: 10.2147/jhc.s258930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/14/2020] [Indexed: 12/29/2022] Open
Abstract
Background The Child–Turcotte–Pugh score (CTP) is the most commonly used tool to assess hepatic reserve and predict survival in hepatocellular cancer (HCC). The CTP stratification accuracy has been questioned and attempts have been made to improve the objectivity of the system. Serum insulin-like growth factor-1 (IGF-1)-CTP has been proposed to improve CTP prognostic accuracy. We aimed to validate the IGF-CTP score in our patient population. Patients and Methods A total of 84 diagnosed HCC patients were enrolled prospectively. IGF-CTP scores in addition to CTP scores were calculated. C-index was used to compare the prognostic significance of the two scoring systems and overall survival (OS). Results Cirrhosis was present in 48 (57.1%) patients, 35 (41.7%) patients were non-cirrhotic, 36 (42.8%) patients were hepatitis B (HBV) positive, and 8 (9.5%) patients were hepatitis C (HCV) positive. Serum IGF-1 levels were significantly lower in cirrhotic compared with non-cirrhotic patients (p=0.04). There was a significant difference in OS rates of patients with serum IGF-1 level <50 ng/mL and patients with serum IGF-1 levels ≥50 ng/mL (p=0.02); the OS rates were 6.5 and 14.8 months, respectively (p=0.02). The median OS of all patients was 7.38 months (95% CI: 5.89–13.79). The estimated C-index for CTP and IGF-CTP scores was 0.605 (95% CI: 0.538, 0.672) and 0.599 (95% CI: 0.543, 0.655), respectively. The U statistics indicated that the C-indices between two scoring systems are not statistically different (P= 0.91). Conclusion This study evaluated IGF-1 levels and the IGF-CTP classification in a predominantly HBV (+) cohort of HCC patients with 41.7% non-cirrhotic. Although the prognostic value was similar, among patients with CTP-A, class those reclassified as IGF-CTP B had shorter OS than those with IGF-CTP score A. Thus, further validations of IGF-CTP score in similar populations may add additional value as a stratification tool to predict HCC outcome.
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Affiliation(s)
- Sahin Lacin
- Yeditepe University, Faculty of Medicine, Department of Medical Oncology, İstanbul, Turkey
| | - Suayib Yalcin
- Hacettepe University, Hacettepe Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Yusuf Karakas
- Hacettepe University, Hacettepe Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Manal M Hassan
- University of Texas, MD Anderson Cancer Center, Department of Epidemiology, Division of Cancer Prevention and Population Sciences, Houston, Texas, USA
| | - Hesham Amin
- University of Texas, MD Anderson Cancer Center, Department of Hematopathology, Division of Pathology and Laboratory Medicine, Houston, Texas, USA
| | - Yehia Ibrahim Mohamed
- University of Texas, MD Anderson Cancer Center, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, Houston, Texas, USA
| | - Asif Rashid
- University of Texas, MD Anderson Cancer Center, Department of Pathology, Division of Pathology and Laboratory Medicine, Houston, Texas, USA
| | - Jeffrey S Morris
- Department of Biostatistics, Epidemiology and Informatics Center for Clinical Epidemiology and Biostatistics University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Lianchun Xiao
- University of Texas, MD Anderson Cancer Center, Department of Biostatistics, Division of Basic Sciences, Houston, Texas, USA
| | - Aliya Qayyum
- University of Texas, MD Anderson Cancer Center, Department of Diagnostic Radiology, Division of Diagnostic Imaging, Houston, Texas, USA
| | - Ahmed O Kaseb
- University of Texas, MD Anderson Cancer Center, Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, Houston, Texas, USA
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Abstract
Background: Neovascularization plays a crucial pathogenic role in tumor development and
vascular endothelial growth factor (VEGF-A) is a key signaling element that
drives angiogenesis, thereby facilitating hepatocellular cancer (HCC) growth
and metastasis. We aimed to define the relationship between serum VEGF-A
levels and clinical outcomes in a cohort of Turkish patients with HCC. Methods: We enrolled and prospectively followed 84 patients with HCC in our study.
Serum VEGF-A levels were measured and we assessed the association between
VEGF-A levels and clinical features. Results: Forty-eight patients had cirrhosis while 35 patients were noncirrhotic. Serum
VEGF-A levels were significantly lower in HCC patients with cirrhosis
compared to non-cirrhotic HCC patients (p = 0.03).In terms of viral
hepatitis subtype, 36 (%42.8) of patients were hepatitis B virus (HBV)
positive and 8 (%9.5) of patients were hepatitis C virus (HCV) positive.
Patients with serum VEGF-A levels ≥100 pg/mL had significantly lower OS
rates than patients with serum VEGF-A level <100 pg/mL (p = 0.01). The OS
rates were 5.8 and 14.2 months, respectively (p = 0.02). The median OS was
7.38 months (95% CI: 5.89-13.79 months). We observed a significant
relationship between serum VEGF-A level and tumor size. Patients with tumor
size ≤ 5cm had lower VEGF-A levels than patients with VEGF-A levels <5
cm. The VEGF-A levels were 132.7 and 342.1 pg/mL, respectively (p <
0.001). The median follow-up was 32 months. Conclusions: Serum VEGF-A level, a biological marker of angiogenesis, is an independent
predictor of survival in patients with HCC. Serum VEGF-A levels may be
utilized to predict response to treatment targeting serum VEGF-A in patients
with HCC.
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Affiliation(s)
- Sahin Lacin
- Department of Medical Oncology, Faculty of Medicine, 64173Yeditepe University, İstanbul, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, 64005Hacettepe University, Hacettepe Cancer Institute, Ankara, Turkey
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Lacin S, Sogutcu N. The importance of clinical and pathological features in bladder cancer and its effects on disease course. Dicle Tıp Dergisi 2019. [DOI: 10.5798/dicletip.661400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yalcin S, Lacin S. Impact of tivozanib on patient outcomes in treatment of advanced renal cell carcinoma. Cancer Manag Res 2019; 11:7779-7785. [PMID: 31496820 PMCID: PMC6701608 DOI: 10.2147/cmar.s206105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/13/2019] [Indexed: 11/23/2022] Open
Abstract
Renal cell carcinoma (RCC) is the most common type of kidney malignancy, and the clear-cell subtype represents the majority of RCCs. RCC is a heterogeneous disease in terms of genetic and histological features which determine the behavior of the disease. The von Hippel-Lindau (VHL) is a tumor suppressor gene and mutations of this gene are seen in 95% of clear-cell RCCs. Inactivation of VHL causes the accumulation of hypoxia-inducible factor-1 (HIF-1), and in turn, accumulation of HIF-1 induces overexpression of vascular endothelial growth factor (VEGF); the increase in VEGF expression makes RCC a highly vascularized tumor, and forms the rationale for antiVEGF treatment. In the past decade, improvement in the survival of RCC patients has been observed due to new effective therapies, such as antiVEGF and mammalian target of rapamycin (mTOR) targeting agents and immune checkpoint inhibitors. The majority of VEGF targeted agents are not just selective to VEGF receptors, but usually also have inhibitory effects on other kinases, such as c-KIT and FLT3. Tivozanib is an extremely potent and selective tyrosine kinase inhibitor (TKI) of VEGFR-1, 2, and 3, with a relatively long half-life, that is approved by the European Commission for the treatment of advanced/metastatic RCC. Tivozanib, at very low serum concentration can inhibit phosphorylation of VEGFR -1, -2, and -3 tyrosine kinase activity. This article summarizes the clinical data on tivozanib in the treatment of advanced/metastatic RCC.
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Affiliation(s)
- Suayib Yalcin
- Hacettepe University Institute of Cancer, Department of Medical Oncology, Ankara, Turkey
| | - Sahin Lacin
- University of Health Sciences, Diyarbakir Gazi Yasargil Training and Research Hospital, Department of Medical Oncology, Diyarbakir, Turkey
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Guven DC, Dizdar O, Alp A, Akdoğan Kittana FN, Karakoc D, Hamaloglu E, Lacin S, Karakas Y, Kilickap S, Hayran M, Yalcin S. Analysis of Fusobacterium nucleatum and Streptococcus gallolyticus in saliva of colorectal cancer patients. Biomark Med 2019; 13:725-735. [PMID: 31157977 DOI: 10.2217/bmm-2019-0020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: The aim of the study was to examine the prevalence and amount of Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg) and Streptococcus gallolyticus (Sg) in the saliva of colorectal cancer (CRC) patients and controls. Methods: PCR analyses performed in 71 CRC patients and 77 controls. Results: Saliva samples of patients had higher amounts of Fn (p = 0.001) and Sg (p < 0.001) compared with controls. Amount of Fn and Sg were lower in the microsatellite instability (+) group. Evaluation of salivary Sg amount by receiver operating characteristics analysis found to have diagnostic value for CRC (AUC: 0.84, 95% CI: 0.72-0.96). Conclusion: We found higher amounts of Fn and Sg in the saliva of CRC patients. Salivary Sg could helpful in distinction of CRC.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Omer Dizdar
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | | | - Derya Karakoc
- Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Erhan Hamaloglu
- Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Sahin Lacin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Saadettin Kilickap
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
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Lacin S, Tasar GE, Usubutun A, Arik Z, Karakas Y, Yuce D, Salman MC, Kars A. Is microsatellite instability a negative prognostic factor in early stage endometrial cancer patients? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17107 Background: Endometrial cancer(EC) is a heterogeneous disease with diverse histological features and biological behaviour. Microsatellite instability (MSI) which occurs in cancerous tissue secondary to mismatch repair (MMR) defect of hereditary or somatic origin is a well-known feature further diversifying genetic tumor landscape. In this study, we aim to investigate the relationship between MSI and prognosis in patients with early stage EC. Methods: The patients diagnosed with EC between 2004 and 2017 were retrospectively analysed in the study. The demographic characteristics, disease stage, menopausal status, and clinical and laboratory values were noted. MLH1, MSH2, MSH6 and PMS2 antibodies were used to detect microsatellite status within the tumor tissue samples. Results: The mean age of the 93 patients and menopause was 60.6 ± 9.8 and 49.68 ± 4.5 years , respectively. The median follow-up period was 28 (1-110) months. At the time of diagnosis, number of the patients with stage IA, IB, II, III, and IV were 5, 64, 8, 14, and 2, respectively. Forty three patients were grad 1, 23 patients grad 2, and 27 patients were grade 3. In terms of microsatellite status, 59 patients (63.4%) were microsatellite stable (MSS) and 34 patients (36.6%) were microsatellite instable(MSI). There was no significant association between MSI and tumor stage or grade (X2 = 1.97 p = 0.74 and X2= 3.2, p = 0.19, respectively). There was a significant relationship between peritumoral lymphocyte infiltration rate (pTIL) and MSI. PTIL ratio was higher in tumoral tissues with MSI, whereas pTIL was low in MSS tumor tissues (X2= 28.6, p < 0.0001). Patients with MSI tended to have poorer survival than patients with MSS irrespective of disease stage; mOS rates were 76 and 91 months, respectively (p = 0.086). However, patients with early stage disease and MSI had significantly poorer survial in comparison to patients with similar disease stage and MSS: Overall survival rates for patients with MSI and MSS were 75.8 and 94.7 months, respectively (Log-rank p = 0.048). Conclusions: There is a limited number of studies assessing the association between MSI and clinical outcomes in EC. Our study hints at the presence of potential relationship between MSI and pognosis in patients with MSI. Similar to previous studies performed with various types of tumors we found that EC with MSI attract more immune cells to tumor microenvironments. Interestingly, patients with MSI tended to have poorer prognosis despite augmented immune-cell inftration.
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Affiliation(s)
- Sahin Lacin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gozde Elif Tasar
- Department of Medical Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alp Usubutun
- Department of Medical Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zafer Arik
- Hacettepe University Institute of Oncology, Department of Medical Oncology, Ankara, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Deniz Yuce
- Hacettepe University Cancer Institute, Department of Preventive Oncology, Ankara, Turkey
| | - Mehmet Coskun Salman
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayse Kars
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Abugabal YI, Hassan M, Abdel-Wahab R, Lacin S, Carmagnani Pestana R, Wolff RA, Yao JC, Kaseb AO. Utility of Neuropilin-1 in predicting survival in patients with hepatocellular carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Manal Hassan
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sahin Lacin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | | | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Guven DC, Dizdar O, Alp A, Akdogan Kittana FN, Karakoc D, Hamaloglu E, Lacin S, Karakas Y, Kilickap S, Hayran M, Yalcin S. Analysis of Fusobacterium nucleatum, Streptococcus gallolyticus and Porphyromonas gingivalis in saliva in colorectal cancer patients and healthy controls. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Deniz Can Guven
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Omer Dizdar
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Derya Karakoc
- Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erhan Hamaloglu
- Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sahin Lacin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Kaseb AO, Abugabal YI, Abdel-Wahab R, Lacin S, Botrus G, Carmagnani Pestana R, Wolff RA, Yao JC, Hassan M. Prognostic significance of periostin in patients with hepatocellular carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Sahin Lacin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gehan Botrus
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- University of Texas MD Anderson Cancer Center, Houston, TX
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Kaseb AO, Hassan M, Lacin S, Abdel-Wahab R, Amin HM, Shalaby A, Wolff RA, Yao J, Rashid A, Vennapusa B, Feng J, Ohtomo T. Evaluating clinical and prognostic implications of Glypican-3 in hepatocellular carcinoma. Oncotarget 2018; 7:69916-69926. [PMID: 27655712 PMCID: PMC5342524 DOI: 10.18632/oncotarget.12066] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/05/2016] [Indexed: 12/21/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most deadly cancers worldwide. In patients with HCC, histopathogical differentiation is an important indicator of prognosis; however, because determination of HCC differentiation is difficult, the recently described immunohistochemical (IHC) marker glypican3 (GPC3) might assist in HCC prognostication.The goal of our study was to investigate GPC3's IHC staining pattern and define the relationship between its expression and patients' clinicopathologic features and overall survival. We retrieved clinical parameters from 101 pathologically diagnosed HCC patients' medical records and classified these patients into 4 clinical score categories (0–3) based on increasing GPC3 staining intensity and the percentage of stained tumor cells in their resection and biopsy specimens. Histopathological samples were well, moderately, and poorly differentiated in 33, 22, and 12 patients, respectively, and the GPC3 expression rate was 63%, 86%, and 92%,respectively. The median overall survival was 49.9 months (confidence interval (CI): 35.3–64.6 months) for clinical scores 0–1 and 30.7 months (CI: 19.4–41.9 months) for clinical scores 2–3. This difference was not statistically significant (P = .06) but showed a strong trend. In conclusion, a greater GPC3 expression is associated with a worse HCC prognosis and may be a promising prognostic marker.
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Affiliation(s)
- Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Manal Hassan
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sahin Lacin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Medical Oncology, Hacettepe University, Medical Faculty, Ankara, Turkey
| | - Reham Abdel-Wahab
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt
| | - Hesham M Amin
- Division of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed Shalaby
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Asif Rashid
- Division of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Janine Feng
- Ventana Medical Systems, Inc., Tucson, Arizona, USA
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15
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Affiliation(s)
- Yusuf Karakas
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Sahin Lacin
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
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16
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Hassan MM, Botrus G, Abdel-Wahab R, Wolff RA, Li D, Tweardy D, Phan AT, Hawk E, Javle M, Lee JS, Torres HA, Rashid A, Lenzi R, Hassabo HM, Abaza Y, Shalaby AS, Lacin S, Morris J, Patt YZ, Amos CI, Khaderi SA, Goss JA, Jalal PK, Kaseb AO. Estrogen Replacement Reduces Risk and Increases Survival Times of Women With Hepatocellular Carcinoma. Clin Gastroenterol Hepatol 2017; 15:1791-1799. [PMID: 28579181 PMCID: PMC5901750 DOI: 10.1016/j.cgh.2017.05.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/18/2017] [Accepted: 05/21/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Environmental factors have been identified that affect risk of hepatocellular carcinoma (HCC), but little is known about the effects of sex hormones on liver cancer development or outcome. The authors investigated whether menopause hormone therapy (MHT) affects risk, age at onset, or outcome of HCC. METHODS We performed a case-control study of 234 female patients treated for HCC at a tertiary medical center and with 282 healthy women (controls) from January 1, 2004 through May 31, 2015. We collected detailed information on environmental exposures, ages of menarche and menopause, hysterectomies, and uses of birth control and MHT. We performed multivariable logistic and Cox regression analyses to determine the independent effects of factors associated with women on risk and clinical outcome in HCC. The primary outcomes were effect of MHT on HCC risk, the relationship between MHT with hepatitis virus infection on HCC development, and effect of MHT on age at HCC onset or survival after diagnosis of HCC. RESULTS The estimated adjusted odds ratio (AOR) for HCC in women who ever used estrogen was 0.53 (95% confidence interval [CI], 0.32-0.88). This association was supported by the older age of HCC onset among estrogen users (mean, 64.5 ± 0.9 years) vs nonusers (mean 59.2 ± 1.1 years; P = .001) and the reduced risk of HCC among long-term users (more than 5 years) (AOR, 0.36; 95% CI, 0.20-0.63). Users of estrogen also had a reduced risk for hepatitis-associated HCC: AOR for users, 4.37 (95% CI, 1.67-11.44) vs AOR for nonusers, 17.60 (95% CI, 3.88-79.83). Estrogen use reduced risk of death from HCC (hazard ratio, 0.55; 95% CI, 0.40-0.77; P = .01). Median overall survival times were 33.5 months for estrogen users (95% CI, 25.7-41.3 months) and 24.1 months for nonusers (95% CI, 19.02-29.30 months; P = .008). CONCLUSION In a case-control study of women with HCC vs female control subjects at a single center, we associated use of estrogen MHT with reduced risk of HCC and increased overall survival times of patients with HCC. Further studies are needed to determine the benefits of estrogen therapy for women and patients with HCC, and effects of tumor expression of estrogen receptor.
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Affiliation(s)
- Manal M Hassan
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Gehan Botrus
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reham Abdel-Wahab
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donghui Li
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Tweardy
- Division of Internal Medicine, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Ernest Hawk
- Division of Cancer Prevention and Population Science, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ju-Seog Lee
- Department of System Biology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harrys A Torres
- Department of Infectious Diseases, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Asif Rashid
- Department of Pathology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Renato Lenzi
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hesham M Hassabo
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yasmin Abaza
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmed S Shalaby
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sahin Lacin
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Jeffrey Morris
- Department of Biostatistics, the University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yehuda Z Patt
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Christopher I Amos
- Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Saira A Khaderi
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - John A Goss
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas; Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Prasun K Jalal
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
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Al-Shamsi HO, Abdel-Wahab R, Hassan MM, Shalaby AS, Dahbour I, Lacin S, Mahvash A, Odisio BC, Murthy R, Avritscher R, Abdelsalam ME, Rashid A, Vauthey JN, Aloia TA, Conrad C, Chun YS, Krishnan S, Das P, Koay EJ, Amin HM, Yao JC, Kaseb AO. Natural History of T1N0M0 Hepatocellular Carcinoma: Large-Scale Study in the United States. Oncology 2017; 93:233-242. [PMID: 28683459 DOI: 10.1159/000455957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) prognosis depends on clinicopathological features in addition to the treatment provided. We aimed to assess the natural history of TNM stage I HCC tumors which received different treatment over a period of 20 years. METHODS Between 1992 and 2011, a total of 397 stage I HCC patients were included. Detailed information was retrieved from MD Anderson Cancer Center patients' medical records. The Kaplan-Meier method was used to calculate patients' overall survival (OS). Cox regression analysis was used to calculate the estimated hazard ratio and 95% confidence interval of different prognostic factors. RESULTS Out of 397 patients, 67.5% were males, 42.8% had hepatitis-related HCC, and 59.7% had underlying cirrhosis. After adjustment for confounding factors, we found that all therapeutic modalities were associated with a significant mortality rate reduction with an OS of 63, 42.03, 34.3, and 22.1 months among patients treated with surgery, ablation, local, and systemic therapy, respectively. A restricted analysis of cirrhotic and noncirrhotic patients showed that ablative and local therapy were significantly associated with a longer OS compared to systemic therapy. CONCLUSION TNM stage I HCC patients have a favorable prognosis regardless of the type of treatment. Notably, ablative and local therapy significantly improved OS compared to systemic therapy.
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Affiliation(s)
- Humaid O Al-Shamsi
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abdel-Wahab R, Hassan M, Lacin S, Shalaby AS, Afshar-Kharghan V, Kaseb AO. Erythropoietin and hepatocellular carcinoma: What is patients survival outcome? J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15660 Background: Erythropoietin (Epo) is a glycoprotein that stimulates cell proliferation and angiogenesis. Both, hypoxia and anemia are triggering factors that induce Epo overproduction. Although, previous studies reported that Epo induces angiogenesis in hepatocellular cancer (HCC), the relationship between Epo and HCC remains unclear .Our study aims to assess Epo level in HCC patients and evaluate its prognostic roles. Methods: We enrolled 766 HCC patients from MD Anderson Cancer Center Between 2001 and 2014. Under IRB approval, baseline patients’ clinical characteristics were retrieved from medical records. Based on the plasma level of Epo, we classified our patients into two groups: group 1 (N = 407) had normal serum level ( < 20mIU/ml) and group 2 (N = 359) had higher level (≥20mIU/ml). Median overall survival (OS) was estimated by kaplan meier curve and log rank test. We used multivariate hazard ratio (HR) and 95% Confidence interval (CI) to determine the independent effect of Epo on the prognosis of HCC patients. Results: Univariate analysis showed that higher level of Epo had a statistically significant association to a higher Child Pugh Score (CTP), and an advanced stage in Barcelona clinic liver cancer (BCLC) and Cancer of the Liver Italian Program (CLIP). Median OS and 95%CI was 16.1 months (12.7 – 19.4) in group 1 compared to 11.4 months (8.6 – 14.3) in group 2 ( P< .0001). The same significant difference was achieved among HCC patients with cirrhosis ( P = .005) and without cirrhosis ( P= .002). The estimated multivariate HR and 95%CI for elevated Epo level was 1.4 (1.04 – 1.9) (P = .03) in the absence of cirrhosis, while it was 0.97 (0.79 – 1.2) (P = .8) in the presence of cirrhosis after adjustment for several confounding factors. Conclusions: Abnormal Epo level in the plasma is significantly associated with a worse clinico-pathological characteristics and a shorter OS. Previous studies showed that HCC stimulates erythrocytosis and increases Epo production. Although, our study concluded that Epo is an independent prognostic factor among non-cirrhotic HCC patients only. Future studies are warranted to understand the mechanistic pathways of Epo effect in HCC patients and its variation in the presence and absence of cirrhosis.
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Affiliation(s)
| | - Manal Hassan
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sahin Lacin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ahmed S Shalaby
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vahid Afshar-Kharghan
- Benign Hematology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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Karakas Y, Kertmen N, Lacin S, Aslan A, Demir M, Ates O, Aksoy S, Altundag K. Comparison of prognosis and clinical features between synchronous bilateral and unilateral breast cancers. J BUON 2017; 22:623-627. [PMID: 28730766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The clinical significance of synchronous bilateral breast cancer (SBBC) is unclear and its influence on prognosis is controversial. Our study objective was to determine the epidemiological features, tumor characteristics, and prognosis of SBBC in comparison with those of unilateral breast cancer (UBC). METHODS A total of 3675 breast cancer patients diagnosed and treated between 2000 and 2014 were evaluated. Of these patients, 132 (3.6%) had bilateral breast cancer, including 55 patients (1.5%) with SBBC and 77 (2.1%) with metachronous bilateral breast cancer (MBBC). The patient demographic characteristics, including survival data and clinicopathological tumor characteristics, were obtained from medical charts and compared between the patients with SBBC and those with UBC. RESULTS The median age in the SBBC group was 51 years (range 32-77). The mastectomy rate was higher in the SBBC group (72.7%) than in the UBC group (66.6%) (p=0.08). In both the SBBC and UBC groups, the baseline clinicopathological features and the history of treatment with radiotherapy and chemotherapy were similar. Infiltrating ductal carcinoma was the most common histology in both groups. Lobular histology was more frequent in the SBBC group (36.3%) than in the UBC group (17.1%; p<0.001). Stage IV disease at initial presentation was more frequent in the SBBC group than in the UBC group (34.5 vs 8.7%, p<0.001). The 5-year disease-free survival (DFS) rates were 90% and 82% in the SBBC and UBC groups, respectively (p=0.99). The 5-year overall survival (OS) rates were 83% and 88%, respectively (p=0.357). The multivariate Cox regression analysis, including stage, hormone receptor status, grade, and SBBC, revealed that the presence of SBBC was not associated with OS (hazard ratio 0.929; 95% confidence interval, 0.455-0.1894, p=0.839). CONCLUSION Despite the differences in histology, initial stage, and other characteristics, the prognoses of UBC and SBBC were similar.
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Affiliation(s)
- Yusuf Karakas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Ali MA, Lacin S, Abdel-Wahab R, Uemura M, Hassan M, Rashid A, Duda DG, Kaseb AO. Nonalcoholic steatohepatitis-related hepatocellular carcinoma: is there a role for the androgen receptor pathway? Onco Targets Ther 2017; 10:1403-1412. [PMID: 28424556 PMCID: PMC5344425 DOI: 10.2147/ott.s111681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The epidemic of insulin resistance, obesity, and metabolic syndrome has led to the emergence of nonalcoholic steatohepatitis (NASH) as the most common cause of liver disease in the US. Patients with NASH are at an increased risk for hepatic disease-related morbidity and death, and chronic inflammation in NASH patients can lead to hepatocellular carcinoma (HCC). The prevalence of HCC is higher in males than in females, and genetic studies have identified androgen and androgen receptors (ARs) as partially responsible for the gender disparity in the development of liver disease and HCC. Although many factors are known to play important roles in the progression of inflammation in NASH patients, the role of androgen and AR in the progression of NASH to HCC has been understudied. This review summarizes the evidence for a potential role of androgen and the AR pathway in the development of NASH-related HCC and in the treatment of HCC. It has been proposed that AR plays a role in the progression of HCC: inhibitory roles in early stages of hepatocarcinogenesis and tumor-promoting roles in advanced stages. AR can be activated by several pathways, even in the absence of androgen. While AR has been explored as a potential therapeutic target in HCC, several clinical trials have failed to demonstrate a clinical benefit of antiandrogen drugs in HCC. This review discusses the potential reason for these observations and discuss the potential future trials design in this important setting.
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Affiliation(s)
- Mahmoud A Ali
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sahin Lacin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reham Abdel-Wahab
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Clinical Oncology, Assiut University, Assiut, Egypt
| | - Mark Uemura
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Manal Hassan
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dan G Duda
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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21
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Abdel-Wahab R, Hassan M, Wolff RA, Lacin S, Al-Shamsi HO, Raghav KPS, Shalaby AS, Yao JC, Kaseb AO. Association of elevated alpha-1 antitrypsin with advanced clinicopathologic features of hepatocellular carcinoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
289 Background: Alpha-1 Antitrypsin (A1AT) is a circulating liver derived protease inhibitor. There is an evolving evidence that elevated level of A1AT stimulate tumor cell proliferation, and invasion in different cancers. Despite A1AT well-known involvement in hepatic fibrosis, its role in hepatocellular carcinoma (HCC) pathogenesis is not well characterized. The current study aimed to investigate the association between A1AT and clinicopathologic features and prognosis of patients with HCC. Methods: Between 2001 and 2014, total of 766 HCC patients from MD Anderson Cancer Center were enrolled. Under IRB approval, baseline patients’ clinical characteristics were retrieved from medical records. The normal level of plasma A1AT was defined based on the Mayo clinic reference value (1 – 1.9 mg/ml). Survival analysis included Kaplan Meier statistic and Cox regression analysis. Multivariate Hazard Ratio (HR) and 95% Confidence interval (CI) were estimated to determine the independent effect of A1AT on HCC prognosis. Results: The mean and standard deviation of plasma A1AT level was 2.7 ± 0.98 mg/mL. All patients were categorized into 2 groups: group 1 (N = 156) with normal serum level ( ≤ 1.9) and group 2 (N = 610) with higher values ( > 1.9). Median survival (months), 95% CI were 24.4 (18.02 – 30.7) and 11.6 (9.6 – 13.6) in group 1 and 2 respectively, (P < .0001). Patients in group 2 experienced poor clinical characteristics than group 1. The estimated multivariate HR (95% CI) for A1AT is 1.4 (1.1 – 1.7) after adjustment for age, sex, race, cirrhosis, AFP, TNM staging, and treatment exposure. Conclusions: High plasma level of A1AT is associated with higher α-feto protein, advanced TNM and Barcelona clinic liver cancer (BCLC) staging and poor survival of HCC patients. Recent preliminary studies suggested that changes in glycosylaion of production of A1AT by HCC cells correlates with the microenvironment inflammatory and proteolytic activities, which are probably linked to advanced clinicopathologic features and poorer survival. Future excremental studies are warranted to understand the mechanistic pathways of potential A1AT involvement in HCC initiation and progression.
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Affiliation(s)
| | - Manal Hassan
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sahin Lacin
- Medical Oncology Department, Hacettepe University,Faculty of Medicine, Ankara, Turkey
| | - Humaid Obaid Al-Shamsi
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ahmed S Shalaby
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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22
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Karakas Y, Esin E, Lacin S, Ceyhan K, Heper AO, Yalcin S. A case of acanthosis nigricans as a paraneoplastic syndrome with squamous cell lung cancer. Onco Targets Ther 2016; 9:4815-20. [PMID: 27536145 PMCID: PMC4976921 DOI: 10.2147/ott.s95020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 55-year-old man presented with oral mucosal ulcers, blackening of both hands, and hyperpigmentation on axillary, anal, and inguinal regions for the last 3 months, which were all progressive. The patient was referred to the oncology department with the diagnosis of acanthosis nigricans for investigation of an underlying malignancy. He was a smoker. A computed tomography scan of thorax revealed enlarged mediastinal lymphadenopathies and a lesion on the left upper lobe. Fine-needle aspiration biopsy of the mediastinal lesion was consistent with squamous cell carcinoma, and biopsies of the skin and oral mucosal lesion also further confirmed the diagnosis of acanthosis nigricans. After docetaxel and cisplatin chemotherapy, a significant improvement in his skin and mucosal lesions was observed with almost complete resolution of the pulmonary lesion and the mediastinal lymph nodes.
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Affiliation(s)
- Yusuf Karakas
- Medical Oncology Department, Hacettepe University Cancer Institute
| | - Ece Esin
- Medical Oncology Department, Hacettepe University Cancer Institute
| | - Sahin Lacin
- Medical Oncology Department, Hacettepe University Cancer Institute
| | - Koray Ceyhan
- Department of Medical Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Aylin Okcu Heper
- Department of Medical Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Suayib Yalcin
- Medical Oncology Department, Hacettepe University Cancer Institute
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23
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Sarici F, Babacan T, Buyukhatipoglu H, Balakan O, Sever AR, Kertmen N, Unlu O, Ates O, Diker O, Akin S, Sunar V, Karakas Y, Lacin S, Altundag K. Correlation of educational status and clinicopathological characteristics of breast cancer: a single center experience. J BUON 2016; 21:826-831. [PMID: 27685902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Educational status may be an important parameter in assessing breast cancer risk and prognosis. The purpose of this study was to investigate the correlation between the level of education and clinicopathological characteristics of breast cancer, including tumor grade, HER-2 and estrogen receptor (ER) status, tumor size, axillary lymph node involvement and metastasis. METHODS The study included 1800 women who were diagnosed with invasive breast cancer during 2005-2013 at Hacettepe University Cancer Institute. Patients were divided into three groups according to their educational status at the time of diagnosis as follows: low (illiterate and elementary school, 5 years or less of education), medium (secondary school and upper secondary school, 6-12 years of education) and high (university level, more than 12 years of education). The associations between educational status and clinicopathologic features of breast cancer at the time of diagnosis were evaluated. RESULTS In all patient, a significant relationship was found between educational status and T stages (p<0.0001). Patients with higher educational levels were reported to have smaller tumor size regardless to their age and were less likely to have axillary lymph node involvement (p=0.001) or metastasis (p=0.001). A significant correlation was found between educational status and ER positivity in patients over 50 years of age (p=0.03). When the patients of all ages were evaluated, no statistically significant correlation was shown (p=0.27) between educational status and ER positivity. A significant relationship was found between educational status and HER-2 status (p=0.003), regardless of the patients' age. HER-2 positivity increased in patients with low educational status, however this significance was lost in patients over the age of 50 (p=0.1). CONCLUSION The relationship between educational status and biological factors in breast cancer are not conclusive as yet, but this particular study revealed that educational status played a major influence in each of the five breast cancer prognostic factors: ER status, HER-2 status, tumor size, lymph node status and metastasis.
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Affiliation(s)
- Furkan Sarici
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
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Abdel-Wahab R, Lacin S, Shalaby AS, Hassan M, Xiao L, Morris J, Amin HM, Kaseb AO. Integrating insulin-like growth factor-1 (IGF-1) score into Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program (CLIP) scores. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Sahin Lacin
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed S Shalaby
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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25
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Shalaby AS, Botrus G, Kaseb AO, Li D, Abdel-Wahab R, Wolff RA, Lacin S, Javle MM, Hawk E, Hassan M. The protective effect of physical activity on risk of hepatocellular carcinoma in USA. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ahmed S Shalaby
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gehan Botrus
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donghui Li
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sahin Lacin
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Milind M. Javle
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ernest Hawk
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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26
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Abdel-Wahab R, Lacin S, Shalaby AS, Hassan M, Xiao L, Morris J, Amin HM, Kaseb AO. Impact of integrating insulin like growth factor-1 (IGF-1) in model for end stage liver disease (MELD) scores on predicting hepatocellular carcinoma patients’ survival. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Sahin Lacin
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed S Shalaby
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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27
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Lacin S, Abdel-Wahab R, Elbanan M, Abdelbaki S, Shalaby AS, Hassan M, Wei W, Sun J, Elsayes KM, Kaseb AO. Impact of sorafenib treatment on portal hypertension in hepatocellular carcinoma patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sahin Lacin
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Mohamed Elbanan
- Diagnostic Radiology Department, MD Anderson Cancer Center, Houston, TX
| | - Shady Abdelbaki
- Diagnostic Radiology Department, MD Anderson Cancer Center, Houston, TX
| | - Ahmed S Shalaby
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Wei
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jia Sun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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28
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Lacin S, Abdel-Wahab R, Hassan M, Shalaby AS, Amin HM, Wolff RA, Yao JC, Mistry A, Feng JD, Ohtomo T, Kaseb AO. Evaluating clinical and prognostic implications of Glypican 3 in hepatocellular carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sahin Lacin
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Manal Hassan
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed S Shalaby
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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Sunar V, Yasar A, Sarici F, Esin E, Diker O, Lacin S, Turker A, Ozdemir E, Barista I, Kars A. The retrospective analysis of central nervous system lymphomas: Single-center experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Veli Sunar
- Hacettepe Unýversity Instýtue of cancer , Medical Oncology, Ankara, Turkey
| | - Arzu Yasar
- Hacettepe University Department of Internal Medicine, Ankara, Turkey
| | - Furkan Sarici
- Hacettepe University Medical Oncology, Ankara, Turkey
| | - Ece Esin
- Hacettepe University, Oncology Institute, Medical Oncology Department, Ankara, TN, Turkey
| | - Omer Diker
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Sahin Lacin
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | | | - Evren Ozdemir
- Department of Medical Oncology, Hacettepe University, Ankara , Turkey, Ankara, Turkey
| | | | - Ayse Kars
- Hacettepe University, Ankara, Turkey
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30
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Diker O, Babacan T, Buyukhatipoglu H, Kertmen N, Balakan O, Sever AR, Unlu O, Ates O, Sarici SF, Akin S, Sunar V, Karakas Y, Lacin S, Altundag K. Correlation of educational status and clinicopathological characteristics of breast cancer: A single center experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e11549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Omer Diker
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Taner Babacan
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | | | - Neyran Kertmen
- Hacettepe University Institute of Cancer, Medical Oncology Department, Ankara, Turkey
| | - Ozan Balakan
- Faculty of Medicine, Department of Medical Oncology, Gaziantep University, Gaziantep, Turkey
| | - Ali Rıza Sever
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozan Unlu
- Hacettepe University Cancer, Department of Medical Oncology, Ankara, Turkey, Ankara, Turkey
| | - Ozturk Ates
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Saim Furkan Sarici
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Serkan Akin
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Veli Sunar
- Hacettepe Unýversity Instýtue of cancer , Medical Oncology, Ankara, Turkey
| | - Yusuf Karakas
- Hacettepe Unýversity Instýtue of cancer , Medical Oncology, Ankara, Turkey
| | - Sahin Lacin
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Kadri Altundag
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
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Lacin S, Esin E, Karakas Y, Yalcin S. Metastatic medullary thyroid cancer: a dramatic response to a systemic chemotherapy (temozolomide and capecitabine) regimen. Onco Targets Ther 2015; 8:1039-42. [PMID: 25999738 PMCID: PMC4437612 DOI: 10.2147/ott.s82906] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 40-year-old male patient presented with increasing serum levels of calcitonin and CEA. He underwent potential curative surgery for medullary thyroid carcinoma, 3 years ago and then 7 months later he had metastasectomy and cervical lymph node dissection for recurrent disease. On admission he had multiple metastatic skin nodules on the chest wall and positron emission tomography-computed tomography revealed multiple visceral metastases as well. The patient had not received any systemic treatment up to that time; therefore, we considered systemic treatment with the new tyrosine kinase inhibitors (vandetanib, cabozantinib, etc). However, since these drugs are only available after cytotoxic chemotherapy, we started temozolomide and capecitabine chemotherapy. After two courses of the treatment all skin nodules disappeared and CEA and calcitonin levels normalized, radiological imaging showed a good partial response.
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Affiliation(s)
- Sahin Lacin
- Department of Medical Oncology, Institute of Cancer, Hacettepe University, Ankara, Turkey
| | - Ece Esin
- Department of Medical Oncology, Institute of Cancer, Hacettepe University, Ankara, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Institute of Cancer, Hacettepe University, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Institute of Cancer, Hacettepe University, Ankara, Turkey
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Baran B, Karaca C, Soyer OM, Lacin S, Demir K, Besisik F, Boztas G. Acute pancreatitis associated with H1N1 influenza during 2009 pandemic: a case report. Clin Res Hepatol Gastroenterol 2012; 36:e69-70. [PMID: 22361440 DOI: 10.1016/j.clinre.2012.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/10/2012] [Indexed: 02/04/2023]
Abstract
The relationship between viral infections and acute pancreatitis (AP) is not well-defined and universally accepted. Although an association is debated due to lack of solid evidence, a vast number of case reports suggest a possible interrelation. Influenza A virus is one of the most common infectious pathogens in humans but the incidence of subclinical or overt AP during the course of flu is unknown. We report a case of AP, which occurs shortly after a H1N1 infection during the pandemic in 2009.
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Affiliation(s)
- Bulent Baran
- Istanbul University, Istanbul Faculty of Medicine, Department of Gastroenterohepatology, Capa, Istanbul, 34390, Turkey.
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33
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Karlikaya G, Karagozoglu H, Kumbak B, Lacin S, Guney A, Kahraman S. O-263. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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34
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Kumbak B, Kahraman S, Karlikaya G, Lacin S, Guney A, Ozturk E. P-378. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Kumbak B, Kahraman S, Ozdiller O, Karlikaya G, Lacin S, Ozturk E. O-111. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kumbak B, Kahraman S, Karlikaya G, Lacin S, Guney A, Ozturk E. P-811. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kumbak B, Kahraman S, Karlikaya G, Karagozoglu H, Lacin S, Guney A. Assisted Reproductive Treatments in Patients With Ovarian Endometriomas: Comparison of Endometriomas With Simple Basal Cysts. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kumbak B, Kahraman S, Karlikaya G, Karagozoglu H, Lacin S, Guney A. Management of Prestimulation Ovarian Cysts During Assisted Reproduction Treatment Cycles: Is Aspiration Required? Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baytur YB, Tarhan S, Uyar Y, Ozcakir HT, Lacin S, Coban B, Inceboz U, Caglar H. Assessment of fetal cerebral arterial and venous blood flow before and after vaginal delivery or Cesarean section. Ultrasound Obstet Gynecol 2004; 24:522-8. [PMID: 15459931 DOI: 10.1002/uog.1749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To compare perinatal intracranial arterial and venous blood velocity changes between healthy term neonates delivered vaginally or by Cesarean section and to correlate these changes with cord blood gases and pH values at birth. METHODS The study involved 43 healthy term neonates who were delivered vaginally (n = 20) or by Cesarean section (n = 23). All fetuses/neonates were examined by Doppler ultrasound to obtain middle cerebral artery (MCA) and cerebral transverse sinus (Tsin) Doppler waveforms on three occasions (before delivery, and 1 h and 24 h after birth). Pulsatility index (PI) and peak systolic velocity (PSV) for MCA and Tsin were measured and compared between neonates who were delivered vaginally or by Cesarean section. Umbilical cord blood samples were analyzed for umbilical artery and vein pH, pO(2) and pCO(2) and values were correlated with MCA and Tsin Doppler indices. RESULTS MCA-PI increased and MCA-PSV decreased at 1 h after birth, and Doppler measurements returned to predelivery values at 24 h after birth. Tsin Doppler measurements remained unchanged at 1 h and 24 h when compared to predelivery values in both the Cesarean and vaginal delivery groups. There was a negative correlation between Tsin-PI before birth and umbilical venous pH. There was a positive correlation between Tsin-PSV at 1 h after birth and umbilical vein pCO(2). CONCLUSIONS Cerebral arterial blood velocity decreases immediately after birth and increases within 24 h, probably as part of neonatal adaptation. Cerebral venous blood velocity remains constant during the perinatal period and is likely to be regulated in a different and more complex manner than that of arterial blood velocity. Mode of delivery does not affect cerebral blood velocity.
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Affiliation(s)
- Y B Baytur
- Department of Obstetrics and Gynecology, School of Medicine, Turkey
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Lacin S, Vatansever S, Kuscu NK, Koyuncu F, Ozbilgin K, Ceylan E. Clomiphene citrate does not affect the secretion of alpha3, alphaV and beta1 integrin molecules during the implantation window in patients with unexplained infertility. Hum Reprod 2001; 16:2305-9. [PMID: 11679509 DOI: 10.1093/humrep/16.11.2305] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The expression of integrin molecules on the endometrium suggests that certain integrins may participate in the cascade of molecular events leading to successful implantation. A prospective, controlled study was carried out to investigate the effect of clomiphene citrate (CC) on secretions of beta1, alpha3 and alphaV integrin molecules in the endometrium of patients with unexplained infertility during the implantation window. METHODS A total of 40 endometrial samples was evaluated in both spontaneous (n = 13) and ensuing clomiphene-treated cycles (100 mg on days 5-9) and also from fertile women serving as controls (n = 14) during postovulatory 7th or 8th day of menstrual cycle. A semiquantitative grading system (H-score) was used to compare the immunohistochemical staining intensities. Endometrial thickness and serum oestradiol and progesterone concentrations were also measured on the day of sampling. RESULTS Staining of alpha(v) but not beta1 and alpha3 integrins was significantly less intense in infertile cases than fertile control cases (1.42 +/- 0.12 versus 2.21 +/- 0.13 respectively, P = 0.012) and this was not restored to normal concentrations with treatment. CONCLUSIONS Our study indicated that cc treatment significantly decreased the endometrial thickness and increased oestradiol and progesterone concentrations. However, secretion of alpha(v), beta1 and alpha3 integrin molecules, which might play a role in implantation, was not affected.
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Affiliation(s)
- S Lacin
- Department of Obstetrics and Gynaecology and Department of Histology and Embryology, School of Medicine, Celal Bayar University, Manisa, Turkey
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Coskun S, Yüksel H, Bilgi Y, Lacin S, Tansug N, Onag A. Non-invasive evaluation of the adaptations of cardiac function in the neonatal period: a comparison of healthy infants delivered by vaginal route and caesarean section. Acta Med Okayama 2001; 55:213-8. [PMID: 11512563 DOI: 10.18926/amo/31993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Postnatal adaptations of cardiac hemodynamics in infants born vaginally or by caesarean section may be different. These cardiac functions were evaluated by Doppler echocardiography to assess adaptation differences. Cardiac output, heart rate, stroke volume, mean arterial pressure, total systemic vascular resistance, ejection fraction, and ductus arteriosus diameter were determined and compared at 1, 24 and 72 h of life in 22 infants born vaginally (group 1) and 23 born by caesarean section (group 2). One hour after delivery, heart rate, mean blood pressure, and total systemic resistance were found to be higher in group 1 infants (P < 0.01, P < 0.05, P < 0.05 respectively). Stroke-volume measurements were significantly higher in group 2 (P < 0.05). The ejection fraction and cardiac output values were similar in both groups. At 24 and 72 h, no significant differences were observed in measurements of infants born vaginally or by caesarean section. We did not find a parameter negatively affecting healthy newborns in either mode of delivery. However, under pathological conditions affecting the cardiovascular system at 1 h of life, including perinatal infections and hypoxemia, a lower stroke volume, higher heart rate, higher mean blood pressure, and higher peripheral resistance may cause additional work load to the cardiovascular system in infants born vaginally.
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Affiliation(s)
- S Coskun
- Department of Pediatrics, Celal Bayar University Medical Faculty, Manisa, Turkey.
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Abstract
Although genital lymphoma either being an initial manifestation of occult nodal disease or secondary involvement is not uncommon, extranodal lymphoma originating primarily from the genitalia is quite rare. Here, we report a new case of primary genital lymphoma involving the uterus and ovaries, but not the Fallopian tubes. We also wish to emphasize that misdiagnosis of genital lymphoma, either clinically or histologically can occur.
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Affiliation(s)
- U Sungurtekin
- Department of Obstetrics and Gynaecology, Celar Bayar University Hospital, Turkey
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Lacin S, Demir N, Uslu T, Yorukoglu K, Erten O. Three cases of diffuse mullerian neoplasia. EUR J GYNAECOL ONCOL 1998; 18:537-40. [PMID: 9443031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Lacin
- Department of Obstetrics and Gynecology, Dokuz Eylul University, School of Medicine, Izmir, Turkey
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Abstract
Ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted within the ovary. The incidence is 0.5 to 3% of all ectopic gestations. In contrast to patients with tubal pregnancies, traditional risk factors, such as pelvic inflammatory disease and prior surgical procedure upon the pelvis, may not play a role in the aetiology. In the 2 cases reported here, it seems that using an intrauterine contraceptive device was an important factor.
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Affiliation(s)
- T Ercal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Lacin S, Demir N, Koyuncu F, Goktay Y. Value of intraplacental villous artery Doppler measurements in severe preeclampsia. J Postgrad Med 1996; 42:101-4. [PMID: 9715309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Blood flow velocity waveforms were recorded by color Doppler ultrasound from intraplacental villous and umbilical arteries in 20 normal and 23 severe preeclamptic pregnancies. The results of the resistance index measurements in intraplacental villous arteries were 0.51 +/- 0.037 and 0.55 +/- 0.052 in healthy controls and preeclamptics respectively, which was not significantly different. Resistance indices showed a decrease through the umbilical cord from fetus to placenta in both groups. We also noted that Doppler examination of the umbilical cord might be an early indicator of fetal compromise. Detectable intraplacental villous flows were in normal limits even in patients with abnormally high umbilical resistance indices and failure to detect villous artery color Doppler flow signals is probably associated with fetal compromise. We conclude that Doppler measurements from the intraplacental arteries cannot be used in clinical management of patients with severe preeclampsia.
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Affiliation(s)
- S Lacin
- Department of Obstetrics and Gynecology and Radiology, Dokuz, Eylul University, School of Medicine, Izmir, Turkey
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Ercal T, Lacin S, Altunyurt S, Saygili U, Cinar O, Mumcu A. Umbilical coiling index: is it a marker for the foetus at risk? Br J Clin Pract 1996; 50:254-6. [PMID: 8794602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to determine the relationship between the number of coils in the umbilical cord and perinatal outcome. The umbilical cords and delivery records of 147 liveborn neonates were prospectively studied. The umbilical coiling index (UCI) of each cord was calculated by dividing the total number of complete umbilical vascular coils by the umbilical cord length. Subjects with UCIs below the 10th percentile, above the 90th percentile, and between the 10th and 90th percentiles were defined as hypocoiled, hypercoiled, and normocoiled, respectively. Several different parameters were used to measure neonatal outcome. The mean UCI was 0.20 +/- 10 (SD). No relationship was noted between UCI and maternal age, gravidity, parity, oligohydramnios, or birth weight. When we compared the hypocoiled group (n = 30) with the normocoiled group (n = 87), we detected a statistically significantly higher incidence of meconium staining, interventional delivery, apgar scores, fetal blood pH and intrapartum fetal heart rate disturbances. As a result, we concluded that the UCI has a strong relationship with perinatal outcome and may be used antenatally as a marker for identifying the fetus at risk.
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Affiliation(s)
- T Ercal
- Dokuz Eylul University Medical Faculty Department of Obstetrics and Gynaecology, Izmir, Turkey
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