Non-melanoma skin cancers (NMSCs) are the most common malignancies worldwide. This study aimed to evaluate the clinical outcomes of radiotherapy (RT) alone versus surgery followed by RT in patients with high-risk head and neck (HN) NMSCs. Patients diagnosed with HN-NMSCs and treated with RT at three institutions between June 2010 and September 2022 were retrospectively analyzed. The primary endpoint was local recurrence-free survival (LRFS). A total of 73 patients were included. The median follow-up was 50 months (range: 18-164). Fifty patients (68.5%) underwent surgery prior to RT, while 23 patients (31.5%) received definitive RT. Nine patients (12.3%) experienced in-field recurrence. The 2-year LRFS was 90.2%, and the 5-year LRFS was 86.3%. LRFS was significantly better in patients who received surgery plus RT compared to those treated with definitive RT alone (p= 0.014; HR: 0.20; 95% CI: 0.05-0.83). Hypofractionated RT regimens were associated with improved LRFS compared to conventional RT (p= 0.040; HR: 4.4; 95% CI: 0.91-21.3). In high-risk HN-NMSC patients, the combination of surgery and RT, as well as hypofractionated RT regimens, provided superior local control compared to definitive RT alone and conventional fractionation schedules.
The use of Total Body Irradiation (TBI) as part of allogeneic hematopoietic stem cell transplantation has shown promising results in reducing the risk of relapse in children with Acute Lymphoblastic Leukemia (ALL) without increasing the incidence of transplant-related mortality. This study aims to evaluate the outcomes and toxicity of TBI in combination with etoposide for allogeneic hematopoietic stem cell transplantation in pediatric ALL patients. The patient data from Ege University Hospital was used for this study. The following is a retrospective evaluation of 91 patients who underwent TBI in the allogenic transplant protocol with a diagnosis of ALL between January 2009 and December 2022. The patients received treatment according to two different protocols-the BFM 2003 protocol (19 cases) between 2009 and 2012 and the BFM 2012 protocol (62 cases) after 2012. Total body irradiation was administered in 6 fractions twice a day, totaling 12 Gy. The median age at diagnosis was 8 years (range: 1-17), and at the time of TBI application 10 years (range: 3-18). Sibling donors were used in 61 cases (67%), while 30 cases (33%) received transplants from unrelated donors. For 14 patients with central nervous system involvement at diagnosis or relapse, an additional 6 Gy cranial boost dose was administered according to the protocol. After a median follow-up of 56 months (range: 1-145), recurrence was observed in 9 cases (8.8%). Disease recurrence resulted in the loss of 9 cases, and 12 cases (13.2%) were lost due to treatment-related complications. Recurrence sites were identified as bone marrow in 6 cases and central nervous system in 3 cases. The 4-year overall survival rate was determined as 76.9. Four-year survival rate of 18.3% was observed in related donor transplantation, whereas it was 32.3% in unrelated donor transplantation (p< 0.01). Acute side effects related to total body irradiation of grade 2-3 were observed in 37 cases (41.7%). The most common acute side effects were nausea in 21 cases, parotitis in 11 cases, and headache in 3 cases. Late-onset side effects were observed in 47 cases. TBI related side effects was reported as sexual dysfunction in 3 cases, hypothyroidism in 6 cases, cataract in 3 cases, osteoporosis in 1 case, and veno-occlusive disease in 4 cases. Also, soft tissue sarcoma was diagnosed in 1 case 79 months after treatment. Transplant-associated Graft Versus Host Disease (GVHD) was observed in 13 cases (12.1%). Studies have shown that including total body irradiation (TBI) in the conditioning regimen for patients undergoing allogeneic transplantation is a reliable and effective protocol with favorable side effect profiles. For long-term outcomes, a more comprehensive multidisciplinary follow-up is recommended.
Hyperleukocytosis, defined as a white blood cell (WBC) count exceeding 100x10(9)/L, is a life-threatening complication in acute myeloid leukemia (AML) and is associated with early mortality (EM) and poor outcomes. This multicenter retrospective study included 58 newly diagnosed adult AML patients with hyperleukocytosis. Clinical features and survival outcomes were analyzed. The median age at diagnosis was 55 years, with 24.1% of patients aged above 65. Clinical leukostasis (CL) was observed in 48.3%. FLT3 and NPM1 mutations were present in 56.8% and 44.8% of patients, respectively. Overall, 22% experienced EM, and the median overall survival (OS) was 15.0 months. Intensive induction chemotherapy was administered in 77.3% of cases, with a composite complete remission (CR + CRi) rate of 80.5% compared to 45.5% in patients receiving low-intensity therapy (p= 0.020). In multivariate analysis, age > 65 years was the only independent predictor of EM (OR: 10.05; p= 0.035), while both advanced age and poor ECOG performance status (2-3) were independently associated with inferior OS (HR: 2.59 and 3.26, respectively). Leukapheresis, performed in all patients with CL, was not associated with improved survival outcomes. The interval between cytoreduction and induction therapy initiation did not significantly affect EM or OS. Hyperleukocytic AML continues to pose a high risk of early death, particularly among elderly patients. Advanced age remains the most powerful predictor of adverse outcomes. Given the acute clinical complexity and poor outcomes in this high-risk group, prospective trials are urgently needed to guide evidence-based, standardized management approaches.
Pathologic response to neoadjuvant FLOT chemotherapy is a key prognostic indicator in gastric cancer, yet reliable predictors remain unclear. This study aimed to identify clinicopathologic and biologic factors associated with response and to develop a preliminary predictive model. A single-center, retrospective cohort of 75 patients with resectable gastric cancer treated with perioperative FLOT between October 2022 and September 2025 was analyzed. Clinicopathologic and laboratory parameters were compared between good responders (Ryan 0-1) and poor responders (Ryan 2-3) using Mann-Whitney U and Chi-square tests. A random-forest classifier incorporating pre-treatment variables was built to explore multivariate interactions and feature importance. The median age was 65 years, and 84% were male. Stage III disease was observed in 81% of patients. Good pathologic response occurred in 45 patients (60%). Poor response correlated significantly with stage III, T3-T4, and high-grade tumors (p= 0.001, 0.003, 0.002, respectively) and higher platelet-to-lymphocyte ratio (p= 0.04). In multivariate analysis, advanced T stage (OR 4.39, p= 0.018), high tumor grade (OR 5.24, p= 0.005), and proximal tumor location (OR 0.30, p= 0.04) independently predicted poor response. The random-forest model achieved an AUC of 0.611 with 65% accuracy. Key predictive features were T stage, N stage, CEA level, and BMI. Tumor depth, histologic grade, and location significantly affect FLOT response. Non-proximal tumors showed more favorable outcomes. The modest machine-learning performance highlights the need to integrate molecular and radiomic markers to refine prediction and personalize perioperative therapy.
The addition of immunotherapy to neoadjuvant chemotherapy (NAC) has shown promising efficacy in early-stage triple-negative breast cancer (TNBC), particularly in achieving pathologic complete response (pCR). However, real-world data remain limited. This study aimed to evaluate pCR rates and potential predictive factors in a real-world cohort of patients with stage II-III TNBC receiving neoadjuvant pembrolizumab-based chemotherapy. We retrospectively analyzed 4 4 TNBC patients treated at Ege University between 2022-2024. All received pembrolizumab plus taxane- and anthracycline-based NAC. Clinical and pathological variables, including Ki-67 index, were analyzed for associations with pCR. The overall pCR rate was 56.8%, which is broadly comparable to real-world reports but slightly lower than clinical trials. No standard clinicopathologic variable, including age, stage, histology, or nodal status, significantly predicted pCR. While conventional Ki-67 cut-offs (>= 30% or median) were not predictive, a ROC-derived threshold of >= 75% was significantly associated with higher pCR rates (OR 5.67; p= 0.042), although its discriminative ability was limited (AUC= 0.598). Neoadjuvant pembrolizumab yields pCR rates comparable to real-world reports but modestly lower than clinical trial outcomes. Extremely high Ki-67 proliferation index (>= 75%) may help identify responders, though larger studies are warranted for validation.
Chronic lymphocytic leukemia (CLL) is the most common leukemia in Western countries. The clinical outcome of CLL is heterogeneous and is affected by immunogenic properties. The basic leucine zipper transcription factor (BATF) is a key regulator of Th17 and TFH cells, and plays an important role in B cell activation. The role of BATF in CLL pathogenesis remains unclear. This study aimed to evaluate BATF mRNA expression in whole blood and intracellular BATF levels in different lymphocyte subsets of CLL patients and to investigate their potential association with clinical outcomes. Long-term clinical follow-up data were used to compare BATF levels between patients who required treatment and those managed without therapy. BATF mRNA expression in whole blood was significantly higher in patients than in healthy subjects. Similarly, elevated BATF levels were found in CD19+ B, CD3+ T, CD3+CD4+ T helper, CD8+ T, and TFH cells of CLL patients by flow cytometry. A positive correlation was observed between BATF levels and the count of CD5+CD19+ B-CLL cells. Notably, BATF levels in lymphocytes, CD4+T, CD8+ T and TFH cells were lower in CLL patients who required treatment than the levels in patients who required no treatment. Elevated BATF expression in CLL patients suggests its potential role in CLL pathogenesis. Reduced levels of BATF in CD8+ T cells in patients who required treatment may indicate a reduced cytotoxic response against malignant cells. These findings might indicate that BATF expression could serve as a potential biomarker for predicting disease progression and treatment necessity in CLL.
In this study, we aimed to evaluate the effect of pre-treatment positron emission tomography-computed tomography (PET/CT) maximum standardized uptake value (SUV max) on the response to tyrosine kinase inhibitor (TKI) treatment and survival in patients with metastatic lung adenocarcinoma. We retrospectively evaluated data from 77 patients diagnosed with advanced-stage lung adenocarcinoma, who had activating EGFR mutations and received first-line anti-EGFR TKI treatment between 2011 and 2022. We determined the effect of the PET/CT SUV max value on the anti-EGFR TKI treatment response by identifying a cut-off with ROC analysis. Median age was 63 years (range 30-86), 46 patients were female (59.7%). Median follow-up time was 24 months (range 3-122), median overall survival (OS) was 25 months, median progression-free survival (PFS) was 14 months, and the median SUV max was 9 (range 2-35). Ideal cut-off value of pretreatment SUV max that predicted 1-year PFS was 9 in the ROC analysis [AUC: 0.649 (0.524-0.774) / p= 0.025] with a sensitivity of 65% and specificity of 65%. While the >1-year PFS rate was 65% in patients with pretreatment SUV max <= 9, it was 35% in patients with SUV max > 9 (p= 0.012). Patients with a pretreatment PET/CT SUV max median <= 9 had significantly longer median PFS (18 months vs. 11 months) (p= 0.038) and median OS (30 months vs. 20 months) (p= 0.023) compared to those with SUV max median > 9. An increase in baseline PET/CT SUV max value before treatment negatively predicts response to anti-EGFR treatments, PFS, and OS.
Acute kidney injury (AKI) is a common and serious complication in newly diagnosed multiple myeloma (MM), often causing dialysis and impairing treatment. Although modern chemotherapy improves renal function and survival, the benefit of adding prophylactic plasma exchange (PE) remains uncertain. This study investigates its effect on renal recovery and treatment response. A total of 47 MM patients with AKI were retrospectively analyzed. Seventeen patients received prophylactic PE alongside chemotherapy, while thirty received chemotherapy alone. Renal function, dialysis status, and treatment response were assessed over two chemotherapy cycles.In the PE group, median serum creatinine decreased significantly from 3.1 to 1.7 mg/dL (p= 0.002). Median reductions were also observed in free light chain (-202 mg/dL, p= 0.009) and heavy chain levels (-2959 mg/dL, p= 0.013). Dialysis independence was achieved in 50% of PE-treated patients compared to 16.7% in the non-PE group (p= 0.545). A strong positive correlation was identified between the number of PE sessions and creatinine improvement (r = 0.795, p= 0.006). Although bortezomib-based regimens yielded greater early reductions in creatinine (p= 0.021), this difference was no longer significant after the second cycle. Prophylactic PE was associated with rapid biochemical improvement and higher dialysis independence rates, particularly in patients with a high circulating light chain burden. However, its long-term benefit appears limited. Chemotherapy-particularly proteasome inhibitors and anti-CD38 monoclonal antibodies-remains the primary driver of renal recovery in MM-associated AKI, supporting a selective rather than routine use of PE.
Infections remain one of the leading causes of morbidity and mortality in patients with multiple myeloma (MM), particularly during the first three months following diagnosis. This study specifically aimed to evaluate the infection burden and survival outcomes in MM patients with acquired hypogammaglobulinemia receiving antibiotic prophylaxis alone. This retrospective single-center study included 22 MM patients diagnosed with acquired hypogammaglobulinemia between January 2020 and December 2022. Hypogammaglobulinemia was defined as IgG < 500 mg/dL (excluding paraproteins). Patients received levofloxacin prophylaxis for the first 3 months after diagnosis, followed by trimethoprim/sulfamethoxazole and valacyclovir throughout the treatment process. The median age was 66.9 years (range: 53-88), and 63.6% of patients were ≥65 years old and 59.1% of the patients were male. A total of 43 infections were recorded, with pneumonia being the most common (30.2%). Only 4 patients (18.2%) required hospitalization due to infection, and 2 patients (9.1%) had neutropenia during the infection period. The median overall survival (OS) was 22 months (range: 1-85), with 7 deaths (31.8%) recorded, and only 1 (4.5%) was infection-related. Patients with light chain myeloma had a higher incidence of infections compared to other myeloma types (p= 0.02). Hospitalization due to infection was associated with shorter OS (p= 0.002). Our findings suggest that antibiotic prophylaxis may help limit severe infections and infection-related mortality in MM patients with hypogammaglobulinemia, particularly in the early phase of treatment. Further studies are warranted to determine optimal prophylactic strategies in this high-risk subgroup. Keywords: Multiple Myeloma, Hypogammaglobulinemia, Antibiotic Prophylaxis, Levofloxacin, IVIG Replacement
Endometrial cancer (EC), a leading malignancy in women, has seen rising incidence and decreasing age of onset globally, turning it into a significant health concern. Postmenopausal uterine bleeding is a key early sign, enabling prompt diagnosis. EC risk factors include hormonal influences, metabolic disorders, and genetic predispositions. Recent studies have unveiled the vital role of fatty acid metabolism reprogramming in cancer initiation and progression. This research focuses on the gene expression of lipogenesis-related molecules –SREBP cleavage-activating proteins (SCAP), Sterol Regulatory Element Binding Protein (SREBP), Stearoyl-CoA Desaturase (SCD), and Fatty Acid Synthase (FASN)– in endometrial cancer tissues. Using real-time PCR, we analyzed 54 EC patients and 36 healthy controls. The results reveal a significant upregulation of SCAP, SREBPF1, FASN, and SCD in cancerous tissues compared to controls (p< 0.05). Additionally, FASN (p= 0.014) and SCD (p= 0.0001) expression levels were markedly higher in the proliferative phase of controls. These findings highlight the reprogramming of lipid metabolism as a critical driver in EC progression. A deeper understanding of these metabolic pathways could lead to innovative therapies, making lipid metabolism a promising target for future cancer treatments. Keywords: Endometrial cancer, SCAP, SREBP, FASN, SCD
In previous studies, excessive expression of Glyoxalase-1 enzyme (GLO-1) has been reported in various tumor tissues and cells, and it has been shown to be associated with poor prognosis in some tumors. In this study, we examined the relationship between GLO-1 expression, progression-free survival (PFS) and metastatic overall survival (mOS). We retrospectively appraised 99 patients diagnosed with metastatic pancreatic adenocarcinoma from July 2012 to August 2020. GLO-1 expression was assessed by immunohistochemistry. According to the immunoreactivity score, the patients were divided into two groups: those with low immunoreactivity and those with high immunoreactivity. Survival probabilities were predicted with the Kaplan-Meier method and group comparisons were applied with the Log-rank test. Furthermore, univariate and multiple Cox regression analyses were used to determine the most substantial risk elements. While the median PFS was 3 months (95% CI: 1.84-4.16) in the low GLO-1 IRS group, the median PFS was 2 months (95% CI: 1.76-2.24) in the group with high GLO-1 IRS (p= 0.002). While the median mOS was 7 months (95% CI: 6.39-7.61) in the group with low GLO-1 IRS, the median mOS was 5 months (95% CI: 3.72-6.28) in the group with high GLO-1 IRS (p< 0.001). According to multivariate analysis; a low GLO-1 immunoreactivity score was the independent variable for good mOS (HR= 0.51; 95% CI: 0.33-0.79, p= 0.003) and PFS (HR= 0.64; 95% CI: 0.42-0.97, p= 0.035). In conclusion, increased GLO-1 expression was associated with a poor prognosis in metastatic pancreatic cancer patients. Keywords: Glyoxalase 1, Pancreatic cancer, Prognosis
Ki-67 is a critical biomarker in early-stage breast cancer, influencing adjuvant treatment decisions in patients not receiving neoadjuvant therapy. Variations in Ki-67 between core needle biopsies (CNB) and postoperative specimens can complicate treatment planning. The aim of this study was to determine whether there is a significant difference in Ki-67 changes between CNB and surgical specimens in estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) positive and triple negative (TNBC) breast cancer subtypes. Data from 184 nonmetastatic, operable breast cancer patients who did not receive neoadjuvant treatment were analyzed. Age, tumor size, axillary lymph node involvement, adjuvant therapy, and CNB and postoperative Ki-67 values were evaluated. In the overall group, a statistically significant increase of 4.26 units and 2.50 units in the median was observed between pre and post-surgery Ki-67 values (p< 0.05). Significant increases were found in HER2-positive (mean change +7.58 ± 18.46%, 95% CI: 7.16–14.65, p= 0.029) and TNBC (mean change +14.58 ± 14.68%, 95% CI: 12.13–18.10, p= 0.007) subtypes, while the hormone receptor (HR)-positive group showed no significant median change (mean change +2.89 ± 10.89%, 95% CI: -1.58–2.43). In conclusion, HER2-positive and triple-negative tumors demonstrated a significant post-biopsy increase in Ki-67, indicating higher proliferative activity following biopsy. In HR-positive tumors, Ki-67 remained stable, indicating its reliability as a treatment predictor without genomic testing. Keywords: Breast cancer, Ki-67 variability, Pathologic specimens, Adjuvant chemotherapy
Neurological complications in cancer patients may arise due to direct tumor effects, treatment-related toxicity, or paraneoplastic syndromes. Neurological complications in patients with neoplasms can affect all structures of the peripheral nervous system, either alone or in combination. We reviewed the electrodiagnostic test database of our EMG unit between 2017 and 2024. The clinical and electrophysiological data from 322 patients with cancer were collected. Descriptive statistics were reported and electrophysiological findings were compared between the two groups with the largest number of patients (gynecological and breast cancer groups). Among 322 patients, 189 (58.6%) had polyneuropathy, 21 (6.5%) had myopathy, 63 (19.5%) exhibited spinal root/anterior horn involvement, and 4 (1.2%) had plexopathy. Additionally, 19 patients developed nerve damage postoperatively, with spinal accessory nerve injury being the most common (63%). Electrophysiological findings related to anticancer drugs were detected in 57 patients (17.7%). Significant differences were found between gynecological and breast cancer groups regarding peroneal compound muscle action potential amplitude (p= 0.007) and sural sensory nerve action potential amplitude (p= 0.03). To the best of our knowledge, this study is the first to report the routine EMG findings of patients with oncological and hematological diseases with a broad approach design. Patients with plexopathy, neuropathy, and myopathy were examined in combination. Therefore, our findings will provide valuable insights into the electrophysiological findings of patients with oncological and hematological diseases. Keywords: Cancer, Chemotherapy, EMG, Myopathy-Polyneuropathy, Neurotoxicity
In recent years, there has been a significant increase in the number of patients diagnosed with colorectal cancer (CRC) under the age of 40. Patients in this age group are diagnosed at more advanced stages, and their disease prognosis is more aggressive. We aim to present the clinicopathologic features, treatment options, and survival outcomes of patients diagnosed with CRC under 40 in our clinic and compare our data with the literature. Our study, designed with a retrospective approach, focused on patients younger than 40 with CRC diagnosed by histopathologic examination between 2004 and 2024. At diagnosis, 5% of patients were Stage 1, 25% Stage 2, 37% Stage 3, and 31% Stage 4. 41.9% of the tumors were located in the rectum, and 26.3% in the sigmoid colon. 24.8% of patients had a family history of colorectal cancer, 23.7% of patients had mucinous subtype, 12.1% had MSH/I features and 55.6% were KRAS/NRAS mutant. Among metastatic patients, oxaliplatin-based and irinotecan-based first-line therapies showed no significant difference in PFS (8.9 vs. 9.7 months, p= 0.627) and OS (34.5 vs. 32.2 months, p= 0.690). Patients are usually diagnosed at an advanced stage, which leads to an aggressive course of the disease and makes clinical management difficult. Screening programs should not be interrupted in terms of early diagnosis, especially in individuals with a family history. Furthermore, in the future, defining the molecular profile underlying the early development of sporadic CRC will help to plan individualized screening recommendations and improve management. Keywords: Colorectal cancer, Young-onset colorectal cancer, Oxaliplatin, Irinotecan
The administration of immunotherapy and coronavirus disease (COVID-19) vaccines can concurrently enhance systemic immune responses. Consequently, it is hypothesized that this potential overlapping immunological enhancement from the two treatments may result in an increased occurrence of immune-related adverse events. This study aimed to demonstrate the reciprocal effects of COVID-19 vaccines and immunotherapies. In this prospective study, the type and number of COVID-19 vaccines, levels of vaccineinduced antibodies, lymphocyte subtype counts, oncological treatments, response to immune therapy, adverse events, and involvement of lymph nodes (LN) were evaluated in cancer patients and healthy volunteers. Patients who received the BioNTech vaccine regimen had a higher rate of partial response to immune therapy at 3 months. There was no significant difference in the mean vaccineinduced antibody levels between the patient and control groups. In predicting mortality, pre- and post-vaccination CD20+ lymphocyte counts, post-vaccination C-reactive protein and lactate dehydrogenase levels, total lymphocyte count, albumin level, and LN size were significant (p= 0.011, p< 0.001, p= 0.005, p= 0.003, p= 0.001, p< 0.001, and p= 0.001, respectively). In this study, the relationship between peripheral blood T and B lymphocytes, immune responses, and adverse events were clearly demonstrated. Despite the majority of patients receiving inactivated vaccines as their first dose, the absence of significant differences in antibody levels between the patient and healthy volunteer groups highlights the influence of immunotherapy on the vaccine response. The group receiving the BioNTech vaccine exhibited better treatment response results at 3 months post-vaccination than the group without BioNTech. The types of adverse events displayed distinct changes in peripheral lymphocyte counts. Keywords: COVID 19 vaccines, Immunotherapy, Lymphocyte counts
Cell adhesion molecules (CAMs) are involved in many cellular processes such as proliferation, apoptosis, metastasis and have the potential to be diagnostic markers and therapeutic targets for malignancies. This study aimed to investigate the role of the IGSF9B gene, a CAM, in colorectal carcinoma via bioinformatics databases. GEPIA2 was used for gene expression analysis, UALCAN for methylation analysis, Kaplan-Meier Plotter for prognosis analysis, cBio Cancer Genomics Portal for gene alteration analysis, and Tumor Immune Estimation Resource databases were used for correlation analyses. In colon adenocarcinoma (COAD) and rectum adenocarcinoma (READ) cohorts, IGSF9B gene expression was decreased compared to normal samples (p< 0.05). Hypermethylation was observed in the IGSF9B gene promoter region in the COAD cohort (p< 10 -12 ) ) and hypomethylation was observed in the READ cohort (p= 5.58x10 -5 ). IGSF9B gene changes were observed in 36 out of 526 patients (7%). In COAD there was a significant weak positive correlation between IGSF9B gene expression and CD4+ T cells, macrophages, neutrophils, and dendritic cells infiltrations. In READ there was a significant weak positive correlation between IGSF9B gene expression and CD4+ T cells and dendritic cells infiltration. Low IGSF9B gene expression levels were associated with longer OS (p= 0.0079) and RFS (1.8x10 –6 ). Low expression of IGSF9B gene may be a positive prognostic marker in colorectal cancer patients. Also, alterations in IGSF9B gene may be effective in colorectal carcinogenesis. Keywords: Cell adhesion molecules, IGSF9B gene, Colorectal carcinoma
Childhood pre-B acute lymphoblastic leukemia (pre-B-ALL) can be identified through routine genetic diagnostic methods in approximately 70-75% of cases. However, in 20-25% of cases, genetic abnormalities remain undetected at diagnosis, complicating the prediction of relapse risk, treatment response, and therapy-related cytotoxicity. Identifying reliable biomarkers is crucial for early diagnosis and optimized treatment strategies. Bone marrow samples were collected from 15 pediatric pre-B-ALL patients and 5 healthy child donors. Following cDNA synthesis, mRNA expression levels of AURKA, CASP1, GPM6B, NUDT15, S100A8, and Survivin genes were analyzed using qRT-PCR. AURKA, CASP1, and Survivin genes showed significantly increased expression in childhood pre-B-ALL cases (p< 0.05). However, no significant difference was observed for GPM6B, NUDT15, and S100A8. Kaplan-Meier analysis revealed no correlation between gene expression levels and relapse time. Spearman’s rho test showed a strong positive correlation between AURKA and Survivin expression (p< 0.0001). AURKA and Survivin overexpression are significantly correlated and may serve as potential biomarkers for predicting relapse in pediatric pre-B-ALL. CASP1 overexpression may indicate glucocorticoid resistance, potentially affecting treatment response; GPM6B, NUDT15, and S100A8 did not show significant relationships with relapse. Further validation in larger cohorts is required. Protein-level studies are needed to confirm the functional significance of these gene expression changes. Keywords: Pediatric B-ALL, qRT-PCR, Survivin, CASP1, AURKA
This study aimed to investigate the prognostic factors affecting overall survival (OS) in patients with de novo metastatic breast cancer (dnMBC). Additionally, the importance of local treatments on survival was evaluated. The data of 106 patients with dnMBC were analyzed. Primary breast surgery was performed in 15 patients (14%), while first-line systemic therapy constituted the initial treatment modality for 91 patients (86%). Local treatments were administered to 48 patients (45%), of which 63% underwent breast surgery alone and 37% underwent both breast surgery and radiotherapy. In univariate analysis, patient performance status, extent of metastasis, response of primary breast tumors and metastatic lesions to first-line systemic therapy, administration of local treatments, and the use of breast radiotherapy and surgery were identified as prognostic factors (p< 0.050). In multivariate analysis, being in the triple-negative subgroup (HR: 5.06, 95% CI: 2.46–10.43, p< 0.001), having polymetastatic disease (HR: 1.19, 95% CI: 1.15–3.17, p= 0.013), partial response of metastatic lesions to first-line systemic therapy (HR: 2.25, 95% CI: 1.84–4.29, p= 0.014), and non-response to first-line systemic therapy (HR: 2.67, 95% CI: 1.56–4.59, p< 0.001) were identified as independent poor prognostic factors. The median OS was 34 months, with 2-year OS at 58% and 5-year OS at 19%. The most significant prognostic factors for dnMBC in this study were molecular subtyping, extent of metastasis, and response of metastatic lesions to first-line systemic therapy. Although local treatments targeting the breast influenced prognosis, their impact was not as strong as the aforementioned variables. Keywords: De novo metastatic breast cancer, Radiotherapy, Prognostic factors, Overall survival
Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer and identifying prognostic biomarkers for pediatric ALL is critical for improving outcomes. In this study, we aimed to investigate CXCR4, PDGFR-β, RANTES, TWIST1, and VEGFR2 genes as candidate prognostic biomarkers associated with pediatric ALL immunophenotypes. Bone marrow and peripheral blood mononuclear cells (PBMCs) of 46 pediatric ALL patients and healthy controls were collected. The expression of CXCR4, PDGFR-β, RANTES, TWIST1, and VEGFR2 genes, considered candidate prognostic biomarkers, was analysed using quantitative reverse transcription polymerase chain reaction (qRT-PCR). RANTES expression was upregulated in pre-B-ALL, pro-B-ALL, and T-ALL patients compared to healthy controls (p= 0.015). The expression of all targeted genes, except CXCR4, was elevated in patients with trisomies of chromosomes 1, 6, 8, 12, 17, 21, and 22 (p< 0.05). Increased CXCR4 and RANTES expression was observed in patients with the t(9;22) translocation (p= 0.039, p= 0.017, respectively). High PDGFR-β and RANTES expression was associated with prolonged remission duration (p= 0.007, p= 0.015, respectively). Additionally, CXCR4 expression was highest in the high risk (HR) group (p= 0.039). The results of this study indicate that RANTES and PDGFR-β may be potential prognostic biomarkers in pediatric ALL in the presence of common clinical features. Monitoring RANTES and PDGFR-β expressions could be a novel approach for determining and managing prognosis in pediatric ALL. The main limitation of the study is the collection of healthy bone marrow samples due to ethical concerns, which may require confirmation of our findings in larger cohorts. Keywords: Pediatric ALL, RANTES, PDGFR-β, Prognosis, Biomarker
The aim of this study was to predict SBRT response in patients with early-stage lung cancer who underwent SBRT using 4-dimensional computed tomography (4DCT) radiomics. 44 cases diagnosed with early-stage lung cancer and treated with SBRT between 2020-2024 were included in the study. The radiomic features of the patients were obtained from the planning 4DCT with the Lifex program. The LASSO method was used to determine important variables. The SMOTE method was used to create a balanced data set. SBRT response estimate (complete response/partial response/stable response) was created using artificial intelligence methods using important variables. Median BED10 was 100 (min: 72, max: 132) Gy. SBRT scheme was applied as 8-12.5 Gy x 4-6 fr. Median PFS and OS after SBRT were 15 and 20 months at median 20-month follow-up. SBRT response assessment was performed using RECIST criteria. Complete, partial and stable response rates among patients were 36.4%, 36.4% and 27.3%, respectively. 7 of 55 radiomic features obtained with Lifex program were determined as significant variables with LASSO method. Prediction models were created with 5 different artificial intelligence algorithms using 7 significant variables. When the test groups are examined, SBRT response prediction was performed with 71%, 78%, 64%, 92% and 72% accuracy rates using MLPNN-1, MLPNN-2, ANFIS-1, ANFIS-2 and MLPC algorithms, respectively. Radiomics are easy to obtain, non-invasive and contains patient-specific information. However, the imaging method, segmentation differences between users, obtaining Radiomics and creating prediction algorithms are quite heterogeneous, and standardization should be provided with multi-center studies with more patients. Radiomics can be a potential biomarker in SBRT response prediction when these steps are standardized. In the current study, the highest accuracy rate was created with the ANFIS-2 algorithm and studies with more patients are needed. Keywords: Early-stage lung cancer, Stereotactic body radiotherapy, Radiomics, treatment response prediction, Artificial intelligence
