BACKGROUND:Lymph node metastasis is a predominant prognostic indicator in colorectal cancer. Number of lymph nodes removed surgically was demonstrated to correlate with staging accuracy and oncological outcomes. However, number of lymph nodes removed depends on uncontrolled variables. Therefore, a more reliable prognostic indicator is needed. Calculation of ratio of positive lymph nodes to total number of removed lymph nodes may be an appealing solution. MATERIALS AND METHODS:We retrospectively analyzed data of 156 Stage III colorectal cancer patients whom underwent surgery between 2008 and 2015. Patients' demographic characteristics, tumor grade, location, vascular-perineural invasion status, number of removed lymph nodes, and ratio of positive lymph nodes to number of removed lymph nodes were recorded. Spearman correlation analysis was used to determine the correlation coefficient while Kaplan-Meier method and Cox proportional hazard regression model were performed for the prediction of survival and multivariate analysis, respectively. RESULTS:Number of removed lymph nodes did not correlate with survival, but it was inversely correlated with number of positive lymph nodes. Multivariate analysis showed that ratio of removed positive lymph nodes to the total number of lymph nodes was a significant prognostic factor for survival for a ratio equal or above 0.31 was a poor prognostic indicator (108 months vs. 34 months, hazard ratio: 4.24 [95% confidence interval: 2.15-8.34]; P < 0.019). Tumor characteristics failed to demonstrate any prognostic value. CONCLUSIONS:This study showed that positive lymph node ratio (PLNR) is an important prognostic factor for Stage III colorectal cancer. Although 0.31 can be taken as threshold for "PLNR," prospective trials including larger patient groups are needed to validate its role as a prognostic indicator.

Gastric cancer is mostly diagnosed at advanced stages and in that case palliative treatment is the choice.In advanced stages better outcomes has been shown with chemotheurapeutics such as docetaxel, 5-FU, cisplatin, epirubicin and in Japan S1. Mostly combination regimens are studied; docetaxel, cisplatin and 5-FU combination has shown better outcomes and higher response rates.

e12578 Background: Chemotherapy regimens that contain both antracyclines and taxanes have been shown to increase disease free and overall survivals in patients with operable breast cancer patients. For node-positive patient group, sequential antracycline+cyclophosphamide (AC) and taxane regimen improved disease free survival (DFS) when compared with concurrent doxorubisin, cyclophosphamide and docetaxel (TAC) combination. To our knowledge, there is no data regarding the difference in between these regimens for the molecular subtypes of breast cancer. In this study we aimed to compare the clinical outcomes of triple negative breast cancer (TNBC) patients who had received adjuvant TAC versus AC followed by paclitaxel chemotherapy regimens. Methods: The files of TNBC patients were reviewed retrospectively and the demographical and clinicopathological properties of the patients and tumors were noted. The patients who had taken AC followed by paclitaxel or TAC regimens in adjuvant setting were identified and overall survival (OS) and DFS values were compared between these 2 groups. Results: A total of 414 TNBC patients’ files were reviewed and of these 328 (79.2%) had taken adjuvan treatments. TAC was given to 46 patients and AC followed by paclitaxel was given to 78 patients in adjuvant setting. Median ages were 44 and 46 years and there was no difference in between two groups (p:0.737).T and N stages; presence of lymphovascular and perineural invasion and extracapsular extension were compared in between two groups and there was no significant difference in between (p > 0.05 for all). Median DFS was 94.3 months for sequential group but it was not reached in TAC group and the difference was statistically significant (p:0.033). Median OS values were not reached in both groups, but survival in TAC group was statistically longer than other group (p:0.011) Conclusions: In this retrospective study, TAC regimen seems to be more effective than sequential regimen in TNBC subgroup. But prospectively designed studies are needed to verify this finding whether molecular subtypes and genetic profiles make the difference.

e12572 Background: Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype and accounts for %15-20 of all breast cancer cases. Since the clinical course is characterised by early relapses and poor survivals, still it represents an unmet clinical need. The aim of this study was to evaluate some conventional clinicopathologic and demographical parameters of patients with TNBC. Methods: The files of 4715 breast cancer patients were retrospectively evaluated and the ones with TNBC were identified. The demographical features of the TNBC patients, tumor features, stage at diagnosis and the treatments were noted. For all patients overall survival (OS) and in early stage patients disease free survival (DFS) values were calculated. Results: There were 414 TNBC patients and it was 8.7% of whole breast cancers. Median age was 48 years. Breast conserving surgery and sentinel lymph node were performed for 162 (39.1%) and 89 (21.5%) patients respectively. . Multicentricity and multifocality were detected in 24 (5.8%) of the cases. At diagnosis 26 (6.3%) patients were in metastatic stage, whereas neoadjuvant and adjuvant treatments were given to 53 (12.8%) and 328 (79.2%) patients respectively. Most of the tumors (75.7%) were grade 3. pCR (ypT0N0) was obtained in approximately 57% of patients. Lymphovascular space invasion and extracapsular extension were determined in 165 of all patients and were present in 118 (71.5%) and 55 (33.3%) of them respectively. Antracyclines and taxanes were used in the treatment of 77.3% and 43.7% of the patients that were not metastatic at diagnosis. During median 37 months follow-up period 94(22.9%) patients had recurrences; most common being visceral metastases (in 36 patients) and brain metastases comprising 17.8% of all recurrences. Median DFS was 117months. 3 year OS was %46.9 for all patient group and 48 patients died during this period. Median OS was not reached yet for the whole group. Conclusions: Studies relevant with molecular biology characteristics of TNBC, evaluating its gene expression profiles and mechanisms at molecular level should focus on effective targeted therapies according to these pathways to improve prognosis.

There is very little information about breast cancer characteristics, treatment choices, and survival among elderly patients. The purpose of this multicenter retrospective study was to examine the clinical, pathologic, and biologic characteristics of 620 breast cancer patients age 70 years or older. Between June 1991 and May 2012, 620 patients with breast cancer, recruited from 16 institutions, were enrolled in the retrospective study. Patients had smaller tumors at diagnosis; only 15% of patients had tumors larger than 5 cm. The number of patients who had no axillary lymph node involvement was 203 (32.7%). Ninety-three patients (15.0%) had metastatic disease at diagnosis. Patients were characterized by a higher fraction of pure lobular carcinomas (75.3%). The tumors of the elderly patients were also more frequently estrogen receptor (ER) positive (75.2%) and progesterone receptor (PR) positive (67.3%). The local and systemic therapies for breast cancer differed according to age. An association between age and overall survival has not been demonstrated in elderly patients with breast cancer. In conclusion, the biologic behavior of older patients with breast cancer differs from younger patients, and older patients receive different treatments.

Background: The standard therapy for stage I rectum cancer is surgical resection. Currently, there is no strong evidence to suggest that any type of adjuvant therapy is beneficial. The risks of local relapse and distant metastasis are higher in rectal tumors. Therefore, while there is no clearly defined absolute indication for adjuvant therapy in lymph node negative colon cancers, rectum tumors that are T3N0 and higher require adjuvant treatment. Due to the more aggressive nature of rectal cancers, we explored the clinical and pathologic factors that could predict the risk of relapse in Stage I (T1-T2) disease and whether there was any progression-free survival benefit to adjuvant therapy. Materials and Methods: This multicenter study was carried out by the Anatolian Society of Medical Oncology. A total of 178 patients with rectal cancers who underwent curative surgery between January 1994 and August 2012 in 13 centers were included in the study. Patient demographics, including survival data and tumor characteristics were obtained from medical charts. Results: The median age was 58 years (range 26-85 years). Most tumors were well or moderately differentiated. For adjuvant treatment, 13 patients (7.3%) received radiotherapy alone, 12 patients (6.7%) received chemotherapy alone and 15 patients (8.4%) were given chemoradiotherapy. Median follow up was 29 months (3-225 months). Some 42 patients (23.6%) had relapse during follow up; 30 with local recurrence (71.4%) whereas 12 (28.6%) were distant metastases. Among the patients, 5-year DFS was 64% and OS was 82%. Mucinous histology and receiving adjuvant therapy were found to have statistically insignificant correlations with relapse and survival. Conclusions: In our retrospective analysis, approximately one quarter of patients exhibited either local or systemic relapse. The rates of relapse were slightly higher in the patients who had no adjuvant therapy. There may thus be a role for adjuvant therapy in high-risk stage I rectal tumors.

BACKGROUND:In Muslim majority countries (MMC) opioid use for pain management is extremely low. The underlying factors contributing to this are not well defined.AIM:The aim of this study was to survey the attitudes of cancer patients towards morphine use for pain management in a MMC and identify the factors that influence patient decisions to accept or refuse morphine as treatment for cancer pain.SETTINGS/PARTICIPANTS:Patients were questioned whether they had pain or not, the severity and the medications for pain management. Questions included what type of medication they thought morphine was, whether or not they would be willing to take morphine if recommended for pain management and the basis for their decision if they were against morphine use.RESULTS:Four hundred and eighty-eight patients participated in the study. Some 50% of the patients who refused morphine use and 36.8% of the patients who would prefer another drug, if possible, identified fear of addiction as the basis for their decision. Reservation of morphine for later in their disease was the case for 22.4% of the patients who refused morphine use. Only 13.7 % of the patients refusing morphine and 9.7% of the patients who preferred another drug, if possible, cited religious reasons as the basis for this decision.CONCLUSIONS:Identifying the underlying factors contributing to low opioid use for pain management in MMC is important. Once the underlying factors are identified, all efforts should be taken to overcome them as they are barriers to improving patient pain management.

In this study, we aimed to evaluate the prognostic value of pretreatment blood count values, particularly WBC counts, in patients with advanced non-small cell lung cancer (NSCLC).The records of 186 patients with advanced stage (stage IIIB and IV) NSCLC were assessed retrospectively.Patients were divided into 3 subgroups according to WBC levels; ≤10000 /mm 3 as Group 1, >10000 and ≤15000/mm 3 as Group 2 and >15000/mm 3 as Group 3. Patient and tumor characteristics as well as outcomes in terms of overall survival (OS) were evaluated.Median OS was 13.3 months in the whole population, 25.7 months in stage IIIB and 8.9 months in stage IV patients.According to the pretreatment leukocyte values, median OS was 17.9 months in Group 1, 11.2 months in Group 2 and 8.4 months in Group 3 (p= 0.003).Median OS values in WBC groups according to stages IIIB and IV were significantly different (p< 0.001).In multivariate analyses, ECOG-PS 2 or 3, stage IV disease, anemia and high WBC levels were associated with poorer OS.In this study, higher pretreatment WBC levels were associated with poorer OS in patients with advanced stage NSCLC.Pretreatment WBC counts may represent a simple prognostic factor and may aid in tailoring treatment in patients with advanced NSCLC.

Although more palliative care is necessary for terminally ill cancer patients, excess investigational tests, invasive procedures, and treatments are given instead. Between November 2009 and December 2013, six hundred and twenty-four patients with end-stage cancer who were died at inpatient setting evaluated retrospectively. Patients' characteristics, sites of tumor and metastasis, tests and invasive procedures, treatments performed in the last 2 weeks before death were collected from the hospital files and analyzed. Median age of 624 patients was 58 (range 16-96) years. More than half of the patients (370, 59.3%) were men. The most frequent cancer sites were gastrointestinal (GI) system (32.2%), lung (24.0%), and breast (11.1%). Frequent metastatic sites were liver (34.8%), bone (31.5%), lung (23.3%), and/or brain (16.9%). Causes of death were respiratory failure, infections, and/or liver failure in 49.9, 23.9, and 19.4% of patients, respectively. Radiological tests performed in the last 2 weeks before death were ultrasonography, computed tomography, magnetic resonance imaging, bone scan in 25.6, 16.3, 11.4, and 3.8% of patients, respectively. Treatments received were intravenous (i.v) serum infusion, blood transfusion, total parenteral nutrition (TPN), human albumin infusion in 55.9, 44.1, 34.9, and 9.5% of patients, respectively. Invasive procedures such as invasive pain relief, terminal sedation, and chemotherapy performed in 12.6, 4.4, and 10.0% of patients, respectively. Central venous catheter application, paracentesis, thoracentesis, and GI endoscopy were applied in 41.7, 9.8, 5.6, and 3.4% of the patients, respectively. Radiological tests, invasive procedures, TPN, and human albumin transfusion were used excessively in terminal stage cancer patients in our medical oncology inpatient clinics. Invasive pain relief and terminal sedation were still underused in our cancer clinics. There is an urgent need in developing national palliative care program to improve the understanding of end-of-life care in our medical oncology clinics.

Several studies have now demonstrated that the lymph node ratio (LNR), as a superior indicator of axillary tumor burden to the number of excised nodes. While, about the prognostic value of LNR on the the survival of elderly patients is limited. The aim of this retrospective multicenter study is to evaluate the prognostic value of lymph node ratio in elderly patients with node positive breast cancer.METHODS: Onehundredeightyfour patient with operable breast cancer, recruited from 17 institutions, were enrolled into the retrospectively study. Eleven potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival.RESULT: Among the eleven variables of univariate analysis, four variables were identified to have prognostic significance for Overall survival (OS): pathologic tumor size (T), No. of positive nodes (N), LNR and estrogen receptor-positive (ER). Among the eleven variables of univariate analysis, two variables were identified to have prognostic significance for Disease-free survival (DFS): N and LNR. Multivariate analysis by Cox proportional hazard model showed that 7; LNR and ER were considered independent prognostic factors for OS. Furthermore, LNR was considered independent prognostic factors for DFS.CONCLUSION: In conclusion, the LNR was associated with the prognostic importance for DFS and OS in elderly patients who were administered adjuvant treatments.

Background/Aims: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract. In an attempt to survey the approximate incidence, clinicopathological characteristics, and immunophenotypic features of GISTs in Turkey, we conducted a clinicopathological and immunohistochemical analysis of GISTs. Methodology: Three hundred and thirty-three patients with GIST from nine institutions in Turkey were retrospectively evaluated. Results: Between January 2001 and March 2011, a total of 333 patients with GISTs were included; of these, 204 (61.2%) were male and 129 (38.8%) were female. The median age was 55 years (range; 22402 years). At the median follow-up of 26 months (range; 4-166 months), the 1-, 3- and 5-year OS rates of the 333 patients were 96.9%, 85.8% and 78.5%, respectively. The 5-year DFS rate was 40%. The 5-year OS rate and median OS time for the patients with R-0 resection were significantly higher than for patients with metastatic diseases (79.7 vs. 75.7% and not reached vs. 115 months, respectively, p=0.04). Conclusion: Although our results should be confirmed by prospective studies, we believe that they contribute to the literature because the study included both resectable and metastatic or unresectable GIST patients and multicenter findings from Turkey.

e14662 Background: There is no strong evidence to suggest that type of adjuvant therapy has any role in the management of stage I rectum cancer. The risks of local relapse and distant metastasis are higher in rectal cancer than colon cancer. Due to the more aggressive nature of rectal cancers, we explored the clinical and pathologic factors that could predict the risk of relapse in stage I disease. Methods: This multicenter study was carried out by Anatolian Society of Medical Oncology. 178 patients with rectal cancers who underwent curative surgery between 1994 and 2012 were included. Retrospective analyses were made using data collected from medical records. Results: The median age was 58 years (26-85). Low anterior resection (LAR) was the most preferred surgical method. Most tumors were well or moderately differentiated. After surgery, 13 patients (7.3%) received radiotherapy alone, 12 patients (6.7%) received chemotherapy alone and 15 patients (8.4%) were given chemoradiotherapy. Median follow-up was 29 months (3-225). 41 patients (23%) had relapse; relapses were local in 18 patients (10.1%) and distant in 12 patients (6.7%). 11 patients (6.2%) who had no relapse data were considered to be disease free. The 3-year disease free survival (DFS) was 74% and the overall survival (OS) was 94%. Mucinous histology and adjuvant therapy were found to have statistically insignificant correlations with relapse and survival. Conclusions: There is no strong evidence to support the role of any type of adjuvant therapy after resection in stage I rectal cancer. Approximately ¼ of patients had local or systemic relapse. This is a high rate for stage I tumors. The rates of relapse were slightly higher in the patients who had no adjuvant therapy and those who had mucinous tumors. There may be a role for adjuvant therapy in high-risk stage I rectal tumors. However, there is still a need for prospective studies in this regard. [Table: see text]

Ann. Ital. Chir., 84, 2, 2013 143 Pervenuto in Redazione Settembre 2012. Accettato per la pubblicazione Novembre 2012 Correpondence to: Ali Inal, M.D, Dicle University, School of Medicine, Department of Medical Oncology, Diyarbakır, Turkey (e-mail: dr.ainal@gmail.com) Ali Inal1, Tulay Akman2, Sebnem Yaman3, Selcuk Cemil Ozturk4, Caglayan Geredeli5, Mehmet Bilici6, Mevlude Inanc7, Hakan Harputoglu8, Umut Demirci9, Ali Suner10, Havva Yesil Cınkır11, Suleyman Alıcı12, Dilsen Colak13, Ozlem Uysal Sonmez14, Gamze Goksel15, Gamze Gokoz Dogu16, Huseyin Engin17, Olcun Umit Unal2, Tulay Tamozlu3, Suleyman Buyukberber4, Cem Melih Boruban5, Abdurrahman Isıkdogan1

Background/Aims: The efficacy and tolerability of oxaliplatin in combination with either folinic acid, fluorouracil (5-FU) (FOLFOX4 regimen) or capecitabine (XELOX regimen) was evaluated in advanced pancreatic cancer. Methodology: In this study, eighty-five patients with advanced pancreatic cancer were enrolled after failing to gemcitabine-based chemotherapy between November 2005 and August 2011. FOLFOX4 was repeated every two weeks and XELOX regimen was repeated every three weeks until either disease progression or unacceptable toxicity occurred. Results: Eighty-five patients were evaluated for tumor response. Seven patients (18%) achieved a partial response with XELOX and stable disease was observed in 16 patients (41%). Eight patients (17%) achieved a partial response with FOLFOX4 and stable disease was observed in 12 patients (26%). Disease control rates were 59% in the XELOX arm and 43% in the FOLFOX4 arm. The median time to progression was 16 weeks in both arms. The median overall survival was 21 weeks with XELOX and 25 weeks with FOLFOX4. Conclusions: Oxaliplatin-based combination therapy showed moderate clinical activity with acceptable toxicity in patients who had progressive disease after receiving gemcitabine-based chemotherapy for advanced and/or metastatic pancreatic cancer. We conclude that XELOX is similar in terms of efficacy and toxicity profile to FOLFOX4 in the second-line treatment of metastatic pancreatic cancer.