Strong evidence indicates that tumor growth can be actively controlled by the immune system, and interleukins (ILs) are known to play an influential role in immune response regulation. Moreover, inflammatory cytokines are significantly involved in lymphoma pathogenesis. We aimed to investigate serum levels of IL-4 and IL-18 in aggressive non-Hodgkin's lymphoma (A-NHL) patients and their relationship with prognostic parameters and therapy outcome. These serum factors were measured by enzyme-linked immunosorbent assay in 46 patients with pathologically verified A-NHL before and after chemotherapy, and in 20 healthy controls. No significant difference in serum IL-4 (P = 0.11) and IL-18 (P = 0.261) levels was observed between the A-NHL and controls groups. None of the prognostic parameters analyzed significantly correlated with serum IL-4 concentration, while only lactate dehydrogenase (LDH) measurements were associated with IL-18 values. Serum IL-18 was elevated in the patients with high LDH levels compared to those exhibiting normal values (P = 0.045). In addition, no correlation was found between the concentrations of serum IL-4 and IL-18 in A-NHL patients (r = 0.188, P = 0.187). While IL-18 values did not change, serum IL-4 levels decreased following chemotherapy, independently from treatment response (P = 0.002). Our study is the first to report the response of serum IL-4 levels to chemotherapy. In conclusion, although IL-4 serum concentration has no diagnostic role, it is sensitivite to standard chemotherapy in A-NHL. However, serum IL-18 measurements have no diagnostic or prognostic role in this disease.

Purpose: The purpose of the study was to evaluate the effects of the rehabilitation program after simultaneously total knee replacement on balance and functionality in patients with osteoarthritis and to compare the results with the healthy individuals. Methods: Two study groups of osteoarthritic patients between ages 50-85 who underwent bilateral TKA and one control group (Group 3, n=20) were included in the study. Exercise program with frequent physical therapist supervision (2 session/1 week) was performed in Group 1 (n=20) and less supervised exercise program was performed Group 2 (n=20) (1 session/2 week). Exercise program was continued during the first month. All the patients were evaluated preoperatively as well as 1.and 2.month postoperatively. The patients were checked every week by telephone interview. Functionality was evaluated with WOMAC (The Western Ontario and McMaster Universities Arthritis) Index, dynamic balance with Timed Up&Go (TUG) and stair climbing test (SCT), static balance with single limb standing test (SLST). Results: There was no statisitical significance between groups in terms of age (p=0,463). In preop evaluation there were significant differences between groups in all tests in favor of the control group. WOMAC pain scores in Groups 1 and 2 were similar in 1.month postop evaluation while the decrease in the pain score in Group 1 was higher than the scores of Group 2 and was close to the scores of healthy controls (p=0,00). WOMAC stiffness scores were higher in postop period than preop period in both Group 1 and 2. The stiffness scores of Group 1 were significantly lower than Group 2 in 2. month postoperatively and were close to healthy controls (p=0,00). WOMAC functionality scores of Group 1 and 2 were significantly higher in 1.and 2.month postop compared to preop period. The functionality scores of Group 1 were significantly higher in postop 2.month compared to Group 2 and were closer to the scores of healthy controls (p=0,00). The completion time of TUG test of the groups were shorter in 1.and 2.month scores and were similar to the 1.and 2.month scores of controls (p=0,33). SCT time of the groups were shorter in both 1.and 2. month postop period compared to preop period. Stair climbing time of Group 1 was significantly shorter than Group 2 in 2.month postoperatively and was closer to the scores of healthy controls (p=0,00). SLST for both legs of Group 1 were significantly higher than Group 2 in 1. and 2. month postoperatively and were closer to healthy controls (p=0,00). Conclusions: The patients which have applied exercise program after simultaneously bilateral TDR under the supervision of the physiotherapist 2 days a week for 1 month has obtained improvements in balance and functional parameters and it has been shown that their performances approach the healthy control group values.

Background: Superficial fungal infections are among the world's most common diseases and the distribution of etiological agents varies in different countries and geographic areas. Aims:The aim of this study was to determine the frequency of etiological agents of superficial mycoses encountered in outpatients attended to Dermatology Department of Cerrahpasa Medical Faculty, Istanbul.Materials and methods: Clinical samples were collected from 2125 patients over a period of four years and examined by direct microscopy and culture.Result: Isolated fungi were identified by classical mycology methods.Pathogen fungi (n= 643) were detected in 623 of the patients.Of the isolates were 206 (32.0%)Candida spp, 308 (47.9%) dermatophytes, 3 (0.5%) Malassezia spp and 126 (19.6%) other keratinophylic fungi, 18 (2.8%)Fusarium, 106 (16.5%)Trichosporon spp, 2 (0.3%) Phoma spp.Two different significant fungi were cultured from samples of 20 (3.2%) patients.T. rubrum was the most frequent isolate (n=135, 21.0%) and toenail onychomycosis was the most common type of infection (n=294, 47.2%). Conclusion:The most common agents isolated were Trichophyton species, being Candida spp the second prevalent.Non dermatophyte molds were cultured as agents of onychomycosis.Epidemiological surveys will be a usefull tool for the awareness of emerging species and infection control.

Malignant tumors have a capacity to degrade the extracellular matrix by controlled proteolysis. One system involved in these processes is the urokinase-type plasminogen activator (uPA) system. uPAR levels are elevated in tumors from several types of cancer. Our study was planned to investigate serum and urine levels of uPAR in breast cancer patients (n=180) and healthy controls (n=60) by ELISA. Serum (p<0.001) and urine (p<0.001) uPAR values in the patients were both significantly elevated. High serum and urine levels of uPAR can be used as diagnostic tools in lymph node positive patients.

The synergistic effects of new generation chemotherapeutics when combined with cisplatin have encouraged the development of new triplet combination regimens in the treatment of advanced non-small cell lung cancer (NSCLC). The aim of this study was to evaluate the feasibility of triplet chemotherapy using weekly cisplatin-gemcitabine-docetaxel (CGD) for patients with chemotherapy-naive NSCLC. Twenty-seven patients with stage IIIB/IV disease and performance status of 0 to 2 were included in this prospective trial. A combination of gemcitabine 750 mg/m(2), cisplatin 25 mg/m(2) and docetaxel 25 mg/m(2) was administered on days 1, 8 and 15, with cycles repeated every 3 weeks. Leucopenia and/or neutropenia and to a lesser extent thrombocytopenia were the main dose-limiting toxicities. Grade III-IV neutropenia and thrombocytopenia occurred in 26 and 7% of the patients, respectively. Only one patient developed febrile neutropenia. Dose reductions were required in 26% of patients, delays in 44% of patients and early treatment discontinuation in 15% of patients. The overall response rate was 52% and all of them experienced a partial response. The median progression-free (PFS) and overall survival (OS) times were 6 and 13 months, respectively. The one-year survival rate was 46%. In conclusion, weekly administration of CGD is an active first-line therapy with acceptable toxicity in advanced NSCLC patients.

Ovarian metastases from renal cell carcinoma (RCC) are very rare, with only 23 cases reported in the literature. We report a case of 54-year-old women who developed bilateral ovarian metastasis 39 months after diagnosis of clear cell carcinoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was carried out. Subsequently she was treated with sunitinib and her disease stabilized, She is still alive four years after diagnosis of the renal primary, and disease has stabilized on sunitinib. We conclude that. although rare, the possibility of metastatic RCC should be considered in the differential diagnosis of clear cell tumors of the ovary. Due to therapeutic and prognostic implications, it is very important to differentiate if the tumor is a primary ovarian tumor or a metastasis from a renal cell carcinoma. Early diagnosis of this rare metastatic tumor results in prompt treatment and prolonged patient survival.

Objective: To present an extremely rare case of a primary carcinoid tumor arising in a Mature cystic teratoma of the ovary. Malignant transformation of mature cystic teratoma is an uncommon complication occuring in approximately 1-3% of patients with mature cystic teratoma. Clinical Presentation and Intervention: A 54-year-old woman presented with abdominal swelling and abnormal uterine bleeding. Physical examination revealed a smooth, non-painful, 8-9 cm diameter mass in the right anterior pelvis which was diagnosed histologically as carcinoid tumor arising in a mature cystic teratoma. The patient underwent it total abdominal hysterectomy with bilateral salpingo-oophorectomy and was scheduled for surveillance CT of the abdomen and pelvis at 3-monthly intervals. Conclusion: This case adds to the rare reports in the literature of a carcinoid of low malignant potential occurring in a mature cystic teratoma. The treatment for early-stage ovarian carcinoid tumors confined to one ovary is Surgery alone and excellent outcomes can be expected in these cases.

There exists strong evidence that tumor growth can be actively controlled by the host immune system and interleukins are known to play a significant role in immune response regulation. Inflammatory cytokines play important roles in the pathogenesis of lymphomas. This study was conducted to investigate the serum levels of IL-6 and IL-10 in patients with aggressive non-Hodgkin's lymphoma (A-NHL) and the relationships with prognostic parameters and therapy. These serum factors were measured in 46 A-NHL patients pathologically verified before and after chemotherapy in comparison with 21 healthy controls using enzyme-linked immunosorbent assays (ELISAs). There were significant differences in the serum IL-10 and IL-6 levels between A-NHL patients and controls (p=0,038 and p<0,001, respectively). None of the prognostic parameters analyzed was significantly correlated with the serum IL-6 concentrations. This was also true for serum IL-10 values, except for LDH and bone marrow involvement. Serum IL-10 levels were elevated in the group of patients with high level LDH compared with the group of patients with a normal level (p=0,017). Also, serum IL-10 levels were significantly different in the presence or absence of bone marrow involvement (p= 0,016). In addition, we found a significant relationship between the serum levels of serum levels of IL-6 and IL-10 in patients with A-NHL (r=0,47, p<0,001). We found that serum IL-10 levels decreased due to chemotherapy effect independent of the chemotherapy response (p= 0,027). However, serum IL-6 levels were not changed. In conclusion, our data suggest that higher serum IL-6 and IL-10 levels can be useful for diagnosis of A-NHL. However, our sample size is small, and larger scale research is needed in this field to provide new knowledge.

Objective: To evaluate the clinicopathological prognostic features, factors and outcomes of chemotherapy in ovarian yolk sac tumours (YST).Study design: We reviewed the medical records of 32 women with ovarian YST treated from 1990 to 2006 at two centres.Results: The median follow-up was 36 months. The median age was 22 (range, 9-68). Two patients were postmenopausal. The most common symptoms at diagnosis included abdominal swelling or mass (72%) and abdominopelvic pain (62%). The location of the tumour was bilateral in 2 cases. Eight patients were in stage I, 4 patients in stage II, 17 patients in stage III, and 3 patients in stage IV. Eighteen patients underwent unilateral salpingo-oophorectomy, two bilateral salpingo-oophorectomy and two cystectomy, while 10 patients had total abdominal hysterectomy and two bilateral salpingo-oophorectomy. Of 32 patients who received postoperative chemotherapy, 27 were treated with a bleomycin/etoposide/cisplatin (BEP) regimen. Seventy-two percent of patients were alive at the last follow-up visit. Ten (31%) patients suffered from a recurrence of the disease with a median time to recurrence of 8 months (range, 6-28 months). The most common site of recurrence was the intra-abdominal space, with 8 patients. Only one patient who had recurrence could be salvaged. Fertility-sparing surgery was found at least as effective as radical surgery. While age, histology (mixed vs. pure), stage, tumour size, ascites, and marker levels were not found as prognostic factors, the presence of residual tumour (P = 0.014) and BEP chemotherapy (P = 0.016) were significant prognostic factors in univariate analysis.Conclusions: In patients with ovarian YST, fertility-sparing surgery is as effective as radical surgery. Optimal cytoreductive surgery and standard BEP regimen are the most decisive prognostic factors. In these tumours, adjunctive therapeutic modalities to eradicate intra-abdominal disease and effective salvage therapy strategies are needed. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Abstract Introduction: T1N0 breast cancer (BC) has a very favorable outcome therefore the need of adjuvant systemic therapy is controversial. Molecular profiling studies identified BC subtypes with distinct clinical outcomes. We planned to determine whether immunohistochemically (IHC) defined subgroups of T1N0 BC patients have different clinical outcomes. Methods: Medical records of pts with T1N0 BC and known ER, PR and Her-2 status who have been treated between 1998-2008 were reviewed. Patients with bilateral disease, who had adjuvant trastuzumab therapy were excluded. Clinical/pathological, treatment characteristics were recorded and patients were subdivided into four BC subtypes: triple negative (ER, PR, HER2 negative), HER2 (ER and PR-negative, HER2-positive), luminal B (ER-positive and/or PR-positive, HER2-positive), and luminal A (ER and/or PR-positive and HER2-negative). Her-2 positivity was defined as IHC 3+ or FISH positive IHC2 2+. Survival outcome of the IHC defined subgroups were analyzed the Kaplan-Meier method and compared with the log-rank test. Results: A total of 1035 pts have been identified from 17 Medical/Radiation Oncology centers in Turkey. Median age was 51 and median follow up was 39 months. Forty-four % of patients were premenopausal, 55% had left breast involved, 73% had breast conserving surgery, 81% had invasive ductal carcinoma. T1a,b,c tumors were 7%, 30%, 63% ; grade 1,2,3 tumors were 20%, 53%, 27% respectively. HER2 was 2 + in 59 (6%) and 3 + in 111 (11%) tumors. Twelve % tumors were triple negative. Thirty-seven % patients had adjuvant chemotherapy; 80 % had adjuvant endocrine therapy 73% had adjuvant radiotherapy. Five-yr DFS and OS of the whole group were 92% and 99% respectively. So far, 19 pts had local and 24 pts had distant metastases, 4 pts had secondary cancers, 6 patients contralateral BC and 11 patients died (7/11 pts died from breast cancer). Classification based on ER, PR and Her-2 status had significant impact on 5-yr DFS (p:0.00) and OS (p:0.00). The 5-yr DFS and OS were 84%;74%;%;94% and 96%;83%;100%;99% respectively for triple negative, HER2, luminal B, and luminal A subgroups respectively. Hormone receptor and triple negative status were the two other parameters affecting survival outcome significantly (p:0.00, p: 0.007) in the univariate analyses. Conclusion: Most patients with T1N0 disease have generally a favorable clinical outcome, however even within this very early stage of BC there are subgroups with diverse clinical outcomes. Despite our short follow up with low number of events, we found that Her-2 positive and triple negative T1N0 BC have poor clinical outcomes compared to luminal T1N0 subgroups and therefore they might need special concern with respect to adjuvant systemic therapy. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3167.

Background: Metastatic involvement of the breast and the rectum from ovarian carcinoma are very rare events. Case Report: We report a case of ovarian carcinoma with metastasis to the breast and rectum simultaneously, 6 years after initial diagnosis. Results: Morphologic and immunohistochemical findings from pathologic samples of all involved sites confirmed the ovarian origin, which spared the patient unnecessary breast and rectal surgery. To our knowledge, this is the first case of ovarian carcinoma with simultaneous metastases to the breast and rectum reported to date. Conclusion: Accurate differential diagnosis from primary breast and rectal carcinoma is very important because the prognosis and treatment differ significantly.

BACKGROUND:Both gemcitabine and pegylated liposomal doxorubicin (PLD) are antineoplastic drugs with clinical activity in patients with platinum-resistant ovarian cancer. The present study was designed to assess the efficacy and safety of biweekly scheduled gemcitabine and PLD combination therapy in such patients.METHODS:Eighteen women with ovarian cancer that had recurred within 6 months after standard carboplatin and paclitaxel therapy were eligible for enrollment. Gemcitabine 2000 mg/m(2) and PLD 20 mg/m(2) were administered intravenously on days 1 and 15 of a 28-day cycle.RESULTS:Hematological toxicity was mild. No severe (grade III/IV) leucopenia/neutropenia or thrombocytopenia was observed. Severe anemia was seen in only 3 (17%) patients. Several other severe nonhematological adverse effects were well tolerated and easily managed. The overall response rate was 28% (5 of 18; 95% confidence interval [CI], 10%-54%) with 2 (11%) complete and 3 (17%) partial responses. The median overall survival time was 17 months (range, 1 to 25 months). The median survival for patients with clinical benefit including disease response or stabilization was 17 months (range, 3 to 26 months) compared to that of patients with progressive disease, which was 2 months (range, 1 to 11 months; P = 0.04).CONCLUSION:A biweekly schedule of gemcitabine combined with PLD is an active and safe chemotherapy regimen with acceptable and easily manageable toxicities in women with recurrent platinum-resistant ovarian cancer.

Testis cancer is the most common cancer in young men and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. We aimed to evaluate whether two courses of chemotherapy after orchiectomy in patients with clinical stage I, non-seminomatous germ cell testicular tumour at high risk of relapse, will spare patients additional chemotherapy or surgery. High-risk patients had one or more of the following: preorchiectomy alpha-fetoprotein level of 80 ng/dl, 80% embryonal cell carcinoma or greater, vessel invasion in the primary tumour and tumour stage pT2 or greater. Low-risk patients had none of these factors or had 50% teratoma or more without vessel invasion. High-risk patients were offered two 21-day courses of outpatient chemotherapy consisting cisplatin, etoposide and bleomycin (BEP). Low-risk patients were observed. Of the 108 patients, we classified 71 as high risk and 37 as low risk of relapse. All of the high-risk patients received two courses of BEP chemotherapy. Low-risk patients were kept on close-up. The median follow-up was 26 months (range 10-60). Of the 71 patients in high-risk group, 3 relapsed with viable cancer and required additional chemotherapy and 1 patient with normal biomarkers and a late-appearing mass underwent retroperitoneal lympadenectomy for mature teratoma. All 4 relapsed patients were in high-risk group and presently they are free of disease. None of the 37 patients at low risk of recurrences developed relapse. We recommend two courses of adjuvant chemotherapy after postorchiectomy for high-risk patients with stage I non-seminomatous germ cell tumour of the testis. Adjuvant chemotherapy for these patients results in a low relapse and morbidity, wich compares favourably with the results of surveillance or RPLND. This well-tolerated approach may spare patients additional surgery or protracted chemotherapy, reduce the cost and eliminate the compliance problems associated with intensive follow up of high-risk patients.

Gemcitabine and cisplatin are the active agents in metastatic breast cancer pretreated with anthracycline and/or taxane as a second line treatment. The present study was designed to assess the efficacy and safety of this regimen given biweekly schedule in these patients. Twenty-seven women, median age 57, with metastatic breast cancer previously treated with anthracycline and taxane were eligible for enrollment. Gemcitabine was administered intravenously on days 1 and 15 at a dose of 2,000 mg/m2 and Cisplatin was given intravenously on day 1 and 15 at a dose of 50 mg/m2. Treatment cycles were repeated on an outpatient basis every 28 days. Of all 27 evaluable patients, the overall response rate was 26% (7 of 27; 95% CI: 11–46%) with seven all partial responses. The stable diseases were found in 9 (33%) patients. At the time of last follow-up, 11 (41%) of the patients died of their disease progression. The median overall survival duration was 7.4 ± 2.8 months. The 1-year overall survival rate was 46.9% ± 12.3. Hematological toxicity was not found as the principal dose-limiting toxicity. Severe (grade III/IV) neutropenia was observed only one (4%) patients. No patient was complicated by febrile neutropenia and G-CSF usage was not performed. Grade III and IV anemia were seen in only 4 (15%) and thrombocytopenia was noted only one (4%) patients. Severe hepatic (n = 2) and renal toxicity (n = 1) were observed and these all recovered completely without complication. Several other severe non-hematological side effects were managed easily. Permanent dose reductions were necessary in 9 (33%) patients and chemotherapy administration was also delayed in 7 (26%) patients because of delayed both hematological and non-hematological toxicity recovery. Treatment was discontinued in one (4%) patient due to severe fatigue and deteriorating performance status. In conclusion, gemcitabine and cisplatin combination therapy with this biweekly schedule and dosage is moderately active and extremely safe in patients with metastatic breast cancer previously treated with anthracycline and taxanes.

Cell adhesion is a basic count in inter- and intra-cellular communication and plays an important role in tumor progression. This study was conducted to investigate the serum levels of intercellular adhesion molecule (ICAM-1) and E-selectin in patients with advanced stage non-small cell lung cancer (NSCLC) and the relationships with known prognostic parameters and therapy. These serum factors were measured of 57 NSCLC patients pathologically verified before and after chemotherapy in comparison with 24 healthy controls by using ELISA method. Serum levels of ICAM-1 were increased significantly in NSCLC patients compared with the healthy controls (P = 0.006). However, serum E-selectin levels were not significantly different from healthy control groups (0.643). No statistically significant relationships were found between investigated all serum parameters and various characteristics of patients, and the diseases such as stage and tumor burden. Likewise, we also found no correlation between serum ICAM-1 and E-selectin (P = 0.78). We found that serum ICAM-1 levels were decreased owing to the chemotherapy effect, independently from chemotherapy response. However, serum E-selectin levels were not changed by the chemotherapy effect. The median survival of all patients was 11.9 months and 1-year survival rate was 47.6%. We found that patients performance status (P = 0.013), age (P = 0.015), and weight loss (P = 0.007) were prognostic factors for survival. Serum E-selectin levels showed a trend (P = 0.08) related to worse prognosis, however serum ICAM-1 levels were determined as ineffective on survival (P = 0.11). Multivariate analysis revealed that only weight loss (P = 0.005) and E-selectin levels (P = 0.002) remained as an independent prognostic factor for survival in patients with advanced NSCLC. In conclusion, our data suggest that higher serum ICAM-1 can be useful for diagnosis while E-selectin levels have prognostic significance and could be a potential prognostic factor in NSCLC patients.

Background: Capecitabine has demonstrated high efficacy as first-line treatment for metastatic colorectal cancer (mCRC). In this non-randomized pilot study, we investigated the efficacy and safety of sequentially administered XELOX and XELIRI regimens or the reverse sequence in patients with advanced colorectal cancer. Patients and Methods: Entry criteria were histologically confirmed mCRC, ECOG performance status (PS) ≤2 and adequate bone marrow, renal and hepatic function. All patients consecutively received XELOX followed by XELIRI at disease progression or vice versa. Results: In multivariate analysis, independent prognostic factors with worse overall survival were: lower PS (p = 0.0001), multiple metastatic sites (p = 0.016) and high tumor grade. Higher serum levels of alkaline phosphatase and worse ECOG PS were associated with a shorter progression-free survival. Grade 3/4 mucositis, nausea/vomiting, grade 3/4 alopecia and grade 3 diarrhea were more frequent with XELIRI, whereas major toxicity events with XELOX were grade 3 neutropenia, thrombocytopenia and grade 2/3 neurotoxicity. Conclusion: Capecitabine appears to be an acceptable alternative to continuous-infusion fluorouracil (FU)/leucovorin (LV) in combination therapy and offers an effective, but more convenient alternative to continuous infusion FU/LV in the first-line treatment of patients with mCRC.

Introduction: Hormone receptor negative breast cancer is encountered in about 30% of all patients with breast cancer and is considered as a prognostically unfavorable subset. The aim of this study is to evaluate the prognostic impact of various molecular markers in patients with receptor negative breast cancer. Methods: Tumor specimens from 140 patients with receptor negative (ER, PR) breast cancer were analyzed for MAPK, Her-2/neu, EGFR and PI3K expression by immunohistochemistry. The prognostic significance of these molecular factors, in addition to various prognostic variables were determined with respect to disease-free and overall survival. Results: Nineteen (13.6%), 45 (32.1%), 16 (11.4%) and 47 (33.5%) patients had positive staining for EGFR, PI3K, Her-2/neu and MAPK, respectively. Twenty-three patients with positive MAPK (16.4%) had a high level of expression (score 4-7) and 24 (17.1%) had a low score (1-3). A lower percentage of MAPK expression was significantly associated with a poorer OS (p = 0.03) and a tendency for shorter DFS (p = 0.08) among those who were positive for MAPK. Anthracycline resistance remained the only independent significant variable for OS by Cox regression analysis (p = 0.001, HR:26.1). In patients with recurrent disease, median survival after initial relapse was 16.8 months. MAPK was determined as the only prognostic factor for this endpoint. Patients with higher level of MAPK staining showed significantly shorter survival following initial recurrence (p = 0.04). Conclusion: MAPK expression is a significant prognostic factor for non-metastatic patients with hormone receptor breast cancer. A lower level of staining is shown to be associated with with antracycline resistance and oveall survival, whereas a higher expression level is correlated with shorter survival following initial relapse, suggesting possible role of different molecular mechanisms pertaining to tumor progression once recurrence occurs. Further translational research is required to elucidate molecular mechanisms of the cross-talk between intracellular signaling and molecular pathways leading to drug resistance in patients with receptor negative breast cancer.

Context: This study was conducted to investigate the prognostic role and the effects of chemotherapy on serum apoptosis biomarkers consisting of survivin and tumor necrosis factor alpha (TNF-alpha) in patients with advanced stage nonsmall cell lung cancer (NSCLC).Materials and methods: Fifty-seven patients with newly diagnosed NSCLC were enrolled into study. Performance status was 0 or 1 in 47 patients and 2 in 10 patients. Thirty-two of them were no or less than 10% weight toss. Patients were treated with platinum-based chemotherapy. Serum levels of TNF-atpha and survivin were determined by enzyme-linked immunosorbent assay (ELISA) technique.Results: White serum survivin levels in patients were not significantly different from controls (p = 0.321), serum TNF-alpha levels in patients were found significantly higher than in controls (p = 0.029). We found that serum TNF-alpha levels were increased (p < 0.001), whereas serum levels of survivin (p = 0.025) were decreased by the chemotherapy effects. The changes of the TNF-alpha and survivin serum levels due to chemotherapy effect showed a significant negative correlation (r = -0.36 p = 0.007). The increase of serum TNF-alpha levels was independent from chemotherapy response; however, the reduction of serum survivin levels was found only significant in the chemoresponsive group (p=0.039). White older age, weight loss and performance status yielded prognostic value, neither TNF-alpha nor survivin levels proved to be significant for survival.Conclusion: Our findings suggest that the reduction in the serum survivin levels of advanced NSCLC patients after chemotherapy can be used as a predictor of response to the chemotherapy but not that of survival. (C) 2007 Elsevier Ireland Ltd. All rights reserved.