Background and Objectives: In ampullary cancer, 5-year survival rates are 30–50%, even with optimal resection and perioperative systemic therapies. We sought to determine the important clinicopathological features and adjuvant treatments in terms of the prognosis of patients with operable-stage ampullary carcinomas. Materials and Methods: We included 197 patients who underwent pancreaticoduodenectomy to treat ampullary carcinomas between December 2003 and May 2019. Demographics, clinical features, treatments, and outcomes/survival were analyzed. Results: The median disease-free survival (mDFS) and median overall survival (mOS) were 40.9 vs. 63.4 months, respectively. The mDFS was significantly lower in patients with lymphovascular invasion (p < 0.001) and lymph node involvement (p = 0.027). Potential predictors of decreased OS on univariate analysis included age ≥ 50 years (p = 0.045), poor performance status (p = 0.048), weight loss (p = 0.045), T3–T4 tumors (p = 0.018), surgical margin positivity (p = 0.01), lymph node involvement (p = 0.001), lymphovascular invasion (p < 0.001), perineural invasion (p = 0.007), and poor histological grade (p = 0.042). For the multivariate analysis, only nodal status (hazard ratio [HR]1.98; 95% confidence interval [CI], 1.08–3.65; p = 0.027) and surgical margin status (HR 2.61; 95% CI, 1.09–6.24; p = 0.03) were associated with OS. Conclusions: Nodal status and a positive surgical margin were independent predictors of a poor mOS for patients with ampullary carcinomas. Additional studies are required to explore the role of adjuvant therapy in patients with ampullary carcinomas.

e15666 Background: In this study we aimed to evaluate the possible important clinicopathological features and adjuvant treatment approaches in terms of prognosis in patient with early stage ampullary carcinoma. Methods: We included 197 patients who underwent pancreaticoduodenectomy for ampullary carcinoma between 2002 and 2014. Demographics, clinical features, treatment and outcome/survival were analyzed. Results: The median age at diagnosis was 60 years. The most common presenting symptom was jaundice (60%). Lymph node involvement was observedin 46% of thepatients. Sixty-six percent of patients had stage II-III disease.Perineural and lymphovascular invasion was seen in 50 (29.4%) and 69(40%) patients, respectively. Median overall survival (OS) and disease-free survival (DFS) were 63.4 and 40.9 months, respectively. mDFS was significantly lower in the patients with lymphovascular invasion (mDFS, 27 & 108.5 p < 0.001) and lymph node involvement (28.8 & 67.8 p = 0.027). Potential predictors of decreased survival on univariate analysis included age ≥ 50(mOS, 78.8 & 53.1 p = 0.045), poor performance status(108.5 & 46 p = 0.048), weight loss (38.8 & 108.5 p = 0.045), T3-T4 tumor (108.5 & 19.3 p = 0.018), microscopic positive margin (20.1 & 78.8 p = 0.01), lymph node involvement (38.8 & 141.9 p = 0.001), lymphovascular invasion (36.9 & not reached (NR)p < 0.001), perineural invasion (39.2 & 108.8 p = 0.007), and poor histological grade (NR &36.9 p = 0.042). In the multivariate analysis, only nodal status (HR,1.98; P = 0.028) and surgical margin (HR,2.61; P = 0.03) were associated with overall survival.While 70.1% of the patients recieved chemotherapy or chemoradiotherapy, 29.9% of the patients didn’t have any adjuvant therapy. There was no survival difference between the patients without any adjuvant therapies and with an adjuvant therapy (53.1 & 108.5 P = 0.166) Conclusions: Even though ampullary carcinoma has the best prognosis among all periampullary carcinomas, its long-term survival remain slow. Nodal status and surgical margin were an independent predictor of OS for patients with ampullary carcinoma. Additional studies are necessary to specify the role of adjuvant therapy of ampullary carcinomas.

Background: We investigated the role of standardized uptake values (SUVs) of the primary tumor in small cell lung cancer (SCLC) patients. Patients and Methods: The relationship between SUV and response to treatment was investigated using receiver operating characteristic (ROC) curve analysis, and the efficient cut-off value for detecting response to treatment was determined. The effects of SUV on response to treatment and survival were investigated. Results: 90 patients with a median age of 58 years (range 39-83 years) were included. Median follow-up was 11 months. The suitable cut-off SUV for determination of response was found to be 10 in ROC analysis. The sensitivity and specificity of this value were 85.7% (95% confidence interval (95% CI) 63-96) and 61.8% (95% CI 49-73) (area under the curve 0.783; p = 0.0001), respectively. The overall objective response rate in patients with involvement above the cut-off value was 93.3% compared to 59.1% in those with involvement below the cut-off value (p < 0.0001). In uni- and multivariate analysis, favorable effects of limited-stage disease on response to treatment were established (p < 0.05). The effect of an SUV higher than the cut-off value on progression-free survival was borderline (p = 0.085). Conclusion: These data may contribute to identifying prognostic disease characteristics and response to treatment.

Concomitant administration of chemotherapy and radiotherapy is currently recognized as the standard of treatment in locally advanced inoperable non-small cell lung cancer (NSCLC). Our study aimed to compare the efficacy and toxicities of three different chemotherapy regimens delivered concurrently with radiotherapy. We retrospectively reviewed the clinical records of patients who received the PE (cisplatin, 50 mg/m2, on days 1, 8, 29, and 36 plus etoposide, 50 mg/m2, on days 1 to 5 and 29 to 33), PD (docetaxel, 20 mg/m2, on day 1 plus cisplatin, 20 mg/m2, on day 1, every week), and PC (carboplatin, AUC 2 plus paclitaxel, 45 mg/m2, on day 1, every week) regimens concurrently with radiotherapy. A total of 227 patients were evaluated in the study. Median follow-up time was 13 months (2–101). There were 27 females (11.9 %) and 200 males (88.1 %) with a median age of 61 (38–82) years. The PD group had higher rates of esophagitis, mucositis, and anemia (p < 0.05). The PC group had higher rates of neuropathy (p = 0.000). The progression-free survival (PFS) time was 10 months for patients in the PC group, 15 months for patients in the PD group, and 21 months for the PE group (p = 0.010). Patients in the PC group had a median overall survival time of 23 months, those in the PD group 27 months, and those in the PE group 36 months (p = 0.098). Combination of cisplatin-etoposide with radiotherapy led to a more favorable outcome compared with the other two regimens. It shows generally manageable toxicity profile and compliance to treatment is noticeable.

The optimal treatment in older persons with metastatic colorectal cancer (mCRC) is complicated by a lack of general agreement. The aim of this study was to evaluate the activity of bevacizumab plus capecitabine combination in elderly mCRC patients who were not suitable for chemotherapy with irinotecan and oxaliplatin-containing regimens.

Purpose: The aim of this study was to determine risk factors for brain metastasis as the first site of disease recurrence in patients with HER2-positive early-stage breast cancer (EBC) who received adjuvant trastuzumab.Methods: Medical records of 588 female patients who received 52-week adjuvant trastuzumab from 14 centers were evaluated. Cumulative incidence functions for brain metastasis as the first site of disease recurrence and the effect of covariates on brain metastasis were evaluated in a competing risk analysis and competing risks regression, respectively.Results: Median follow-up time was 36 months. Cumulative incidence of brain metastasis at 12 months and 24 months was 0.6% and 2%, respectively. HER2-enriched subtype (ER- and PR-) tumor (p = 0.001, RR: 3.4, 95% CI: 1.33-8.71) and stage 3 disease (p = 0.0032, RR: 9.39, 95% CI: 1.33-8.71) were significant risk factors for development of brain metastasis as the first site of recurrence.Conclusions: In patients with HER2 positive EBC who received adjuvant trastuzumab, HER2-enriched subtype (ER- and PR-) tumor and stage 3 disease were associated with increased risk of brain metastasis as the first site of disease recurrence. (C) 2015 Elsevier Ltd. All rights reserved.

60 Background: Tumor invasion and metastasis are complex processes, involving regulation at the molecular level of adhesive molecules, proteolitic enzymes, and cell growth and angiogenesis factors. A Disintegrin and Metalloproteinase (ADAM)17 has been indicated to be indispensable regulator of celular event from proliferation to migration.Although prognostic importance of ADAM17 expression has been investigated in several tumors, its clinical utility as a useful prognostic molecular marker remains unclearin gastric cancer.In the present study, we evaluated the expression of ADAM17 and its prognostic significance in gastric cancer patients after surgery. Methods: Prognostic significance of ADAM17 expression was analyzed by immunohistochemically in 158 patients with gastric cancer and the relationship between its expression and clinicopathological factors was also evaluated. Results: High expression of ADAM17 was detected in 81 patients(51%),while low expression was found in 77 cases (49%). There was significant correlation between gender, histology, lymph node metastasis, vascular invasion, the presence of recurrence and high ADAM17 expression. Recurrence in patients with high ADAM17 expression was significantly higher than that for patients with low ADAM17 expression(p=0.032). The median disease-free survival (DFS) time for patients with high ADAM17 expressed tumors were worse than those of patients with low ADAM17 expressed tumor (16.6 vs. 44.2 months, p=0.004).In addition, patients with low ADAM17 expression had a higher median overall survival (OS)interval than those of high ADAM17 expressed patients (49.6 vs. 26.9 months, p=0.019). Multivariate analysis indicated that the rate of ADAM17 expression was an independent prognostic factor for DFS, in addition to known important clinicopathological prognostic indicator for DFS. But its' prognostic importance could not be proved by multivariate analysis for OS. Conclusions: The potential value of ADAM17 expression as a useful molecular marker in gastric cancer progression should be evaluated comprehensively,it may predict recurrence and poor prognosis in patients with gastric cancer after curative resection.

Patients with advanced non-small cell lung cancer (NSCLC) generally require second-line treatment although their prognosis is poor. In this multicenter study, we aimed to detect the characteristics related to patients and disease that can predict the response to second-line treatments in advanced NSCLC. Data of 904 patients who have progressed after receiving first-line platinum-based chemotherapy in 11 centers with the diagnosis of stage IIIB and IV NSCLC and who were evaluated for second-line treatment were retrospectively analyzed. The role of different factors in determining the benefit of second-line treatment was analyzed. Median age of patients was 57 years (range 19–86). Docetaxel was the most commonly used (20.9 %, n = 189) single agent, while gemcitabine–platinum was the most commonly used (6.7 %, n = 61) combination chemotherapy regimen in second-line setting. According to survival analysis, median progression-free survival after first-line treatment (PFS2) was 3.5 months (standard error (SE) 0.2; 95 % confidence interval (CI), 3.2–3.9), median overall survival (OS) was 6.7 months (SE 0.3; 95 % CI, 6.0–7.3). In multivariate analysis, independent factors affecting PFS2 were found to be hemoglobin (Hb) level over 12 g/dl and treatment-free interval (TFI) longer than 3 months ( p = 0.006 and 0.003, respectively). Similarly, in OS analysis, Hb level over 12 g/dl and time elapsed after the first-line treatment that is longer than 3 months were found to be independent prognostic factors ( p = 0.0001 and 0.045, respectively). In light of these findings, determining and using the parameters for which the treatment will be beneficial prior to second-line treatment can increase success rate.

ABSTRACT Aim: The benefit of the addition of 9-weeks or 52-weeks adjuvant trastuzumab to chemotherapy compared with chemotherapy alone was shown in five randomized trials. Despite retrospective series having shown the poor prognosis of HER2-positive T1a/b node-negative tumors, the efficacy of adjuvant trastuzumab was not known exactly. The aim of this study is to evaluate the efficacy of trastuzumab in HER2-positive T1abN0M0 breast cancer. Methods: Newly diagnosed 705 T1a/b node-negative breast cancer patients from July 2000 to December 2013 in 13 clinics were retrospectively analyzed; a total of 166 HER2-positive patients were included in this study. In this study 54 (32.5%) patients were treated with adjuvant trastuzumab, whereas 112 (67.5%) patients were not treated with adjuvant trastuzumab. Demographic and medical data including age, performance status, tumor characteristics and comorbid diseases were collected from the medical charts. Kaplan–Meier survival analysis was carried out for DFS and OS. Results: The median age of the study population was 53 (24-79) years. Median follow up was 37 (2-157) months. Baseline demographic characteristics of both groups were similar and non-significant. In both treatment groups, median age, histology, menopausal status lymphovascular invasion and perineural invasion positivity were similar. But in trastuzumab treatment group grade 3 tumors were significantly higher compared with non-trastuzumab arm (55.1% vs 26.0%, P = 0.002). Also in trastuzumab treatment arm, combination chemotherapy (P Conclusions: In retrospective series, patients with HER2-positive T1abN0M0 tumors have a significant risk of relapse and recurrence. But in our study, due to the low events no comment can be made with 9-weeks adjuvant trastuzumab. Future studies with longer follow-up are needed to show the efficacy of adjuvant trastuzumab in HER2-positive T1abN0M0 breast cancer. Disclosure: All authors have declared no conflicts of interest.

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.

Aim: The benefit of the addition of 9-weeks or 52-weeks adjuvant trastuzumab to chemotherapy compared with chemotherapy alone was shown in five randomized trials. Despite retrospective series having shown the poor prognosis of HER2-positive T1a/b node-negative tumors, the efficacy of adjuvant trastuzumab was not known exactly. The aim of this study is to evaluate the efficacy of trastuzumab in HER2-positive T1abN0M0 breast cancer.

Aim: Stage III non-small cell lung cancer (NSCLC) is one of the most controversial areas in managing lung cancer and gives a chance to clinicians to practice the art of medicine. The aim of the current study was to compare three chemotherapy regimens commonly used concurrently with radiotherapy in terms of efficacy and safety.

Small cell lung cancer (SCLC) has a high relapse rate despite being very chemosensitive. The efficacy of second-line treatment is dismal. Our aim was to evaluate the outcome of second-line treatment.

e11540 Background: Tumor marker monitoring is generally performed by the physicians, although in many guidelines, it has not been recommended for breast cancer. In this study, we aimed to research the role of CEA and CA15.3 levels in metastatic process. Methods: In between years 2000 January and 2011 August, the documents of 482 female patients followed by breast cancer diagnosis in Medical Oncology and Radiation Oncology clinics of Kartal Dr. Lutfu Kirdar Education and Research Hospital, were evaluated retrospectively. Results: To determine the role of CEA and CA15.3 levels in evaluation of metastatic process, ROC analysis was performed and its cut-off values were 1.3 ng/ml and 14 U/ml, respectively. Sensitivities of CA15.3 and CEA levels were detected as 83.33% and 87.50%; specificities were 40.80% and 41.14%, respectively. Evaluation of the relationship between CEA and CA15.3 levels and the status of hormone receptors by ROC analysis showed the cut-off values as 26 U/ml and 1,6 ng/ml, respectively. In determination of endocrine sensitivity, the sensitivities of tumor markers elevation were 88.17% and 54.12%, respectively. Their specificities were 26.92% and 73.08%. CEA level elevation in hormone sensitive patients was statistically significant (p: 0.007). When sensitivity and specificity of CA15.3 and CEA levels on detection of c-erbB2 positivity were evaluated by ROC analysis, cut-off values were determined as 17 U/ml and 1,7 ng/ml. Sensitivities of these distinctive cut-off values were found as 58.8% and 71.15% and specificities were 60% and 51.67% (p: 0.017). When the relation between CA15.3 and CEA levels and node involvement was evaluated by ROC analysis, cut-off values were respectively 16 U/ml and 0.9 ng/ml. Their sensitivities were 53.45% and 87.93% and specificities were 55.56% and 51.67%, respectively. Conclusions: The levels of tumor markers have been suggested to have a significant role in prognosis of the disease with respecttothe correlation between different histopathological and clinical features and tumor markers. Randomised controlled prospective studies planned and performed in this issue may clarify this uncertainity.

e15100 Background: Biomarkers which indicate invasion and metastasis in patients with gastric cancer are important. Collapsin response mediator protein (CRMP) family proteins are cytosolic phosphoproteins involved in semaphorin 3A-mediated neuronal cell growth cone collapse and cancer invasion. CRMP1 over expression levels were found to have negative association with invasion and metastasis in lung cancer tissue samples. The aim of the study was to investigate relationship between CRMP1 expression and histopathological parameters and prognostic value of CRMP1 expression in patients with gastric cancer. Methods: We analyzed 52 patients who were diagnosed with gastric cancer. The CRMP1 expression was examined by performing immunohistochemical staining. High CRMP1 expression in gastric tumor samples was defined as being immunoreactive to CRMP1 antibody in more than 50% of the cancer cells. The correlation between CRMP1 expression and age, gender, tumor grade, lenfovascular-perineural invasion, t stage and nodal involvement was investigated. Results: Among the 52 patients (CRMP1 positive/CRMP1 negative= 24/28), median age was 56 years (27-84). Thirty-five patients were male and 17 patients were female. The median follow-up time was 14 (2-60) months. The median disease-free survival time (DFS) was 20 (SE: 4; 95% CI: 13-27) months. In addition, the median overall survival time (OS) was not reached. The significant relationship was found between CRMP1 high expression levels and high grade tumors (p:0.03), and nodal metastasis (p:0.019). In univariate analysis, only high CRMP1 expression was associated with poor disease-free survival (p:0.004). Also, male gender (p:0.023), high grade tumors (p:0.044), nodal involvement (p:0.028) and high CRMP-1 expression were associated shorter overall survival. In multivariate analysis, no independent prognostic factor was found in this group. Conclusions: We found that high expression of CRMP1 was associated with tumor aggressiveness of tumor and poor survival. Larger studies and further clinical trials are warranted to confirm these findings.

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]

CONTEXT:Netrin-1 is found to be elevated and usable as a diagnostic biomarker in many human cancers.OBJECTIVES:We evaluated serum Netrin-1 concentrations in patients with advanced gastric cancer compared with those in a healthy group.MATERIAL AND METHODS:Thirty patients with advanced gastric cancer and thirty healthy people were included in the study. Serum netrin-1 concentrations were measured by quantitative ELISA method in both groups.RESULTS:The mean serum Netrin-1 concentrations were found to be significantly higher in patients with gastric cancer than in healthy controls. The mean serum Netrin-1 concentrations were found to be significantly higher in patients with gastric cancer before the beginning of chemotherapy when compared after the completion of third cycle.DISCUSSION AND CONCLUSION:Our results indicated that netrin-1 concentrations elevated in advanced gastric cancer compared to a healthy control group and netrin-1 concentrations decreased with chemotherapy.