GÝRÝÞ ve AMAÇ: Endometriyal kanser çoðunlukla erken evrelerde teþhis edilir ve iyi bir prognoza sahiptir. Endometriyal kanserli hastalarýn tedavisinde cerrahi tedavi temeldir ve belirli risk gruplarýnda adjuvan radyoterapi (RT) uygulanmaktadýr. Bu retrospektif çalýþmada, RT uygulanan endometriyal kanserli hastalada prognozu etkileyen faktörler inceledi.
YÖNTEM ve GEREÇLER: Çalýþmaya endometriyal kanser tanýsý almýþ toplam 181 hasta dahil edildi. Prognostik faktörlere göre risk gruplarý düþük, orta, yüksek-orta, yüksek riskli ve ileri/metastatik olarak kaydedildi. Hastalarýn genel saðkalýmý (GS), Kaplan-Meier yöntemi kullanýlarak hesaplandý.
BULGULAR: Ortanca yaþ 60'tý (28-82). Tek baþýna adjuvan RT, RT ve kemoterapi ve tek baþýna kemoterapi alan hasta sayýsý sýrasýyla 77 (%42,5), 65 (%36) ve 39 (%21,5) idi. Ortanca GS 12.4 (0.1-21) yýldý. Ýleri/metastatik risk grubu dýþýnda diðer tüm risk gruplarýnda, tek baþýna RT alan hastalarda GS daha iyi bulundu (p<0.001).
TARTIÞMA ve SONUÇ: Endometriyal kanserli hastalarda adjuvan tedavi alanlarda; risk gruplarý (prognostik risk faktörlerine göre), p53 ve uygulanan tedavi (yalnýz RT) önemli prognostik göstergelerdir. RT'ye adjuvan kemoterapi eklenmesi prognozu olumsuz etkilemektedir.

INTRODUCTION: Endometrial cancer is mostly diagnosed in the early stages and has a good prognosis. Surgery has main role in the treatment of patients with endometrial cancer and adjuvant radiotherapy (RT) is administered in certain risk groups. In this retrospective study, we analyzed the factors affecting the prognosis of patients with endometrial cancer who underwent RT.
METHODS: A total of 181 patients who were diagnosed with endometrial cancer were included in the study. Based on the prognostic factors, risk groups were recorded as low, intermediate, high-intermediate, high risk, and advanced/metastatic. Patients’ overall survival (OS) was calculated using Kaplan– Meier method.
RESULTS: Median age was 60 years (28–82). The number of patients who received adjuvant RT alone, RT and chemotherapy, and chemotherapy alone were 77 (42.5%), 65 (36%), and 39 (21.5%), respectively. Median OS was 12.4 (range, 0.1-21) years. Except for the advanced/metastatic risk group, OS was better in all the other risk groups who received RT alone (p<0.001).
DISCUSSION AND CONCLUSION: Risk groups (based on prognostic risk factors), p53, and treatment applied (RT alone) are the significant prognostic indicators for patients received adjuvant therapy in endometrial cancer. Adding adjuvant chemotherapy to RT adversely affects the prognosis.

GÝRÝÞ ve AMAÇ: Meme kanseri hastalarýnda depresyon, uyku ve cinsel iþlev bozukluklarýný sorgulamak ve tanýmak hastalarýn yaþam kalitesini iyileþtirmektedir. Erken evre meme kanserli hastalarda adjuvan endokrin tedavisi ve diðer deðiþkenlerin depresyon, uyku kalitesi ve cinsel iþlev bozukluðu üzerine etkilerini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýz, hormon reseptörü pozitif, erken evre (evre I-III) meme kanseri tanýsý almýþ ve medikal onkoloji polikliniðinde en az 3 ay takip edilen 105 hastanýn katýlýmýyla gerçekleþtirildi. Veri toplama aracý olarak sosyodemografik form, Beck Depresyon Envanteri (BDI), Pittsburgh Uyku Kalitesi Ýndeksi (PSQI) ve Kadýn Cinsel Ýþlev Ýndeksi (FSFI) kullanýldý.
BULGULAR: Çalýþmamýzda elde ettiðimiz sonuçlara göre hastalarýn %55.8'inde depresyon, %60,6'sýnda kötü uyku kalitesi, %77.1'inde cinsel iþlev bozukluðu saptandý. PR pozitif olan hastalarda cinsel iþlev bozukluðuna eðilim gözlendi ve istatistiksel olarak anlamlý bulundu (P=0,005). Hastalarýn PUKÝ ve BDI deðerleri arasýnda güçlü (p<0,001) bir korelasyon vardý. Depresyon, uyku ve cinsel iþlev bozukluðu olan hastalarda farklý endokrin tedavi ajanlarý (tamoksifen/anastrozol/letrozol) arasýnda ise anlamlý bir iliþki yoktu (p> 0.05).
TARTIÞMA ve SONUÇ: Çalýþmamýzda çoðu hastada depresyon, uyku bozukluðu ve cinsel iþlev bozukluðuna eðilim saptadýk. Bazý sosyodemografik özelliklerin, adjuvan tedavi ve hormon reseptör durumunun cinsel iþlevselliði etkileyebileceði ortaya çýktý. Bu nedenle meme kanseri tanýsý ile takip edilen hastalarda bu belirtilerin sorgulanmasý ve deðerlendirilmesi önemlidir.

INTRODUCTION: Questioning and recognizing depression, sleep and sexual dysfunctions in breast cancer patients improves the patients' quality of life. We aimed to evaluate the effects of adjuvant endocrine treatment and other variables on depression, sleep quality and sexual dysfunction in patients with early-stage breast cancer.
METHODS: Our study was performed with the participation of 105 patients who were diagnosed with hormone receptor positive, early stage (stage I-III) breast cancer and at least 3 months followed by the medical oncology outpatient clinic. Sociodemographic form, Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI) and Female Sexual Function Index (FSFI) were used as data collection tools.
RESULTS: According to the results obtained in our study, 55.8% patients had depression, 60.6% patients had poor sleep quality, 77.1% had poor sexual function. A tendency to sexual dysfunction was observed in patients with PR positivity and it was found to be statistically significant (P=0.005). There was a strong (p<0.001) correlation between the PSQI and BDI values of the patients. There was no significant relationship between different endocrine therapy agents (tamoxifen/anastrozole/letrozole) in patients with depression, sleep and sexual dysfunction (p> 0.05).
DISCUSSION AND CONCLUSION: In our study, we found a tendency to depression, sleep disturbance, and sexual dysfunction in most patients. It was revealed that some sociodemographic features, adjuvant treatment and hormone receptor status may affect sexual functionality. Therefore, these symptoms should be questioned in patients followed up with a diagnosis of breast cancer.

GÝRÝÞ ve AMAÇ: Ortopedik onkolojik cerrahi planlanan hastalar sýklýkla operasyondan önce kemoterapi veya radyoterapi gibi çeþitli tedaviler almaktadýr. Uygulanan tedaviler ve bunlara baðlý yan etkiler, eþlik eden ko-morbiditeler ve yapýlacak olan cerrahinin özellikleri anestezi seçimini etkileyerek spesifikleþmeyi gerektirir. Bu çalýþmada, hastanemizde primer veya metastatik kemik tümörü tanýsý ile tümör rezeksiyon protezi uygulanan hastalarýn retrospektif olarak deðerlendirilmesi planlandý.
YÖNTEM ve GEREÇLER: Çalýþmaya hastanemiz Ortopedi ve Travmatoloji Kliniði tarafýndan Ocak 2015 ve Aralýk 2016 tarihleri arasýnda Primer veya metastatik kemik tümörü tanýsý ile tümör rezeksiyonu protez operasyonu uygulanan, American Society of Anesthesiologists (ASA) I-III grubunda yer alan 6-84 yaþ arasý 72 hasta bu çalýþmaya dahil edildi. Hastalarýn demografik özellikleri, eþlik eden hastalýklarý, malignite tanýlarý, ASA skorlarý, yapýlan cerrahi giriþim ve anestezi yöntemi, anestezi ve operasyon süresi, ameliyat öncesi ve sonrasý hemoglobin deðerleri, intraoperatif kanama miktarý, intraoperatif sývý yönetimi ve kan transfüzyon ihtiyacý, ve postoperatif yoðun bakým ve/veya mekanik ventilasyon süreleri kaydedildi.
BULGULAR: En sýk taný alan primer kemik tümörü osteosarkom, en çok yapýlan ameliyat ise geniþ tümör rezeksiyonu ve femur proksimal tümör rezeksiyon protezi olarak bulundu. Anestezi süresi, kanama miktarý, yaþ, ASA ve ek hastalýk gibi parametrelerin postoperatif mekanik ventilasyon veya yoðun bakým ihtiyacýyla iliþkili olduðu gösterildi. Hastalarda uygulanan postoperatif analjezi yöntemlerinde ise en sýk olarak intravenöz analjezi yöntemi tercih edildiði görüldü.
TARTIÞMA ve SONUÇ: Ortopedik onkolojik cerrahilerde anestezi yönetimi, preoperatif dönemden baþlayarak hastayý bütüncül bir yaklaþýmla deðerlendirmeyi, intraoperatif anesteziyle birlikte postoperatif analjezi ve / veya yoðun bakým gereksinimini belirlemeyi kapsamalýdýr. Anestezi ve cerrahi ekip üyeleri arasýnda iletiþim optimal onkolojik cerrahi bakýmýn saðlanmasý açýsýndan önemlidir.

INTRODUCTION: Patients scheduled for orthopedic oncological surgery often receive various treatments, such as chemotherapy or radiotherapy, before the operation. The treatments applied and related side effects, accompanying co-morbidities and the characteristics of the surgery to be performed affect the choice of anesthesia and require specificity. In this study, it was planned to retrospectively evaluate the patients who underwent tumor resection prosthesis with the diagnosis of primary or metastatic bone tumor in our hospital.
METHODS: 72 patients between the ages of 6-84 who underwent tumor resection prosthesis operation with the diagnosis of primary or metastatic bone tumor and who are in American Society of Anesthesiologists (ASA) I-III group were included in the present study. Demographic characteristics of patients, accompanying diseases, malignity diagnoses, ASA scores, surgical intervention carried out and anesthesia method, duration of anesthesia and operation, pre and postoperative hemoglobin values, amount of intraoperative bleeding, intraoperative fluid management and need for blood transfusion, need for and duration of postoperative intensive care and/or mechanic ventilation were recorded
RESULTS: The most frequently diagnosed primary bone tumor was osteosarcoma, and the most common operation was wide tumor resection and femoral proximal tumor resection prosthesis. Parameters such as duration of anesthesia, amount of bleeding, age, ASA, and comorbidity were shown to be associated with the need for postoperative mechanical ventilation or intensive care. In the postoperative analgesia methods applied to the patients, it was seen that the most frequently preferred method was intravenous analgesia.
DISCUSSION AND CONCLUSION: In orthopedic oncologic surgeries, anesthesia management should encompass evaluating the patient with a holistic approach starting from the preoperative period, and considering the need for postoperative analgesia and/or for intensive care in addition to intraoperative anesthesia. Communication between members of anesthesia and surgery teams is important for providing optimal surgical care.

GÝRÝÞ ve AMAÇ: Küçük hücreli akciðer kanseri (KHAK), çok kötü prognozlu, oldukça ölümcül bir akciðer kanseri þeklidir. Sistemik inflamasyon, kanser geliþimi için önemli bir risk faktörüdür. Dolaþan baðýþýklýk hücreleri, kansere karþý mücadelede önemli bir rol oynar. Bu çalýþma, küçük hücreli akciðer kanserinde dolaþýmdaki baðýþýklýk hücrelerinin bileþenleri olarak farklý periferik kan lökosit biyobelirteçlerinin prognostik deðerini araþtýrmak için tasarlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþmaya 2012-2021 yýllarý arasýnda Dokuz Eylül Üniversitesi Hastanesi Týbbi Onkoloji Anabilim Dalý'nda izlenen toplam 81 KHAK hastasý dahil edildi. Hastalarýn taný anýnda periferik kan testleri kaydedildi. Sistemik immün-inflamasyon indeksi (SIRI) (nötrofil sayýsý×monosit sayýsý)/lenfosit sayýsý olarak tanýmlandý. Pan-immün inflamasyon deðeri (PIV) þu þekilde hesaplandý: (nötrofil sayýsý x trombosit sayýsý x monosit sayýsý)/lenfosit sayýsý. Optimal cut-off deðerleri, ROC eðrisine göre belirlendi. Bu deðerler SIRI ve PIV için sýnýrlý evreli KHAK'de sýrasýyla 2,8 ve 585 ve yaygýn evre KHAK'de 1,33 ve 497 idi. Genel saðkalým (GS), Kaplan-Meier yöntemiyle hesaplandý ve log rank testiyle karþýlaþtýrýldý. Cox regresyon modeli kullanýlarak çok deðiþkenli analiz tahmin edildi.
BULGULAR: 81 KHAK'li hastanýn 28'inde (%34,6) sýnýrlý evre KHAK, 53'ünde (%65,4) yaygýn evre hastalýk vardý. Tüm grupta medyan SIRI 2,37 (IQR, 0,34–18,59), medyan PIV ise 634,80'di (IQR, 61,57–8320). Tüm evreleri içeren hasta grubunda yapýlan analizde saðkalým arasýnda nümerik fark olmasýna raðmen her iki belirteç için istatistiksel anlamlýlýk elde edilememiþtir (SIRI için p=0,20; PIV için p=0,058). Sýnýrlý evre KHAK'li hastalarýn GS, ECOG, SIRI ve PIV durumu için istatistiksel anlamlýlýk bulunurken,çok deðiþkenli analizde deðiþkenler arasýnda anlamlý bir fark bulunmadý.
TARTIÞMA ve SONUÇ: Bulgularýmýz, SIRI ve PIV'in KHAK'de prognoz için umut verici belirleyiciler olabileceðini göstermektedir.

INTRODUCTION: Small cell lung cancer (SCLC) is a highly lethal form of lung cancer with very poor prognosis. Systemic inflammation is an important risk factor forcancer development.Circulating immune cells play an important role in fighting againstcancer.This study was designed to investigate the prognostic value of different peripheral blood leukocyte biomarkers as components of circulating immune cellsin small cell lung cancer.
METHODS: A total of 81 SCLC patients followed up at Dokuz Eylül University Hospital Department of Medical Oncologybetween 2012 and 2021 were included in this study. Peripheral blood tests of patients were recorded at the time of diagnosis.Systemic immune-inflammation index (SIRI) was defined as (neutrophil count×monocytes count)/lymphocyte count. Pan-immune inflammation value (PIV) was calculated as follows: (neutrophil count × platelet count × monocyte count)/lymphocyte count.The optimal cut-off valuesweredetermined according to the receiver operating characteristic (ROC) curve. These values were 2.8 and 585 in limited stage SCLC and 1.33 and 497 in all-stage SCLC for SIRI and PIV, respectively.Overall survival (OS) was estimated withthe Kaplan-Meier method and compared with the log rank test. Multivariate analysis was estimated using the Cox regression model.
RESULTS: Of the 81 patients with SCLC,28 (34.6%) patients had LS-SCLC while 53 (65.4%) patients had extensive stage disease.In whole group, median SIRI was 2.37 (IQR, 0.34–18.59), while median PIVwas 634.80 (IQR, 61.57–8320). Although there was a numerical difference between survival in analysis performed in the patient group including all stages, statistical significance could not be achieved for both markers (p=0.20 for SIRI; p=0.058 for PIV).While statistical significance was found for OS and ECOG, SIRI, and PIV status in univariate analysis of patients with limited stage SCLC, no significant difference was found between the variables with multivariate analysis.
DISCUSSION AND CONCLUSION: Our findings show that SIRI and PIV may be promising predictors for prognosis in SCLC.

GÝRÝÞ ve AMAÇ: Enfeksiyon hastalýklarýnýn klinik ve laboratuvar tanýsýndaki geliþmeler ve yýllar içinde deðiþen etken spektrumu kanser tedavisi süresince Febril nötropeni (FEN) ataklarýnýn güncel takibini gerekli hale getirmiþtir. Bu çalýþmada FEN ataklarýnda deðiþen paradigmalarýn ve prognostik faktörlerin araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Prospektif, gözlemsel yürütülen bu çalýþmaya, Nisan 2020-Nisan 2021 tarihleri arasýnda kanser merkezimizde FEN nedeniyle yatarak tedavi gören 18 yaþ ve üzeri solid tümörü ve hematolojik malignitesi olan 145 eriþkin hasta alýndý ve hastalarda geliþen 176 FEN ataðý incelendi.
BULGULAR: Çalýþmaya dâhil edilen 145 hastanýn %70.3’ünde (n=102) hematolojik malignite mevcuttu FEN ataklarýnýn %46’sýnda mikrobiyolojik olarak kanýtlanmýþ enfeksiyon saptandý ve en sýk enfeksiyon odaðýnýn %27.1 ile alt solunum yolu enfeksiyonlarý olduðu görüldü. FEN ataklarýnýn %66.2’sinde (n=45) sadece gram negatif, %19.1’inde (n=13) sadece gram pozitif mikroorganizma üredi. Hematolojik maligniteli hastalarda solid organ tümörlü hastalara göre bakteriyemi istatistiksel olarak anlamlý olacak þekilde daha yüksekti (p<0.001). Sýfýrýncý günde derin nötropeni olmasý bakteriyemi ile iliþkili bulunurken (p<0.001), uzamýþ nötropeninin bakteriyemi ile iliþkisi gösterilemedi (p=0.34). FEN’e baðlý mortalite %9.7 (n=17) oranýnda görüldü. FEN’de mortalite riski, pnömonisi bulunan hastalarda 10.25 kat ve uzamýþ nötropenisi olan hastalarda 6.05 kat daha fazlaydý.
TARTIÞMA ve SONUÇ: FEN ataklarýnýn klinik ve laboratuvar bulgularýnýn araþtýrýldýðý bu çalýþmada yeni kullanýma giren kemoterapötiklerin etkisiyle FEN kliniðinde pnömoni sýklýðýnýn arttýðý ve etken profilinde geçtiðimiz dekattan farklý olarak gram negatif mikroorganizmalarýn daha çok olduðu saptanmýþtýr. Ayrýca pnomoni ve uzamýþ nötropeni varlýðýnýn mortaliyeti arttýrdýðý görülmüþtür. Kapsamlý multicenter çalýþmalar, deðiþen paradigmalara yönelik yeni yönetim algoritmalarýnýn oluþturulmasýna olanak saðlayacaktýr.

INTRODUCTION: The epidemiology of pathogens responsible of febrile neutropenia (FEN) has changed and so did the diagnostic tools in the field of infectious diseases. This study examined the changing paradigms and prognostic factors in FEN episodes.
METHODS: This was a prospective and observational study of 145 adult patients aged 18 and older with solid tumor and hematological malignancies and who received FEN treatment at the our cancer center between April 2020 and April 2021; 176 FEN episodes developed in patients and were examined.
RESULTS: Hematological malignancy was present in 70.3% (n=102) of the 145 patients. Microbiologically-confirmed infections were seen in 46% of FEN episodes. The most common focus of infection was lower respiratory tract infections with 27.1%. In 66.2% (n=45) of FEN episodes, only gram-negative microorganisms grew while only gram-positive microorganisms grew in 19.1% (n=13). Bacteremia was significantly higher in patients with hematological malignancies versus patients with solid organ tumors (p<0.001). Deep neutropenia on day zero was associated with bacteremia (p<0.001), but the relationship between prolonged neutropenia and bacteremia could not be demonstrated (p=0.34). FEN-related mortality was 9.7% (n=17). The risk of mortality in FEN was 10.25-fold higher in patients with pneumonia and 6.05-fold higher in patients with prolonged neutropenia.
DISCUSSION AND CONCLUSION: We determined that the frequency of pneumonia increased in the FEN clinic due to the effects of newly introduced chemotherapeutics. Gram-negative microorganisms were more common in the causative profile unlike the previous decade. Pneumonia and prolonged neutropenia increase mortality. Comprehensive multicenter studies will allow for the development of new management algorithms for changing paradigms.

GÝRÝÞ ve AMAÇ: Gastrik adenokarsinom (GK), sýk görülen ve kötü prognoza sahip bir malignitedir. GK'de tedavi kararlarýna yardýmcý olmak için prognostik belirteçlere ihtiyaç vardýr. Naples prognostik skoru (NPS) ve beslenme durumunun kontrol edilmesi (CONUT) skoru, farklý tümörlerde prognoz ile iliþkili immün-beslenme skorlarýdýr. Bunlarýn metastatik GK'deki performansýna iliþkin veriler ise azdýr. Metastatik GK'li hastalarda CONUT ve NPS'nin prognoz ile iliþkisini deðerlendirdik.
YÖNTEM ve GEREÇLER: 2017-2021 yýllarý arasýnda metastatik GC için birinci basamak platin bazlý kemoterapi alan 201 hastayý geriye dönük olarak analiz ettik. Tedavi öncesi laboratuvar sonuçlarý deðerlendirlerek NPS ve CONUT skorlarý hesaplandý. NPS ve CONUT ile ilgili genel saðkalým (OS) analizleri yapýldý.
BULGULAR: Medyan saðkalým, NPS ve CONUT ile negatif korelasyona sahipti. OS ile iliþkili olabilecek klinik parametreler deðerlendirildi. Karaciðer metastazlarý daha kýsa saðkalým ile iliþkiliyken, peritoneal tutulum bunu göstermedi. Tümör farklýlaþmasý OS ile iliþkili deðildi. Tek deðiþkenli analizde, metastatik odaklarýn sayýsý, hepatik metastazlarýn varlýðý, artmýþ Ca19-9, azalmýþ albümin seviyeleri, ekstraperitoneal metastatik hastalýk, NPS ve CONUT, daha düþük OS ile iliþkiliydi. Yaþ, cinsiyet, tümör farklýlaþmasý ECOG ve CEA seviyeleri saðkalýmla iliþkili deðildi. Çok deðiþkenli analizlerde, daha düþük albümin, daha yüksek Ca19-9, hepatik metastazlar ve NPS (OR: 2.9) baðýmsýz olarak daha kýsa saðkalým ile iliþkilendirildi. CONUT, çok deðiþkenli analizde OS üzerinde bir etkiye sahip deðildi.
TARTIÞMA ve SONUÇ: Ýmmüno-beslenme skorlarý arasýnda CONUT ve NPS, metastatik GK hastalarýnda kötü prognozu öngörür. Bu açýdan NPS, CONUT'tan üstün görünmektedir

INTRODUCTION: Gastric adenocarcinoma (GC) is a common malignancy with a poor prognosis. There is a need for prognostic markers to assist treatment decisions in GC. Naples prognostic score (NPS) and controlling nutritional status (CONUT) score are immune-nutritional scores that predict outcomes in different early-stage tumours. Data on the performance of these in metastatic GC are scarce. We evaluated the relationship of CONUT and NPS with prognosis in patients with metastatic GC.
METHODS: We retrospectively analysed 201 patients who received first-line platinum-based chemotherapy for metastatic GC between 2017-2021. NPS and CONUT were calculated depending on the pre-treatment laboratory. Overall survival (OS) analyses were performed regarding NPS and CONUT.
RESULTS: Median survival negatively correlated with NPS and CONUT. Clinical parameters that may be associated with OS were evaluated. Liver metastases were associated with shorter survival, while peritoneal involvement did not. Tumour differentiation was not associated with OS. In the univariate analysis, the number of metastatic foci, the presence of hepatic metastases, increased Ca19-9, decreased albumin levels, extraperitoneal metastatic disease, NPS, and CONUT were associated with lower OS. Age, gender, tumour differentiation ECOG, and CEA levels did not affect survival. In multivariate analyses, lower albumin, higher Ca19-9, hepatic metastases, and NPS (OR: 2.9) were independently associated with shorter survival. CONUT did not have an effect on OS in multivariate analysis.
DISCUSSION AND CONCLUSION: Among immuno-nutritional scores, CONUT and NPS, predict poor prognosis in metastatic GC patients. The NPS seems superior to the CONUT.

GÝRÝÞ ve AMAÇ: Pankreas adenokarsinomu en ölümcül kanserlerden biridir. Metastatik pankreas kanserli hastalarýn prognozunu tahmin etmek için günlük hayatta kullanýlabilecek etkili, basit ve pratik yöntemler halen eksiktir ve prognozu tahmin etmek için umut verici bir biyobelirteç gerekmektedir. Çalýþmamýzda metastatik pankreas kanserinde HALP skorunun prognoz ile iliþkisini göstermeyi amaçladýk.



YÖNTEM ve GEREÇLER: 2016-2022 yýllarý arasýnda Türkiye'de 4 merkezden metastatik pankreas kanseri tanýsý alan hastalar dahil edildi. Demografik veriler, hemogram parametreleri, biyokimya deðerleri ve alýnan tedaviler kaydedildi. Genel saðkalým (OS) ve progresyonsuz saðkalým (PFS) da kaydedildi.
BULGULAR: Çalýþmamýzda 280 hasta vardý. Tüm popülasyon için medyan PFS 7,53 aydý, medyan OS ise 11,53 aydý. Medyan PFS, HALP-Düþük grup için 7,1 ay ve HALP-Yüksek grup için 14,8 aydý. HALP-Düþük grubun median PFS'si HALP-Yüksek gruba göre daha kýsaydý ve gruplar arasýnda istatistiksel olarak anlamlý bir fark vardý (p: <0,001).
TARTIÞMA ve SONUÇ: Sonuç olarak, HALP skoru ucuz, pratik, literatüre katkýda bulunan bir belirteçtir ve prospektif çalýþmalarla doðrulanýrsa, metastatik pankreas kanseri olan hastalarýn prognozunu tahmin etmek için rutin klinik uygulamada kullanýlabilir.

INTRODUCTION: Pancreatic adenocarcinoma is one of the deadliest cancers. Effective, simple and practical methods that can be used in daily life are still lacking to predict the prognosis of patients with advanced pancreatic cancer and a promising biomarker is needed to predict prognosis. Our study's objective was to demonstrate the correlation between the HALP score and prognosis in patients with metastatic pancreatic cancer.
METHODS: Patients diagnosed with metastatic pancreatic cancer from 4 centers in Turkey between 2016 and 2022 were included. Demographic data, hemogram parameters, biochemistry values, as well as the treatments received were recorded. Survivals were also recorded
RESULTS: There were 280 patients in our study. The median PFS was 7.53 months, while the median OS was 11.53 months for the whole population. Median PFS was 7.1 months for the HALP-Low group and 14.8 months for the HALP-High group. The HALP-Low group exhibited a significantly shorter median progression-free survival (PFS) compared to the HALP-High group, with a statistically significant difference between the two groups (p<0.001). Median OS was 10.57 months for the HALP-Low group and 18 months for the HALP-High group. The HALP-Low group demonstrated a significantly shorter median overall survival (OS) compared to the HALP-High group, with a statistically significant difference between the two groups (p<0.001)
DISCUSSION AND CONCLUSION: In conclusion, the HALP score is an inexpensive, practical, literature-contributing marker and, if validated by prospective studies, can be used in routine clinical practice to predict the prognosis of patients with metastatic pancreatic cancer.

GÝRÝÞ ve AMAÇ: Tümörle iliþkili inflamasyon, tümör geliþimi ve ilerlemesinin önemli bir özelliðidir. Klasik Hodgkin lenfoma (kHL) hastalarýnýn klinikopatolojik ve prognostik özelliklerinin sistemik immün-inflamasyon indeksi (SII), nötrofil-lenfosit oraný (NLO) ve platelet-lenfosit oraný (PLO) ile iliþkili olup olmadýðýný araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu, Ocak 2012 ile Aralýk 2021 tarihleri arasýnda yürütülen retrospektif bir kohort çalýþmasýdýr. Çalýþmaya yeni taný almýþ toplam 77 kHL hastasý dahil edildi.
BULGULAR: Hastalarýn ortanca yaþý 37 (24-49) idi. Evre IV hastalýðý (p=0,036), B semptomlarý (p=0,005) ve ekstranodal tutulumu (p=0,012) olan hastalarda NLO anlamlý olarak daha yüksekti. Kadýn hastalarda (p=0,005), B semptomu olanlarda (p=0,014) ve ekstranodal tutulumu olanlarda (p=0,011) PLR anlamlý olarak daha yüksekti. Ayrýca B semptomu olan hastalarýn olmayanlara göre SII deðeri anlamlý olarak daha yüksekti (p=0,009). Uluslararasý prognostik skor-7 ile SII (r=0,271, p=0,017), PLO (r=0,294, p=0,010) ve NLO (r=0,378, p=0,001) arasýnda anlamlý ancak zayýf düzeyde korelasyon vardý.
TARTIÞMA ve SONUÇ: SII, B semptomlarý ile iliþkili bulundu, ancak kHL için prognostik deðildi. Ayrýca PLO ve NLO da kHL'li hastalarda prognozla iliþkili deðildi. Ancak bu konudaki verilerin son derece sýnýrlý olduðu düþünüldüðünde, inflamasyon indekslerinin deðerlendirilmesi için daha fazla çalýþmalara ihtiyaç vardýr.

INTRODUCTION: Tumor-associated inflammation is an important feature of tumor development and progression. We aimed to investigate whether the clinicopathological and prognostic characteristics of patients with classical Hodgkin lymphoma (cHL) were associated with systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).
METHODS: This was a retrospective cohort study conducted between January 2012 and December 2021. A total of 77 patients with newly diagnosed cHL were included in the study.
RESULTS: The median age of the patients was 37 (24-49) years. Patients with stage IV disease (p=0.036), B symptoms (p=0.005), and extranodal involvement (p=0.012) had significantly higher NLR. Female patients (p=0.005), those with B symptoms (p=0.014) and subjects with extranodal involvement (p=0.011) had significantly higher PLR. Also, the SII of patients with B symptoms was significantly higher compared to those without (p=0.009). There were significant but weak correlations between international prognostic score-7 and SII (r=0.271, p=0.017), PLR (r=0.294, p=0.010) and NLR (r=0.378, p=0.001).
DISCUSSION AND CONCLUSION: SII was associated with B symptoms, but was not prognostic for cHL. PLR and NLR were also unassociated with prognosis in patients with cHL. However, considering the exceedingly limited data on this topic, further studies to assess inflammation indices are necessary.

Anaplastik multipl miyelom ve anaplastik plazmasitoma içeren anaplastik multipl miyelom (AMM), multipl miyelomun (MM) morfolojik bir alt tip olarak agresif bir þekilde ilerleyen nadir bir hastalýktýr. Kötü bir prognoza sahiptir ve tedaviye özellikle dirençli olduðuna inanýlmaktadýr. Bu olgu sunumunda AMM tanýsý alan 66 yaþýnda bir kadýn hastayý sunduk. MM'nin anaplastik morfolojisi tanýsal bir zorluk teþkil edebilir. Bu örnekte hematolojik neoplazmlarý tespit etmek için multidisipliner bir yaklaþýma olan ihtiyaç vurgulanmýþtýr. AMM vakalarý için hýzlý radyografik, akým sitometri ve histolojik inceleme, etkili tedavi stratejilerini yönlendirmeye yardýmcý olabilir.

Anaplastic multiple myeloma (AMM), which comprises anaplastic multiple myeloma and anaplastic plasmacytoma, is a rare illness that aggressively advances as a morphological subtype of multiple myeloma (MM). It has a poor prognosis and is believed to be particularly resistant to treatment. In this case report, we presented a 66-year-old woman diagnosed with AMM. The anaplastic morphology of MM may pose a diagnostic challenge. The need for a multidisciplinary approach to detect hematological neoplasms is highlighted in this example. For AMM instances, prompt radiographic, flowcytometry, and histological examination may assist guide effective treatment strategies.

Diffüz büyük B hücreli lenfoma (DBBHL), tüm Hodgkin dýþý lenfomalarýn %30-40'ýný oluþturan büyük ve transforme B hücrelerinden oluþan heterojen bir tümör grubudur. DBBHL'nin ekstranodal meme tutulumu oldukça nadirdir. Coombs pozitif hemolitik anemi ve nörolojik semptomlarla baþvuran, meme kaynaklý bir DBBHL olgusunu sunmaktayýz. Elli dört yaþýnda kadýn hasta acil servise halsizlik ve çarpýntý þikayetleri ile baþvurdu. Periferik kan yaymasýnda atipik hücre görülmeyen hastada hemolitik anemi düþünüldü. Pozitron emisyon tomografi-bilgisayarlý tomografide sol meme orta ve üst kadranda florodeksiglikoz tutulumunda artýþ saptandý. Bilinci bozuk, konuþmasý dizartrik, oryantasyon kýsýtlý, kas kuvveti ve duyu ise muayenesi doðaldý, patolojik refleksi yoktu. Kranial manyetik rezonans görüntülemede pons seviyesinde difüzyonu kýsýtlayan ekspansil özellikte T2 ve FLAIR hiperintens lezyon saptandý. Meme iliþkili kitlenin tru-cut biyopsisinde CD20(+), PAX5(+), CD3(-), CD5(-) büyük B hücreli lenfoma infiltrasyonu görüldü. Bir kür R-CHOP ve MTX tedavisi sonrasý hastanýn transfüzyon ihtiyacý geriledi. Nörolojik semptomlarý ve radyolojik bulgularý bir kür tedaviden sonra tamamen düzeldi. Bu hasta, nörolojik semptomlarla baþvurmasý, otoimmun hemolitik anemi etiyolojisinin araþtýrýlmasý sýrasýnda meme iliþkili kitleden DBBHL tanýsý almasý ve tedavi tercihi açýsýndan literatüre önemli bir katký saðlamaktadýr.

Diffuse large B cell lymphoma (DLBCL) is a heterogeneous tumor group consisting of large and transformed B cells that make up 30-40% of all non-Hodgkin lymphomas. Extranodal breast involvement of DLBCL is very rare. We present a case of breast derived DLBCL who presented with coombs positive hemolytic anemia and neurological symptoms. A 54-year-old female patient was admitted to the emergency department with complaints of weakness and palpitations. Hemolytic anemia was considered in the foreground in the patient who did not show atypical cells in the peripheral blood smear. There were an increased fluorodexiglucose uptake detected in the middle and upper quadrant of the left breast in positron emission to-mography–computed tomography. She had impaired consciousness, her speech was dysarth-ric, orientation restricted, muscular strength and sensory examination was natural, and there was no pathological reflex. Cranial magnetic resonance imaging revealed a T2 and FLAIR hyperintense lesion at the pons level, which did not correspond to apparent diffusion coeffi-cient, and had an expansile feature that restricted the diffusion. In the tru-cut biopsy of the breast associated mass, CD20 (+), PAX5 (+), CD3 (-), CD5 (-) large b-cell lymphoma infiltra-tion was observed. The patient's need for transfusion regressed after a course of R-CHOP and MTX treatment. The patient's neurological symptoms and radiological findings improved and regressed completely after one course of therapy. This patient makes a significant contribution to the literature in terms of referring with neurological symptoms, getting a diagnosis of DLBCL from the breast associated mass during the investigation of autoimmune hemolytic anemia etiology and treatment preference.