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Öğe Merkel cell carcinoma in Turkey: A multicentric study(Wolters Kluwer Medknow Publications, 2021) Yıldız, Fatih; Demirci, Umut; Küçükarda, Ahmet; Büyükşimşek, Mahmut; Sakalar, Teoman; Öztürk Topçu, Türkan; Aslan, Ferit; Tufan, Gülnihal; Aydın, Övgü; Turna, Hande; Akgül Babacan, Nalan; Başoğlu, Tugba; Kurt, Bediz; Yıldız, Birol; Eren, Tülay; Demiray, Atike Gökçen; Gümüşay, Özge; Arslan, Çağatay; Özdemir, Nuriye; Ürün, Yüksel; Baykara, Meltem; Turan, Nedim; Uysal, Mükremin; Bilici, Ahmet; Kavgacı, Halil; Çiçin, İrfan; Kılıçkap, Saadettin; Paydaş, SemraBackground: Merkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine carcinoma of the skin. In this study, we aimed to evaluate the clinicopathologic characteristics, treatment outcomes, and survival of MCC cases in Turkey. Materials and methods: The patients diagnosed with MCC between 1999 and 2018 at twenty different centers in Turkey were included in the study. Patient and tumor characteristics and adjuvant and metastatis treatment outcomes were analyzed retrospectively. Results: The median age of totally 89 patients was 70 (26-93). The most common primary location was lower limbs (n = 29, 32.5%). Immunohistochemically, CK20 positivity was present in 59 patients (66.3%). Only two patients had secondary malignancy. The majority of the patients (n = 76, 85.4%) were diagnosed at the localized stage. Surgery was performed for all patients in the early stage, and adjuvant radiotherapy or/and chemotherapy was applied to 52.6% (n = 40) of nonmetastatic patients. The median follow-up was 29 months. Recurrence developed in 21 (27.6%) of the 76 patients who presented with local or regional disease. Two-year disease-free survival (DFS) was 68.1% and 5-year DFS was 62.0% for localized stage. The 5-year DFS was similar for patients receiving adjuvant treatment (chemotherapy, radiotherapy, or sequential chemoradiotherapy) and without adjuvant therapy (P > 0.05). Two-year overall survival in patients who presented with localized disease was 71.3% and 18.5% in metastatic patients (P < 0.001). In the metastatic stage, platinum/etoposide combination was the most preferred combination regimen. Median progression-free survival (PFS) in first-line chemotherapy was 7 months (95% confidence interval: 3.5-10.5 months; standart error: 1.78). Conclusions: Although MCC is rare in Turkey, the incidence is increasing. Gender, CK20 status, tumor size, lymph node involvement, and adjuvant treatment were not associated with recurrence.Öğe Outcomes of surveillance versus adjuvant chemotherapy for patients with stage IA and IB nonseminomatous testicular germ cell tumors(Springer, 2017) Gümüş, Mahmut; Bilici, Ahmet; Odabaş, Hatice; Öven Ustaalioğlu, Bala Başak; Kandemir, Nurten; Demirci, Umut; Cihan, Şener; Bayoğlu, İbrahim Vedat; Öztürk, Türkan; Türkmen, Esma; Urakçı, Zürat; Şeker, Mehmet Metin; Günaydın, Yusuf; Selçukbiricik, Fatih; Turan, Nedim; Sevinç, AlperBackground Currently, it is accepted that risk assessment of clinical stage I (CS I) nonseminomatous germ cell tumors (NSGCT) patient is mainly dependent on the presence of lymphovascular invasion (LVI). Initial active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection (RPLND) are acceptable treatment options for these patients, but there is no uniform consensus. The purpose of this study was to compare outcomes of active surveillance with adjuvant chemotherapy. Methods A total of 201 patients with CS I NSGCT after orchiectomy were included. Outcomes of active surveillance and adjuvant chemotherapy were retrospectively analyzed. The prognostic significance of risk factors for survival and relapse was evaluated. Results Of the 201 patients, 110 (54.7%) received adjuvant chemotherapy, while the remaining 91 patients (45.3%) underwent surveillance. Relapses were significantly higher for patients underwent surveillance compared to adjuvant chemotherapy group (18.3 vs. 1.2%, p < 0.001). The 5-year relapse-free survival (RFS) rate for patients who were treated with adjuvant chemotherapy was significantly better than those of patients underwent surveillance (97.6 vs. 80.8%, respectively; p < 0.001). Univariate analysis showed that the presence of LVI (p = 0.01) and treatment option (p < 0.001) were prognostic factors for RFS and pT stage (p = 0.004) and invasion of rete testis (p = 0.004) and the presence of relapse (p < 0.001) were significant prognostic factors for OS. Multivariate analysis revealed that the treatment strategy was an independent prognostic factor for RFS (p < 0.001, HR 0.54). A logistic regression analysis demonstrated that treatment options (p = 0.031), embryonal carcinoma (EC) > 50% (p = 0.013) and tumor diameter (p = 0.016) were found to be independent factors for predicting relapse. Conclusion Our results indicate that adjuvant chemotherapy is associated with improved RFS compared with surveillance for CS I NSGCT patients. Moreover, the treatment strategy is an important prognostic indicator for RFS and a predictive factor for relapse. Although adjuvant chemotherapy seems to be a suitable treatment for patients with risk factors for relapse, surveillance is still preferred management option.Öğe Outcomes of surveillance VS. adjuvant chemotherapy for patients with STAGE IA and IB NON-seminomatous testicular germ-cell tumors(American Society of Clinical Oncology, 2016) Bilici, Ahmet; Gümüş, Mahmut; Odabaş, Hatice; Kandemir, Nurten; Demirci, Umut; Cihan, Şener; Bayoğlu, İbrahim Vedat; Öven Ustaalıoğlu, Bala Başak; Öztürk, Türkan; Türkmen, Esma; Urakçı, Zuhat; Şeker, Mehmet Metin; Günaydın, Yusuf; Selçukbiricik, Fatih; Turan, Nedim; Sevinç, Alper[Abstract Not Available]Öğe Prognostic factors for lymph node negative stage I and IIA non-small cell lung cancer: Multicenter experiences(Asian Pacific Organization for Cancer Prevention, 2013) Ustaalioğlu Öven, Başak Bala; Ünal, Olçun Ümit; Turan, Nedim; Bilici, Ahmet Erkan; Kaya, Serap; Eren, Tülay; Ulaş, Arife; İnal, Ali; Berk, Veli; Demirci, Umut; Alıcı, Süleyman; Bal, Öznur; Benekli, Mustafa; Gümüş, MahmutSurgery is the only curative treatment for operable non-small lung cancer (NSCLC) and the importance of adjuvant chemotherapy for stage IB patients is unclear. Herein, we evaluated prognostic factors for survival and factors related with adjuvant treatment decisions for stage I and IIA NSCLC patients without lymph node metastasis. Materials and Methods: We retrospectively analyzed 302 patients who had undergone curative surgery for prognostic factors regarding survival and clinicopathological factors related to adjuvant chemotherapy. Results: Nearly 90% of the patients underwent lobectomy or pneumonectomy with mediastinal lymph node resection. For the others, wedge resection were performed. The patients were diagnosed as stage IA in 35%, IB in 49% and IIA in 17%. Histopathological type (p=0.02), tumor diameter (p=0.01) and stage (p<0.001) were found to be related to adjuvant chemotherapy decisions, while operation type, lypmhovascular invasion (LVI), grade and the presence of recurrence were important factors in predicting overall survival (OS), and operation type, tumor size greater than 4 cm, T stage, LVI, and visceral pleural invasion were related with disease free survival (DFS). Multivariate analysis showed operation type (p<0.001, hazard ratio (HR):1.91) and the presence of recurrence (p<0.001, HR:0.007) were independent prognostic factors for OS, as well visceral pleural invasion (p=0.01, HR:0.57) and LVI (p=0.004, HR:0.57) for DFS. Conclusions: Although adjuvant chemotherapy is standard for early stage lymph node positive NSCLC, it has less clear importance in stage I and IIA patients without lymph node metastasis.
