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    The effect of performance score, prognostic nutritional index, serum neutrophil-to-lymphocyte ratio, and thrombocyte-to-lymphocyte ratio on prognosis in non-small cell lung cancer
    (MARMARA UNIV, 2022) Tuna, Tibel; Kemal, Yasemin; Güllü, Yusuf Taha; Köksal, Nurhan; Ala, Selen
    Objective: Systemic inflammatory markers and nutritional status of the patients can be helpful both in identifying high-risk cancer patients and in showing the prognosis of the disease. In this study we aimed to determine the effects of nutritional status and systemic inflammatory markers on prognosis in non-small cell lung cancer. Patients and Methods: Patients diagnosed with non-small cell lung cancer between 2015 and 2019 were analyzed retrospectively. The prognostic nutritional index (PNI), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio(NLR) were calculated and Eastern Cooperative Oncology Group performance status (ECOG PS), and the dates of death or last follow-up were recorded. Cox regression analysis and Kaplan-Meier curves were used to analyze the effects of parameters on survival. Results: In the study, a total of 219 patients were analyzed. 85.4% of the patients had died. At the third step Cox regression model, ECOG 3-4 (HR:2.18), PLR (HR:1.20) and PNI (HR:1.12) predicted the survival times. Patients with PNI>45 had a higher median survival (495 days) than patients with PNI<45 (314 days). Conclusion: In order to determine the prognosis of the patients at the time of diagnosis, it is recommended to use PNI and PLR values, which can he obtained through repeated tests and evaluated at low cost, together with performance scores.
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    Family physicians' awareness of skin cancer and sun protection practices
    (2021) Nilden Arslan, Hatice; Kemal, Yasemin
    Objective: The objective of this study was to determine the knowledge level of family physicians about skin cancer and their attitudes and behaviors about sun protection. Methods: The sample of this study was composed of 295 family physicians who worked in Samsun province and participated in in-service trainings organized by the Provincial Health Directorate in March 2019. A questionnaire form consisting of questions on sociodemographic characteristics, attitudes and behaviors about sun protection was applied to the participants. Result: A total of 295 family physicians, 64.7% male and 35.3% female, participated in the study. Most of the physicians (87.8%) expressed that they tried to protect from sunlight. Women (68.3%) used sunscreen lotions/creams more frequently than men (41.4%). Those who had 2 and more severe sunburns throughout their lifetime (51.5%) stated that they described themselves at higher risk than those who did not (36.2%) which was statistically significant (p<0.05). The reasons of the physicians for application to a dermatologist were: 47(15.9%) had asymmetrically shaped, irregularly structured moles larger than 5 mm, 37(12.5%) had suspected presence of moles, 11(3.7%) wanted whole body examination for moles, 20(6.8%) requested advice on daily skin care and prevention of skin aging. Conclusion: Awareness studies should be carried out on the harmful effects of the sun and early diagnosis of skin cancer especially for family physicians, healthcare professionals and other parts of the society. In addition, considering that visual evaluation has a role in the diagnosis of skin cancer, it will be useful for family physicians to inform their patients about the detrimental effects of the sun and self-skin examination.
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    PD-L1 expression in medullary thyroid carcinoma and its association with clinicopathological findings
    (Turkish Journal of Pathology, 2021) Kemal, Yasemin; Çalışkan, Sultan; Gün, Seda; Kefeli, Mehmet
    Objective: Medullary thyroid carcinoma (MTC) is a rare tumor originating from parafollicular C cells. It has more aggressive biologic behavior than differentiated thyroid carcinomas, and it is insensitive to treatment with radioactive iodine. Vandetanib and cabozantinib are the newly approved tyrosine kinase inhibitors in advanced stages, but novel effective systemic therapeutics could be crucial and needed for the clinical management of these patients. We aimed to evaluate the Programmed death-ligand 1 (PD-L1) expression, which is a novel immunotherapy target, in our MTC cohort, and determine whether it has an association with clinical and pathological features. Material and method: This retrospective study involved 41 cases of MTC with a median follow-up of 54 months. PD-L1 monoclonal antibody (SP263 clone) was investigated immunohistochemically. Complete and/or partial membranous staining pattern in more than 1% of tumor cells was considered positive. The correlations of PD-L1 expression with clinicopathologic and prognostic features were analyzed. Results: PD-L1 positivity was detected in 5 (12.2%) of 41 tumors. The extent of PD-L1 staining was low ( < 5%) for all tumors. There was no clinicopathologic and prognostic relevance regarding PD-L1 expression in our MTC patients. Conclusion: Although PD-L1 expression could be a potential biomarker to predict the prognosis of various cancers and response to checkpoint inhibitors, we did not find any significant correlation between PD-L1 expression and clinicopathologic features in our cases. Studies with larger patient numbers are still required to perform a more comprehensive analysis.
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    Pre-treatment and post-treatment neutrophil-to-lymphocyte ratio predict pathological tumor response and survival in rectal cancer patients treated with neoadjuvant chemoradiotherapy
    (KARE PUBL, 2022) Delikgöz Soykut, Ela; Kemal, Yasemin; Odabaşı, Eylem; Şahin, Nilgün; Keskinkılıç Yağız, Betül
    OBJECTIVE The aim of this study is to investigate the relationship between baseline and post-treatment neutrophil-to-lymphocyte ratio (NLR) levels and response to neoadjuvant chemoradiotherapy (CRT) in terms of good pathological response and survival. METHODS Fifty-six patients who underwent neoadjuvant CRT and curative surgery for locally advanced rectal cancer (LARC) were analyzed retrospectively. Pre-CRT and post-CRT hematologic parameters were recorded. The link between NLR and clinical outcomes was explored. RESULTS The receiver operating characteristic analysis revealed appropriate cut-off values of 2.87 for pre-CRT NLR associated with good pathological response and 8.68 for post-CRT NLR predicting survival. The low pre-CRT NLR group had better outcomes in terms of good pathological response compared to the high pre-CRT NLA group (OR 4.15, 95% CI 1.23-13.76, p=0.021). However, the analysis failed to show the correlation between NLR and pCR (OR 2.74, 95% CI 0.37-20.15, p=0.320). Patients with elevated post-CRT NLR had significantly worse 5-year overall survival (OS), disease-free survival (DFS) and local regional recurrence-free survival (LRRFS) rates compared to low post-CRT NLR in multivariate analysis (46.6% vs. 74.4%, p=0.020; 35.3% vs. 71.9%, p=0.018; 40.8% vs. 78.1%, p=0.006). CONCLUSION High pre-CRT NLR might be used as a poor pathological tumor response predictor in LARC patients treated with neoadjuvant CRT. In addition, low post-CRT NLR is associated with favorable OS, DFS, and LRRFS. Therefore, easily accessible and cost-effective NLR can be considered as a potential predictive marker to identify patients and establish personalized treatment strategies.
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    Prognostic impact of immune inflammation biomarkers in predicting survival and radiosensitivity in patients with non-small-cell lung cancer treated with chemoradiotherapy
    (WILEY, 2021) Delikgöz Soykut, Ela; Kemal, Yasemin; Karacin, Cengiz; Karaoğlanoğlu, Özden; Kurt, Mümin; Aytaç Arslan, Süheyla
    Introduction: The purpose of this retrospective study was to investigate the prognostic impact of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), derived NLR (dNLR) and systemic immune-inflammation index (SII) in predicting outcomes for patients with locally advanced non-small-cell lung cancer (NSCLC). The secondary endpoint was to evaluate the radiosensitivity in terms of response rate. Methods: Newly diagnosed locally advanced NSCLC patients were enrolled. Immune inflammation biomarkers were calculated from baseline blood samples. Patients were stratified in two groups based on optimal cut-off values for each biomarker. The associations between biomarkers and overall survival (OS), progression-free survival (PFS), local regional recurrence-free survival (LRRFS), and also response to radiotherapy were analysed. Results: A total of 392 patients were included. Five-year OS, PFS and LRRFS rates were 14.6%, 12.1%, and 13.4% respectively. Optimal cut-off values for NLR, PLR, dNLR and SII were 3.07, 166, 2.02 and 817 respectively. Low NLR (HR 1.73, 95% CI 1.34-2.24, P < 0.001), low PLR (HR 1.37, 95% CI 1.06-1.76, P = 0.013), low dNLR (HR 1.66, 95% CI 1.29-2.13, P < 0.001) and low SII (HR 1.63, 95% CI 1.18-2.04, P < 0.001) were independent prognostic factors for OS. Low NLR, PLR, dNLR and SII were also significant prognostic factors for PFS and LRRFS. Low NLR, low dNLR and low SII groups had better radiosensitivity than compared with high NLR, high dNLR and high SII groups (P = 0.001, P = 0.001 and P = 0.012). Conclusion: NLR, PLR, dNLR and SII were independently associated with improved OS, PFS and LRRFS. Low NLR, dNLR and SII groups had better radiosensitivity. Immune inflammation biomarkers are promising prognostic predictors which can be obtained easily and inexpensively.
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    The association of anemia and high neutrophil-lymphocyte ratio with decreased survival in patients with laryngeal cancer treated with radiotherapy
    (MediHealth Academy Yayıncılık, 28 Temmuz 2023) Soykut, Ela Delikgöz; Kemal, Yasemin; Kaplan, Serkan; Karaçin, Cengiz; Odabaşı, Eylem; Unal, Asude; Er, Zehra; Arslan, Suheyla Aytaç; Guney, Yıldız
    Aims: We aimed to examine the prognostic value of inflammatory markers such as neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and anemia on oncological outcomes in patients with laryngeal squamous cell carcinomas (LSCC) treated with radiotherapy. Methods: 213 LSCC patients analyzed retrospectively. Inflammatory markers were established by examining blood samples taken within 7 days before treatment. Patients were categorized into two groups: low and high according to NLR, PLR, and SII threshold values. In addition, to evaluate the effect of hemoglobin (Hb) level, the threshold value of each inflammatory marker and Hb level were combined, and 3 groups were formed (3 groups for NLR, 3 groups for PLR, and 3 groups for SII). The relationship between inflammatory markers and overall survival (OS), disease-free survival (DFS), and local regional recurrence-free survival (LRRFS) was investigated. Results: In univariate analysis, high NLR, PLR, SII, and low Hb (<13 g/dl) level were associated with worse survival (all p<0.022), except for PLR and Hb for LRRFS. OS and DFS were significantly better in patients in each group A with a low inflammatory index and high Hb (all p<0.013). In the multivariate analysis, high NLR and group CNLR (high NLR with low Hb) were statistically significant predictors of decreased OS (HR 1.85, 95% CI 1.05-3.28, p=0.033; HR 2.61, 95% CI 1.14-5.97, p=0.022) and DFS (HR 1.81, 95% CI 1.11-2.96, p=0.017; HR 3.32, 95% CI 1.20-9.16, p=0.028). Conclusion: NLR may serve as a potential prognostic biomarker in LSCC, and its predictive ability is further enhanced when NLR is combined with Hb level.