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Öğe Advanced Hepatocellular Cancer Treated with Sorafenib and Novel Inflammatory Markers(Springer, 2023) Gulmez, Ahmet; Harputluoglu, HakanObjective Hepatocellular cancer (HCC) is an aggressive tumor with an increasing incidence in recent years. Life expectancy is limited, especially due to limited effective treatments and tumor biology. In this study, we aimed to examine the effect of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), prognostic nutritional index (PNI) parameters of treatment efficacy of patients using sorafenib in primary systemic therapy, progression-free survival (PFS), and overall survival (OS). Materials and Methods In this study, we retrospectively analyzed 78 patients who used sorafenib as a first-line systemic treatment. NLR, PLR, and PNI values were calculated with the existing formulas. Cut-off values for these markers were determined by performing ROC curve analysis. These values were determined respectively as 2.88, 111.05, and 38.25. Patients were divided into two groups according to this threshold value. OS and PFS values were calculated using a Cox proportional risk model. The effects of markers on OS and PFS were examined based on the cut-off value. Results The mean PFS was 7.1 (range 1-46) months, and the mean OS was 14.1 (range 1.5-94) months. The pre-treatment decreased NLR (< 2.88) value was prognostic for higher PFS and OS rates. These values were determined respectively as 9.23 +/- 1.79 and 3.45 +/- 0.32 months for PFS and 21.17 +/- 4.53 and 5.32 +/- 0.53 months for OS. Pre-treatment decreased PLR (< 111.05) was found to be a positively significant prognostic value for both survival. These values were determined respectively as 7.37 +/- 1.43 months and 3.16 +/- 0.47 months for PFS and 21.12 +/- 5.52 months and 6.16 +/- 0.87 months for OS. And also, low PNI (< 38.25) value was prognostic for lower PFS and rates. These values were determined respectively as 7.47 +/- 0.59 months and 3.25 +/- 0.21 months for PFS and 16.36 +/- 4.37 months and 5.15 +/- 0.42 for OS. All three parameters were found to be statistically significant (p < 0.05) for both OS and PFS as independent prognostic markers. Conclusion Today, as the standard first-line treatment of HCC has shifted to combinations with immunotherapy (IO), IO transportation is not possible in most countries of the world. However, there are also patients who achieve great survival with only sorafenib. The important point is to identify the biomarkers that predict which patient will benefit better from which treatment. With the markers in our study and a scoring system that can be obtained with these markers, it can be evaluated which patient will be given IO combination and which patient will be given only TKI treatment. We think that such a scoring system can be used to identify suitable patients, especially in countries where, for financial reasons, not every patient can access Immunotherapy. The advantage of these tests is that they are inexpensive, easily calculable and standardized.Öğe Breast cancer subtypes and the risk of distant relapse after breast conserving surgery or mastectomy: An Anatolian Society of Medical Oncology study.(Amer Soc Clinical Oncology, 2015) Kaplan, Muhammet Ali; Urakci, Zuhat; Uncu, Dogan; Dane, Faysal; Ozkan, Metin; Akman, Tulay; Harputluoglu, Hakan[Abstract Not Available]Öğe Does the tumor necrosis factor a predictor factor in patients with chronic hepatitis B and C(Allied Acad, 2017) Bilgic, Yilmaz; Seckin, Yuksel; Cagin, Yasir Furkan; Yildirim, Oguzhan; Yilmaz, Cengiz; Harputluoglu, Murat; Harputluoglu, HakanAim: In our research, we aimed to investigate the importance and pattern of Tumor Necrosis Factor (TNF) alpha in response to the combinatorial treatment of lamuvidin (LAM) and Pegile interferon (PEG INF) 2a + Ribavirin (RIB) in patients with Chronic Hepatitis B (CHB) and Chronic Hepatitis C (CHC). Material and method: Thirty four CHB and 25 CHC patient samples were taken before and after the treatment and stored appropriately. CHB patients were treated with LAM and CHC patients were treated with using the combination of PEG INF 2a and RIB. HBV DNA, anti HBe, ALT, AST and TNF alpha results were obtained from CHB patients before and 48th week of the treatment. HCV RNA, ALT, AST and TNF alpha results were also obtained from CHC patients before and in the 6th month of completing the treatment. Responses to the treatment were taken as negative result of HBV DNA in CHB patients after finishing the treatment and as negative result of HCV RNA in CHC patients after 6 months of finishing the 48 weeks of PEG INF treatment. Results: At the level of decreasing TNF-alpha in CHB patients when the group responding to the treatment compared to the group not responding to the treatment, a significant difference was observed in favor of the respondent group (p< 0.0001). At the level of decreasing TNF-alpha in CHC patients when the group responding to the treatment compared to the group not responding to the treatment, a significant difference was also obtained in favor of the respondent group (p< 0.0001). In the analysis for emphasizing the importance of TNF alpha level in response to the treatment in CHB patients, it was found that predicting the response to the treatment of TNF alpha was 78.6% sensitivity and 75% specificity for 68.78 cutoff. In the analysis for emphasizing the importance of TNF alpha level in response to the treatment in CHC patients, it was found that determining the response of TNF alpha to the treatment was 100% sensitivity and 100% specificity for 122.4 cutoff. Conclusions: With the treatment a decrease in TNF alpha is occured in CHB and CHC patients; however, TNF alpha decrease in the groups responding to the treatment is more significant. The results of this research show that TNF alpha level may be an important non-invasive marker for foresight and determining the response to the treatment.Öğe Drug induced autoimmune hepatitis: a single center experience.(Allied Acad, 2017) Bilgic, Yilmaz; Harputluoglu, Hakan; Yilmaz, Cengiz; Karadag, Nese; Cagin, Yasir Furkan; Akbulut, Sami; Seckin, YukselObjective: Many drugs such as minocycline, nitrofurantoin, halothane, non-steroidal anti-inflammatory drugs, anti TNF (Tumor Necrosis Factor) antagonists can induce the autoimmune hepatitis. Herein, we aimed to assess patients suffering from drug induced autoimmune hepatitis who were hospitalized with acute hepatitis like transaminase elevations to our clinic between 2009-2015. Method: The patients were determined using simplified diagnostic criteria of the International Autoimmune Hepatitis Group. Results: We determined 9 patients whose score were compatible with the diagnosis of Autoimmune hepatitis (AIH). Three patients were older than 50, and six patients were between 19 and 31. Seven of nine patients were female. The drugs thought responsible for AIH were as follows; ciprofloxacin alone, amoxicillin plus nimesulid, amoxicillin plus ornidazole, amoxicillin alone, a combined oral contraceptive pill plus a mixture of natural drugs, metronidazole plus dexketoprofen, ramipril plus metronidazole, levofloxacin alone and venlafaxine plus mianserin for each case. Five of nine patients had been followed up conservatively upon discontinuation of drug(s) and did not need any treatment during hospitalization and resolved spontaneously. Four patients received immunosuppressive treatment which was withdrawn in 3 of those 4 patients after 3 to 6 months upon remission without relapse. Conclusion: Drug induced autoimmune hepatitis (DIAIH) can be presented with acute hepatitis of unknown etiology. Female sex seems to be a risk factor for DIAH. Treatment decisions should be given according to patient's clinical status and follow up at acute presentations. There can be no treatment need, but, when needed generally a short course of immunosuppressive treatment can be sufficient.Öğe THE EFFECT OF FRONT-LINE CHEMOTHERAPY ON OVERALL SURVIVAL IN PATIENTS WITH MALIGNANT PLEURAL MESOTHELIOMA.(Lippincott Williams & Wilkins, 2013) Sevinc, Alper; Elkiran, Emin T.; Harputluoglu, Hakan[Abstract Not Available]Öğe The effect of front-line chemotherapy on overall survival in patients with malignant pleural mesothelioma.(Lippincott Williams & Wilkins, 2013) Elkiran, Emin Tamer; Sevinc, Alper; Harputluoglu, Hakan[Abstract Not Available]Öğe Estimation of risk factors associated with colorectal cancer: an application of knowledge discovery in databases(Academic Publication Council, 2016) Firat, Feyza; Arslan, Ahmet K.; Colak, Cemil; Harputluoglu, HakanColorectal cancer is one of the first reasons for death due to cancer in the world. The goal of this study is to predict important risk factors of colorectal cancer (CRC) by knowledge discovery in databases (KDD) methods. This study comprised a retrospective CRC data of patients who had been diagnosed with colorectal cancer. The selected records between 1 January 2010 and 1 March 2014 were collected randomly from Turgut Ozal Medical Centre databases. The study included 160 individuals: 80 patients admitted to Department of Oncology and diagnosed with CRC, and 80 control subjects with non-CRC categorization. The groups were matched for age and gender. We mined retrospective CRC data from large integrated health systems with electronic health records. Specific demographical and clinical variables including calcium, hemoglobin, white blood cells, platelets, potassium, sodium, glucose, creatinine and total bilirubin were used in multilayer perceptron (MLP) artificial neural networks (ANN) modeling. In this study, patient and control groups consist of 160 individuals. In each group, 45 of these (56.3%) are male, and 35 (43.7%) are women. Mean age of CRC patients and control groups is 58.6 +/- 13.0. While the accuracy was 71.31% in training dataset (n=122), the accuracy was 81.82% in testing dataset. Area under curve (AUC) values of training and testing datasets were 0.73 and 0.81, respectively. The suggested MLP ANN model identified significant factors of calcium, creatinine, potassium, platelets, sodium, hemoglobin and total bilirubin. Taken together, the suggested MLP ANN model might be used for the estimation of risk factors associated with CRC as an application of medical KDD.Öğe Factors Affecting Survival in Non-Small Cell Lung Cancer Patients with Brain Metastasis(Akad Doktorlar Yayinevi, 2016) Harputluoglu, Hakan; Kaplan, Nihal; Dikilitas, Mustafa; Yagar, YavuzIn this study, prognostic factors in non small cell lung cancer (NSCLC) patients with brain metastasis, and relation between brain metastasis location and survival were investigated. 103 NSCLC patients with brain metastasis were enrolled in this study. Demographic, clinical characteristics and treatment modalities of the patients who were followed up in medical oncology department between May 2009 and February 2015 were assessed retrospectively using the hospital database. Brain metastasis location, treatment of brain metastasis, systemic treatment after brain metastasis and survival of the patients were recorded. The relation between these factors and survival was assessed. Follow-up period of the patients was between one and 42 months. Mean survival of the patients after brain metastasis diagnosis was 7.2 months. In the single variant analyses; patient age below 65, good performance status, detection of brain metastasis during initial diagnosis and receiving systemic treatment after brain metastasis were found to be positive prognostic factors. In the multivariant analyses; while combined treatment of brain metastasis with surgery and radiotherapy and systemic therapy after brain metastasis were found to be independent prognostic factors, no relation between location of brain metastasis and survival was found. In this study, systemic therapy including surgery, radiotherapy and chemotherapy was found as independent prognostic factors in selected patients who had NSCLC with brain metastasis. We think that defining prognostic factors in lung cancer patients with brain metastasis is important for both estimating prognosis and selecting optimal therapy for the patient.Öğe Frequency and risk factors of potential drug interactions in breast cancer patients.(Lippincott Williams & Wilkins, 2014) Acar, Fatma; Dursun, Brahim Hakki; Harputluoglu, Hakan; Yigit, Ali; Kilic, Mehmet Salih; Elkiran, Emin Tamer[Abstract Not Available]Öğe Is excision repair cross-complementation Group1 expression a biological marker in nasopharynx carcinoma(Wolters Kluwer Medknow Publications, 2019) Aksoy, Asude; Elkiran, Emin Tamer; Harputluoglu, Hakan; Dagli, Adile Ferda; Isikdogan, Abdurrahman; Urakci, ZuhatObjective: To determine the prognostic value of excision repairs cross-complementation group1 (ERCC1) gene in cases with nasopharyngeal carcinoma (NPC) treated with platinum-containing chemotherapy (PCT). Subjects and Methods: The present study was included 33 cases in local advanced stage with NPC. ERCC1 expression was evaluated by using immunohistochemical staining in biopsy specimens. We evaluated the relationship between the degree of ERCC1 expression and clinicopathological features, response to therapy, survival rates in cases with NPC, retrospectively. Results: ERCC1 expression was not observed in 5 (15.15%) of all cases. Thirteen (39.9%) cases weakly positive (+1, +2) and 15 (45.5%) cases of all them were rather strongly positive (+3). There was no statistically significant difference between the degree of ERCC1 expression and clinicopathological features, response to treatment, survival rates (P 0.05) in cases with NPC. Conclusions: ERCC1 expression has no predictive value for survival in cases locally advanced stage with NPC. Evaluation of ERCC1 expression is not appropriate with a biomarker to detect cases who can benefit from PCT in NPC.Öğe Multicentric study on malignant pleural mesothelioma in Turkey: clinicopathologic and survival characteristics of 282 patients(Humana Press Inc, 2012) Elkiran, Emin Tamer; Kaplan, Mehmet Ali; Sevinc, Alper; Aksoy, Sercan; Demirci, Umut; Seker, Mesut; Harputluoglu, HakanMalignant pleural mesothelioma (MPM) is a relatively rare, but aggressive tumor that causes high mortality. The major risk factor involved in the etiology is environmental and occupational exposure to asbestos. The optimal modality of therapy is controversial. The present study retrospectively evaluated the data pertinent to 282 patients who were examined and treated in 11 different medical oncology centers in Turkey. There were 161 males (57.1 %) and 121 females (42.9 %), with a mean age of 56.38 +/- A 12.07 years. Surgery was used in 74 patients, 21 patients (28.4 %) received only chemotherapy and 28 patients (37.8 %) received chemoradiotherapy after surgery. The median survival in patients who were administered adjuvant therapy after surgery was 24 months, while the median survival in patients who had only surgery was 6 months (p = 0.029). 106 patients were administered pemetrexed-platinum combination and 35 patients were administered gemcitabine-platinum combination as front-line chemotherapy. Median survival, 1- and 2-year survival rates in patients who received platinum analogues and pemetrexed or gemcitabine combinations were found statistically similar (p = 0.15). The median survival for all patients with MPM in our study was 18 months. The main factors influencing the overall survival were stage of the disease (p = 0.020), performance status (p < 0.001), asbestos exposure (p = 0.030) and mesothelioma histological subtypes (p < 0.001). Results of our study suggest that multi-modality treatment regimens consisting of surgery, radiotherapy and chemotherapy prolong overall survival. Survival rates in patients who received combining platinum analogues with pemetrexed or gemcitabine as front-line chemotherapy were found similar.Öğe POSTERIOR REVERSIBLE LEUKOENCEPHALOPATHY SYNDROME DEVELOPING SECONDARY TO SUNITINIB THERAPY IN A PATIENT WITH METASTATIC RENAL CELL CARCINOMA(Carbone Editore, 2018) Kaplan, Nihal Bozdag; Harputluoglu, Hakan; Dikilitas, Mustafa; Elkiran, Emin Tamer; Temelli, OztunPosterior reversible encephalopathy syndrome (PRES) is characterized by vasogenic edema occurring generally in parietal and occipital areas of the brain as a result of different etiologic causes and it is diagnosed by means of clinical and radiologic assessment. Sunitinib is an orally administered tyrosine kinase inhibitor used in the treatment of renal cell carcinoma with its antiangiogenic and antitumor effects. Fatigue, nausea-vomiting, diarrhea, hypertension, cardiotoxicity, hypothyroidism, neutropenia, and skin toxicity are among common side effects associated with sunitinib therapy. The current report presents a female patient with metastatic papillary renal cell cancer who developed posterior reversible encephalopathy syndrome as determined by means of clinical and radiologic assessment at 8 months of sunitinib therapy and who completely recovered with antihypertensive, antiepileptic, and antiedema therapy.Öğe Posterıor reversıble leukoencephalopathy syndrome developıng secondary tosunıtınıb therapy ın a patıent wıth metastatıc renal cell carcınoma(Carbone edıtore, vıa quıntıno sella, 68, palermo, 90139, ıtaly, 2018) Kaplan, Nihal Bozdag; Harputluoglu, Hakan; Dikilitas, Mustafa; Elkiran, Emin Tamer; Temelli, OztunPosterior reversible encephalopathy syndrome (PRES) is characterized by vasogenic edema occurring generally in parietal and occipital areas of the brain as a result of different etiologic causes and it is diagnosed by means of clinical and radiologic assessment. Sunitinib is an orally administered tyrosine kinase inhibitor used in the treatment of renal cell carcinoma with its antiangiogenic and antitumor effects. Fatigue, nausea-vomiting, diarrhea, hypertension, cardiotoxicity, hypothyroidism, neutropenia, and skin toxicity are among common side effects associated with sunitinib therapy. The current report presents a female patient with metastatic papillary renal cell cancer who developed posterior reversible encephalopathy syndrome as determined by means of clinical and radiologic assessment at 8 months of sunitinib therapy and who completely recovered with antihypertensive, antiepileptic, and antiedema therapy.Öğe A rare granular cell tumor of the vulva: a case report(Kare Publ, 2015) Bozdag Kaplan, Nihal; Dursun, Ibrahim Hakki; Dikilitas, Mustafa; Harputluoglu, Hakan; Yilmaz, Ercan; Sahin, NurhanGranular cell tumors are rare tumors, usually located subcutanesously or intramucosal. Most frequent presentation is in the head and neck region especially in the tongue, 5-15% of the cases are vulvar. Originating from Scwhan cells, these tumors are usually benign and only 1-3% of the cases have malign behaviour. As these tumors have an agressive course and do not respond to chemo-radiation, to mention the importance of early diagnosis we present this case.