No abstract

We aimed to investigate the prognostic significance of neutrophil, lymphocyte, platelet, mean platelet value (MPV), platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) in patients with locally advanced gastric cancer (LAGC). One hundred sixty-eight patients with LAGC who had been followed-up between 2004 and 2008 were included in present study. The results of hematological (platelet, lymphocyte, neutrophil and MPV) and biochemical (uric acid and LDH) parameters were evaluated before treatment. NLR was divided into two groups as <2.56 and ≥2.57 and PLR was also divided into two groups as ≤160 and >160. Platelet counts and lymphocyte counts were also divided into two groups; ≤300.000/mm3 and >300.000/mm3, and <1,500/mm3 and ≥1,500/mm3, respectively. Results were evaluated with Kaplan-Meier and Long-rank tests. The mean age of patients at diagnosis was 60.1±12.1 and 114 of patients (67.8%) were male. For 168 patients, 48 months overall survival (OS) rate was 45.2% and the median OS was 39 months (range 33-44). In patients whose PLR was less than 160 (n=54), the median OS was 45 months (range 38-52) and also for cases whose PRL was greater than 160 (n=114), the median OS was 27 months (range 22-32) (p=0.006). While for fifty patients whose lymphocyte counts were less than 1,500, the median OS was 27 months (range 21-33), in cases with high lymphocyte counts (≥1,500) (n=118), it was 41 months (range 35-48) (p=0.03). The median OS was 41 (range 34-48) and 30 (range 23-37) months in two platelets groups, respectively (p=0.24). However, in the patients whose NLR was less than 2.56 (n=107), median OS was better than with cases whose NLR was greater than or equal to 2.56 (42 vs. 27 months). Routine peripheral blood counts may be useful prognostic factor for evaluating the accuracy of risk stratification in patients with radically resected gastric cancer Our results need to be confirmed by study including larger sample size in future.

Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.

BackgroundLocally advanced colorectal cancers are best treated with multivisceral resections. The aim of this study is to evaluate early and late results after multivisceral resections.MethodsAll patients operated for primary colorectal cancer between 2001 and 2010 were -reviewed. These were compared within the patients underwent single organ and multivisceral resections: demographics, tumor and procedure related parameters, perioperative results, early oncological outcomes and 5-year survival.ResultsA total of 354 patients (59.6 ± 13.8 years old, 210 [59.3%] males) were abstracted. Ninety (25.4%) patients underwent multivisceral resections for clinical T4 tumors and en-bloc R0 resection was achieved in 82 (91.1%). Only 31 (34.4% and 8.8% of clinical T4 and all cancers, respectively) cases had actual adjacent organ invasions (pT4). Males (20%) had lower risk for locally advanced tumors than females (33.3%) (p < 0.05). PT4 cancers were more common, if the clinical T4 tumor is located in the colon (48.8% vs 21.3%; p < 0.01). Laparoscopy was seldom initiated and the risk of conversion was higher in clinical T4 tumors (p < 0.05). The rates of sphincter-saving procedures were not different. Operation time, bleeding and transfusion requirements increased when multivisceral resections were necessitated (p < 0.05), but hospital stay, complications and 30-day mortality rates were similar. The 5-year survival rates were identical (p > 0.05).ConclusionsClinical T4 tumors are not rare and more common in women. An actual invasion (pT4) may be observed in one third of all clinical T4 tumors, and more frequent in colon cancers. An en-bloc, R0, multivisceral resection may be achieved in most cases. Multivisceral resections do not alter the rates of sphincter-saving procedures, morbidity and 30-day mortality; do not worsen survival but increase operation time, intraoperative bleeding and perioperative transfusion requirements.

Diagnosis of CRC should not be excluded solely on the basis of age. CRC features in young-adult patients are more similar to adults compared with that of child-adolescent patients according to the symptoms and presentation. In patients with CRC in this age group, curative surgery, adjuvant chemotherapy, and palliative chemotherapy provide survival advantage.

FDG PET/CT is a superior post-therapy surveillance modality for the diagnosis of recurrent gastric cancer compared with diagnostic CT imaging after initial surgery. In addition, integrated FDG PET/CT was specifically helpful in optimizing the treatment plan and it might play an important role in treatment stratification in the future.

Because the mechanisms of 5-Fluorouracil (5-FU) cardiotoxicity have not yet been completely identified, prophylactic options are not available. To our knowledge, there are no published data investigating the use of angiotensin converting enzyme (ACE) inhibitors for 5-Fluorouracil-associated cardiotoxicity. In this study, we aimed to evaluate the influence of 5-FU administration on the diameter of the brachial artery and the levels of angiotensin II. The patients were administered bolus 5-FU/leucovorin in the study group. Angiotensin II and troponin T assays, complete blood cell counts, hepatic and renal function tests were analyzed in five consecutive blood samples in the initiation, just after termination, and on 24, 48, and 72 h after termination of the regimen. Pre- and post-treatment angiotensin II and troponin T assays, complete blood cell counts, hepatic and renal function tests were also analyzed in the control group. Brachial arterial diameters were measured and recorded in all patients before and after the treatment. A total of 59 patients were included in this study. Thirty one out of 59 patients (52.5%) were in the 5-FU study group and the remaining 28 patients (47.5%) were in the control group. Basal and post-treatment brachial artery diameters in the 5-FU study group were 0.436 +/- 0.51 and 0.423 +/- 0.50 cm, respectively (P = 0.001). The corresponding values in the controls were 0.3954 +/- 0.50 and 0.3957 +/- 0.49 cm, basal and post-treatment, respectively (P = 0.979). Angiotensin II levels were not changed significantly at serial measurements (P = 0.496). Moreover, the corresponding measurements were not statistically different in both two groups treated with and without 5-FU (P = 0.372). The pathophysiology of 5-FU-induced cardiac toxicity has not yet been elucidated. In the present study, 5-FU-associated vasoconstriction was not dependent on angiotensin II levels, thus we suggest that the prophylactic administration of ACE inhibitors cannot prevent cardiotoxicity in these patients. The underlying mechanisms of cardiotoxicity related to 5-FU might be multifactorial; nevertheless, further prospective investigation for the toxic effects of fluoropyrimidines on the coronary endothelium and myocardium are needed.

Background: Breast cancer is the most common cancer in women. Primary treatment is surgery, with breast conserving surgery (BCS) being widely used for early-stage disease. Due to changes in body image, depressive symptoms can occur after surgery. Here, we evaluate factors that affect patients’ decision on surgery, and investigate differences in the level of depression after mastectomy or BCS in a population of Turkish patients. Patients and Methods: One hundred breast cancer patients who had undergone mastectomy or BCS and were followed up at our institution between 2007 and 2008 were included. Patients were questioned about their involvement in surgical decision-making. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria via a Structural Clinical Interview for DSM (SCID). Severity of depression was evaluated by using the Beck Depression Inventory (BDI). Results: Patients who were older than 50 years, had more than 1 child, a history of lactation, and a positive family history of breast cancer mostly preferred mastectomy. However, patients who sought a second opinion and further information on BCS preferred BCS (p < 0.005). There was no statistical correlation between marital status, first childbearing age, and educational status and the decision on surgery type (p > 0.005). Mastectomy patients were prone to depression, but this was not statistically significant (p = 0.099). Conclusion: Age, parenthood, lactation, and positive familial history, as well as thorough information about the type of surgery were important factors for the patients’ decision. After breast cancer surgery, patients might experience depression affecting treatment and quality of life. Therefore, adequate information and communication are essential.