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Balıkesir, Turkey

Ulas A.,Ankara Ataturk Training and Research Hospital | Turkoz F.P.,Ankara Oncology Teaching and Research Hospital | Silay K.,Yildirim Beyazit University | Tokluoglu S.,Ankara Oncology Teaching and Research Hospital | And 3 more authors.
PLoS ONE | Year: 2014

Purpose: We aimed to establish a laboratory prognostic index (LPI) in advanced non-small cell lung cancer (NSCLC) patients based on hematologic and biochemical parameters and to analyze the predictive value of LPI on NSCLC survival. Copyright:Patients and Methods: The study retrospectively reviewed 462 patients with advanced NSCLC diagnosed between 2000 and 2010 in a single institution. We developed an LPI that included serum levels of white blood cells (WBC), lactate dehydrogenase (LDH), albumin, calcium, and alkaline phosphatase (ALP), based on the results of a Cox regression analysis. The patients were classified into 3 LPI groups as follows: LPI 0: normal; LPI 1: one abnormal laboratory finding; and LPI 2: at least 2 abnormal laboratory findings.Results: The median follow up period was 44 months; the median overall survival (OS) and median progression-free survival (PFS) were 11 and 6 months, respectively. A multivariate analysis revealed that the following could be used as independent prognostic factors: an Eastern Cooperative Oncology Group performance status score (ECOG PS) ≥2, a high LDH level, serum albumin >3 g/ dL, serum calcium.10.5 g/dL, number of metastases >2, presence of liver metastases, malignant pleural effusion, or receiving chemotherapy ≥4 cycles. The 1-year OS rates according to LPI 0, LPI 1, and LPI 2 were 54%, 34%, and 17% (p<0.001), respectively and 6-month PFS rates were 44%, 27%, and 15% (p<0.001), respectively. The LPI was a significant predictor for OS (Hazard Ratio (HR): 1.41; 1.05-1.88, p<0.001) and PFS (HR: 1.48; 1.14-1.93, p<0.001).Conclusion: An LPI is an inexpensive, easily accessible and independent prognostic index for advanced NSCLC and may be helpful in making individualized treatment plans and predicting survival rates when combined with clinical parameters. © 2014 Ulas et al.


Sungur N.,Ankara Nuclear Research And Training Center | Kankaya Y.,Ankara Nuclear Research And Training Center | Gursoy K.,Balikesir Government Hospital | Dolen U.C.,Ankara Nuclear Research And Training Center | Kocer U.,Ankara Nuclear Research And Training Center
Annals of Plastic Surgery | Year: 2013

Background: There are lots of ways to close a defect according to the reconstruction ladder. In this article, we would like to share our experience with V-Y rotation advancement flap on different parts of the body. Patients and Methods: Between 2006 and 2009, we performed V-Y rotation advancement flap on 68 patients (average age, 50 years). We performed this flap for decubitus and neuropathic ulcer on 33 patients, for defect reconstruction after tumor removal on 29 patients, and for trauma on 6 patients. Results: The sizes of the defects ranged between 2 × 2 and 26 × 16 cm. All flaps survived without any major complications. Patients were satisfied with their scar appearance, and no sensory impairment was seen. Conclusions: V-Y rotation advancement flap restores the defect with a perfect color match and leaves an aesthetically acceptable scar. With its surgical flexibility and durability, this flap disappoints neither the surgeon nor the patient. © 2013 Lippincott Williams & Wilkins.


Ulas A.,Ankara Ataturk Training and Research Hospital | Kos T.,Duzce University | Avci N.,Balikesir Government Hospital | Cubukcu E.,Ali Osman Sonmez Oncology Hospital | And 3 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2015

Background: The aim of the present study was to evaluate clinicopathological characteristics of our early stage breast cancer patients who are epidermal growth factor receptor 2 (HER2) overexpressed/ amplified (HER2+), the efficacy of trastuzumab treatment and survival results. Materials and Methods: Patients with HER2- positive early stage breast cancer receiving adjuvant trastuzumab were investigated retrospectively. Clinicopathological features of 210 patients and treatment outcome were analysed. To evaluate survival rates, the Kaplan-Meier method was used. Univariate and multivariate analyses were conducted with the Cox regression model. Results: Mean age of the patients was 51.8, 71.9% being postmenopausal. Some 37.6% of patients were node negative, and 31% had T1 tumor size and 52.4% were positive for estrogen receptor. Of 210 patients, 89.5% completed planned 52 weeks adjuvant trastuzumab treatment. The median follow up was 27.5 months (6.0-86.0 ). Relapse free survival (RFS) was 68.0 months (95% CI: 62.1-74.0) and overall survival (OS) was 74.8 months (95% CI: 69.5-80.1). The 3 year OS for all patients was 92.0% and RFS was 79.6%. During follow up, relapse was detected at the rate of 14.3%. Trastuzumab associated cardiotoxicity was found at the rate of 3.3%. In univariate analyses, larger tumor size and grade III were significantly associated (p<0.05) with RFS. Multivariate analyses of covariates displaying p<0.05 identified grade III as an independent prognostic factor. Conclusions: In the present study, it was established that trastuzumab had a satisfactory safety profile and treatment efficacy as in other clinical studies and that among clinicopathological factors evaluated, only being grade 3 had a significant effect on RFS. The occurrence of relapse with adjuvant trastuzumab makes it necessary to identify molecular predictors, which will define this group better and help explain resistance to anti HER2 based therapies.


Ulas A.,Ankara Ataturk Training and Research Hospital | Silay K.,Ankara Ataturk Training and Research Hospital | Akinci S.,Ankara Ataturk Training and Research Hospital | Dede D.S.,Yildirim Beyazit University | And 15 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2015

Background: Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. Materials and Methods: This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. Results: Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). Conclusions: Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.


Ulas A.,Ankara Ataturk Training and Research Hospital | Avci N.,Balikesir Government Hospital | Kos T.,Duzce University | Cubukcu E.,Ali Osman Sonmez Oncology Hospital | And 3 more authors.
Journal of B.U.ON. | Year: 2015

Purpose: To investigate whether the pretreatment neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) have any prognostic significance in patients with HER2-positive early breast cancer receiving adjuvant trastuzumab. Methods: 187 patients were retrospectively analyzed. The patients were separated into two groups according to the mean value of NLR and PLR (low NLR <2.38, high NLR >2.38; and low PLR ≤ 161.28, high PLR >161.28, respectively). The relationship between pretreatment NLR, PLR and clinicopathological factors was investigated. Univariate and multivariate Cox regression analyses were performed To evaluate survival rates, the Kaplan-Meier method with log rank test were used. Results: The median duration of follow up was 26.0 months (range 6.0-84.0). In high NLR and PLR groups, the mean age was lower, tumor size was larger and the number of hormone receptor positive patients was higher. No statistically significant relationship was found between clinicopathological factors and both NLR and PLR groups. During follow up, the rate of relapse was 12.6% in the low NLR group, 16.2 % in the high NLR group, 12.6% in the low PLR group and 15.8% in the high PLR group (p=non significant). Although median disease free survival (DFS) was shorter in the high NLR than in the low NLR group, the difference was not statistically significant (p=0.45). No statistically significant difference was found between high and low PLR groups with regard to median DFS and overall survival (OS) (p=0.76, p=0.29, respectively). Conclusion: We conclude that in HER2-positive early breast cancer patients receiving adjuvant trastuzumab with high pretreatment NLR, DFS was shorter. As for PLR, no effect either on DFS or on OS was registered. Prospective studies with larger number of patients are required in order to evaluate the prognostic effect of NLR and PLR in HER2-positive breast cancer patients.

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