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Duraker N.,SB Okmeydani Training and Research Hospital | Bati B.,SB Okmeydani Training and Research Hospital | Caynak Z.C.,SB Basaksehir State Hospital | Demir D.,SB Okmeydani Training and Research Hospital | Kurtulus I.,SB Okmeydani Training and Research Hospital
Breast Journal | Year: 2011

The number of studies forming a base for tumor (T)-node (N)-metastasis (M) classification by comparing T4b tumors with only histological skin involvement in breast carcinoma is limited and results are contradictory. In this study, the survival of patients with T4b tumor and patients whose tumor had only microscopic skin involvement without clinical T4b signs were compared. The file records of 101 patients with T4b tumor (group A) and 79 patients whose tumor had only microscopic skin involvement (group B) were reviewed. The endpoint was disease recurrence. For the whole series, disease-free survival (DFS) of group B patients was significantly better compared with group A patients treated with either adjuvant (p < 0.001) or neoadjuvant (p < 0.001) therapies. When patients were subgrouped according to tumor size, DFS of group B patients was significantly better than group A patients receiving either adjuvant or neoadjuvant therapy for all tumor size subgroups of ≤3, >3, â5, and >5 cm. Presence of T4b clinical signs had independent prognostic value in multivariate Cox analysis. In conclusion, tumors with only histological skin involvement without clinical T4b signs should be classified as T1-T3 according to their size instead of T4 as stated in the TNM classification. © 2010 Wiley Periodicals, Inc.


Kamali S.,SB Okmeydani Training and Research Hospital | Bender O.,SB Okmeydani Training and Research Hospital | Kamali G.H.,SB Okmeydani Training and Research Hospital | Aydin M.T.,SB Fatih Sultan Mehmet Training and Research Hospital | And 2 more authors.
Breast Cancer | Year: 2014

Background: Fiberoptic ductoscopy is a practical and direct approach that allows the visualization of intraductal breast disease. The aim of this study was to assess the efficacy of ductoscopy in the diagnosis and management of intraductal lesions. Methods: Data on 357 ductoscopic investigations from patients with nipple discharge were collected prospectively. Seventy-five patients were diagnosed as having intraductal papillary lesions and these cases were evaluated by final histopathology (55 solitary, 14 multiple papillomatosis, 6 premalignant or malignant lesions). Results of classical diagnostic studies using ultrasonography, mammography, and galactography were compared with those of ductoscopy and pathology. Results: The sensitivities of investigation methods for papillomas in this study were 72 % in ultrasonography, 62.9 % in mammography, 81.4 % in galactography, and 86.6 % in ductoscopy. With ductoscopic papillomectomy (DP), almost 30 % of patient with solitary papilloma did not require further extensive surgery. Conclusion: Since there is an increased risk of malignancy, surgical excision is recommended for multiple, larger papillomas and for papillomas with atypia and in addition for papillomas where diagnostic tools produce suspicious findings. On the other hand DP is a minimally invasive intervention and can aid in the follow-up of lesions proven to have no atypia. © 2012 The Japanese Breast Cancer Society.


Kucuk L.,Istanbul University | Kaya H.,Istanbul University | Kucuk M.,Sb Okmeydani Training And Research Hospital | Yogun O.,Sb Okmeydani Training And Research Hospital | Buzlu S.,Istanbul University
Sexuality and Disability | Year: 2013

This descriptive study investigated the relationship between depression and perceptions of sexuality in people with type II diabetes. The study population comprised all patients who came for check-ups at the polyclinic for diabetes at Istanbul Okmeydani Training and Research Hospital between November 2010 and February 2011. One hundred patients were willing to participate in the study and met the participant criteria. Socio-demographic characteristics, perceptions of sexuality, and other factors related to diabetes were evaluated from information provided by participants. The Beck Depression Inventory-II (BDI-II) was used to evaluate depression. Results revealed an average depression score of 16.34 ± 8.06. The average level of depression was higher in women, those whose level of education was low, and the unemployed. Of the participants, 53% reported that diabetes has affected their sex life adversely. There was no relationship between level of depression and aspects of the illness. However, level of depression was related to sexual satisfaction. Findings suggest that depression and sexually related problems should be addressed when providing care for people diagnosed with type II diabetes. © 2012 Springer Science+Business Media, LLC.


Duraker N.,SB Okmeydani Training and Research Hospital | Civelek Caynak Z.,Bayindir Levent Hospital | Hot S.,SB Okmeydani Training and Research Hospital
International Journal of Surgery | Year: 2014

Background: To compare the patients with primary colorectal carcinoma (CRC) and non-resectable distant metastases with or without primary colorectal tumor resection as a primary treatment in terms of postoperative mortality and overall survival (OS). Patients and methods: The clinicopathological data of 188 CRC patients with non-resectable distant metastases was analyzed. All patient data were collected prospectively. Colorectal tumor was resected in 121 patients (64.3%). Kaplan-Meier method was used for calculation and plotting of the OS curves of the patient groups, and log-rank test was used for the comparison of the survival curves. The relative importance of the prognostic features was investigated using the Cox proportional hazards model. Results: In the whole series and in the patient group undergoing emergency surgical intervention, mortality rate was lower in patients having colorectal tumor resection compared with non-resected patients, with differences approaching the significance level (p = 0.072 and p = 0.076, respectively). Median OS time was significantly longer in resection group (11.0 months), compared with non-resection group (5.5 months) (p < 0.001); in the multivariate Cox analysis colorectal tumor resection had independent prognostic significance (p < 0.001). Conclusion: Resection of colorectal tumor in primary CRC patients with non-resectable distant metastasis gives significant survival advantage without increasing postoperative mortality compared with non-resection. © 2014 Surgical Associates Ltd.


Duraker N.,SB Okmeydani Training and Research Hospital | Demir D.,SB Okmeydani Training and Research Hospital | Bati B.,SB Okmeydani Training and Research Hospital | Yilmaz B.D.,SB Okmeydani Training and Research Hospital | And 3 more authors.
Japanese Journal of Clinical Oncology | Year: 2012

Objective: To investigate the role of post-mastectomy radiotherapy in breast carcinoma patients with a tumor size of 5 cm or smaller (T1-2) and 1-3 axillary lymph node(s) metastasis (N1). Methods: We retrospectively reviewed the file records of 575 patients receiving radiotherapy (452 patients) and not receiving radiotherapy (123 patients). Results: In the whole series, locoregional recurrence-free survival was significantly better in patients receiving radiotherapy compared with patients not receiving radiotherapy (P < 0.001); in the multivariate Cox analysis, radiotherapy had an independent prognostic value (P < 0.001). In patients with a tumor size of 2 cm or less (T1), locoregional recurrence-free survival was significantly better in patients receiving radiotherapy compared with those not receiving radiotherapy (P = 0.016). In the patient subgroup with a T1 tumor and a lymph node ratio (the ratio of the number of metastatic lymph nodes to the number of removed lymph nodes) of 0.25 or less, there was no significant difference between the patients receiving and not receiving radiotherapy in terms of locoregional recurrence-free survival (P = 0.071). In patients with a tumor size of 2.1-5 cm (T2), locoregional recurrence-free survival was significantly better for patients who received radiotherapy compared with those who did not (P = 0.001). In patients with a T2 tumor and a lymph node ratio of ≤0.08, there was no significant difference in locoregional recurrence-free survival between the patients receiving and not receiving radiotherapy (P = 0.645). Conclusions: Post-mastectomy radiotherapy is beneficial in reducing the locoregional recurrence risk in T1N1 breast carcinoma patients with a lymph node ratio of >0.25 and in T2N1 breast carcinoma patients with a lymph node ratio of >0.08. In patients with a lymph node ratio equal to or less than these ratios, post-mastectomy radiotherapy could be omitted to avoid radiotherapy-related risks. © The Author 2012. Published by Oxford University Press. All rights reserved.


Duraker N.,SB Okmeydani Training and Research Hospital | Caynak Z.C.,Bayindir Levent Hospital
Breast Journal | Year: 2014

According to tumor-node-metastasis classification, tumor size should be based only on the largest tumor for multifocal and multicentric (MFMC) carcinomas. We estimated tumor size of MFMC carcinoma using either largest dimension of the largest tumor (dominant tumor size) or sum of the largest dimension of all tumors (aggregate tumor size), and compared the risk of axillary lymph node metastasis and prognosis between MFMC and unifocal carcinoma. We retrospectively reviewed the file records of 3,616 patients with MFMC (258 patients, 7.1%) and unifocal (3,358 patients) carcinoma. In T1 and T2 tumor subgroups, using dominant (p = 0.001 and p < 0.001) and aggregate (p = 0.017 and p = 0.004) tumor size axilla-positivity ratio was significantly higher in MFMC carcinoma compared with unifocal carcinoma. In stage I and II disease classified according to either dominant or aggregate tumor size, there was no significant survival difference between MFMC and unifocal carcinoma patients. In patients with stage III disease by dominant and aggregate tumor size disease-free survival was significantly worse in MFMC carcinoma compared with unifocal carcinoma (p = 0.036 and p = 0.041); multifocality and multicentricity had no independent prognostic significance (p = 0.074 and p = 0.079). The risk of axillary metastasis in MFMC carcinoma was higher than unifocal carcinoma, regardless of the method employed for tumor size estimation. MFMC carcinoma staged according to either dominant or aggregate tumor size had similar survival with unifocal carcinoma. We recommend using the largest dimension of the largest tumor in estimation of tumor size for MFMC carcinoma. © 2013 Wiley Periodicals, Inc.


Duraker N.,SB OkmeydanI Training and Research Hospital | Bati B.,SB OkmeydanI Training and Research Hospital | Caynak Z.C.,BayIndIr Levent Hospital | Demir D.,SB OkmeydanI Training and Research Hospital
World Journal of Surgery | Year: 2013

Background: The aim of the present study was to determine how lymph node ratio (LNR; the ratio of the number of metastatic lymph nodes to the number of removed lymph nodes) can supplement the TNM nodal classification in breast carcinoma. Methods: We retrospectively reviewed the file records of 2,151 patients. Results: Lymph node ratio-based low- (LNR ≤ 0.20), intermediate- (LNR 0.21-0.65), and high-risk (LNR > 0.65) patient groups had significantly different disease-free survival (DFS) (P < 0.001). The DFS of patients with N1, N2, and N3 disease was significantly different (P < 0.001). When LNR and TNM nodal groupings were included together in the Cox analysis, both groupings had independent prognostic significance (P < 0.001 and P < 0.001, respectively). The most significant LNR threshold value separating patients in low-risk and high-risk groups in terms of disease recurrence was 0.20 for N1 disease (P < 0.001), 0.35 for N2 disease (P < 0.001), and 0.90 for N3 disease (P < 0.001). Conclusions: Lymph node ratio and TNM nodal groupings show no superiority over each other in categorizing patients with node-positive breast carcinoma into prognostic groups of low-, intermediate-, and high-risk. However, LNR grouping may supplement TNM nodal classification by categorizing patients within each TNM nodal group into low-risk and high-risk groups with significantly different survival. © 2013 Société Internationale de Chirurgie.


Duraker N.,SB Okmeydani Training and Research Hospital | Civelek Caynak Z.,Bayindir Levent Hospital | Hot S.,SB Okmeydani Training and Research Hospital
International Journal of Surgery | Year: 2014

Background: To investigate the prognostic significance of the number of lymph nodes removed in colorectal cancer (CRC) patients with no metastatic lymph node. Patients and methods: The clinicopathological data of 461 CRC patients was analyzed. In order to compare the survival of patients who had fewer lymph nodes removed versus the survival of patients who had 1-3 metastatic lymph node(s), a separate group of 74 N1 disease patients were also included in the study. All patient data were collected prospectively. Kaplan-Meier method was used for calculation and plotting of the survival curves of the patient groups, and log-rank test was used for the comparison of the survival curves. Results: Cancer-specific survival (CSS) rates of patients who had 1-7 lymph node(s) and 8-11 lymph nodes removed were significantly worse than those who had 12 or more lymph nodes removed (p=0.006 and p=0.037, respectively), while CSS was not significantly different between those who had 1-7 versus 8-11 lymph node(s) removed (p=0.647); this grouping had independent prognostic significance in Cox analysis (p=0.006). CSS of patients with N1 disease was not significantly different from those who had 1-7 and 8-11 lymph node(s) removed (p=0.312 and p=0.165, respectively), while it was significantly worse than CSS of patients who had 12 or more lymph nodes removed (p=0.001). Conclusion: In colorectal cancer patients whose removed lymph nodes are non-metastatic, removal of at least 12 lymph nodes will determine the lymph node status reliably. © 2014 Surgical Associates Ltd.


PubMed | Sb Okmeydani Training And Research Hospital
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

14127 Background: We designed a prospective study to evaluate tolerability, toxicity and effectiveness of concomitant chemoradiotherapy with oral tegafur-uracil (UFT) and leucovorin in locally advanced gastric carcinoma. 13 patients admitted to our center in 10 months of 2003 (March- December) were included.Only one of the patients was female (7.7%). Median age was 52 (34-72). All of them were operated with negative surgical margins (53.8% of them have undergone total gastrectomy and rest of them were operated subtotally). All of them have 0 and 1 performance status (ECOG). Their tumor were mostly located in antrum (53.8%). 4 (30.8%) of them in stage II and in stage IIIA, IIIB and IV were as follows: 2 (15.4%), 5 (38.5%) and 2 (15.4%). Median lymph node dissection was 14 (7-31). Median time interval between surgery and treatment was 49 days (25-63). All patients were treated 45 Gy (one patient 39.6 Gy and other patient 50.4 Gy) locoregional radiotherapy (RT) and UFT 300 mg/mAll patients tolerated therapy well (RT was interrupted 3 times just in one patient because of grade III emesis). At the end of median two years follow up; recurrence was seen as metastasis in 4 (30.8%) patients and locoregional in 3 (23.1%). 8 patients (61.5%) died (one of them was not related). Median progression free survival was 17 months (6-34) with 53.8% in one year and 38.5% in two years. Median overall survival (OS) was 24 months (8-34), one and two years OS were 76.9% and 46.2%, respectively.Concomitant chemoradiotherapy with orally used agent (UFT and leucovorin) in locally advanced gastric carcinoma is well tolerated regimen. But to increase survival data by continuing therapy with these agent after chemoradiotherapy must be researched. To answer this question another study was conducted and is going on in our center. No significant financial relationships to disclose.


PubMed | Sb Okmeydani Training And Research Hospital
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

20108 Background: Cancer is one of the most important health problems existing 10.1 millions of new patients and 6.2 millions dead in 2000. 15 millions of new patients will be supposed to be seen in 2020.In this study; between 1999-2003, 41,564 new patients diagnosed as cancer admitted to our center were analyzed. International Classification Disease of Oncology (ICD-O) was used to classify the patients. Basal cell carcinoma and epidermoid carcinoma of the skin were not included. Rest of 41116 patients were reviewed according to their age, sex, diagnosis and coming region.55.6% of the patients were male. Top five location of the disease can be listed as follows: respiratory system (25.6%), gastrointestinal system (19.2%), breast (15.1%), genitourinary system (11.3%) and lymphoma (4.7%). Analysis according to gender is illustrated in Table . Most cases have come from Marmara Region. While peak incidence was detected between 60-69 years of age in males, it was 50-59 years of age in females. Least comings were seen below 20 years of ages in both sexes.Admission to our department increases gradually while it was 7,020 patients in 1999, it reached to 10,035 person in 2003. General population and population insured by Social Insurance Institution are mostly living in Marmara Region (48.16% of the population are insured by this institution and 41.72% of them reside in Marmara Region). Our department was unique active center in Social Insurance Institutions order at that time. According to SEER (U.S. Surveillance Epidemiology and EndResults) data in United States (US); although prostate cancer is mostly seen cancer (15%) and lung cancer is recorded in just 13% of cases it is the leading data in our study (22.4%) and prostate cancer is only seen 3.8% of cases. This difference can be explained by effective screening programs in US and prostatic cancer patients mostly prefer to apply the Urology Department in our country. Smoking and environmental conditions may be the reason of high incidence in lung cancer. [Table: see text] No significant financial relationships to disclose.

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