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Uslu A.,Turkish Ministry of Health Izmir Bozyaka Research | Bati H.,Turkish Ministry of Health Izmir Bozyaka Research | Postaci H.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Nart A.,Turkish Ministry of Health Izmir Bozyaka Research | And 5 more authors.
Digestion | Year: 2012

Aims: The primary objective of this study was to clarify the influence of histotype on the outcome of D1/D2 gastrectomized patients with pathologically proven R0 resection. The secondary objective was to demonstrate overall survival (OS), disease-free survival (DFS), and locoregional recurrence rates following standard curative surgery. Patients and Methods: All patients had either pure signet-ring cell carcinoma (SRCC)/poorly differentiated adenocarcinoma (PDC) or moderately differentiated adenocarcinoma (MDC) of the stomach, preoperative radiologic evidence of locoregional disease, and no history of neoadjuvant therapy. Standards of surgical treatment were essentially based on the guidelines of the Japanese Research Society for the Study of Gastric Cancer. Results: Between October 2003 and August 2010, seventy-eight patients were enrolled. Twenty-three patients underwent D1 dissection and 55 underwent D2 dissection. The OS and DFS rates were 33.2 ± 5.9 months versus 31.5 ± 4.3 months (p = 0.81) and 28.9 ± 5.6 months vs. 29.3 ± 4.4 months (p = 0.96) in the MDC and SRCC/PDC groups, respectively. Neither the extent of the operation (D1 vs. D2, p = 0.79) nor the histopathologic subtype of the primary tumor (MDC vs. SRCC/PDC, p = 0.91) influenced the OS and DFS. Multivariate logistic regression analysis disclosed pathologic stage (pTNM) as the only significant prognostic determinant of OS (p = 0.007) and DFS (p = 0.0003). Conclusion: Properly performed D1 and D2 dissection in our series resulted in a notable (6.4%) locoregional failure rate. In spite of the satisfactory locoregional control achieved by D1 and D2, there was no improvement in the survival figures of stage IIIA-B and IV gastric cancer patients. The histopathologic subtype of the primary tumor disclosed merely a statistical trend on the outcome measures of gastric cancer after curative surgery. Copyright © 2012 S. Karger AG, Basel. Source


Eliyatkin N.O.,Adnan Menderes University | Aktas S.,Dokuz Eylul University | Zengel B.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Postaci H.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | And 2 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2016

The importance of molecular subtyping in breast cancer is an unresolved issue. In this study we aimed to evaluate the significance of molecular subtyping, and the correlation between the disease-free, and overall survival in breast cancer based on molecular subtypes. A total of 536 patients with the diagnosis of breast cancer between the years 1980 and 2014 were included in the study. Tumors were divided into five molecular subtypes according to their expression profiles as follows: Luminal A: (n=220; 41%); Luminal B: (n=72; 13.4%); Luminal B-like: (n=97, 18.1%); HER2: (n=44;8.2%); and Triple-negative (n=103;19.2%). We found significant differences between molecular subtypes, and histological subtype of the tumor (P=0.004) in terms of local recurrence (P=0.043), and metastasis (P=0.006). A statistically significant difference was found between the number of metastases, and molecular subgroups. (P=0.037). Among all molecular subtypes, local recurrences (11.4%), and metastasis (38.6%) were most frequently seen in the HER2 subtype, while the least number of metastases (15.3%) were detected in the Luminal A subtype. A statistically significant difference was found between Luminal A, and HER2 subgroups as for incidence of metastatic lesions (P=0.007). However in the Luminal A subgroup metastases developed in the long term (at the end of 50 months after onset of the disease). Overall, and disease-free survival curves in the Luminal A subgroup indicated risk of mortality in the long run. Based on molecular subtyping the worst, and the most favourable survival rates were observed in the HER2, and Luminal A subgroups, respectively. Impact: In this study which encompassed multiple number of breast cancer patients encountered within 30 years, HER2 tumors had the worst survival rates Interestingly, Luminal A subgroup which displayed a very favourable prognosis during the early stage of the follow-up period, demonstrated a bad prognosis in the long term. © 2016, E-Century Publishing Corporation. All rights reserved. Source


Zengel B.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Yararbas U.,Ege University | Bingolballi O.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Denecli A.G.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital
Indian Journal of Surgery | Year: 2014

Besides several side effects including anaphylaxis, blue dyes are also known to cause false pulse oximeter readings. We aimed to examine the effects of subareolar isosulfan blue injection on pulse oximeter (SpO2) readings. The study group included 27 patients undergoing SLNB using both radiocolloid and isosulfan blue. Another group of 27 patients constituted the control group. Pulse oximeter readings were compared. SpO2 decline ≥4 % was defined as significant. All but one (96.2 %) of the patients in the study group showed SpO2 declines, compared to only one patient in the control group. Median ± Interqartile Range (IR) SpO2 decrease was 3.0 ± 4.0 % in the study and 0.0 ± 1.0 % in the control group (p < 0.001). There were significant (≥4 %) SpO2 decreases in 13 (48.1 %) patients in the study group. Statistically significant differences were noted between the two groups in all recordings between 15 and 180 min (p < 0.001). Initial time for SpO2 fall and the time to the lowest SpO2 recording were 10.0 ± 10.0 and 40.0 ± 30.0 min respectively. Using subareolar injection, the frequency of false readings is comparable with intraparenchymal injections, and is higher than intradermal injections. Time to peak SpO2 fall, and the recovery period, are delayed in the subareolar technique. © 2012 Association of Surgeons of India. Source


Zengel B.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Yararbas U.,Ege University | Sirinocak A.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Ozkok G.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | And 3 more authors.
Tumori | Year: 2013

Aims and background. Sentinel lymph node biopsy has been accepted as a standard procedure for early stage breast cancer. In this retrospective analysis, the results obtained with different methodological approaches using radiocolloid with or without blue dye were examined. Methods. A total of 158 sentinel lymph node biopsies were performed in 152 patients. Group A (85 patients) underwent lymphatic mapping using a combination of periareolar intradermal radiocolloid and subareolar blue dye injections. Group B (73 patients) underwent only periareolar intradermal radiocolloid injection. One large tin colloid and two small radiocolloids (nanocolloid of serum albumin -NC- and colloidal rhenium sulphide -CS-) were used. Results. Successful lymphatic mapping was attained in 157 of 158 procedures (99.4%). Radiocolloids localized sentinel lymph nodes in 99.4% and blue dye in 75.3% of the cases. The number of sentinel lymph nodes removed was greater in nanocolloid and colloidal rhenium sulphide groups (P ≤0.05). Among 60 metastatic sentinel lymph nodes, frozen section analysis using hematoxylin and eosin staining failed to detect 1 macro- and 10 micrometastasis. Radiocolloid uptake was higher in sentinel lymph nodes accumulating blue dye (1643 ± 3216 counts/10 sec vs 526 ± 1284 counts/10 sec, P <0.001). Higher count rates were obtained by using larger sized colloids (median and interquartile range: tin colloid, 2050 and 4548; nanocolloid, 835 and 1799; colloidal rhenium sulphide, 996 and 2079; P = 0.01). Only 2 extra-axillary sentinel lymph nodes were visualized using periareolar intradermal injection modality. Conclusions. Radiocolloids were more successful than blue dye in sentinel lymph node detection. More sentinel lymph nodes were harvested with small colloids, but different sized radiocolloids were similarly successful. Sentinel lymph nodes having higher radiocolloid uptake tended to accumulate blue dye more frequently. Sentinel lymph nodes manifested higher count rates when a larger colloid was used. Frozen section was very successful in detecting macrometastatic disease in sentinel lymph nodes, but the technique failed in most of the micrometastates. © - Il Pensiero Scientifico Editore downloaded by ELSEVIER BV IP. Source


Uslu A.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Zengel B.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Akpinar G.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | Postaci H.,Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital | And 4 more authors.
Indian Journal of Cancer | Year: 2014

Purpose: The combination of taxanes and anthracyclines has proven efficacy in node-positive (N+) premenopausal primary breast cancer patients. Ovarian ablation is also associated with better survival outcomes in premenopausal hormone-receptor positive (HR+) patients. Therefore, this trial aims to determine the superiority of combined hormonal treatment of ovarian ablation with tamoxifen (TMX) versus TMX alone, in premenopausal N+, HR + patients receiving adjuvant chemotherapy (AC) with taxane and anthracycline. Materials And Methods: Premenopausal women who had surgically removed breast cancer with histologically confirmed N + and HR+ were included in the trial. The AC consisted of six cycles of taxotere, adriamycin, cytoxan or taxotere, epirubicin and cytoxan with the completion of radiation therapy. Patients were randomly assigned to receive TMX 20 mg/day for 5 years or up to menopause or TMX 20 mg/day for 5 years plus goserelin (GOS) 3.6 mg injection per month for 2 years. The primary end point was disease-free survival (DFS). Results: Between 2003 and 2011, 101 consecutive patients were allocated to TMX (51 patients) and TMX/GOS (50 patients) groups. The mean follow-up period was 52.4 ± 2.8 months. DFS was 43.0 ± 3.6 months versus 49.9 ± 4.22 months (P = 0.13) and overall survival was 51.1 ± 3.8 months versus 53.1 ± 4.2 months (P = 0.50) in the TMX and TMX/GOS groups, respectively. The results showed 9% absolute risk reduction with respect to DFS in favor of the TMX/GOS group.Conclusion: This study group was comprised of stage II and III disease patients with high nodal status. The TMX/GOS combination reduced absolute risk of developing first locoregional or distant relapse by almost 9%. Longer follow-up is required to justify this protocol for routine use. © 2014 Indian Journal of Cancer | Pulished by Wolters Kluwer - Medknow. Source

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