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A rare breast tumor; Adenomyoepithelioma: a case report and review of the literature
(2022) Benek, Suat; Zengin, Mehmet; Baydar, Ahmet; Sevmiş, Murat; Gürler, Müjgan
Adenomyoepithelioma is rare benign breast neoplasia characterized by the proliferation of both epithelial and myoepithelial cells of the\rmammary lobules and ducts. This tumour, which does not have specific risk factors and radiological findings, is mostly seen in advanced\rages. This tumour, which occurs with the biphasic proliferation of epithelial and myoepithelial cells, also contains normal breast lobules and\rducts. This tumour is very difficult to diagnose and includes many radiological and pathological pitfalls. Although malignant degeneration\rhas been reported in the literature, it is a rare condition. In this study, we present a rare case with radiologically suspicious findings and\rpathologically reported as adenomyoepithelioma.
Atipik granüler hücreli tümör: olgu sunumu
(2021) Zengin, Mehmet; Gücin, Zühal; Aksoy, Bilgin; Acar, Eren
Granüler hücreli tümör (GHT), nadir görülen mezenkimal bir neoplazmdır. Çoğunlukla baş-boyun bölgesinde özellikle de dilde yerleşim\rgöstermekte olup nadiren rekürrens gösterir. Bu çalışmada 6 ay içerisinde nüks gösteren bir GHT olgusu sunduk. 53 yaşında erkek hasta,\rsırtta yavaş büyüyen kitle GHT olarak rapor edildi, tümörde pleomorfizim, mitoz, nekroz ve atipi mevcut değildi. Olgunun 6 aylık takibinde\rlezyon nüks etti ve tekrar eksize edildi. Nüks lezyon eskisi ile aynı özellikleri göstermekte idi ancak daha düzensiz sınırlı ve etraf dokulara\rinfiltratif görünümde idi, ayrıca yüksek Ki- 67 oranına (%10) sahipti. Belirsiz davranışlı kabul edilen olgumuzun 3 yıllık takiplerinde lokaluzak\ryayılım saptanmadı. GHT genellikle benign gidişli stromal bir tümör olmakla beraber öngörülemeyen agresiv davranma potansiyeli\rnedeniyle tüm olgular takip altında tutulmalıdır.
Comparison of Gleason scoring and the new grade-group system in prostate cancers: a 15-year retrospective study
(2020) Zengin, Mehmet; Eryol, Merve; Akkaya, Merva Aydemir; Balcı, Mahi; Yalçın, Selim; Tuğlu, Devrim
Aim: Prostate cancer is the most common malignant tumour in men. The most widely used histological grading scheme for prostate cancer is Gleason scoring. After the original, this system has been modified several times. In this study, we retrospectively investigated the new Grade-group system (GGS). Material and Method: This study includes 486 cases diagnosed with prostate cancer between 2000 and 2015. All cases were re-grouped for the new Grade-group system and its relationship with prognosis was examined. Results: Grade-group system subgroups had a statistically significant relationship between prognostic factors and this relationship was more significant between GGS 2 and GGS 3 [tumor status (p<0.001), age (p=0.045), PN invasion (p<0.001), stage (p=0.004), and LN status (p<0.001)]. In univariable survival analysis, there was a significant difference between Grade-group system subgroups (for GGS 2-GGS 3, RFS: p=0.035 and OS: p=0.012; for GGS 4-GGS 5, RFS: p=0.001 and OS: p=0.001). In multivariable survival analysis, GGS subgroups were found to be an independent survival parameter for prostate cancer (for GGS 2-GGS 3, OS: HR=2.56, p=0.012 and RFS: HR=2.69, p=0.038; for GGS 4-GGS 5, OS: HR=2.84, p=0.011 and RFS: HR=2.59, p<0.001). Conclusions: According to our results, the new Grade-group system performs the prognostic risk grading more accurately than the old classification. Also, the fact that this system contains fewer categories and is simpler has increased the interobserver compatibility.
Contribution of amniotic membrane to the healing of iatrogenic vas deferens injury
(Tubitak Scientific & Technological Research Council Turkey, 2021) Demir, Sabri; Erturk, Ahmet; Zengin, Mehmet; Yildiz, Dincer; Karahan, Siyami; Senel, Emrah
Background/aim: Iatrogenic vas deferens injury is one of the most serious complications of operations in the inguinal region. Vasovasostomy is performed as treatment. However, stenosis is common after vasovasostomy. Oligospermia or azoospermia may develop and result in infertility. This study aimed to investigate the effect of amniotic membrane on healing in vas deferens injuries. Materials and methods: Four groups consisting of 10 rats each were formed. No procedure was performed in Group-I. In Group -II, the left vas deferens was transected and left to spontaneous healing. In Group-III, the left vas deferens was transected, and end -to-end anastomosis was performed. In Group-IV, the left vas deferens was transected, end-to-end anastomosis was performed, and it was closed with a wrapping of amniotic membrane on the anastomosis line. Rats were sacrificed after 60 days, and each left vas deferens was evaluated. Lumen patency was checked by passing methylene blue through the vas deferens. Subsequently, the vas deferens was evaluated both macroscopically and histopathologically. Data were evaluated using SPSS version 21.0. p < 0.05 was considered statistically significant for all variables. Results: The anastomosis lines in Group-IV healed better than those in Group-III, and less stenosis was observed. There were differences between the groups in terms of luminal patency (p = 0.009), adhesions to surrounding tissues (p = 0.02) and separation of the ends of the vas deferens (p = 0.03). Conclusion: We observed improvement on luminal patency and histology of rat vas deferens injury after surrounding human amniotic membrane on the transected and repaired surface. Further studies are needed to apply this promising result on human beings.
Contribution of Bone Marrowe-Derived Mesenchymal Stem Cells to Healing of Pulmonary Contusion-Created Rats
(Academic Press Inc Elsevier Science, 2021) Demir, Sabri; Erturk, Ahmet; Gunal, Yasemin Dere; Ozmen, Ismail; Zengin, Mehmet; Yildiz, Dincer; Karaoz, Erdal
Background: The most common thoracic injury in children, resulting in trauma, is pulmonary contusion (PC). Bone marrowe-derived mesenchymal stem cells (BM-MSCs) are used in wound healing and many other diseases. This study aims to examine the effects of BM-MSCs on PC healing in rats. Materials and methods: A total of 45 male Wistar albino rats were used. Four groups were formed. BM-MSCs were labeled with the green fluorescent protein. PC was observed in the control group. In group II, PC occured and left to spontaneous healing. In group III, PC formed and BM-MSCs were given. In group IV, BM-MSCs were given without PC formation. Subjects were sacrificed 1 week later. Whether there was any difference in terms of BM-MSC involvement and lung injury score was investigated. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 17.0, software (SPSS Inc., Chicago, IL), and p value of <0.05 was considered statistically significant. Results: BM-MSCs were collected much more in the lungs in group III than in group IV. Group III had a lower lung injury score value than group II. Conclusion: The greater involvement of the BM-MSCs in the injury site, and further reductions in lung injury score suggest that BM-MSCs are contributing to the healing of the injury. The use of BM-MSCs in risky patients with diffuse PC may be an alternative treatment to conventional methods. (C) 2020 Elsevier Inc. All rights reserved.
Contribution of Bone Marrow–Derived Mesenchymal Stem Cells to Healing of Pulmonary Contusion-Created Rats
(Academic Press Inc., 2021) Demir, Sabri; Erturk, Ahmet; Gunal, Yasemin Dere; Ozmen, Ismail; Zengin, Mehmet; Yildiz, Dincer; Karaoz, Erdal
Background: The most common thoracic injury in children, resulting in trauma, is pulmonary contusion (PC). Bone marrow–derived mesenchymal stem cells (BM-MSCs) are used in wound healing and many other diseases. This study aims to examine the effects of BM-MSCs on PC healing in rats. Materials and methods: A total of 45 male Wistar albino rats were used. Four groups were formed. BM-MSCs were labeled with the green fluorescent protein. PC was observed in the control group. In group II, PC occured and left to spontaneous healing. In group III, PC formed and BM-MSCs were given. In group IV, BM-MSCs were given without PC formation. Subjects were sacrificed 1 week later. Whether there was any difference in terms of BM-MSC involvement and lung injury score was investigated. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 17.0, software (SPSS Inc., Chicago, IL), and p value of <0.05 was considered statistically significant. Results: BM-MSCs were collected much more in the lungs in group III than in group IV. Group III had a lower lung injury score value than group II. Conclusion: The greater involvement of the BM-MSCs in the injury site, and further reductions in lung injury score suggest that BM-MSCs are contributing to the healing of the injury. The use of BM-MSCs in risky patients with diffuse PC may be an alternative treatment to conventional methods. © 2020 Elsevier Inc.
Effects of mesenchymal stem cell and amnion membrane transfer on prevention of pericardial adhesions
(WALTER DE GRUYTER GMBH, 2020) Kabalci, Mehmet; Sahin, Mustafa; Pekcan, Zeynep; Zengin, Mehmet; Dogru, Mehmet Tolga; Kisa, Ucler
Background: To investigate and compare the antiadhesive/antifibrotic effects of mesenchymal stem cells (MSC) and amnion membrane transfer (AMT) in a rat model. Material and methods: Three experimental and sham groups were formed using 30 Wistar-Albino rats. AMT and MSC were applied to the related groups. The control group was not treated. After 12 weeks follow-up, intracardiac blood and cardiac-pericardiac tissue samples were taken. The severity of adhesions and fibrosis were scored macroscopically and microscopically with Hematoxylin/ Eosin and Masson's trichrome staining. TNF-alpha, TGF-beta, IL-1, PDGF, FGF, VEGF and Caspase-3 levels were measured with the ELISA method. Results: Severe adhesions were observed in the AMT and control groups, but no adhesion was present in the MSC group. Pericardial thickness, increased vascularity, fibrosis, and collagen accumulation were similar between control and AMT groups, but were less in Sham and MSC groups. Between MSC and AMT groups, only Caspase-3 level was different, which is an apoptosis marker. Conclusion: The positive effects of MSC on adhesion, which we achieved in our study, suggest that it may prevent adhesion. AMT did not provide a positive effect. The correlation of Caspase-3 with postoperative adhesion/fibrosis should be examined in more detail.
Effects of mesenchymal stem cells to prevent adhesions for vascular reoperations: An experimental study
(2019) Kabalcı, Mehmet; Zengin, Mehmet; Muluk, Nuray Bayar; Kısa, Üçler
Objectives: In the present study, we aimed to investigate whether mesenchymal stem cells (MSCs) were useful to reduce cutaneous adhesions, particularly for vascular reoperations. Materials and methods: In this experimental study, 12 adult male Wistar Albino rats were used. In Group 1 (n=2, negative control group), no incision was performed. In Group 2 (n=5, positive control group), skin and subcutaneous tissues were incised. In Group 3 (n=5, MSC group), skin and subcutaneous tissues were incised and 3×106 MSCs were applied. Macroscopic scoring of adhesion and histopathological scoring of tissue repair response were evaluated. Results: Macroscopic view of the adhesion values (Padjusted <0.0175), histopathological evaluation values (histiocytic response, vascularization, and granulocytic response and total response) (Padjusted <0.0175), and collagen deposit values (Padjusted <0.0175) of Group 3 were significantly lower than Group 2. Conclusion: Our study results suggest that the use of MSCs seems to be useful to prevent adhesion formation in cutaneous injuries and that MSCs promote wound healing without adhesions in the experimental setting.
EVALUATION OF CXCL12 AND CXCR4 TO PREDICT POOR SURVIVAL IN LYMPH NODE-POSITIVE COLORECTAL CANCER PATIENTS
(Vesalius Univ Medical Publ, 2020) Zengin, Mehmet; Dursun, Nevra; Behzatoglu, Kemal; Pasaoglu, Husniye Esra; Benek, Suat
It is well known that interactions in the tumour microenvironment are very important in the progression of tumours. We investigated the relationship between chemokine ligand type 12 (CXCL12), chemokine receptor type 4 (CXCR4) and survival in advanced colorectal cancers (CRC). Primary tumour samples of stage III-IV CRC patients were investigated for CXCL12 and CXCR4. Chemokine ligand type 12 and CXCR4 expressions were significantly associated with poor prognostic factors (e.g. for CXCL12: lymphatic invasion [p = 0.009], positive surgical margin [p = 0.006], advanced stage [p = 0.028], etc.). Also, these parameters were independent risk factors for low LIR (e.g. for CXCL12: Odds ratio [OR] = 2.27, p = 0.001) and low tumour stroma-ratio (TSR; e.g. for CXCL12: OR = 1.18, p = 0.003). In univariate analysis, 5-year RFS and OS were poor (e.g. for CXCL12: RFS, p < 0.001 and OS, p = 0.001). Multivariate analysis showed that these parameters were independent poor survival parameters for RFS and OS (e.g. for CXCL12: Hazard ratio [HR] = 3.54 [CI: 1.52-4.67], p = 0.001 and HR = 2.74 [1.48-4.71], p = 0.025). We showed that CXCL12 and CXCR4 expressions are poor prognostic factors in lymph node-positive CRC patients and are associated with low TSR and low LIR.
Gross tumour volume and poorly differentiated clusters can indicate high-risk patients for poor survival in pT1-2 rectal carcinomas
(2020) Zengin, Mehmet; Atasoy, Pınar
Aim: Colorectal carcinomas are one of the most common carcinomas in the Western world. Survival is mainly associated with the tumournode-metastasis (TNM) stage but patients with the same tumour stage usually show marked distinct survival. We analyzed the survival effect of gross tumour volume and poorly differentiated clusters in pT1-2 rectal carcinomas. Material and Method: Sixty-five pT1-2 rectal carcinomas that were curatively resected between 1999 and 2014 were included in this retrospective study at Kırıkkale University Medical Faculty Hospital. Gross tumour volume and poorly differentiated clusters were scored using a macroscopic specimen and hematoxylin and eosin-stained sections. Results: These parameters were significantly associated with large tumour size (gross tumour volume [GTV]: p=0.020), invasive pattern (GTV: p=0.004; poorly differentiated clusters [PDC]: p=0.020), angiolymphatic invasion (GTV: p=0.001; PDC: p=0.009), tumour necrosis (GTV: p=0.002; PDC: p=0.038), and high grade (PDC: p=0.001). In univariate analysis, patients with these parameters had worse 5-year survival for both relapse-free survival (RFS) and overall survival (OS) ([GTV: RFS= 78.5%, p=0.001; OS: 81.0%, p=0.005], [PDC: RFS= 80.0%, p=0.013; OS: 83.1%, p=0.039]). Multivariate analysis confirmed that these parameters are independent predictors of poor survival for RFS (GTV: Hazard ratio [HR]=1.42 [1.06-2.85], p=0.006; PDC: HR=1.39 [1.06-3.28], p=0.028) and OS (GTV: HR=1.35 [1.09-3.37], p=0.011). Also, GTV was found to be more useful than PDC. Conclusions: According to our study, GTV and PDC play an important role in the prognosis of rectal carcinomas and the addition of these markers to the current risk classification may contribute to better patient selection.
Local Inflammatory Response Can Predict Clinical Outcome in Patients with Curatively Resected Stage-IIB Colon Cancer: An Advanced Methodological Study
(SPRINGER, 2020) Zengin, Mehmet
Purpose Although local inflammatory response (LIR) is a reliable survival marker in colon cancers (CCs), there is no consensus on its use in daily practice. We investigated the prognostic value of LIR in a highly homogeneous population with a well-designed methodology. Methods Eighty stage-IIB CC patients operated between 2002 and 2012 were included in the study. Standardization was investigated for extra-biopsy evaluation methods (magnification, staining, and counting). Model A was used for intra-biopsy evaluation methods (block, section, and focus). So, this study makes important contributions to the standardization of pathological evaluations. Results In method 1, the following analyzes showed more successful results for LIR: relationship with prognostic factors [tumour deposits (p=0.017), Crohn's-like reaction (p=0.019), advanced grade, (p=0.012), positive surgical margin (p=0.019), perineural invasion (p=0.025), mismatch repair proteins-proficiency (p=0.031)], reproducibility of the study (Kappa=0.49-0.73, Intra-class correlation=0.442-0.724), and correlation of estimates (r=0.704). The cut-off value was also quite useful (area of under ROC=0.820 [0.694-0.920]). In univariate analysis, low LIR was related to poor overall survival (OS; p<0.001) and poor relapse-free survival (RFS, p=0.001) . Multivariate analysis confirmed that low LIR is an independent poor survival marker for OS (Hazard Ratio [HR]=1.32 [1.08-1.61, p=0.005) and RFS (HR=1.50 [1.22-1.85], p<0.001). Conclusions Our results showed that low LIR had an independent prognostic significance in stage -IIB CCs. We also recommend using model A and method 1 for successful results and standardization.
Meme Kanseri Olgularının Retrospektif Değerlendirilmesi
(2020) Devrim, Tuba; Akkaya, Merva Aydemir; Atasoy, Pınar; Balcı, Mahi; Altunkaya, Canan; Zengin, Mehmet
Amaç:Bu çalışma ile meme kanseri tanısı almış kadınlarda klini-kopatolojik parametrelerin retrospektif olarak değerlendirilmesi ve moleküler alt tiplerin araştırılması amaçlandı.Materyal ve Metot:Çalışmamız kapsamında Kırıkkale Üniversitesi Tıp Fakültesi Tıbbi Patoloji Anabilim Dalı arşivi taranarak Ocak 2007- Haziran 2019 tarihleri arasında meme kanseri tanısı verilmiş 191 hasta incelendi.Bulgular:İncelenen histopatolojik tümör tipleri, meme tümörlerinin Dünya Sağlık Örgütü 2012 sınıflamasına göre, en yüksek oranda (%89) özel tip olmayan (NST, duktal) meme kanseri olgularına ait olduğu belirlendi. Tümör çapı bakımından en büyük grubu (%48,7) 2–5 cm arası olan olguların oluşturduğu anlaşıldı. Modifiye Scarff-Bloom-Richardson ile değerlendirilen meme kanseri derece 2 (%55,5) tümörler, çalışmamızdaki en büyük grubu oluşturdu. Yaş grubu arttıkça tümör derecesinin arttığı istatistiksel olarak anlamlı düzeyde (p<0,001) belirlendi. Tümörlerde, hormon reseptörleri (ER ve PgR) ile yüksek oranda boyanma saptandı. Hastaların %61,2’sin-de lenf nodu invazyonu belirlendi. Bölgesel lenf nodu evresi (pN) 0 olan hastalar %38,8 ile en büyük grubu oluşturdu. Moleküler alt tip bakımından ise en çok (%48,2) luminal A (LA) tipi izlendi. Bunu luminal B (LB) (%37,4), HER2 overeksprese (HO) (%10,8) ve triple negatif (TN) (%4,6) oranları takip etti. LB’nin, LA’ya göre histolojik tümör derecesi bakımından daha ileri olduğu (p<0,001) anlaşıldı. Tümör derecesi HO ve TN’de LA’ya göre daha ileri (p<0,005) dü-zeyde saptandı. Tümör çapı bakımından ise HO, LA’ya göre yüksek düzeyde tespit (p<0,05) edildi. TN’de HO’ya göre daha büyük bir yaş düzeyi (p<0,05) saptandı.Sonuç:Heterojen bir tümör olan meme kanserinde, tümör derece-si en önemli prognostik faktörlerden biridir. Çalışma verilerimiz bir arada değerlendirildiğinde, meme kanseri moleküler alt tiplerinin belirlenmesinin rutin histopatolojik analiz için önemli yararlar sağla-yacağı kanısına varılmış
Novel prognostic markers associated with poor survival in stage III rectal cancers: Invasive growth pattern and Tumor necrosis
(2019) Zengin, Mehmet
Aim: Rectal carcinomas (RC) are one of the most common cancers in the Western World. TNM system is the most significant predictive indicator in these tumors but patients characterized by the same stage often have prominent distinct survival. In this research, we analyzed the survival effect of Invasive growth pattern (IGP) and Tumor necrosis (TN) in stage III RC.Material and Methods: A hundred forty-five patients operated for stage III RC during 1999-2012 at Kırıkkale University were included in this research. These parameters were scored on hematoxylin and eosin stained sections. The relationship between the results and the clinicopathological characteristics was analyzed.Results: These parameters were significantly upregulated in RCs which classified as higher tumor size (IGP: p<0.001; TN: p=0.033), higher pT (IGP: p=0.016; TN: p=0.047), angiolymphatic invasion (IGP: p=0.025), high number of metastatic lymph nodes (IGP: p<0.001; TN: p=0.001), advanced stage (IGP: p<0.001; TN: p=0.018), and advanced grade (IGP: p<0.001). In univariate analysis, patients with these two parameters had worse 5-year survivals ([IGP= RFS: 50%, p=0.001; OS=55%, p=0.003], [TN= RFS: 53%, p=0.005; OS: 58%, p=0.017]). Multivariate analyzes confirmed that these two parameters are independent worse survival parameters for RFS (IGP=Hazard ratio [HR]: 1.58 [1.05-2.66], p=0.005; TN=1.44 [1.07–2.34], p=0.013) and OS (IGP=HR: 1.55 [1.11–3.18], p=0.008; TN= 1.38 [1.09–2.28], p=0.024). In addition, IGP was found to be more successful than TN.Conclusion: Our data suggest that IGP and TN provide valuable prognostic information for RC, and adding these parameters to the current risk classification may contribute to better patient selection.
Orbital plasmasitom
(2021) Zengin, Mehmet; Havare, Semiha Battal; Dursun, Nevra; Kotil, Kadir
Ekstramedüller plazmasitom nadir görülem plazma hücreli bir neoplazidir. Sıklıkla üst solunum yollarını tutar, göz tutulumu ise son derece \rnadirdir. Bu bildiride orbital kaynaklı bir ekstramedüller plazmasitom olgusu sunduk. 55 yaşında erkek hasta, sol gözde şişlik nedeniyle \ryapılan tetkiklerinde orbital yerleşimli 5×6 cm boyutlarında kitle tespit ediliyor. Kitlenin histopatolojik incelemesinde amiloid arasında bol \rmiktarda plazma hücreleri izlenmiş olup kappa-lamda ile monoklonalite görülmüştür. Olgu plasma hücreli neoplazi olarak rapor edilmiş \rolup tetkiklerinde başka bir odak tesbit edilmediğinden soliter plasmasitom olarak kabul edilmiştir. Ekstramedüller plazmasitom orbital \ryerleşimli kitlelerde akılda tutulmalıdır. Prognozu farklılık gösterdiği için tanısında sistemik bir plazma hücre diskrazisinin varlığı mutlaka \rsorgulanmalıdır.
Patients with rheumatoid arthritis and osteoarthritis in terms of sex hormone receptors and histopathological comparison of features
(Turkish League Against Rheumatism, 2021) Kultur, Turgut; Zengin, Mehmet
Objectives: This study aims to investigate the relationship between estrogen receptors (ERs) and progesterone receptors (PRs) and histopathological findings in synovial tissue in rheumatoid arthritis (RA) and osteoarthritis (OA) patients. Patients and methods: Synovial tissue samples obtained from synovial surgery from 30 RA (10 males, 20 females) and 92 OA (27 males, 65 females) patients with median age of 59 (range, 50 to 67) years were analyzed retrospectively between January 2010 and January 2019. The relationship between histopathological features and hormone receptor presence was analyzed. Results: There was a meaningful relationship between histopathological parameters and RA and OA (p=0.01). The sex hormone receptor's presence was significantly higher in females with RA (p=0.01). Additionally, in the RA group, there was a remarkable relationship between ER and focal aggregates of lymphocytes (p=0.01), perivascular infiltrates of lymphocytes (p=0.03), and diffuse infiltrates of lymphocytes (p= 0.01). In the OA group, a significant relationship was observed between PR and subchondral inflammation (p=0.01). In multivariate analysis, it was observed that ER was an independent risk factor for focal aggregates of lymphocytes in RA group (odds ratio [OR]=1.51 [1.02-2.25], p=0.04). Besides, PR was found to be an independent risk factor for subchondral inflammation in OA group (OR=3.90 [1.28-11.80], p= 0.02). Conclusion: The presence of the sex hormone receptor in the synovium may change histopathological features and affect the clinical course.
PD-1 and PD-L2 expression predict relapse risk and poor survival in patients with stage III colorectal cancer
(Springer, 2021) Zengin, Mehmet; Zergeroglu, Sema; Okcu, Oguzhan; Benek, Suat
Background Immune responses have long been an area of interest in cancer research. In this study, the effects of programmed cell death-1 (PD-1) and its ligand (PD-L2) on the prognosis of colorectal cancer (CRC) were investigated. Methods Primary tumour specimens of stage III CRC patients operated between 2002 and 2013 were assessed for PD-1 and PD-L2 expression and various clinicopathological and prognostic factors. Results We observed a significant relationship between poor prognostic factors and PD-1/PD-L2 expression. These biomarkers were also found to serve as independent risk factors for LIR and MSI. In univariate analysis, relapse-free survival (RFS) and overall survival (OS) rates were found to be poor in PD-1 and PD-L2 positive patients. In multivariate analysis, these biomarkers were found to serve as independent poor prognostic factors for RFS and OS. Conclusions Our data indicate that PD-1 and PD-L2 may serve as independent prognostic survival parameters for CRC patients and may be employed for the design of targeted theapies.
Platelet-lymphocyte ratio predicts poor prognosis in stage II / III colon and rectum cancer
(2022) Benek, Suat; Peduk, Şevki; Zengin, Mehmet
Objective: There is an increasing number of studies in the literature reporting that serum platelet/lymphocyte ratio (PLR) can provide useful prognostic data for various cancers. In the present study, the effects of platelet-lymphocyte ratio on survival in stage II/III colorectal cancers (CRC) were examined. Material and Method:A total of 106 Stage II/III CRC patients who underwent curative surgery 2015-2020 were included in the study. Emergency cases and patients diagnosed with other than adenocarcinoma were excluded from the study. The demographic data of the patients, preoperative imaging and laboratory results, postoperative pathology reports, and patient follow-up examination data were obtained from hospital records. The relations between demographic, histopathological, hematological values and the prognosis was analyzed in terms of statistical significance. Results:Among the 106 patients, 62 (58.5%) were male and 44 (41.5%) were female. The mean age was 64.3±12.01 (23-89). The mean follow-up period was calculated as 24.6±15.8 (2-63) months. When the pathology reports were reviewed, it was found that the mean tumor diameter was 5.3±2.33 cm (2-17) and the mean metastatic lymph node was 1.8±2.4 (0-10). The PLR ratio was determined as a poor prognostic factor affecting survival in the cox regression analysis, in which preoperative complete blood count, c-reactive protein and albumin values, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and PLR were compared, and was separated from other variables (P=0.002 CI= 95%). When variables such as age, clinical stage, and tumor diameter were included in the model, PLR was similarly found to be an important predictive variable (P= 0.002). When only NLR, LMR, and PLR were evaluated, PLR again came to the forefront with a significance value of P=0.01. Also, high neutrophil count, increased platelet distribution volume (PDW), advanced age, and perineural invasion (PNI) were found to be significant factors in predicting poor prognosis. Conclusions: High PLR is a poor prognostic factor for CRC patients. For this reason, it may be necessary to follow a more aggressive strategy in the management of postoperative treatment in patients who have high PLR.
The Proportion of Tumour-Stroma in Metastatic Lymph Nodes is An Accurately Prognostic Indicator of Poor Survival for Advanced-Stage Colon Cancers
(SPRINGER, 2020) Zengin, Mehmet; Benek, Suat
The importance of tumour microenvironment in tumour behaviour has now become clearer. This study aimed to determine the prognostic effect of the proportion of tumour-stroma (PTS) in metastatic lymph nodes of advanced-stage colon cancers (CCs). We investigated PTS in positive lymph nodes of stage III-IV CC patients who underwent surgical treatment between 2004 and 2014. We used a standard approach in methodology. PTS was significantly associated with prognostic factors in the metastatic lymph nodes (perineural invasion [p = 0.031], lymphatic invasion [p = 0.032], invasive margin [p = 0.043], advanced pT [p = 0.020], and margin involvement [p = 0.034]). In addition, the correlations between PTS estimates (R = 0.704 to 0.617,p < 0.001), the reproducibility of the research (Kappa appa = 0.72-0.68) and the usefulness of the cut-off value (ROC: 50.33%; AUC = 0.752 [0.667-0.857]) were successful. In univariate analysis, 5-year survival was poor for RFS (p < 0.001), OS (p = 0.001) and LR (p = 0.013) in high PTS patients. Multivariate analysis confirmed that high PTS was an independent worse parameter for RFS (HR = 1.32, 95% CI: 1.17-2.55,p = 0.001) and OS (HR = 1.37, 95% CI: 1.25-1 - 2.56,p = 0.009). In this study, we showed that high PTS in metastatic lymph nodes was a successful prognostic marker for advanced-stage CCs. Also, the standard approach we used for the methodology was successful.
RECTUM CANCERS WITH DISTANT METASTASES (STAGE IV) SHOW DECREASED TISSUE EXPRESSION OF E CADHERIN AT THE INVASIVE TUMOR FRONT
(2020) Zengin, Mehmet
PURPOSE: Rectal cancers (RC) are one of the most important causes of death worldwide. Survival of patients is mainly associated with the TNM stage. However, patients characterized by the same tumor stage often have prominent distinct survival. This is particularly a clinical challenge and new biomarkers are needed. In this research, we analyzed the prognostic role of E-cadherin (EC) in stage IV RC. MATERIAL AND METHODS: Eighty-five stage IV RC patients operated at Kırıkkale University between 2001 and 2015 were included in this retrospective study. EC was scored using model A on immunohistochemical (IHC) stained sections. The relationship between the results and the clinicopathological characteristics was analyzed. RESULTS: EC percentage was significantly downregulated in RCs classified as advanced pT (p=0.005), angiolymphatic invasion (p=0.034), stage IVb (p=0.006), high number of metastatic lymph nodes (p=0.039) and high grade (p=0.014). In univariate analysis, low EC patients had worse 5-year survival (RFS: 28.3%, p<0.001; OS: 41.2%, p<0.001). Multivariate analyzes confirmed that low EC is an independent worse survival parameter for RFS (Hazard ratio [HR]: 1.33 [1.15-3.46], p=0.001) and OS (HR: 1.57 [1.09–4.32], p=0.002). CONCLUSION: Our study confirmed the prognostic significance of low EC in stage IV RCs. Therefore, we suggest that this parameter may be an indicator of worse prognosis in RCs. This biomarker can be easily defined on IHC stained slides and can use a molecular agent in RC therapy
The role of cancer-related inflammation for prediction of poor survival in postmenopausal female patients with stage II/III colon cancer
(ELSEVIER, 2020) Zengin, Mehmet; Karahan, Irfan
Objective: Cancer-related inflammation (CRI) is thought to be a successful predictor of prognosis in colon cancers (CC), but opinions on how to use it are highly variable. In this study, the role of CRI cells in survival for CC patients was investigated by considering gender and menopausal status. Methods: 163 stage II/III CC patients who underwent curative surgery between 1995 and 2015 were included in the study. The relationship between CRI cells was examined using a standard methodology. Results: High neutrophil-lymphocyte ratio (NLR) had a better relationship with prognostic factors, especially in postmenopausal women (gender, p = 0.037, positive surgical margin, p = 0.001; MSI, p < 0.001; Crohn's-like reaction, p = 0.001, etc). Also, the reproducibility of the study was better in postmenopausal women (intraobserver agreement = 0.72, intra-class correlation = 0.722, correlation of estimates = 0.718). In univariate analysis, 5-year survival was worse in postmenopausal women with high NLR (OS, p= 0.001; RFS, p < 0.001). In multivariate analysis, high NLR was independently a worse biomarker for OS (hazard ratio [HR], 1.29; 95% CI, 1.18-2.12; p = 0.001) and RFS (HR, 1.30; 95% CI, 1.21-2.59; p < 0.001) in postmenopausal women. Conclusions: NLR had an independent poor prognostic significance in postmenopausal female patients, and the use of a standard approach for methodology improved successful results.

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