Ahmet Ulusan

D-Valine as a mirror-image antifibrotic agent: Inhibiting fibroblast proliferation and attenuating airway fibrosis - Turkish Journal of Thoracic and Cardiovascular Surgery

MicroRNA-299-3p as a potential marker of tumor size in non-small cell lung cancer - Turkish Journal of Thoracic and Cardiovascular Surgery

Objective: Amphiregulin (AREG), which is known as a ligand for the epidermal growth factor receptor (EGFR), is widely expressed by cancerous and immune cells. By activating EGFR signaling, AREG enhances GLUT1 expression. It also promotes intracellular glucose uptake. In this way it supports glycolysis and lactate production. This metabolic hallmark is known as the Warburg effect. A similar glycolytic shift occurs in activated natural killer (NK) cells, which are essential components of antiviral and antitumor immunity. The aim of this study is to investigate the relationship between serum AREG levels and NK cell activation in patients with non-small cell lung cancer (NSCLC). Methods: This is a case-control study which includes 40 NSCLC patients and 40 healthy controls. Serum AREG levels were measured by ELISA and NK cell activation was assessed by using flow cytometric analysis of CD107a, CD69, CD314 (NKG2D), and CD337 (NKp30) parameters. Results: Serum AREG levels were significantly lower in NSCLC patients compared to healthy individuals. Although the overall percentage of NK cells was increased in patients, expression of activation markers especially CD107a was reduced. Correlation analysis revealed weak negative associations between AREG levels and expression of CD107a, CD69, CD314, and CD337. Conclusion: Collectively, these findings suggest that reduced serum AREG levels may be linked to impaired NK cell activation in NSCLC, potentially through limited glucose uptake, highlighting AREG as a potential regulator of immune metabolism and a candidate for further investigation in tumor immune evasion.

Objectıves: T4 non-small-cell lung cancer comprises a biologically and anatomically heterogeneous group. The 9th edition of the Tumour-Node-Metastasis staging system introduced refined T4 definitions and subdivided N2 disease into single- and multi-station involvement. This study aimed to assess long-term survival and prognostic factors in surgically treated T4 non-small-cell lung cancer patients, focusing on T4 subgroups and nodal status. Methods: We retrospectively analysed patients who underwent resection for pathologically confirmed T4 non-small cell lung cancer between 2006 and 2024. Patients were categorized based on T4 criteria: tumour diameter >7 cm, adjacent structure invasion, or multiple T4 features. Survival outcomes were assessed using Kaplan-Meier, Aalen-Johansen and Cox regression analyses. Results: A total of 191 patients were analysed. The 5-year overall survival rate was 34.1%, varying across subgroups: 38.7% (size), 29.9% (invasion), and 6.1% (multiple criteria) (P < .001). Adjuvant chemotherapy was associated with improved overall survival (hazard ratio [HR]: 0.511; P = .001), while N2 disease (HR: 1.750; P = .012) and multiple T4 features (HR: 2.590; P < .001) predicted worse outcomes. Similar patterns were observed in recurrence-free survival. N2 involvement was particularly adverse in the invasion group. Conclusıons: T4 aetiology and nodal status significantly impact survival following surgery. These findings support the prognostic utility of the 9th Tumour-Node-Metastasis edition and underscore the value of tailored surgical strategies.

The aim of our study is to evaluate the impact of metastasectomy on survival in patients with oligometastatic stage 4 lung cancer. Fifty-nine oligometastatic lung cancer cases operated on in our clinic between January 2015 and January 2024 were retrospectively examined. Demographic characteristics, metastasis type, metastasis locations, treatments applied, location of the primary tumor, histological type of the tumor, and metastasectomy status of the patients included in the study were evaluated. All patients underwent surgery for primary lung cancer. Generally, the mass in the lung was excised first. The metastasis was then removed. When brain surgery became a priority in some brain metastases, the metastasis was first removed and then the lesion in the lung was completely removed. In patients with oligometastasis, the tumor was either completely removed surgically or a complete cure was achieved with radiotherapy. All patients were stage 4a patients with metastases. The median age of the patients was 61 (36–76) years. 31 (52.6%) of the patients were aged 60 and over. 96.6% (n:57) of the patients were male and 3.4% (n:2) were female. Histopathological diagnosis was 35.6% squamous cell carcinoma (SCC) and 42.4% adeno cancer. 61.0% of the patients had brain metastases and 23.7% had adrenal metastases. The hospital stay of the patients was 14.0 ± 9.9 days. Disease-free survival time was 18.3 ± 24.4 months and overall survival time was 13.6 ± 11.5 months. While 32.2% (n:19) of the patients were alive, 67.8% (n:40) died. The survival rate was statistically significantly higher in patients who underwent metastasectomy compared to those who did not undergo metastasectomy (p = 0.027). The risk factors were found to be significantly associated with survival in the logistic regression analysis included metastasectomy (OR: 3.942, p = 0.030), diagnosis (SCC) (OR: 9,000, p = 0.042), recurrence (OR: 5.248, p = 0.012), adjuvant RT (OR: 0.298, p = 0.045), and neoadjuvant therapy (OR: 4.154, p = 0.040). In stage 4a lung cancer patients with oligometastasis, curative treatment of metastasis (metastasectomy) has a positive effect on survival. The low rate of radiotherapy and chemotherapy treatments given after metastasectomy will protect patients from the side effects of these treatments.

Background and Objectives: This study aims to evaluate the prognostic significance of various laboratory parameters in predicting the length of hospital stay and mortality among pediatric patients undergoing lobectomy and pneumonectomy for infectious or noninfectious diseases. Materials and Methods: This study was conducted by retrospective data analysis of 59 pediatric patients who underwent lobectomy and pneumonectomy due to variable diseases at the department of chest surgery. Pediatric patients diagnosed with variable diseases and who underwent lobectomy or pneumonectomy, patients who were hospitalized during the study period and underwent surgical intervention, and patients who had at least one laboratory parameter recorded before surgery were included in the study. Laboratory parameters included white blood cell (WBC) count, red cell distribution width (RDW), platelet (PLT) count, neutrophil count, mean platelet volume (MPV), monocyte count and lymphocyte count. Laboratory results were obtained from the patients’ most recent blood samples before surgery. In addition, derived ratios such as platelet-to-lymphocyte ratio (PLR), MPV-to-PLT ratio (MPR), MPV-to-monocyte ratio (MMR), MPV-to-lymphocyte ratio (MPVLR), monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR), and Pan-Immune-Inflammation Value (PIV) were calculated and their potential prognostic values were evaluated. Results: The mean age of the patients was 6.3 years (0–15 years). The gender distribution of the patients in the study group was determined as 36 male patients (61%) and 23 female patients (39%). Lobectomy was the most commonly performed surgical procedure, accounting for 83% of cases, while pneumonectomy was applied in 17% of cases. The postoperative complication rate was observed as 34%. The mean hospital stay of the patients was calculated as 12.61 days (2–84 days), while the mortality rate was recorded as 8.5%. The relationship between the neutrophil count and the length of hospital stay is quite strong, and the r value was calculated as 0.550 (p < 0.01). PIV showed a strong correlation with length of hospital stay, with an r value of 0.650 (p < 0.01). A significant relationship was also found between PLR and length of hospital stay (r = 0.500, p < 0.01). The parameters with the highest positive effect on the hospital stay are neutrophil count (B = 0.400, p < 0.01) and PIV (B = 0.500, p < 0.01). The mean hospital stay was 10.00 days (2–30) in patients without complications and 15.00 days (5–40) in patients with complications, and this difference was also significant (p < 0.01). Finally, the mortality rate was 2.5% in patients without complications, while it was determined as 20% in those with complications (p < 0.01). Conclusions: This study determines the effects of laboratory parameters (particularly PIV, neutrophil, PLR, and NLR) on the duration of hospital stay, development of complications, and mortality and emphasizes the importance of monitoring these parameters in the treatment of infectious or noninfectious diseases.

Post-intubation tracheal stenosis (PITS) is a serious complication of prolonged intubation, often requiring surgical intervention. This study aims to present the long-term outcomes of patients with PITS who underwent tracheal resection and reconstruction, as well as to discuss the efficacy of these surgical methods in comparison to stenting. This retrospective study included patients treated for PITS at our center between October 2005 and October 2022. Patients were divided into two groups: those who underwent tracheal resection and reconstruction (n = 29) and those treated with stenting (n = 47). The clinical characteristics, surgical techniques, complications, and long-term outcomes were recorded and analyzed. The mean age of the patients was 41.3 years, with 40.0% aged between 40 and 60 years. The mean intubation duration was 16.8 days. In the resection group, 22 of 29 patients (75.8%) showed no recurrence or complications during long-term follow-up. The overall success rate for surgical treatment was 93.1%, with a mortality rate of 6.8%. In the stenting group, successful stent removal was achieved in 9 of 47 cases, with a mean stent removal time of 26 months. Granulation tissue formation and restenosis were more frequently observed in stented patients compared to those who underwent surgery. Tracheal resection and end-to-end anastomosis remain the gold standard treatment for PITS, with a lower recurrence rate and fewer long-term complications compared to stenting. However, stenting may be a viable option for patients who are not suitable candidates for surgery. Careful preoperative evaluation and long-term follow-up are essential to optimize patient outcomes.

Single center experience of war-related thoracic injuries in Syria

Introduction: Despite all advances in diagnosis and treatment, lung cancer is the leading cause of cancer death in both sexes worldwide. Because of the different survival rates in lung cancer, additional factors are needed to determine prognosis. In this study, we aimed to investigate the relationship between survival and clinical data of primary tumor SUV (Standardized Uptake Value) to evaluate the role of FDG-PET ([18F]-fluoro-2-deoxy-D-glucose Positron Emission Tomography) as a prognostic factor in lung cancer.Material and methods: The data of patients who underwent anatomic resection and preoperative positron emission tomography/computed tomography (PET/CT) were performed retrospectively between February 2006 and October 2019 in the Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University.Results: All cases were 666 patients, 64 of whom (9.6%) were females and 602 of them (90.4%) were males. The mean age of the patients was 61.91±9.6 years. Histologically, there were 369 (55.4%) epidermoid carcinomas, 233 (34.9%) adenocarcinomas. The overall mean survival was 68.2 months and the median survival was 63.6 months. The mean mass SUV values of the patients were 13.73 ± 6.65. The effect of histological type, TNM stage, metastasis and recurrence on survival was statistically significant (p < 0.05). According to the univariate analysis (Cox regression analysis), it was found that 1 unit increase in SUV value contributed to a statistically significant increase in mortality risk (p = 0.002, HR: 1.024, 95% CI: 1.009-1.040).Conclusions: In our study on 666 patients, unlike literature, no statistically significant relationship was found between SUV value and survival.