Burcu Yapar Taşköylü

Objective: Computed tomography–defined low skeletal muscle mass, often termed radiological sarcopenia in oncology, has been associated with adverse outcomes in several cancers, but its prognostic role in metastatic breast cancer (MBC) remains uncertain. The authors evaluated its prevalence and associations with clinicopathological features and survival in MBC. Methods: The authors retrospectively analyzed 61 women with MBC diagnosed during 2018-2023 who underwent positron emission tomography–computed tomography (PET-CT) at or near metastatic diagnosis. Low skeletal muscle index (SMI) was defined as <41 cm2/m2 and used as an imaging-based operational definition of sarcopenia; muscle strength and physical performance were unavailable. Logistic regression and Cox models assessed associated factors, diagnosis-based overall survival (OS), and first-line progression-free survival (PFS) (median follow-up, 35.5 months). Results: Low SMI was present in 33 of 61 patients (54.1%; 95% CI: 41.7-66.0). Higher body mass index was independently associated with lower odds of low SMI (odds ratio [OR]: 0.63; 95% CI: 0.47-0.84; P = .001). Low SMI was associated with worse diagnosis-based OS after adjustment (hazard ratio [HR]: 2.99; 95% CI: 1.08-8.28; P = .035), but not with first-line PFS (HR: 1.67; 95% CI: 0.87-3.19; P = .124). The analysis anchored to the PET-CT date did not confirm the OS association (adjusted HR: 2.15; 95% CI: 0.83-5.55; P = .115). Visceral metastasis was associated with shorter OS and PFS. Conclusion: Computed tomography-defined low skeletal muscle mass was common and associated with worse diagnosis-based OS, but the estimate was imprecise and was not confirmed in the date-anchored sensitivity analysis. These findings require confirmation in larger prospective cohorts using standardized muscle and functional assessments. Cite this article as: Güçlü Kantar T, Taş S, Doğan T, et al Prevalence and prognostic significance of positron emission tomography–computed tomography–defined low skeletal muscle mass (radiological sarcopenia) in metastatic breast cancer. Cerrahpaşa Med J 2026, 50, 0112, doi:10.5152/cjm.2026.26112.

Body composition and routinely available blood biomarkers may help characterize prognosis in extensive-stage small-cell lung cancer (ES-SCLC). We retrospectively evaluated 81 patients who received first-line carboplatin, etoposide, and atezolizumab. Baseline L3 skeletal muscle index (SMI) was derived from [18F]FDG PET/CT and classified using the Martin criteria. Overall survival (OS) was assessed using Kaplan–Meier and Cox regression. Of 80 classifiable patients, 33 (41.3%) had low SMI. Median OS was 10.51 months (95% CI, 7.98–14.26) and was 8.48 versus 14.26 months in patients with low versus normal SMI (log-rank p = 0.050). In the primary multivariable model, low SMI was associated with higher mortality (HR, 2.03; 95% CI, 1.07–3.86; p = 0.030); lower albumin and higher lactate dehydrogenase were also associated with mortality. In exploratory analyses, the low-SMI association persisted after post hoc adjustment for bone metastasis (HR, 2.16; 95% CI, 1.05–4.42; p = 0.035), although diagnostics suggested time-varying effects. Continuous SMI and alternative thresholds were not associated with OS, and low SMI was not associated with progression-free survival. Martin-defined low SMI may complement routine biomarkers in prognostic assessment, but its cutoff- and time-dependent association requires cautious interpretation and external evaluation.

Purpose: This study aimed to identify the prognostic and predictive factors affecting survival in patients with early-stage human epidermal growth factor receptor 2 (HER2) positive breast cancer who received adjuvant treatment.Materials and methods: A retrospective analysis was conducted on 124 female patients diagnosed with early-stage HER2-positive breast cancer at Pamukkale University Faculty of Medicine between January 2014 and December 2019. Clinicopathological characteristics, treatment regimens, and laboratory findings were analyzed. Survival analyses were performed using the Kaplan-Meier method, and factors influencing survival were evaluated using Cox regression analysis.Results: The mean follow-up duration were 63.9 months. The mean overall survival and progression-free survival were 65.1 and 58.8 months, respectively. Lymph node involvement greater than three, elevated Cancer Antigen 15-3 (CA15-3) (>25 U/mL), and high lactate dehydrogenase (LDH) levels (>214 U/L) were significantly associated with shorter progression-free survival (p

Background and Objectives: Reliable pretreatment biomarkers to guide treatment selection in HER2-positive metastatic breast cancer (mBC) remain an unmet need. Systemic inflammatory indices derived from routine blood tests have emerged as accessible prognostic markers. This study evaluated the prognostic value of inflammation-based indices in patients with HER2-positive mBC treated with trastuzumab emtansine (T-DM1). Materials and Methods: In this retrospective single-center cohort study, 50 patients with HER2-positive mBC treated with T-DM1 in the second-line setting were analyzed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. ROC analysis assessed the prognostic performance of the CRP/albumin ratio (CAO), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Variables associated with PFS were further evaluated using multivariable Cox regression. Results: The median follow-up was 46 months. Median OS from initial diagnosis and median PFS from T-DM1 initiation were 96 and 7 months, respectively. Metastatic pattern (p = 0.010), CNS involvement at T-DM1 initiation (p = 0.025), liver metastasis (p = 0.041), and best radiologic response (p < 0.001) were associated with PFS. ROC analysis showed modest discrimination (CAO AUC 0.694, NLR 0.658, PLR 0.646, and SII 0.653). In multivariable analysis, best radiologic response to T-DM1 was strongly associated with progression risk and appeared to reflect treatment sensitivity rather than acting as a pretreatment predictor. Conclusions: T-DM1 provided meaningful disease control in this real-world cohort. Treatment response was the main determinant of progression, while baseline inflammatory markers offered modest complementary prognostic value. These findings may aid patient selection for T-DM1, particularly in settings with limited access to trastuzumab deruxtecan.

Background: Accurate prognostic stratification is essential for clinical decision-making in metastatic renal cell carcinoma (mRCC). Although the International Metastatic RCC Database Consortium (IMDC) model is widely used, its discriminatory capacity may be limited in specific clinical subpopulations. The Royal Marsden Hospital (RMH) score, based on serum albumin, lactate dehydrogenase, and the number of metastatic sites, has not been evaluated as a prognostic tool in patients with de novo mRCC receiving first-line tyrosine kinase inhibitor (TKI) therapy. Methods: We retrospectively analyzed the data of 149 patients with de novo metastatic renal cell carcinoma who received first-line TKI therapy (pazopanib, sunitinib, or cabozantinib) at two tertiary oncology centers in Turkey. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent prognostic factors. Results: The median OS and PFS were 23.1 months (95% CI: 19.4–26.8) and 9.4 months (95% CI: 7.0–11.8), respectively. The OS showed a stepwise decline across RMH risk groups, ranging from 40.7 months in patients with an RMH score of 0 to 8.6 months in those with an RMH score of 3. In the multivariate analysis, the RMH score (HR 1.29, 95% CI: 1.03–1.61; p = 0.026) and sarcomatoid differentiation (HR 2.01, 95% CI: 1.09–3.72; p = 0.025) were independently associated with worse OS. The IMDC score did not retain independent prognostic significance (p = 0.129). The RMH score was not significantly associated with PFS after multivariable adjustment, and the IMDC score was not significantly associated with PFS in univariate analysis and was therefore not entered into the multivariable PFS model. Conclusions: The RMH score independently predicted overall survival in patients with de novo mRCC receiving first-line TKI therapy, whereas the IMDC score did not retain independent prognostic significance in this cohort. Given its simplicity and reliance on objective parameters, the RMH score may provide complementary prognostic information in this patient population; however, external validation in independent cohorts is required before broader clinical implementation can be considered.

Objectives: In patients receiving immune checkpoint inhibitors (ICIs), baseline nutritional status is frequently recorded, but what happens during treatment may be at least as informative. We examined whether the 3-month change in Mini Nutritional Assessment (ΔMNA)–Short Form (SF) is associated with survival, and how this relates to baseline systemic inflammation measured by modified Glasgow Prognostic Score (mGPS). Methods: We retrospectively screened institutional records and included 54 adults with advanced/metastatic solid tumors treated with ICIs who had MNA-SF documented at treatment start and again at approximately 3 months. ΔMNA was defined as MNA-SF (~3 months) minus baseline MNA-SF (higher values indicate improvement) and was categorized for Kaplan–Meier analyses as worsened (≤ −1), stable (= 0), or improved (≥ +1). Baseline mGPS was derived using CRP >5 mg/L and albumin <35 g/L. Overall survival (OS) and progression-free survival (PFS) were measured from ICI initiation. Cox regression assessed ΔMNA as a continuous variable, with prespecified adjustment for baseline mGPS, age, and sex. Results: Median follow-up was 317 days (IQR 170.5–457.3). Death occurred in 16/54 patients and a PFS event in 27/54. Median OS was 706 days (1-year OS 71.3%; 2-year OS 49.4%), and median PFS was 337 days (1-year PFS 48.5%; 2-year PFS 15.1%). Nutritional categories shifted toward better status at 3 months (baseline normal/risk/malnutrition 29/23/2 vs 35/17/2 at follow-up). In univariable Cox models, higher ΔMNA was associated with longer survival (PFS: HR 0.72, 95% CI 0.56–0.94; P=0.016; OS: HR 0.56, 95% CI 0.38–0.82; P=0.003). In prespecified multivariable models, baseline mGPS was independently associated with OS (HR 1.86, 95% CI 1.00–3.45; P=0.048). After adjustment, the association between ΔMNA and outcomes remained in the protective direction but did not meet conventional statistical significance (OS: HR 0.67, 95% CI 0.42–1.06; P=0.086; PFS: HR 0.72, 95% CI 0.56–1.05; P=0.094). In an exploratory lung cancer subgroup (n=36), ΔMNA was associated with improved PFS (HR 0.62; P=0.008) and OS (HR 0.59; P=0.018). These subgroup findings should be interpreted as hypothesis-generating. Conclusions: Baseline mGPS captured inflammatory risk at ICI start, while ΔMNA captured what happened to nutritional status over the first 3 months. In this cohort, nutritional improvement showed a consistent protective direction for OS and PFS even after accounting for baseline inflammation, and mGPS retained an independent association with OS. These findings support prospective studies that reassess nutrition during immunotherapy rather than relying on a single baseline measurement.

Background and Objectives: Nasopharyngeal carcinoma (NPC) is a distinct type of head and neck cancer with unique epidemiological and pathological characteristics. Inflammatory and nutritional markers have been increasingly recognized as prognostic indicators in cancer. In this study, we aim to evaluate the significance of the prognostic nutritional index (PNI) and C-reactive protein/albumin ratio (CRP/Alb) in the prognosis of patients with locally advanced nasopharyngeal carcinoma (NPC). Materials and Methods: We retrospectively analyzed a total of 78 patients diagnosed with locally advanced NPC who received chemoradiotherapy (CCRT) with or without induction or adjuvant chemotherapy between January 2010 and April 2024. Patient characteristics, treatment modalities, inflammatory and nutritional markers, overall survival (OS), and progression-free survival (PFS) were assessed. Kaplan–Meier survival analysis and Cox regression models were used to evaluate the prognostic impact of PNI and CRP/Alb. Results: A lower PNI (≤52.90) and lower CRP/Alb ratio (≤0.14) were significantly associated with higher mortality risk (p = 0.043 and 0.023, respectively). Tumor size (≥32.85 mm) was also found to be a significant prognostic factor (p = 0.041). Patients receiving CCRT alone or with adjuvant chemotherapy had a better OS and PFS compared to those who received induction chemotherapy plus CCRT (p = 0.028 and 0.002, respectively). Multivariate Cox regression analysis indicated that CCRT + AC (HR: 0.17, p = 0.029) and CCRT (HR: 0.25, p = 0.049) significantly reduced the risk of death. Conclusions: PNI and CRP/Alb ratio are independent prognostic markers in locally advanced NPC, providing valuable insights into patient stratification and treatment optimization. These findings support their integration into routine clinical practice for risk assessment. Future large-scale, multicenter studies are warranted to confirm these findings.

Background: Non-small cell lung cancer (NSCLC) is the most prevalent form of malignancy and the leading cause of cancer-related fatalities. In clinical practice, metastatic sites are identified on a case-by-case basis. ALK rearrangements are detected in 3–5% of NSCLC cases and are known to have a tendency (tropism) to metastasize to the brain. Methods: Data from 81 ALK-positive and 91 ALK-negative metastatic NSCLC patients were retrospectively analyzed. Systemic markers, including HALP score, NLR, PLR, LMR, and LDH, were calculated from blood tests at the time of metastasis. Optimal cut-off values were determined using ROC analysis. Survival outcomes and prognostic factors were assessed using Kaplan–Meier and Cox regression analyses. Results: ALK-positive patients were significantly associated with female gender (p = 0.002), non-smoking status (p = 0.001), adenocarcinoma histology (p = 0.001), and a higher incidence of brain metastases (p = 0.001). In univariate analysis, age, time to metastasis, liver metastasis, and NLR were prognostic for survival. Crucially, multivariate analysis identified liver metastasis as an independent predictor of poor prognosis (HR = 1.618; 95% CI: 1.050–2.494; p = 0.029), indicating a 61.8% increased risk of death or progression. While inflammation markers (NLR, HALP, PLR, LMR) did not predict metastasis to specific sites, elevated LDH levels were significantly associated with liver metastasis (p = 0.007). Conclusion: ALK-positive NSCLC demonstrates a marked CNS tropism; however, liver metastasis remains a more critical adverse prognostic factor than brain metastasis in real-world settings. While routine inflammation markers showed limited utility in predicting site-specific metastasis, LDH levels correlated significantly with liver involvement. Aggressive management strategies are warranted for ALK-positive patients presenting with liver metastases.

Aim: Despite the survival benefit achieved with immune checkpoint inhibitors in advanced non–small-cell lung cancer (NSCLC), outcomes remain heterogeneous. While PD-L1 expression is an established biomarker, less is known about the prognostic relevance of on-treatment systemic inflammatory dynamics and the utility of endothelial stress–based indices such as the Endothelial Activation and Stress Index (EASIX) in patients receiving immunotherapy.Material and Methods: We retrospectively evaluated patients with advanced NSCLC treated with nivolumab. PD-L1 expression, metastatic burden, baseline inflammatory parameters, and baseline EASIX were recorded. On-treatment inflammatory markers, including derived neutrophil-to-lymphocyte ratio (dNLR) at 3 months and longitudinal changes in NLR (ΔNLR), were analyzed. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan–Meier and Cox regression models. To account for time-dependent bias, 3-month landmark analyses were performed.Results: Eighty-one patients were included. High PD-L1 expression (≥50%) was associated with significantly improved OS but did not retain independent prognostic significance for PFS. A high metastatic burden, particularly involvement of four or more metastatic organs, was associated with inferior OS. In landmark-adjusted analyses, dNLR at 3 months was independently associated with both OS and PFS, while ΔNLR was associated with OS, indicating that favorable on-treatment immune–inflammatory changes correlated with improved survival. Baseline EASIX was not associated with either OS or PFS.Conclusion: In nivolumab-treated advanced NSCLC, survival outcomes are primarily driven by tumor biology, disease burden, and immune–inflammatory dynamics evolving during therapy. On-treatment inflammatory markers, particularly dNLR and ΔNLR, provide more clinically relevant prognostic information than baseline indices, whereas baseline EASIX appears to have limited utility in this setting. These findings support a treatment-specific, time-dependent approach to biomarker-based risk stratification in immunotherapy.

Hormon reseptör pozitif meme kanseri tedavisinde hormonal tedaviler gerek adjuvan dönemde gerekse metastatik dönemde yaygın şekilde kullanılan etkin tedavilerdir. Bu tedavileri kullanan hastalar tedavi sürecinde yan etkiler açısından takip edilmelidir. Onkolojik açıdan kontrol sağlanırkan yan etki nedeniyle olabilecek komplikasyonlar hastanın yaşam kalitesini etkileyebilmektedir. Bu tedavileri belirlerken hastanın menopoz durumu, kemik dansitesi, kardivasküler durumu gibi çeşitli faktörlere dikkat edilmektedir. Tamoksifen ile karşılaştırıldığında aromataz inhibitörleri daha yüksek osteoporoz, kırık, kardiyovasküler hastalık, diyabet ve hiperkolesterolemi riski ile ilişkilidir. Tamoksifen tedavisinde ise endometriyal kanser ve tromboembolik olaylarda artış görülebilmektedir.