Berk Çimenoğlu

Non-small cell lung cancer (NSCLC) has a high mortality rate, emphasizing the need for reliable preoperative prognostic tools. Recent studies have focused on markers that reflect both inflammatory and nutritional status. This study aimed to evaluate the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting postoperative outcomes in NSCLC patients. This retrospective observational study included patients diagnosed with NSCLC who underwent curative surgery between January 1, 2019, and January 1, 2024. Preoperative HALP scores were calculated from routine blood tests to assess their potential as independent predictors of survival and long-term outcomes. The study cohort comprised 238 patients, divided into 2 groups: survivors (n = 153, 64.3%) and deceased patients (n = 85, 35.7%). The median HALP score was significantly lower in the deceased group (31.2) compared to survivors (52.3; P < .001). Follow-up duration was also significantly shorter in the deceased group (median 22 months) compared to survivors (median 34 months; P < .001). In the Cox univariate analysis, age ≥ 65 years (hazard ratio [HR] 2.02, 95% confidence intervals [CI] 1.32–3.1, P = .002), positive surgical margins (HR 3.04, 95% CI 1.61–5.76, P = .003), and low HALP scores (HR 5.17, 95% CI 3.33–8.03, P < .001) were significantly associated with decreased survival. However, in the multivariate analysis, positive surgical margins (HR 2.74, 95% CI 1.35–5.56, P = .005) and low HALP scores (HR 5.80, 95% CI 3.6–9.3, P < .001) remained independent predictors of decreased survival, while age ≥ 65 years did not retain significance. These findings suggest that positive surgical margins and low HALP scores are key prognostic factors for survival in NSCLC patients. The HALP score was identified as an independent predictor of postoperative mortality in NSCLC patients. Lower scores were significantly associated with higher mortality, indicating its potential use in both risk assessment and guiding postoperative management.

Background: In this study, we aimed to evaluate the predictive value of the Haller index for recurrence risk in primary spontaneous pneumothorax patients. Methods: Between January 2018 and December 2023, a total of 285 patients (260 males, 25 females; median age: 23 years; range, 17 to 35 years) with primary spontaneous pneumothorax who underwent thoracic computed tomography and followed for at least one year were retrospectively analyzed. The patients were divided into two groups as the non-recurrence group (n=170) and recurrence (n=115) group. The Haller index was calculated from computed tomography scans at presentation and its predictive value for recurrent pneumothorax was estimated. Results: The median age was significantly higher in the non-recurrence group than in the recurrence group (p< 0.001). The median time to recurrence was two (IQR 1-3) months. The diagnostic validity of Haller index for predicting recurrence showed an area under the receiver operating characteristic of 0.824 (95% confidence interval [CI]: 0.775-0.866) (p< 0.001). The optimal cut-off value of Haller index (>2.4) showed a sensitivity of 70.43% (95% CI: 61.2-78.6) and specificity of 76.47% (95% CI: 69.4-82.6). Conclusion: A high Haller index is associated with increased recurrent pneumothorax risk in primary spontaneous pneumothorax patients. Traditionally used for pectus excavatum severity, incorporating Haller index in the management of these patients may help to identify high-risk patients and guide personalized management strategies.

Introduction: In this study, we investigated the clinical outcomes of patients who underwent surgery with proven lymph node metastasis.Methods: Patients who were operated for lung cancer with pN1 or pN2 were examined in the study. The clinicopathological features and survival of the subjects were evaluated according to pN1‐pN2 status, presence of neoadjuvant treatment, Positron emission tomography and computed tomography (PET/CT) avidity on mediastinal lymph nodes and specific lymph node stations.Results: The study examines 100 patients operated from January 2016 to December 2021. Number of cases with pN1 and pN2 disease were 45 (45%) and 55 (55%) respectively. Thirty (30%) patients received neoadjuvant treatment. The 5‐year overall survival (OS) and disease‐free survival (DFS) of the patients were computed as 42.5% and 42.4% correspondingly. The 5‐year cancer‐related survival was 55.3%. In pN2 cohort, 5‐year DFS was 67.9% in the neoadjuvant group and 15.9% in the non‐neoadjuvant group (P = 0.042). In non‐neoadjuvant group, 5‐year DFS was 19.9% in cases with mediastinal PET/CT avidity and 56.3% in patients without mediastinal PET/CT avidity (P = 0.018). In pN2 disease, the presence of subcarinal or paratracheal lymph node metastasis did not create a significant difference in 5‐year OS or DFS, but pulmonary ligament lymph node metastasis was found to be linked with worse survival in both 5‐year OS (P = 0.005) and DFS (P = 0.017).Conclusion: The main elements related with poor prognosis were absence of neoadjuvant treatment and pulmonary ligament lymph node metastasis in pN2 disease, detecting PET/CT avid mediastinal lymph nodes in non‐neoadjuvant group.

Aims: The primary aim of this study is to evaluate the surgical outcomes of lobectomy and pneumonectomy operations performed due to lung cancer in individuals aged 70 and above, and to analyze the factors influencing these outcomes. Methods: This retrospective study covers lobectomy and pneumonectomy operations performed on 103 lung cancer patients over the age of 70, from January 2018 to December 2021. A dataset was created including patients’ demographic information, smoking status, comorbidities, results of pulmonary function tests and echocardiography, preoperative complete blood count, and serum albumin levels, and these data were analyzed. Results: The average age of the patients was 73.3; 83.5% were male, and 16.5% were female. The complication rate was 47.6%, and the 30-day surgical mortality rate was 8.7%. Patients with a high American Society of Anesthesiologists (ASA) score had higher rates of complications and mortality (p=0.015). Low preoperative serum albumin (p=0.017) and hemoglobin (p=0.026) levels were associated with an increased risk of complications. Postoperative outcomes between Video Assisted Thoracoscopic Surgery (VATS) and thoracotomy were found to be similar. Conclusion: The study demonstrates that in elderly lung cancer surgery, comorbidities and preoperative nutritional status are decisive factors affecting surgical outcomes. Preoperative albumin and hemoglobin levels emerge as significant indicators in assessing the risk of postoperative complications. VATS and thoracotomy are surgical techniques with similar safety and efficacy profiles.

Aims: The aim of this study is to reveal the relationship between the timing of thoracic computed tomography (CT) imaging conducted prior to surgery and the pre-surgical period in patients planned for pulmonary metastasectomy (PM), and to determine a safe pre-surgical timing for thoracic CT. Methods: This study is a retrospective cohort study examining the data of patients who underwent pulmonary metastasectomy (PM). The research includes 96 patients who underwent PM between January 2017 and July 2022. Patients’ demographic data, primary malignancy diagnoses, type of operation, sizes of masses requiring anatomical resection, the number of lesions detected in thoracic CT, the number of lesions identified during surgery, and the timing of thoracic tomography were recorded. The timing of thoracic CT imaging was compared with the number of lesions detected preoperatively and postoperatively. Results: The study included 96 patients, comprising 49 females and 47 males. The most common primary pathological diagnosis was colon cancer at 36.5%, followed by breast cancer at 12.5%. 66.6% of the patients were operated on with thoracotomy, 29.1% with video-assisted thoracoscopic surgery (VATS), and 4.2% with rethoracotomy. The average number of lesions detected in preoperative thoracic tomography was 1.67±0.96, while the average number of lesions detected during surgery was 2.03±1.41. In patient groups where thoracic CT was performed 10 days or less before the operation, no significant difference was found between the number of lesions detected during surgery and the number of lesions in the CT. However, in patients where thoracic CT was performed more than 10 days before the operation, the number of lesions detected during surgery was significantly higher than the number of lesions detected in the CT. Conclusion: In this research, it was concluded that for patients planned for PM, repeating thoracic CT after the 10th day following the initial detection of metastases in the pre-surgical phase may contribute to the detection of more lesions.

Background Mediastinal lymphadenopathies with high 18-fluorodeoxyglucose uptake in patients previously operated on for lung cancer are alarming for recurrence and necessitate invasive diagnostic procedures. Peroperative placement of oxidized cellulose to control minor bleeding may lead to a metastasis-like image through a foreign body reaction within the dissected mediastinal lymph node field at postoperative examinations. In this study, we investigated clinicopathological features and the frequency of foreign body reaction mimicking mediastinal lymph node metastasis. Methods Patients who underwent surgery for lung cancer between January 2016 and August 2021 and who were subsequently evaluated for mediastinal recurrence with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were included. Patients were grouped according to the results of EBUS-TBNA as metastasis, foreign body, and reactive. Clinicopathological features of these patients were compared and characteristics of patients in the foreign body group were scrutinized. Results EBUS-TBNA was performed on a total of 34 patients during their postoperative follow-up due to suspicion of mediastinal recurrence. EBUS-TBNA pathological workup revealed metastasis in 18 (52.9%), foreign body reaction in 10 (29.4%) and reactive lymph nodes in 6 (17.6%) patients. Mean maximum standardized uptake value (SUVMax) for metastasis group and foreign body group were 9.39 ± 4.69 and 5.48 ± 2.54, respectively (p = 0.022). Time interval between the operation and EBUS-TBNA for the metastasis group was 23.72 ± 10.48 months, while it was 14.90 ± 12.51 months in the foreign body group (p = 0.015). Conclusion Foreign body reaction mimicking mediastinal lymph node metastasis is not uncommon. Iatrogenic cause of mediastinal lymphadenopathy is related to earlier presentation and lower SUVMax compared with metastatic lymphadenopathy.

To investigate the prognostic significance of STAS (Spread through air spaces) and its effect on survival in the various types of non-small cell lung cancer (NSCLC). Descriptive analytical study. Place and Duration of the Study: Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkiye, between 2018 and 2021. Early-stage lung cancer patients who underwent lobectomy were included. STAS was defined as presence of tumour cell clumps, solid nests or set of single cells located in airway spaces apart from the main tumour border and determined by pathological work-up. The clinical significance of STAS was investigated by means of histopathological subtype, tumour size, and maximum standardised uptake value (SUVmax) on PET-CT scan in early-stage lung cancer by grouping it as adenocarcinoma and non-adenocarcinoma. Five-year overall and disease-free survival, and recurrence were the outcome measures. A total of 165 patients were included in the study. No recurrence was observed in 125 patients, 40 patients developed recurrence. Five-year overall survival (OS) was 69.6% in STAS (+) cohort and 74.5% in STAS (-) cohort (p=0.88). Five-year disease-free survival (DFS) was 51.1% in STAS (+) cohort and 73.1% for STAS (-) cohort (p=0.034). While the absence of STAS in the adenocarcinoma group was associated with better DFS, lower SUVMax and smaller tumour size, similar results were not found to be at statistically significant level in the non-adenocarcinoma group. STAS positivity makes a difference in DFS, tumour size and SUVmax, especially in adenocarcinoma, however, it does not create a significant difference in survival or clinic pathological features in the non-adenocarcinoma. Lung Cancer, Lobectomy, Spread through air spaces, Survival, Prognosis.