Engin Kut

Breast cancer is a major global health challenge, and spirituality is increasingly recognized as a supportive factor in patient adaptation. This study examined the relationship between spiritual well-being (SpWB) and quality of life (QoL) among stage II breast cancer patients in Türkiye, exploring how distinct spiritual dimensions are associated with multidimensional QoL outcomes. A cross-sectional study was conducted with 288 stage II breast cancer patients. QoL was assessed using the FACT-G, and SpWB using the FACIT-Sp-12. Analyses included Spearman correlations with Bonferroni correction ( p < 0.0025) and multiple linear regression analyses. The mean age of participants was 56.1 ± 11.7 years. Average total scores were 62.5 ± 12.3 for FACT-G and 34.2 ± 6.2 for FACIT-Sp. Regression models showed modest explanatory power (up to 14.1% of the variance). The Peace subscale showed the strongest independent associations with overall QoL (β = 0.210; p = 0.011), physical well-being (β = 0.279; p = 0.001), and functional well-being (β = 0.303; p < 0.001). The Peace subscale was negatively associated with emotional well-being (β = −0.205; p = 0.016), although this finding should be interpreted as exploratory. The Faith subscale was independently associated with social/family well-being (β = 0.209; p = 0.009). The findings indicate statistically significant associations between dimensions of spiritual well-being and quality-of-life outcomes among breast cancer patients. However, given the modest explanatory power of the models, the potential integration of spiritual well-being assessment into oncology care requires further validation through prospective intervention studies.

Background/Objectives: We aimed to evaluate the real-world outcomes of first-line osimertinib in patients with advanced EGFR-mutant non-small cell lung cancer, together with the progression patterns, including the management and outcomes of oligoprogressive disease in the real-world setting. Methods: Patients who received first-line osimertinib at 33 oncology centers across Türkiye were retrospectively analyzed. Results: The median (IQR) age of 143 patients was 59.4 (50.9–68.9), 62.9% were female, and 68.5% were non-smokers. The most frequently identified EGFR mutations were exon 19 deletion (64.3%) and exon 21 L858R (28.7%). The median progression-free survival (PFS) was 17.6 months (95% CI 14.6–20.6). Exon 19 deletion subgroup had significantly longer median PFS than exon 21 L858R subgroup (22.0 vs. 11.7 months; HR = 0.40 [95% CI 0.25–0.64]; p < 0.001). Of the patients who experienced disease progression, 51.2% had oligoprogression. Among these, 81.8% received local ablative treatments (LATs) while continuing osimertinib. The median time to osimertinib discontinuation was significantly longer in patients treated with LATs than in those who continued osimertinib without LATs (8.5 vs. 3.0 months; p = 0.001). In the overall cohort, 12- and 24-month overall survival (OS) rates were 93.0% and 82.5%, respectively. The median OS was significantly longer in patients with oligoprogression compared to those with systemic progressive disease (57.7 vs. 36.5 months; p = 0.007). Any-grade and grade ≥ 3 osimertinib-related adverse events occurred in 55.2% and 6.3% of patients, respectively. Conclusions: This study supports the real-world effectiveness and tolerability of first-line osimertinib. Oligoprogression was associated with longer OS compared with systemic progression, and the integration of LATs in carefully selected patients with oligoprogression may be associated with prolonged osimertinib treatment duration and favorable post-progression outcomes.

Background and Objectives: Perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard of care for resectable gastric and gastroesophageal junction adenocarcinoma; however, up to 50% of patients develop metastatic recurrence. These patients have prior exposure to platinum and taxane agents, and optimal first-line treatment in the metastatic setting remains undefined. This study aimed to characterize real-world treatment patterns and outcomes in patients progressing after perioperative FLOT, focusing on relapse timing and HER2 status. Materials and Methods: This retrospective, multicenter cohort study included 296 patients from 31 centers across Türkiye, stratified into early relapse (≤6 months, n = 114) and late relapse (>6 months, n = 182) groups. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazards regression. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Results: Median PFS and OS for the entire cohort were 6 and 9 months, respectively. Early relapsers had significantly shorter median PFS (4 vs. 6 months, p = 0.029) and OS (8 vs. 12 months, p = 0.047); however, early relapse timing did not retain independent prognostic significance on multivariable analysis. No significant difference in PFS or OS was observed between cytotoxic chemotherapy regimens in either relapse group. HER2 positivity was the only independent predictor of improved PFS on multivariable Cox analysis (HR 0.48, 95% CI 0.29–0.81; p = 0.006). In the late relapse group, trastuzumab-based chemotherapy achieved a median PFS of 14 months and OS of 18 months, significantly superior to all cytotoxic regimens (PFS p = 0.007; OS p = 0.029). Conclusions: In patients progressing after perioperative FLOT, cytotoxic chemotherapy regimen selection did not demonstrate a statistically significant survival difference in this retrospective cohort, regardless of relapse timing. HER2 positivity is the dominant predictive biomarker, and trastuzumab-based therapy suggests a potential survival benefit that warrants prospective validation. Comprehensive biomarker profiling at metastatic diagnosis and prospective trials designed for this post-FLOT population are needed to establish evidence-based treatment standards.

This study aims to evaluate the effectiveness and real-world applicability of total neoadjuvant therapy (TNT) in patients with locally advanced rectal cancer (LARC), focusing on pathological complete response (pCR) and disease-free survival (DFS) across different chemotherapy regimens. In this multicenter retrospective study, patients treated between January 2019 and January 2023, 437 patients with locally advanced rectal cancer who underwent total neoadjuvant therapy followed by surgery were analyzed. Standard fluoropyrimidine-based chemotherapy regimens (CAPOX, FOLFOX, or FOLFIRINOX) were used according to institutional practice, and long-course chemoradiotherapy constituted the predominant radiotherapy approach. Patients were grouped based on chemotherapy sequencing as induction, consolidation, or sandwich regimens. Outcomes were evaluated using multivariable logistic regression for pathological complete response and Kaplan–Meier analysis with Cox proportional-hazards modeling for disease-free survival. The median follow-up duration was 66 months. The overall pCR rate was 26.3% (n = 115). pCR rates did not differ significantly between induction, sandwich, and consolidation chemotherapy regimens. A longer interval (> 8 weeks) between radiotherapy and surgery was associated with a higher likelihood of achieving pCR. In contrast, cT4 disease and baseline CEA levels > 3 ng/mL were associated with lower pCR rates.The estimated 3-year disease-free survival (DFS) rate was 83.8%. Recurrence rates within 3 years were numerically higher in patients receiving induction and sandwich regimens compared with consolidation chemotherapy, although these differences did not reach statistical significance. In multivariable analysis, poor tumor regression grade, ypT4 stage, ypN + disease, and post-TNT CEA ≥ 3 ng/mL were independently associated with an increased risk of recurrence. TNT is effective and feasible in real-world settings, achieving pCR and DFS outcomes comparable to clinical trials. No statistically significant differences were observed in pCR or recurrence rates between induction, consolidation, and sandwich chemotherapy regimens. Prospective phase III trials are needed to compare DFS and OS outcomes across these treatment strategies. The online version contains supplementary material available at 10.1007/s12672-026-04842-3.

The C-PLAN index, which comprehensively considers inflammation, nutritional status, tumor grade/metabolism, and functional status, has been proven to be an

This study primarily aimed to assess whether baseline [(18)F] fluorodeoxyglucose (FDG) PET/CT metabolic parameters—including SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG)—can predict tumor regression grade (TRG) and survival in patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiotherapy (nCRT). In addition, secondary analyses were performed to identify other clinical and pathological variables associated with treatment response and prognosis. This retrospective study included patients diagnosed with LARC who underwent nCRT followed by surgical resection between 2014 and 2023. Pre-treatment staging with F-18 FDG PET/CT was performed for all patients. Postoperative pathological response was assessed using the TRG system. Patients were categorized into two groups: complete responders (TRG1) and incomplete responders (TRG2–5). Demographic characteristics, PET/CT metabolic parameters (SUVmax, MTV, TLG), Carcinoembryonic antigen (CEA), Carbohydrate antigen 19 − 9 (CA19-9), and histopathological features (perforation, lymphovascular invasion [LVI], and perineural invasion [PNI]) were compared between the groups. Statistical analyses included chi-square tests, Mann–Whitney U tests, logistic regression models with odds ratios (ORs), and Kaplan–Meier survival analysis. A total of 151 patients were included. A statistically significant difference was found between TRG1 and TRG2-5 groups regarding family history (p = 0.034), CEA at diagnosis (p = 0.002), Ca19.9 after radiotherapy (p = 0.045), and presence of concurrent chemotherapy (CC) (p = 0.004). Significant differences were also observed in postoperative pathological features, including perforation (p = 0.045), LVI (p = 0.023), PNI (p = 0.031), and post-operative CEA levels (p = 0.001). In terms of outcomes, TRG1 was associated with better survival (p = 0.001), longer disease-free survival (p = 0.001), and overall survival (p = 0.001). Logistic regression identified independent predictors of complete response (TRG1): family history (OR: 5.08, p = 0.027), post-RT CEA (OR: 0.61, p = 0.015), post-op CEA (OR: 1.13, p = 0.012), perforation (OR: 20.93, p = 0.033), LVI (OR: 0.33, p = 0.042), and PNI (OR: 0.49, p = 0.045). Kaplan–Meier analysis demonstrated significantly longer overall survival in patients with TRG1 compared to TRG2–5 (log-rank p = 0.001). Similarly, disease-free survival was significantly better in the TRG1 group (log-rank p = 0.001). In the multivariate Cox regression model, TRG1 (HR: 0.41; 95% CI: 0.26–0.66; p = 0.001), CC (HR: 0.62; 95% CI: 0.39–0.98; p = 0.039), and absence of perforation (HR: 0.51; 95% CI: 0.28–0.95; p = 0.034) were found to be independent predictors of improved survival. Baseline F-18 FDG PET/CT parameters, including SUVmax, MTV, and TLG, were not predictive of TRG or survival in patients with LARC undergoing neoadjuvant chemoradiotherapy. However, clinical and pathological variables such as family history, post-treatment CEA levels, perforation, lymphovascular invasion, and perineural invasion were significantly associated with TRG1. TRG1, histopathological subtype, perforation, and CC were also found to be independent predictors of survival. These findings suggest that while FDG-PET/CT may have limited utility in predicting treatment response, certain clinical and pathological features remain critical for outcome assessment.

Aim: Hormone receptor (HR)-positive, human epidermal growth factor 2 (HER2)-negative breast cancer which represents the most common subgroup of metastatic breast cancer (MBC). Recently, further subclassification for HER2-negative tumors has emerged as HER2-low. There is limited knowledge regarding the effect of HER2-low expression on outcomes of patients with HR-positive and HER2-negative MBC treated with CDK 4/6 inhibitors plus hormonal therapy. Therefore, we evaluated survival parameters according to HER2-low status for this patient group in this study. Material and Methods: As the Turkish Oncology Group (TOG) Project, retrospectively collected data from 423 patients with HR-positive/HER2-negative MBC treated with ribociclib and palbociclib plus letrozole therapy was assessed. Included patients had metastatic first-line therapy and endocrine-sensitive disease. Survival outcomes were compared between HER2-negative and HER2-low patient groups. Conclusion: HER2-low status had no statistically significant impact on survival in patients treated with palbociclib or ribociclib plus letrozole.

Small cell lung cancer (SCLC) is a common cancer among the world’s lung cancers. Despite advances in diagnosis and treatment, the prognosis is still poor. There is no effective biomarker other than stage in daily practice. However, in daily practice, patients may have different features and survival times even though they have the same stage. Previously, albumin–bilirubin (ALBI) grade, platelet–albumin–bilirubin (PALBI) grade were used to determine the prognosis of acute-chronic liver failure and acute upper gastrointestinal bleeding in liver cirrhosis. In subsequent studies, they were found to be associated with prognosis in hepatocellular carcinoma (HCC) and other solid cancers. However, the prognostic relationship between ALBI grade, PALBI grade, and SCLC is unknown. Therefore, we conducted this study to examine the relationship between ALBI grade and PALBI grade and prognosis in SCLC patients. Data of 138 patients with advanced SCLC at diagnosis between 2009 and 2020 were analyzed retrospectively. The results of the multivariate analysis were as follows: ALBI grade 1 vs 2, hazard ratio (HR) = 1.608, p = 0.002 for OS and HR = 1.575, p = 0.002 for PFS; ALBI grade 1 vs 3, HR = 2.035, p < 0.001 for OS and HR = 2.675, p < 0.001 for PFS; PALBI grade 1 vs 2, HR = 1.302, p = 0.006 for OS and HR = 1.674, p = 0.002 for PFS; and PALBI grade 1 vs 3, HR = 1.725, p < 0.001 for OS and HR = 2.675, p < 0.001 for PFS. In conclusion, the ALBI and PALBI grades were determined to be associated with the prognosis of SCLC, and they can be used as easy, inexpensive, and practical markers in determining the follow-up treatment and prognosis of SCLC patients.

Aim: Gastric cancer (GC) is a common cancer with high mortality. Stage is the most important predictor of prognosis. But the clinical course of patients who are at the same stage may be different. Therefore, other prognostic markers other than stage are needed. Hemoglobin, albumin, lymphocyte and platelet (HALP) score and geriatric nutritional risk index (GNRI) related with prognosis in many malignancies, but their relationship to prognosis in patients with GC with advanced age is unknown. For this reason, we retrospectively analyzed patients older than 75 years, receiving chemotherapy, and metastatic GC. Material and Methods: We retrospectively analyzed 145 patients with metastatic gastric cancer, older than 75 years, receiving chemotherapy in secondary level state hospital between 2009 and 2022. Patients’ gender, age, Eastern Cooperative Oncology Group (ECOG) performance score, diagnosis dates, follow-up visits, albumin, hemoglobin, lactate dehydrogenase (LDH) levels, white blood cell, neutrophil, lymphocyte and platelet count, weight (kg), height (cm) values were examined. Using these values, HALP score, GNRI, and overall survival (OS) were calculated. Then, the relationship of these parameters with OS was analyzed retrospectively. Results: The median overall survival (OS) was 8.1 (95% Confidence interval (CI), 7.07 – 9.13) months. In multivariate analysis, GNRI (0.035) and HALP (p<0.001) were associated with survival time. Median OS was 4.5 (95% C,3.77-5.24 ) months in the low HALP group, and 10.2 (95% CI, 9.04- 11.36 ) months in the high HALP group (p<0.001). Median OS was 6.2 (95% CI, 4.25-8.14) months in the low GNRI group and 8.6 (95% CI, 7.92-9.27) months in the high GNRI group. Conclusion: GNRI and HALP score are associated with survival in metastatic GC patients older than 75 years. GNRI and HALP score can be used as an easy, cheap and practical method for follow-up, treatment and prognosis in elderly patients with metastatic GC. Amaç: Mide kanseri (MK) sık görülen ve mortalitesi yüksek bir kanserdir. Evre, prognozun en önemli belirleyicisidir. Ancak aynı evrede olan hastaların klinik seyri farklı olabilir. Bu nedenle evre dışında başka prognostik belirteçlere ihtiyaç vardır. Hemoglobin, albümin, lenfosit ve trombosit (HALP) skoru ve geriatrik nütrisyonel risk indeksi (GNRI) birçok malignitede prognoz ile ilişkilidir, ancak ileri yaştaki mide kanserli hastalarda prognozla ilişkisi bilinmemektedir. Bu nedenle metastatik, 75 yaş üstü, kemoterapi alan mide kanserli hastaları retrospektif olarak inceledik. Gereç ve Yöntemler: İkinci basamak bir devlet hastanesinde 2009-2022 yılları arasında kemoterapi alan, 75 yaş üstü metastatik mide kanserli 145 hasta retrospektif olarak incelendi. Hastaların cinsiyeti, yaşı, Eastern Cooperative Oncology Group (ECOG) performans skoru, tanı tarihleri, kontrole geliş tarihleri, albümin seviyeleri, hemoglobin, laktat dehidrogenaz (LDH), beyaz küre sayısı, nötrofil, lenfosit ve trombosit sayısı, ağırlık (kg), boy (cm) değerleri incelendi. Bu değerler kullanarak HALP skoru, GNRI, genel sağkalım (OS) hesaplandı. ardından bu parametrelerin OS ile ilişkisi retrospektif olarak analiz edildi. Bulgular: Medyan genel sağkalım (OS) 8.1 (%95 Güven aralığı (GA), 7.07 – 9.13) aydı. Çok değişkenli analizde, GNRI (0.035) ve HALP skoru (p<0.001) sağkalım süresi ile ilişkiliydi. Medyan OS, düşük HALP grubunda 4,5 (%95 C,3.77-5.24 ) ay ve yüksek HALP grubunda 10.2 (%95 CI, 9.04- 11.36 ) ay saptandı (p<0.001). Medyan OS, düşük GNRI grubunda 6.2 (%95 GA, 4.25-8.14) ay ve yüksek GNRI grubunda 8.6 (%95 GA, 7.92-9.27) ay saptandı. Sonuç: GNRI ve HALP skoru, 75 yaş üstü metastatik, mide kanserli hastalarda sağkalım süresi ile ilişkilidir. Metastatik mide kanserli yaşlı hastalarda takip stratejisi geliştirmek, tedavi planlamak ve prognoz belirlemek için kolay, ucuz ve pratik bir yöntem olarak kullanılabilir