Aykut Özmen

Background: The Lung Immune Prognostic Index (LIPI), based on the derived neutrophil-to-lymphocyte ratio and lactate dehydrogenase, may reflect systemic inflammation and tumor-related metabolic burden. This study evaluated the prognostic value of pretreatment LIPI and its relationship with programmed death-ligand 1 (PD-L1) expression in patients with advanced non-small cell lung cancer (NSCLC) receiving nivolumab after first-line therapy. Methods: A total of 158 patients were included in this retrospective, single-center study. Patients were classified into LIPI 0, LIPI 1, or LIPI 2 groups according to their pretreatment LIPI scores. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan–Meier analysis and multivariable Cox regression. The prognostic value of LIPI was also evaluated within PD-L1-negative and PD-L1-positive subgroups, and LIPI × PD-L1 interactions were explored. Harrell’s concordance index was used to examine whether adding LIPI improved model discrimination beyond clinical variables and PD-L1 expression. PD-L1 data were available for 145 patients. Results: Median PFS was 566, 340, and 109 days for the LIPI 0, LIPI 1, and LIPI 2 groups, respectively, while median OS was 841, 760, and 201 days, respectively; the differences were statistically significant for both outcomes (both p < 0.001). The objective response rate (ORR) was 55.6%, 36.5%, and 4.9%, whereas the disease control rate (DCR) was 75.9%, 65.1%, and 14.6% in the LIPI 0, LIPI 1, and LIPI 2 groups, respectively (both p < 0.001). In multivariable analyses, higher LIPI remained independently associated with shorter PFS and OS, with the strongest association observed in the LIPI 2 group. LIPI also differentiated survival outcomes within both PD-L1-negative and PD-L1-positive subgroups, although no significant LIPI × PD-L1 interaction was identified for PFS or OS. The addition of LIPI increased the C-index from 0.583 to 0.698 for PFS (ΔC-index, 0.115; p < 0.001) and from 0.588 to 0.697 for OS (ΔC-index, 0.109; p = 0.003). Conclusions: Pretreatment LIPI was independently associated with PFS and OS in patients with advanced NSCLC receiving nivolumab after first-line therapy. Its association remained after adjustment for available PD-L1 expression data, and its addition improved model discrimination. These findings suggest that LIPI may provide prognostic information complementary to PD-L1 expression and routinely available clinical factors.

Background and Objectives: Evidence regarding predictors of pathological response and long-term outcomes in older patients receiving perioperative FLOT chemotherapy for resectable gastric or gastroesophageal junction cancer remains limited. We aimed to identify factors associated with pathological response and survival in patients aged ≥65 years treated with neoadjuvant FLOT. Materials and Methods: This retrospective single-center study included 86 consecutive patients (median age, 69 years; 72.1% male) aged ≥65 years with resectable gastric or gastroesophageal junction adenocarcinoma who underwent neoadjuvant FLOT chemotherapy followed by curative-intent gastrectomy. Major pathological response was defined as College of American Pathologists tumor regression grade (CAP TRG) 0–1. Logistic regression analyses were performed to identify predictors of pathological response. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox proportional hazards regression analyses. Results: Overall, 14 patients (16.3%) achieved a major pathological response. Body mass index (BMI) ≥ 25 kg/m² (OR 5.13, p = 0.04) was independently associated with a major pathological response. During a median follow-up of 29.2 months, 39 patients (45.3%) developed recurrence and 35 (40.7%) died. ECOG performance status (ECOG PS) ≥ 1 was independently associated with both inferior DFS (HR = 2.76, p = 0.02) and OS (HR = 2.52, p = 0.045). In addition, ypN stage 2–3 (HR = 2.58, p = 0.008) was independently associated with worse DFS, whereas positive surgical margins were independently associated with worse OS (HR = 2.62, p = 0.02). Conclusions: In older patients with resectable gastric or gastroesophageal junction adenocarcinoma treated with perioperative FLOT chemotherapy, baseline BMI was independently associated with major pathological response, whereas ECOG PS and postoperative pathological factors were independently associated with survival. These findings highlight the importance of careful patient selection and individualized multimodal treatment in this population.

Real-world Outcomes of Second-line Irinotecan Plus Bevacizumab in Recurrent High-grade Gliomas: A Single-center Retrospective Study - Journal of Oncological Sciences

Investigation of 25-Hydroxyvitamin D Levels in Patients with Cirrhosis: Relationship with Liver Disease Severity, Etiology, and Complications - Istanbul Medical Journal

Background/Objectives: Metastatic hormone-sensitive prostate cancer (mHSPC) is a biologically heterogeneous disease in which treatment intensification with androgen receptor pathway inhibitors has significantly improved clinical outcomes. However, direct comparative evidence between abiraterone and enzalutamide remains limited. We aimed to evaluate radiographic progression-free survival (rPFS) in patients with mHSPC treated with first-line abiraterone or enzalutamide and to perform exploratory subgroup analyses according to baseline clinical and laboratory characteristics. Methods: This retrospective single-center study included patients with mHSPC who received first-line abiraterone or enzalutamide in combination with androgen deprivation therapy. Baseline demographic, clinical, and laboratory characteristics were collected retrospectively. The primary endpoint was rPFS. Survival was analyzed using the Kaplan–Meier method and compared using the log-rank test. Results: A total of 172 patients were included, of whom 84 received abiraterone and 88 received enzalutamide. The median follow-up duration was 24.7 months (95% CI 21.5–27.9). In the overall population, median rPFS was comparable between the abiraterone and enzalutamide groups (50 vs. 49 months, p = 0.21). However, enzalutamide was associated with significantly longer rPFS among patients aged p = 0.02), those with baseline hemoglobin ≥12 g/dL (HR 0.36, 95% CI 0.15–0.85; p = 0.01), and those with baseline ALP < 147 U/L (HR 0.43, 95% CI 0.19–0.98; p = 0.04). No significant differences were observed in other subgroups. Conclusions: rPFS was comparable between abiraterone and enzalutamide in the overall mHSPC population. However, enzalutamide was associated with longer rPFS in patients aged <70 years and in those with preserved hemoglobin and lower ALP levels. These findings suggest that baseline clinical and laboratory characteristics may influence treatment outcomes and should be prospectively validated.

Background: Non–small cell lung cancer (NSCLC) is one of the most commonly diagnosed malignancies and a leading cause of cancer-related mortality worldwide. Although immune checkpoint inhibitors such as nivolumab have become a standard option in the second-line and later-line settings, identifying patients who derive meaningful benefit remains challenging. Established biomarkers, including PD-L1 expression, have shown limited predictive performance. The Lung Immune Prognostic Index (LIPI), a simple score reflecting systemic inflammation and tumor burden, has emerged as a potential prognostic tool. However, its real-world prognostic value in patients receiving nivolumab after first-line therapy remains insufficiently defined. Methods: This retrospective, single-center study included 109 patients with advanced NSCLC who received nivolumab following disease progression after first-line therapy. LIPI was calculated based on derived neutrophil-to-lymphocyte ratio (dNLR ≥3) and lactate dehydrogenase (LDH) levels above the upper limit of normal. Patients were stratified into three groups (LIPI 0-1-2). Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and compared with the log-rank test. Multivariable Cox proportional hazards models were used to identify independent prognostic factors. Results: Patients were categorized as LIPI 0 (n=32), LIPI 1 (n=45), and LIPI 2 (n=32). A clear stepwise deterioration in outcomes was observed across increasing LIPI categories. Median PFS was not reached in the LIPI 0 group, and was 340 days and 109 days in the LIPI 1 and LIPI 2 groups, respectively (p < 0.001). Similarly, median OS was not reached in the LIPI 0 group, while it was 820 days and 201 days in the LIPI 1 and LIPI 2 groups, respectively (p < 0.001). In multivariable analysis, LIPI remained independently associated with both PFS and OS. In contrast, PD-L1 expression and other clinicopathological variables were not independently associated with survival outcomes, suggesting that the prognostic impact of LIPI is independent of PD-L1. Conclusions: LIPI appears to be a robust, readily available prognostic marker in patients with advanced NSCLC treated with nivolumab beyond the first-line setting. Its independent association with survival outcomes, irrespective of PD-L1 expression, suggests that it captures distinct biological processes related to systemic inflammation. Incorporation of LIPI into routine clinical practice may improve risk stratification and support more individualized treatment decisions. Notably, LIPI may provide complementary prognostic information beyond tumor-specific biomarkers such as PD-L1.

Background: We aimed to evaluate the prognostic significance of bone pain at presentation in metastatic castration-sensitive prostate cancer (mCSPC) and its association with radiographic progression-free survival (rPFS), independent of established prognostic factors. Methods: We retrospectively analyzed 205 patients with mCSPC treated at our center. Data were obtained from patient files and hospital records. rPFS was estimated using the Kaplan–Meier method and compared using the log-rank test. Baseline characteristics according to bone pain status were compared using the χ² test for categorical variables and the Wilcoxon test for continuous variables. Results: Median rPFS for the entire cohort was 23.8 months (95% CI: 18.6–29.0). In univariate analysis, median rPFS was significantly shorter in patients with bone pain compared to those without (16.9 vs. 29.5 months, p < 0.001). Other factors associated with worse rPFS included ECOG PS ≥ 1, DNA repair mutations, high disease volume, liver metastasis, hemoglobin < 12 g/dL, and albumin < 3.5 g/dL. In multivariate analysis, bone pain (HR = 2.37, 95% CI: 1.29–4.34; p = 0.005), albumin < 3.5 g/dL (HR = 1.99; p = 0.034), hemoglobin < 12 g/dL (HR = 2.00; p = 0.005), and liver metastasis (HR = 3.07; p = 0.024) remained independent predictors of shorter rPFS. Conclusions: Bone pain at presentation is an independent prognostic factor for shorter rPFS and may help guide risk stratification and treatment decisions in mCSPC.

Background: We aimed to evaluate the prognostic significance of bone pain at presentation in metastatic castration-sensitive prostate cancer (mCSPC) and its association with radiographic progression-free survival (rPFS), independent of established prognostic factors. Methods: We retrospectively analyzed 205 patients with mCSPC treated at our center. Data were obtained from patient files and hospital records. rPFS was estimated using the Kaplan–Meier method and compared using the log-rank test. Baseline characteristics according to bone pain status were compared using the χ² test for categorical variables and the Wilcoxon test for continuous variables. Results: Median rPFS for the entire cohort was 23.8 months (95% CI: 18.6–29.0). In univariate analysis, median rPFS was significantly shorter in patients with bone pain compared to those without (16.9 vs. 29.5 months, p < 0.001). Other factors associated with worse rPFS included ECOG PS ≥1, DNA repair mutations, high disease volume, liver metastasis, hemoglobin < 12 g/dL, and albumin < 3.5 g/dL. In multivariate analysis, bone pain (HR = 2.37, 95% CI: 1.29–4.34; p = 0.005), albumin < 3.5 g/dL (HR = 1.99; p = 0.034), hemoglobin < 12 g/dL (HR = 2.00; p = 0.005), and liver metastasis (HR = 3.07; p = 0.024) remained independent predictors of shorter rPFS. Conclusions: Bone pain at presentation is an independent prognostic factor for shorter rPFS and may help guide risk stratification and treatment decisions in mCSPC.

Ejmi Eurasian Journal of Medical Investigation