Nebi Batuhan Kanat

Background/Objectives : Accurate prognostic assessment remains crucial in metastatic renal cell carcinoma (mRCC), especially as treatment options have expanded beyond vascular endothelial growth factor (VEGF)-targeted therapies to include immune checkpoint inhibitors (ICIs) and ICI–TKI combinations. The widely used IMDC classification shows important limitations in the modern therapeutic era, highlighting the need for complementary prognostic tools. In this context, the Meet-URO and CANLPH scores—incorporating clinical, inflammatory, and nutritional markers—have emerged as promising alternatives. To evaluate and compare the prognostic performance of the Meet-URO and CANLPH scoring systems in a real-world mRCC cohort predominantly treated with first-line tyrosine kinase inhibitor (TKI) monotherapy due to limited access to ICI-based combinations. Methods: This retrospective single-center study included 112 patients with mRCC. The Meet-URO score was calculated for all patients, while the CANLPH score was assessed in 56 patients with complete laboratory data. CAR, NLR, and PHR were computed using baseline pre-treatment measurements. Overall survival (OS) and progression-free survival (PFS), the latter defined exclusively for first-line therapy, were estimated using the Kaplan–Meier method. Correlations between inflammatory markers and survival outcomes were analyzed using Spearman’s rho. Results: Meet-URO demonstrated clear prognostic stratification across all five categories, with the most favorable outcomes in score group 2 and progressively poorer OS and PFS in higher-risk groups. CANLPH also showed meaningful survival discrimination, with the highest inflammatory group (score 3) exhibiting markedly reduced OS and PFS. CAR was the strongest individual predictor of survival, while NLR and PHR showed weaker associations. Conclusions: Both Meet-URO and CANLPH provide strong, complementary prognostic information in mRCC, even in a cohort largely treated with TKI monotherapy. Their integration into routine risk assessment may enhance clinical decision-making, particularly in resource-limited settings.

Background: Accurate prognostic assessment remains crucial in metastatic renal cell carcinoma (mRCC), especially as treatment options have expanded beyond vascular endothelial growth factor (VEGF)–targeted therapies to include immune checkpoint inhibitors (ICIs) and ICI–TKI combinations. The widely used IMDC classification shows important limitations in the modern therapeutic era, highlighting the need for complementary prognostic tools. In this context, the Meet-URO and CANLPH scores—incorporating clinical, inflammatory, and nutritional markers have emerged as promising alternatives. Objective: To evaluate and compare the prognostic performance of the Meet-URO and CANLPH scoring systems in a real-world mRCC cohort predominantly treated with first-line tyrosine kinase inhibitor (TKI) monotherapy due to limited access to ICI-based combinations. Methods: This retrospective single-center study included 112 patients with mRCC. The Meet-URO score was calculated for all patients, while the CANLPH score was assessed in 56 patients with complete laboratory data. CAR, NLR, and PHR were computed using baseline pre-treatment measurements. Overall survival (OS) and progression-free survival (PFS) the latter defined exclusively for first-line therapy—were estimated using the Kaplan–Meier method. Correlations between inflammatory markers and survival outcomes were analyzed using Spearman’s rho. Results: Meet-URO demonstrated clear prognostic stratification across all five categories, with the most favorable outcomes in score group 2 and progressively poorer OS and PFS in higher-risk groups. CANLPH also showed meaningful survival discrimination, with the highest inflammatory group (score 3) exhibiting markedly reduced OS and PFS. CAR was the strongest individual predictor of survival, while NLR and PHR showed weaker associations. Conclusion: Both Meet-URO and CANLPH provide strong, complementary prognostic information in mRCC, even in a cohort largely treated with TKI monotherapy. Their integration into routine risk assessment may enhance clinical decision-making, particularly in resource-limited settings.

Background: Ewing sarcoma (ES) is a highly aggressive malignant tumor that predominantly affects children and young adults. Despite advances in multimodal therapy, relapse and refractory disease remain the leading causes of treatment failure. High-dose chemotherapy followed by autologous stem cell transplantation (HDCT-ASCT) has been proposed as a consolidation strategy for high-risk or relapsed ES; however, its clinical value remains controversial. Methods: We retrospectively analyzed 46 consecutive patients with locally advanced or metastatic ES who underwent HDCT-ASCT after at least one prior systemic therapy line. Clinical, pathological, and transplant-related variables were evaluated for associations with overall survival (OS), post-transplant OS (OS-2), and progression-free survival (PFS). Survival was estimated using the Kaplan–Meier method, and prognostic factors were assessed by Cox proportional hazards modeling. Results: The median age at diagnosis was 23 years (range: 14–55). Median OS from diagnosis was 42 months, while post-transplant OS-2 and PFS were 8 and 5 months, respectively. Younger patients (≤23 years) had significantly longer OS (50 vs. 34 months; p = 0.027). Liver metastasis predicted inferior OS (HR = 5.411; p = 0.006), whereas lung metastasis was associated with shorter OS-2 (HR = 2.672; p = 0.025) and PFS (HR = 6.037; p = 0.016). Treatment-related mortality was low (2.1%), though hematologic toxicity was universal. Overall, HDCT-ASCT provided transient disease control, with modest benefit confined to younger, chemosensitive, and medically fit patients. Conclusions: In this real-world cohort, HDCT-ASCT was feasible and safe but offered limited survival advantage in heavily pretreated Ewing sarcoma. Prognosis was primarily influenced by age and metastatic distribution, particularly hepatic and pulmonary involvement. These findings support a risk-adapted, biology-driven approach reserving HDCT-ASCT for selected patients and highlight the need for post-transplant maintenance strategies integrating targeted or immunotherapeutic modalities.

Background: The role of high-dose chemotherapy followed by autologous stem-cell transplantation (HDCT–ASCT) in advanced Ewing sarcoma remains uncertain, with mixed prospective data and heterogeneous retrospective findings. Materials and Methods: We performed a single-center, retrospective cohort study of consecutive patients with histologically confirmed ES who received HDCT–ASCT after ≥1 prior systemic therapy line (N=46). Conditioning was ICE. Prespecified endpoints were overall survival (OS; diagnosis → death), post-transplant overall survival OS-2 (ASCT → death), and progression-free survival PFS (ASCT → progression/death). Survival was estimated by Kaplan – Meier and compared by log-rank. Prognostic factors (age at diagnosis, primary tumor site, metastatic organ involvement) were evaluated using Cox models. Results: Median age at diagnosis was 23.5 years (14–55); 69.6% were male and 21.7% had metastatic disease at presentation. Median OS was 42.0 months, median PFS and OS-2 after HDCT–ASCT were 5.0 months and 8.0 months, respectively. Younger age (≤23 years) was associated with longer OS (50.0 vs 34.0 months; p=0.027). Primary tumor site was not independently associated with PFS, OS-2, or OS. Metastatic site showed endpoint-specific effects: liver metastasis independently predicted worse OS (HR 5.411; p=0.006), while lung metastasis was associated with shorter PFS (HR 6.037; p=0.016) and OS-2 (HR 2.672; p=0.025). Post-transplant best responses were CR 8.7%, PR 17.4%, SD 15.2%, and PD 58.7%. Grade 3–4 hematologic toxicities were universal (febrile neutropenia, neutropenia, thrombocytopenia 100%; anemia 86.9%); common non-hematologic events included nausea/vomiting (82.6%), diarrhea (78.2%), and mucositis/stomatitis (65.2%). Treatment-related mortality was 2.1% (1/46). Conclusions: In this young-adult–predominant cohort, HDCT–ASCT achieved limited disease control with substantial but manageable toxicity. Prognosis was driven more by age and metastatic organ involvement than by primary site, with liver metastasis portending inferior OS and lung metastasis adversely affecting PFS/OS-2. These data support risk-adapted patient selection and exploration of post-transplant maintenance strategies in future prospective studies.

Background and Objectives: Relapsed or refractory germ cell tumors are commonly treated with HDCT/ASCT, but robust predictors of hematopoietic recovery are limited. Quantitative CT-based metrics of body composition are readily available, but their prognostic value for post-transplant engraftment remains uncertain. We investigated whether muscle and fat indices derived from routine CT scans are associated with the pace of hematologic recovery after HDCT/ASCT. Materials and Methods: This retrospective study analyzed a single-center cohort (n = 43) with relapsed/refractory GCT undergoing HDCT/ASCT. CT within 6 months pre-HDCT/ASCT was analyzed at L3 to derive the Skeletal muscle index, Psoas muscle index, Subcutaneous fat area, Visceral fat area, Total fat area, Visceral-to-subcutaneous fat area ratio. Primary endpoint: The engraftment time post-ASCT. Spearman’s ρ was used for univariable associations; multivariable linear regressions were adjusted for age, Hb, weight, and BSA to evaluate the independent effects. The significance was set at p < 0.05. Results: The median hematologic engraftment duration was 12.0 days, and the engraftment duration was positively correlated with age and negatively with hemoglobin. According to the multivariable analysis, older age and lower hemoglobin independently predicted longer engraftment; body weight and BSA were not significant. Among the morphometrics, only the VFA/SFA ratio was associated with delayed engraftment. The SMI, PMI, and TFA were not significant. As expected, after HDCT, grade 4 neutropenia and thrombocytopenia occurred in all patients. Conclusions: In relapsed/refractory GCT treated with HDCT/ASCT, older age and lower post-transplant hemoglobin independently predicted a prolonged engraftment. Beyond traditional muscle/fat areas, a higher VFA/SFA ratio—reflecting visceral adiposity—is also associated with delayed recovery, suggesting that fat distribution may influence hematopoietic regeneration. These variables may support pre-transplant risk stratification and individualized supportive care.

Background Relapsed or refractory Germ cell tumors are commonly treated with HDCT/ASCT, yet robust predictors of hematopoietic recovery are limited. Quantitative CT-based body-composition metrics are readily available in practice, but their prognostic value for post-transplant engraftment remains uncertain. We investigated whether muscle and fat indices derived from routine CT scans are associated with the pace of hematologic recovery after HDCT/ASCT Methods Retrospective single-center cohort (n=43) with relapsed/refractory GCT undergoing HDCT/ASCT. CT within ±6 months of ASCT was analyzed at L3 to derive SMI, PMI, SFA, VFA, TFA, and VFA/SFA. Primary endpoint: engraftment time post-ASCT. Univariable associations used Spearman ρ; multivariable linear regression adjusted for age, Hb, weight, and BSA evaluated independent effects. Significance: p< 0.05 Results Median hematologic engraftment duration was 12.0 days . Engraftment duration correlated positively with age and negatively with hemoglobin. In multivariable analysis, older age and lower hemoglobin independently predicted longer engraftment; body weight and BSA were not significant. Among morphometrics, only VFA/SFA associated with delayed engraftment. SMI, PMI, and TFA were not significant. As expected after HDCT, grade 4 neutropenia and thrombocytopenia occurred in all patients. Conclusions In relapsed/refractory GCT treated with HDCT/ASCT, older age and lower post-transplant hemoglobin independently predict prolonged engraftment. Beyond traditional muscle/fat areas, a higher VFA/SFA ratio—reflecting visceral adiposity—also associates with delayed recovery, suggesting fat distribution may influence hematopoietic regeneration. These variables may support pre-transplant risk stratification and individualized supportive care.