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    CEA and CA 19-9 combined tumor marker index as a prognostic tool for metastatic pancreatic cancer: is two better than one?
    (E-Century Publishing Corp, 2025) Demir, Bilgin; Alemdar, Merve Biyikli; Balcik, Onur Yazdan
    Metastatic pancreatic cancer (PC) is one of the cancers with the worst prognosis, and prognostic tests are lacking in this population. If an effective prognostic indicator can be identified, the patient population can be monitored more closely. This retrospective study aimed to investigate the prognostic impact of tumor marker index (TMI) in patients with metastatic PC. Patients diagnosed with metastatic PC at Ayd & imath;n Adnan Menderes University between 2019 and 2024 were included in the study. Demographic data, tumor marker levels, and treatment received were recorded. The prognostic value of TMI was determined as 3.15 using the receiver operating characteristic (ROC) method. Progression-free survival (PFS) and overall survival (OS) were recorded. 218 metastatic PC patients with a median follow-up duration of 10.81 months were included in the study. The median PFS was 7.26 months for the High TMI group, while it was 10.76 months for the Low TMI group (P=0.003). The median OS of patients with high TMI was 9.3 months, which was significantly lower than the 17.9 months observed in the low TMI group (P<0.001). TMI is a simple and, cost-effective prognostic tool for metastatic PC, and a higher TMI is associated with poorer survival outcomes.
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    Efficacy of everolimus plus hormonal treatment after cyclin-dependent kinase inhibitor; real-life experience, A TOG study
    (Springer, 2024) Beypinar, Ismail; Demir, Hacer; Yaslikaya, Sendag; Koseci, Tolga; Demir, Bilgin; Colak, Gokhan; Agaoglu, Ahmet Burak
    Purpose In advanced breast cancer, endocrine therapy is preferred in the absence of visceral crisis. Cyclin-dependent kinase inhibitors (CDKi) are the gold standards. The selection of subsequent treatments after CDKi treatment is still controversial, and the efficacy of everolimus (EVE) combinations is unknown. In this study, we aimed to investigate the efficacy of EVE after CDKi administration in real-life experiences. Method The study received data from 208 patients from 26 cancer centers. Demographic and histologic features, diagnosis, progression, last visit dates, and toxicities were recorded. This study was a retrospective case series. Results One hundred and seven patients received palbociclib, while 101 patients received ribociclib as a CDKi. The overall response and disease control rates of EVE combinations were 60% and 88%, respectively. In univariate analysis, the absence of liver metastasis, age > 40 years, better type of response, and immediate treatment after CDKi were related to increased progression-free survival. Liver metastasis and response type were significantly associated with overall survival. In the multivariate analysis, response remained significant in terms of progression-free survival, while response type, liver metastatic disease, and hematologic toxicity were prognostic in terms of overall survival. Conclusion This study provides evidence of the benefits of EVE combinations after CDKi treatment. EVE combinations may be more appropriate for patients with non-liver metastasis, and the first treatment response shows the benefit of treatment. In addition, immediate treatment after CDKi treatment is more beneficial than later lines of treatment.
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    Küçük hücreli dışı akciğer kanserinde PBİ, SİYİ ve AİPİ'nin Prognostik Önemi
    (Alanya Alaaddin Keykubat Üniversitesi, 2023) Balçık, Onur Yazdan; Aytaç, Ali; Avcı, Tugay; Demir, Bilgin; İlhan, Yusuf; Karakya, Gökhan; Erdoğan, Atike Pinar
    Amaç: Küçük hücreli dışı akciğer kanseri (KHDAK) en sık görülen ve en çok ölüme sebep olan 3 kanserden birisidir. Mevcut çalışmanın amacı, metastatik KHDAK’lı hastalarda Prognostik Beslenme İndeksi (PBI), sistemik inflamatuvar Yanıt İndeksi (SİYİ), Akciğer İmmün Prognostik İndeksi (AİPİ)’nin prognostik bir öneminin olup olmadığını araştırmaktır. Yöntem: Çalışmamıza 2016-2022 yılları arasında Türkiye'de 5 farklı hastanede patolojik doğrulanmış metastatik KHDAK tanısı almış hastalar dahil edilmiş ve retrospektif olarak incelenmiştir. Bazı hemogram parametreleri ve ldh, albumin gibi biokimyasal parametreler, ayrıca genel sağkalım (GSK) ve progresyonsuz sağkalım (PSK) kaydedilmiştir. Bulgular: Çalışmamıza 297 hasta dahil edilmiştir. Median PSK 5,5 ay iken median GSK 16,03 ay idi. Median GSK PBİ-düşük grup için 14,86 ay, PBİ-yüksek grup için ise 17,2 ay ay idi (p: <0.121). PBİ-düşük grubunun medyan GSK’sı, PBİ-yüksek gruptan daha kısaydı, ancak gruplar arasında istatistiksel olarak anlamlı bir fark yoktu. Median GSK SİYİ-düşük grup için 19,86 ay iken, SİYİ-yüksek grup için ise 14,23 ay idi(p: <0.112). SİRİ-düşük grubunun medyan GSK’sı, SİYİ-yüksek gruptan daha uzundu, ancak gruplar arasında istatistiksel olarak anlamlı bir fark yoktu. Medyan GSK, AİPİ-Düşük grup için 17,76 (%95 GA 16,51 -19,02) ay, AİPİ- orta grup için 15,13 ay, AİPİ-yüksek grup için 13,73 ay (%95 GA 8,05 -19,41) bulundu. AİPİ -Düşük AİPİ -orta ve AİPİ -Yüksek grupları arasında istatistiksel olarak anlamlı bir fark yoktu (p: <0,391). Sonuç: Sonuç olarak PNI ve SIRI daha çok hasta sayısıyla yapılacak spesifik bir hasta grubunda prospektif bir çalışmada KHDAK hastaların prognozunu tahmin etmek için anlamlı çıkabilir.
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    Novel tumor marker index combining carcinoembryonic antigen and carbohydrate antigen 19-9: New prognostic factor for metastatic colorectal cancer
    (Baishideng Publishing Group Inc, 2025) Ilhan, Yusuf; Balcik, Onur Yazdan; Guzel, Halil Goksel; Onder, Arif Hakan; Demir, Bilgin; Baser, Mehmet Nuri; Karadag, Ibrahim
    BACKGROUND Metastatic colorectal cancer (mCRC) is a global health challenge with a poor prognosis. Prognostic markers are critical for survival prediction. AIM To evaluate a novel tumor marker index (TMI) combining carcinoembryonic antigen and carbohydrate antigen 19-9. METHODS This multicenter, retrospective study measured baseline carcinoembryonic antigen and carbohydrate antigen 19-9 levels to calculate a TMI as the geometric mean of values normalized to their upper limits of normal. Receiver operating characteristic curve analysis assessed TMI's prognostic accuracy, and patients were stratified into high-TMI (>= 1.39) and low-TMI (< 1.39) groups. The primary endpoint was overall survival (OS), with progression-free survival and treatment response as secondary endpoints. RESULTS The study included 305 mCRC patients with a median follow-up of 22.9 months. The median OS for high-TMI patients was 29.5 months, significantly lower than the 45.6 months observed in the low-TMI group (P = 0.02). The 2-year OS rates for the high- and low-TMI groups were 59.4% and 72.9%, respectively. Median progression-free survival was also shorter for the high-TMI group (14.0 vs 16.0 months, P = 0.84). High TMI is an independent prognostic factor for worse OS. CONCLUSION TMI is a simple, cost-effective prognostic tool for mCRC, with high TMI associated with poorer survival outcomes.
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    Second-line Chemotherapy for Advanced Bladder Cancer: Taxanes Versus Vinflunine
    (2025) Demir, Bilgin; Aytaç, Ali; Çolak, Gökhan; Balçık, Onur Yazdan; Acar, Omer
    Aim: Second-line chemotherapy in advanced urothelial carcinoma (UC) remains a significant clinical challenge, with limited high-level evidence guiding regimen selection. Vinflunine is the only agent approved by the European Medicines Agency for this setting, while taxanes are widely used off-label based on phase 2 data. Methods: We conducted a retrospective analysis of patients with metastatic bladder cancer treated at Aydın Adnan Menderes University between 2013 and 2022. Eligible patients had received at least three months of second-line chemotherapy with either vinflunine or taxane-based regimens (docetaxel or paclitaxel). Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and adverse events were compared between groups. Results: Among 38 patients receiving second-line therapy, 25 (65.8%) were treated with taxanes and 13 (34.2%) with vinflunine. Median PFS was significantly longer in the taxane group (4.9 vs. 2.2 months; p=0.001). Median OS favored taxanes numerically (13.2 vs. 4.33 months) but did not reach statistical significance (p=0.068). ORR was higher in the taxane group (52% vs. 23.1%), but the difference was not statistically significant (p=0.87). Adverse event profiles were consistent with known toxicities. Conclusion: This single-center retrospective study suggests that taxane-based regimens may offer superior PFS compared to vinflunine in the second-line treatment of advanced UC, despite the lack of statistically significant OS benefit. Given limitations in access to immunotherapy and targeted agents, cytotoxic chemotherapy remains essential, underscoring the need for further prospective trials to define optimal second-line strategies.