Araştırma Çıktıları
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Item Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options(SPRINGER-VERLAG ITALIA SRL, 2022-01-01) Agcaoglu, Orhan; Sezer, Atakan; Makay, Ozer; Erdogan, Murat Faik; Bayram, Fahri; Guldiken, Sibel; Raffaelli, Marco; Sonmez, Yusuf Alper; Lee, Yong-Sang; Vamvakidis, Kyriakos; Mihai, Radu; Duh, Quan-Yang; Akinci, Baris; Alagol, Faruk; Almquist, Martin; Barczynski, Marcin; Bayraktaroglu, Taner; Berber, Eren; Bukey, Yusuf; Cakmak, Guldeniz Karadeniz; Canturk, Nuh Zafer; Canturk, Zeynep; Celik, Mehmet; Celik, Ozlem; Ceyhan, Banu Ozturk; Cherenko, Sergii; Clerici, Thomas; Coombes, David Scott; Demircan, Orhan; Deyneli, Oguzhan; Dionigi, Gianlorenzo; Emre, Ali Ugur; Erbil, Yesim; Filiz, Ali Ilker; Gozu, Hulya Iliksu; Gurdal, Sibel Ozkan; Gurleyik, Gunay; Haciyanli, Mehmet; Kebudi, Abut; Kim, Seokmo; Koutelidakis, Giannis; Kuru, Bekir; Mert, Meral; Oruk, Guzide Gonca; Ozbas, Serdar; Palazzo, Fausto; Pandev, Rumen; Riss, Phillip; Sabuncu, Tevfik; Sahin, Ibrahim; Sakman, Gurhan; Saygili, Fusun; Senyurek, Yasemin Giles; Sleptsov, Ilya; Van Slycke, Sam; Teksoz, Serkan; Terzioglu, Tarik; Tezelman, Serdar; Tunca, Fatih; Ugurlu, Mustafa Umit; Uludag, Mehmet; Villar-del-Moral, Jesus; Vriens, Menno; Yazici, DilekPurpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole +/- beta-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.Item Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies(OXFORD UNIV PRESS, 2015-01-01) Ozmen, Vahit; Boylu, Sukru; Ok, Engin; Canturk, Nuh Zafer; Celik, Varol; Kapkac, Murat; Girgin, Sadullah; Tireli, Mustafa; Ihtiyar, Enver; Demircan, Orhan; Baskan, Mazhar Semih; Koyuncu, Ayhan; Tasdelen, Ismet; Dumanli, Esra; Ozdener, Fatih; Zaborek, PiotrBackground: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay timeItem Correlations Between Oncotype DX Recurrence Score and Classic Risk Factors in Early Breast Cancer: Results of A Prospective Multicenter Study in Turkey(AVES, 2016-01-01) Ozmen, Vahit; Atasoy, Ajlan; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikkdogan, Abdurrahman; Cabioglu, Neslihan; Sen, Fatma; Saip, PinarObjective: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the correlations between Recurrence Score (RS) and routine risk factors. Materials and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive patients with breast cancer who had pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at tumor conferences. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classic risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of the 165 patients, 57\% had low RS, 35\% had intermediate RS, and 8\% had high RS, respectively. Multivariate analysis indicated that progesterone receptor (PR) and Ki67 scores were significantly related to RS. Conclusion: Oncotype DX Recurrence Score does not seem to have a significant correlation with the majority of classic risk factors, but it may have a correlation with PR score and Ki67 score.Item Impact of Oncotype DX Recurrence Score on Treatment Decisions: Results of a Prospective Multicenter Study in Turkey(CUREUS INC, 2016-01-01) Ozmen, Vahit; Atasoy, Ajlan; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikdogan, Abdurrahman; Saip, PinarIntroduction: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX (R) 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the impact of the Recurrence Score (R) (RS) on treatment decisions and physician perceptions in Turkey. We also studied correlations between RS and routine risk factors. Patients and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at multidisciplinary tumor conferences. The initial treatment decision was recorded before tumor blocks were sent to the central laboratory. Each case was brought back to tumor conference after receiving the RS result. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classical risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of 165 patients, 57\% had low RS, 35\% had intermediate RS, and 8\% had high RS, respectively. The overall rate of change in treatment decision was 33\%. Initially, chemotherapy followed by hormonal therapy (CT+HT) was recommended to 92 (56\%) of all patients, which decreased to 61 (37\%) patients post-RS assay (p<0.001). Multivariate analysis indicated that progesterone receptor (PR) and Ki-67 scores were significantly related to RS. Conclusion: Oncotype DX testing may provide meaningful additional information in carefully selected patients.Item Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study(AVES, 2019-01-01) Ozmen, Vahit; Cakar, Burcu; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikdogan, Abdurrahman; Saip, PinarObjective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods: A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57\% had low recurrence score (RS), 35\% had intermediate RS, and 8\% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33\%. Results: The cost of adjuvant chemotherapy in public hospitals was estimated at \$3.649, and Oncotype Dx test was \$5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be \$7207.9 per QALY gained and \$5720.6 per LY gained versus current clinical practice. Conclusion: As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.Item Correlation between 18F-FDG Positron-Emission Tomography 18F-FDG Uptake Levels at Diagnosis and Histopathologic and Immunohistochemical Factors in Patients with Breast Cancer(AVES, 2016-01-01) Ugurluer, Gamze; Yavuz, Sinan; Calikusu, Zuleyha; Seyrek, Ertugrul; Kibar, Mustafa; Serin, Meltem; Ersoz, Canan; Demircan, OrhanObjective: In this study, we aimed to determine the correlation between pretreatment-staging 18F-FDG total body positron-emission tomography/computed tomography (PET/CT) maximum standardized uptake value (SUVmax) levels and histopathologic and immunohistochemical predictive and prognostic factors in patients with breast cancer. Materials and Methods: One hundred thirty-nine women with breast cancer who were treated between 2009 and 2015 at our hospital and who had pretreatment-staging PET/CT were included in the study. SUVmax levels and histopathologic and immunohistochemical results were compared. Results: The median age was 48 years (range, 29-79 years). The mean tumor diameter was 33.4 mm (range, 7-120 mm). The histology was invasive ductal carcinoma in 80.6\% of the patients. In the univariate analysis, SUVmax levels were significantly higher in patients with invasive ductal carcinomaItem Silicone implant induced lymphadenopathy after breast reconstructive surgery(CUKUROVA UNIV, FAC MEDICINE, 2019-01-01) Calikusu, Zuleyha; Demircan, Orhan; Saltaoglu, Pinar; Ozcan, Nazli