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TİNAY, İLKER

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    PublicationOpen Access
    Gas6 expression and Tyrosine kinase Axl Sky receptors: Their relation with tumor stage and grade in patients with bladder cancer
    (PAGEPRESS PUBL, 2021-06-28) TİNAY, İLKER; Akgul, Murat; Baykan, Ozgur; Cagman, Zeynep; Ozyurek, Mustafa; Tinay, Ilker; Akbal, Cem; Uras, Fikriye; Turkeri, Levent
    Objectives: It has been shown that the dys-regulation of tyrosine kinase Axl receptor and its ligand growth arrest-specific gene (Gas6) are associated with poor prognosis in various types of tumors but there is not enough study about their importance in bladder cancer (BC). We evaluated the relation of Gas6 gene expression and tyrosine-kinase Axl and Sky (Tyro 3) receptors with tumor stage and grade in patients with BC. Material and Methods: The study group consists of 55 patients whose transurethral resection of bladder (TUR-B) has been performed due to RC and the control group consists of 12 patients with normal bladder mucosa. In tissues mRNAs of Gas6, Axl, and Sky receptors were examined by quantitative (Real-Time) PCR (qPCR). Protein expression was measured by immunohistochemistry. Plasma Gas6 protein levels were compared with control group by ELISA method. Results: Patients with BC were grouped as Ta low (n=17), Ta high (n=5), T1 low (n=9), T1 high (n=8) and T2 (n=16) according to their TUR-B pathologies. The qPCR analysis showed that the expression of Gas6 gene and AxI receptor is higher in the tumor-positive group and the immune-histochemical showed that the bladder samples of the tumor-positive group stained significantly positive. When the patients are grouped according to the TUR-B pathologies, a statistical significant difference was observed among groups in the qPCR analysis ratios of Gas6 gene and Axl receptor by (p < 0.05) but no significance was found for Sky receptor (p > 0.05). When Gas6 protein levels in plasma samples were compared by ELISA method, a statistical significance was determined among groups (p = 0.001). Conclusions: Our findings indicate that mRNAs of Gas6 and Axl receptor are closely related to tumor stage and grade in patients with BC. Further studies are needed for understanding the role of Gas6 and its receptors on the neoplastic transformation in terms of novel biomarkers and potential therapeutic targets.
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    PublicationOpen Access
    The Early Impact of COVID-19 Pandemic on Surgical Urologic Oncology Practice in Turkey: Multi-Institutional Experience From Different Geographic Areas
    (ELSEVIER SCIENCE INC, 2020-08) TİNAY, İLKER; Tinay, Ilker; Ozden, Ender; Suer, Evren; Bozkurt, Ozan; Izol, Volkan; Sahin, Bahadir; Turkeri, Levent
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    PublicationOpen Access
    Atypical Cell'' Parameter in Automated Urine Analysis for the Diagnosis of Bladder Cancer: A Retrospective Pilot Study
    (GALENOS YAYINCILIK, 2020-04-01) FİLİNTE, DENİZ; Tinay, Ilker; Sahin, Bahadir; Saracoglu, Sertac; Yanilmaz, Ozgur; Aksu, Mehmet Burak; Ayas, Ramazan; Filinte, Deniz; Cam, Haydar Kamil; Ilki, Arzu
    Objective: To evaluate the application of an automated urine analyzer (AUA) for the diagnosis of bladder cancer (BC) Materials and Methods: A retrospective data analysis of 2365 urine specimens from the department of urology has been performed and matched with those patients, who have undergone cystoscopic evaluation or surgical treatment for different urological pathologies during 2018. After matching, clinical records of the patients has been further evaluated in order to select patients with recent or previous BC diagnosis. To assess the diagnostic efficacy of AUA, patients were divided into five groups according to the patient history of BC and healthy controls. Results: A total of 106 patients are included in this study and the majority (69.8%) of the patients are follow-up patients with previous diagnosis and treatment of non-muscle invasive BC (NMIBC). For patients with low-risk NMIBC (n=27), the sensitivity and specificity were calculated as 75% and 100%. For patients with high-risk NMIBC (n=47), who were previously treated with intravesical BCG, the sensitivity and specificity were calculated as 54.5% and 83.3%. All patients in radical cystectomy group (n=7) with muscle invasive BC had positive urine analyses results for atypical cells. And none of the patients in the control group (n=8) had positive AUA results and cystoscopic evaluation also did not show any bladder mass suspicious for BC. Conclusion: The results of this retrospective pilot study showed acceptable sensitivity and specificity rates of the fluorescence flow cytometry based AUA and the results of the low-risk group are especially valuable regarding its potential use to decide on performing a follow-up cystoscopy or not. A prospective study is currently on progress to validate the findings of the current study.
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    PublicationOpen Access
    Artificial intelligence-based prognostic model for urologic cancers: A seer-based study
    (2022-07-01) TİNAY, İLKER; Eminaga O., Shkolyar E., Breil B., Semjonow A., Boegemann M., Xing L., TİNAY İ., Liao J. C.
    Simple Summary We describe a risk profile reconstruction model for cancer-specific survival estimation for continuous time points after urologic cancer diagnosis. We used artificial intelligence (AI)-based algorithms, a national cancer registry data, and accessible clinical parameters for the risk-profile reconstruction. We derived a risk stratification model and estimated the minimum follow-up duration and the likelihood for risk stability in prostate, kidney, and testicular cancers. The estimated follow-up duration was in alignment with recognized clinical guidelines for these cancers. Moreover, the estimated follow-up duration was differed by the cancer origin and the disease dissemination status. Overall, the reconstruction of the population\"s risk profile for the cancer-specific prognostic score estimation is feasible using AI and has potential application in clinical settings to improve risk stratification and surveillance management. Background: Prognostication is essential to determine the risk profile of patients with urologic cancers. Methods: We utilized the SEER national cancer registry database with approximately 2 million patients diagnosed with urologic cancers (penile, testicular, prostate, bladder, ureter, and kidney). The cohort was randomly divided into the development set (90%) and the out-held test set (10%). Modeling algorithms and clinically relevant parameters were utilized for cancer-specific mortality prognosis. The model fitness for the survival estimation was assessed using the differences between the predicted and observed Kaplan-Meier estimates on the out-held test set. The overall concordance index (c-index) score estimated the discriminative accuracy of the survival model on the test set. A simulation study assessed the estimated minimum follow-up duration and time points with the risk stability. Results: We achieved a well-calibrated prognostic model with an overall c-index score of 0.800 (95% CI: 0.795-0.805) on the representative out-held test set. The simulation study revealed that the suggestions for the follow-up duration covered the minimum duration and differed by the tumor dissemination stages and affected organs. Time points with a high likelihood for risk stability were identifiable. Conclusions: A personalized temporal survival estimation is feasible using artificial intelligence and has potential application in clinical settings, including surveillance management.
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    PublicationMetadata only
    Prostat kanseri̇nde kli̇ni̇k lokali̇ze hastalik evresi̇nde preoperati̇f ga-68 psma pet/bt gerekli̇ mi̇di̇r?
    (2020-11-10) ÖNEŞ, TUNÇ; ÖZGÜR, GÜNAL; TİNAY, İLKER; Özgür G., Şahin B., Çetin M., Öneş T., Tinay İ.
    PROSTAT KANSERİNDE KLİNİK LOKALİZE HASTALIK EVRESİNDE PREOPERATİF GA-68 PSMA PET/BT GEREKLİ MİDİR?Günal Özgür, Bahadır Şahin, Fevzi Batuhan Topbaş, Mehmet Çetin, Tunç Öneş, İlker TinayAMAÇ:Günümüzde prostat kanseri hastalarında evreleme amaçlı yapılan görüntülemelerde Ga-68 PSMA pozitron emisyon tomografisi / bilgisayarlı tomografi (Ga-68 PSMA PET/BT) giderek artan oranda tercih edilmektedir ancak bu görüntüleme yöntemi yüksek maliyete sahiptir. Bu çalışmada, klinik lokalize hastalık evresindeki prostat kanseri hastalarında radikal prostatektomi (RP) öncesi evreleme amacıyla çekilen Ga-68 PSMA PET/BT görüntülemesinin hasta grubumuzdaki sonuçlarını paylaşmayı amaçladık. MATERYAL METOT: Mart 2016 – Ağustos 2020 tarihleri arasında prostat kanseri nedeniyle RP yapılan ve ameliyat öncesi Ga-68 PSMA PET/BT görüntülemesi yapılan 39 hasta retrospektif olarak incelendi. Hastalardaki Ga-68 PSMA PET/BT görüntüleme endikasyonları; yüksek veya çok yüksek riskli hastalık varlığı, evreleme amaçlı çekilen Tüm Vücut Kemik Sintigrafisi veya Manyetik Rezonans Görüntüleme/Bilgisayarlı Tomografi görüntülerinde kemik ya da lenf nodu metastazı açısından şüpheli lezyon saptanması olarak belirlendi. Ameliyat öncesi Briganti nomogramında skoru %5’in altında olan hastalara lenfadenektomi işlemi uygulanmadı. Hastalarda yaş, preoperatif PSA değeri, biyopsi ve patolojik Gleason derece grupları (GDG), Ga-68 PSMA PET/BT’de lenf nodu tutulumu/seminal vezikül tutulumu ve patoloji örneklerindeki lenf nodu/seminal vezikül tutulumu bulguları incelendi. BULGULAR:Çalışmaya dahil edilen 39 hastanın yaş ortalaması 65,92 (+/- 4,6) idi. Hastaların operasyon öncesi PSA değerleri ortanca değeri 14,6 (2,5-83) ng/dl idi. Hastaların prostat biyopsi ve RP patolojilerine göre GDG kategorileri tablo 1’de verilmiştir. Preoperatif yapılan Ga-68 PSMA PET/BT görüntülemesinde 39 hastanın 5’inde (%12,8) patolojik lenf nodu tutulumu saptanırken, 1 (%2,5) hastada da seminal vezikül tutulumu rapor edildi.Ga-68 PSMA PET/BT görüntülemesinde lenf nodu tutulumu saptanmayan ve GDG 1 ve 2 olan 11 hastada Briganti nomogramına göre lenf nodu tutulumu riski %5 ‘ten az olması nedeniyle lenf nodu diseksiyonu (LND) yapılmadı. Genişletilmiş LND yapılan 28 hastada patoloji örneklerinde ortanca 14 (8-31) adet lenf nodu saptandı. Genişletilmiş LND yapılan 28 hastanın 7’sinde (%25) metastatik lenf nodu tespit edildi. Preoperatif çekilen Ga-68 PSMA PET/BT’de lenf nodu tutulumu tespit edilen 5 hastanın 2’sinde metastatik lenf nodu tespit edilirken 3 hastada ise patolojik örneklerde metastatik lenf nodu saptanmadı. Ga-68 PSMA PET/BT’de preoperatif lenf nodu tutulumu saptanmayan ancak Briganti nomogramına göre lenf nodu tutulumu riski %5 ‘ten yüksek saptanan ve genişletilmiş LND yapılan 23 hastanın ise 5’inde (%21,7) metastatik lenf nodu tespit edildi. PSMA’da tutulum izlenmeyip patolojik lenf nodu metastazı saptanan 5 hastadan 4’ü yüksek risk grubundaki hastalardı. Preoperatif yapılan Ga-68 PSMA PET/BT görüntülemesinde 39 hastanın 1’inde (%2,5) seminal vezikül tutulumu izlendi. RP patolojilerinde bu hasta dahil olmak üzere toplamda 10 hastada (%25,6) seminal vezikül invazyonu saptandı. SONUÇ :Klinik lokalize hastalık evresindeki prostat kanseri hastalarında radikal prostatektomi (RP) öncesi evreleme amacıyla çekilen Ga-68 PSMA PET/BT görüntülemesi evreleme açısından sınırlı bilgi vermektedir. Ga-68 PSMA PET/BT’de lenf nodu tutulumu saptanmamış olsa da patolojik tümör pozitif lenf nodlarının olabileceği göz önünde bulundurularak, yüksek risk grubundaki hastalara ve Briganti nomogramında yüksek tutulum riski olan hastalara genişletilmiş lenf nodu diseksiyonu yapılması onkolojik açıdan uygulanması gerekli yaklaşımdır. Anahtar Kelimeler : prostat kanseri; lenf nodu; prostat spesifik membran antijen; radikal prostatektomi Tablo 1. Prostat biyopsisi ve Radikal Prostatektomi Patolojilerine göre Gleason Grade Grup bilgileri Grade Grup Prostat Biyopsi % Radikal Prostatektomi % 1 10(4*) 25,6 8 20,5 2 6(1*) 15,4 10 25,6 3 4(1*) 10,3 6 15,4 4 13(3*) 33,3 5 12,8 5 6 15,4 10 25,6 * RP patolojisinde gleason grade grup yükselmesi saptanan hasta sayısı
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    PublicationOpen Access
    Mid-term results of surgical interventions of high-grade vena cava tumor thrombus
    (2022-01-01) ÖZTÜRK, FATİH; AK, KORAY; TİNAY, İLKER; ARSAN, SİNAN; Erol M. E. , ÖZTÜRK F., AK K., TİNAY İ., ARSAN S.
    © 2022 All right reserved by the Turkish Society of Cardiovascular Surgery. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes (http://creativecommons.org/licenses/by-nc/4.0/).Background: This study aims to investigate whether the coexistence of advanced renal cell carcinoma and inferior vena cava tumor thrombus could be treated with a multidisciplinary approach and teamwork and to evaluate early and mid-term results. Methods: Between January 2017 and December 2020, a total of 33 patients (28 males, 5 females; mean age: 55.8±13.2 years; range, 27 to 76 years) who underwent radical nephrectomy and thrombectomy of the inferior vena cava were retrospectively analyzed. Demographic characteristics of the patients, types of operations, postoperative data, mortality and morbidity rates were recorded. Results: Of the patients, 12% (n=4) had Stage 2 tumor thrombus, 60.6% (n=20) had Stage 3 tumor thrombus, and 27% (n=9) had Stage 4 tumor thrombus. A total of 55% (n=19) of the patients had right-sided renal cell carcinoma, while 45% (n=14) of them had a left-sided mass. Totally, 66% (n=22) of the patients underwent primary inferior vena cava repair. The thrombectomy procedure and a Dacron® patch was applied with patch plasty in 24% (n=8) of the patients, and Dacron® graft interposition was applied to the inferior vena cava in 9% (n=3) of the patients. The mean follow-up was 20.3±13.0 (range, 2 to 70) months. Deep vein thrombosis was detected in the follow-up of seven (21%) patients, and no pulmonary thromboembolism was observed during the postoperative follow-up period. The mean length of stay in the intensive care unit was 1.39±0.6 (range, 1 to 3) days. The 30-day mortality rate was 3%, due to the loss of one patient from massive pulmonary embolism intraoperatively. Conclusion: Vascular surgical procedures performed regardless of the stage of the tumor thrombus provide satisfactory mid-term results in patients with advanced renal cell cancer.
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    PublicationOpen Access
    Turkey prostate cancer map 2021: Turkish urooncology association prostate cancer database report
    (2022-03-01) ŞAHİN, BAHADIR; TİNAY, İLKER; Sahin B., Celik S., Tinay I., Eskicorapci S., ASLAN G., Sozen S., Ataus S., TURKERI L.
    Objective: This study aimed to present the data of patients with prostate cancer (PCa) whose detailed information was stored in the Urologic Cancer DatabaseProstate, Urooncology Association, Turkey with the title of “Turkey Prostate Cancer Map 2021.” Materials and Methods: Patient data between 1995 and 2020 were retrospectively scanned. The age of the patients, their distribution according to age groups, symptoms during diagnosis, examination findings [digital rectal examination (DRE)], prostate-specific antigen (PSA) values, biopsy methods in the diagnosis, metastatic disease rates, treatment methods, and progression rates at follow-up were examined. These results were compared with the results of the previous report, namely “Prostate Cancer Incidence (Incidence) in Turkey,” by the Urooncology Association in Turkey in 2009. Results: This study analyzed the data of 5040 patients from 19 different centers. The mean patient age was 63.6 (37-97) years. The age distribution examination revealed that most patients (49.8%) were aged 60-69 years. Of the patients, 51.8% were symptomatic at the time of diagnosis. The presence of symptoms was determined in 88.6% in 2009 data. The DRE of patients revealed that 25% of patients had malignancy findings. The PSA distribution examination revealed a >10 ng/mL PSA value in 37.5% of patients. With the increasing use of magnetic imaging resonance (MRI) in PCa diagnosis over the years, increased MR-fusion biopsy rates have been observed. Considering the biopsy data, 91% of patients were diagnosed with a classical transrectal ultrasound-guided biopsy, whereas 9% were diagnosed with MR-Fusion biopsy. Fusion biopsies revealed that 23% of patients with Prostate Imaging-Reporting and Data System (PI-RADS) 4 lesion and 57% with PI-RADS 5 lesion were diagnosed with cancer. Of the patients, 8.9% of patients had metastases during the initial diagnosis. This rate was 17% in 2009 data. The treatment methods examination after the diagnosis revealed that 73.9% of patients had undergone radical prostatectomy. This rate was 51.8% in 2009. Robotic and laparoscopic approaches, which are among the surgical modalities, have increased over the years. However, the most frequently applied modality in our country was open radical prostatectomy with 62.6%. Considering the follow-up data after treatment, 8.9% of patients had progression, of which 62.6% was biochemical, 30.2% was radiological, and 6.9% was a clinical progression. Conclusion: Technological advancements for PCa diagnosis (MRI and MR-guided biopsies) are becoming a routine part of daily practice compared to the results of the “Prostate Cancer Incidence in Turkey” project in 2009. The comparative study results revealed that the rate of symptomatic and metastatic disease decreases at the time of diagnosis, and laparoscopic and robotic surgery methods are used at increasing rates for localized disease
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    PublicationOpen Access
    The Relationship Between Vitamin D Gene Polymorphisms and the Diagnosis of Prostate Cancer in Patients with High Prostate-Specific Antigen Value
    (GALENOS YAYINCILIK, 2020-12-01) HAKLAR, GONCAGÜL; Akgul, Murat; Uren, Nihal; Yaman, Ali; Baykan, Ozgur; Ergul, Emel; Haklar, Goncagul; Tinay, Ilker
    Objective: To investigate the effects of vitamin D levels and vitamin D receptor (VDR) BsmI, FokI, TaqI, and ApaI gene polymorphisms on prostate cancer (PCa) diagnosis in Turkish men with high prostate-specific antigen (PSA) levels during screening. Materials and Methods: Patients who were admitted to the outpatient clinic with elevated PSA levels and were scheduled for transrectal prostate biopsy were included. Patients diagnosed with PCa were divided into two groups of either localized disease (low/intermediate/high risk) or metastatic disease for subgroup analysis. The control group comprised patients whose biopsies revealed benign pathologies. Blood samples were collected from each patient after 12 hours of fasting before the prostate biopsy. Vitamin D levels and VDR gene polymorphisms were determined by ECLIA method and restriction fragment length polymorphism analysis, respectively. Results: A total of 77 patients (PCa, 39; benign, 38) were included in the study. The frequencies of BsmI, FokI, TaqI, and ApaI genotypes for PCa and benign groups were evaluated. Vitamin D deficiency was detected in 88.6% and 94.9% of the benign and PCa groups, respectively (p=0.176). The FokI Ff and BsmI bb genotypes, and FokI FF and BsmI Bb genotypes were found to be more common in the PCa and benign groups, respectively. ApaI Aa and TaqI Tt were found to be more frequent in both groups. In patients with metastatic PCa; Bsml Bb genotype, Apal Aa genotype, and Taql Tt genotypes were found to be more common. Conclusion: Although Bsml Bb genotype, Apal Aa genotype, and Taql Tt genotypes were more commonly found in patients with metastatic PCa, further studies with increased sample sizes are needed to support this relationship in the Turkish PCa population.
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    PublicationOpen Access
    Clinicopathological Characteristics and Oncological Outcomes of Non-urothelial Bladder Carcinomas: A Multicenter Study
    (GALENOS YAYINCILIK, 2021-05-21) TİNAY, İLKER; Selvi, Ismail; Guven, Esref Oguz; Kutukoglu, Mehmet Umut; Urun, Yuksel; Tinay, Ilker
    Objective: The incidence of non-urothelial bladder cancers is very low, so our knowledge about their treatment protocols and prognosis is limited. We evaluated the clinicopathological characteristics of 26 patients in three different clinics and aimed to determine the prognostic factors affecting oncological outcomes. Materials and Methods: Between January 2012 and October 2019, we retrospectively analyzed the data of twenty-six patients aged between 44-75 years who were diagnosed and treated due to non-urothelial bladder carcinomas in three clinics. Results: Among twenty-six cases, nineteen (73.1%) were male and seven (26.9%) were female. The mean age at diagnosis was 60.77 +/- 8.52. The most common presenting complaint was gross hematuria (84.6%). It was followed by lower urinary tract symptoms (38.4%). Histological types of tumors were squamous cell carcinoma (9 cases, 34.8%), adenocarcinoma (eight cases carrying different histopathologic subtypes: Mucinous, signet ring cell, plasmacytoid/signet ring cell mixed variant and signet ring cell containing osteoclast-like giant cell, 30.8%), small cell carcinoma (3 cases, 11.5%), large cell neuroendocrine carcinoma (2 cases, 7.7%), extra-gastrointestinal stromal tumor (1 case, 3.8%) and malignant undifferentiated mesenchymal tumor (1 case, 3.8%) and leiomyosarcoma (2 cases, 7.6%). At a median follow-up of 13 (2-42) months, the progression-free survival rate was 61.5%, while the overall survival rate was 46.1%. In Kaplan-Meier analysis, the median survival of all cases was found to be 16 (9-33) months. Overall survival times were lower in the presence of advanced (3-4) pathological stages (p=0.006) and higher (>= 2) ECOG scores (p=0.005). Conclusion: In our cases, we observed that overall survival rates increased in patients undergoing multimodal treatments involving radical cystectomy compared to the bladder-sparing approach. The survival rates were higher in squamous cell carcinomas, while the rate of metastasis was higher in adenocarcinoma and neuroendocrine tumors. Up-staging rates after cystectomy were higher in adenocarcinomas, sarcomas and squamous cell carcinomas.
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    PublicationOpen Access
    Incidence and risk factors for urinary tract infections in the first year after renal transplantation
    (PUBLIC LIBRARY SCIENCE, 2021-05-03) VELİOĞLU, ARZU; Velioglu, Arzu; Guneri, Gokhan; Arikan, Hakki; Asicioglu, Ebru; Tigen, Elif Tukenmez; Tanidir, Yiloren; Tinay, Ilker; Yegen, Cumhur; Tuglular, Serhan
    Background The most common infections among renal transplant patients are urinary tract infections (UTI). Our main objective in this study is to determine the incidence of UTIs in patients who have undergone renal transplantation in our hospital, to identify the causative microbiological agents, risk factors and determine the effects of UTI on short-term graft survival. Methods Urinary tract infections, which developed within the first year of renal transplantation, were investigated. Patients were compared regarding demographic, clinical, laboratory characteristics and graft survival. Results 102 patients were included in our study. Fifty-three patients (53%) were male and 49 (48%) were female. Sixty-seven urinary tract infection attacks in 21 patients (20.5%) were recorded. Age (p = 0.004; 95% Confidence Interval [CI]: 1.032-1.184), longer indwelling urinary catheter stay time (p = 0.039; 95% Confidence Interval [CI]: 1.013-1.661) and urologic complications (p = 0.006; 95% Confidence Interval [CI]: 0.001-0.320) were found as risk factors for UTI development in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated microorganisms. Of these bacteria, 63.2% were found to be extended spectrum beta lactamase (ESBL) positive. Multidrug resistant microorganisms (MDROs) were more frequent in male patients (32 episodes in males vs. 14 episodes in females, p = < 0.001). UTI had no negative impact on short-term graft survival. Conclusion Our study results represent the high incidence of UTI with MDROs in KT recipients. Infection control methods should be applied even more vigorously especially in male transplant patients since a higher incidence of UTI caused by resistant microorganisms was reported in male patients.