Person: TİNAY, İLKER
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TİNAY
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İLKER
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Publication Open 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.Publication Metadata 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 sayısıPublication Open 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.Publication Open 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 diseasePublication Metadata only Radi̇kal prostatektomi̇ patoloji̇si̇nde gleason grade grubu yükselmesi̇ni̇n kli̇ni̇k önemi̇ var mı?(2021-11-13) ÖZGÜR, GÜNAL; TOPBAŞ, FEVZİ BATUHAN; TİNAY, İLKER; ÇAM, HAYDAR KAMİL; DÖRÜCÜ, DOĞANCAN; Özgür G., Topbaş F. B., Şahin B., Dörücü D., Tinay İ., Çam H. K.RADİKAL PROSTATEKTOMİ PATOLOJİSİNDE GLEASON GRADE GRUBU YÜKSELMESİNİN KLİNİK ÖNEMİ VAR MI?Günal Özgür, Fevzi Batuhan Topbaş, Bahadır Şahin, Doğancan Dörücü, Haydar Kamil Çam ve İlker TinayAMAÇ :Bu çalışmada biyopsi patolojisi Gleason Grade Grup (GGG) 1 ve 2 olarak rapor edilen prostat kanseri hastalarının radikal prostatektomi (RP) patolojileri ile prostat biyopsileri (PB) patolojileri arasındaki farklılıkların değerlendirilmesini ve GGG’da yükselme olan hastalarda onkolojik sonuçların değerlendirilmesini amaçladık. YÖNTEM: Ekim 2015 ve Haziran 2020 tarihleri arasında ameliyatı gerçekleştirilen ve sonrasında düzenli Üroonkoloji poliklinik takiplerine devam eden 101 hastanın verileri retrospektif olarak incelendi. Hastalar GGG yükselmesi olan ve olmayan hastalar olarak 2 gruba ayrıldı. Bu iki grup arasında yaş, ameliyat öncesi prostat spesifik antijen (PSA), biyopsi GGG, PB kor sayısı, RP GGG, kapsül invazyonu, seminal vezikül invazyonu ve biyokimyasal nüks oranları değerlendirildi. BULGULAR: Çalışmaya dahil edilen 101 hastanın yaş ortalaması 63,47 (+/-6,25) yıl olarak saptandı. Toplam 20 (%19,8) hastada GGG yükselme olduğu ve 81 (%80,2) hastada ise değişik olmadığı saptandı. Bu iki grup arasında yaş, ameliyat öncesi PSA, PB’de alınan kor sayıları tümör saptanan kor sayıları ve tümör pozitif kor yüzdeleri arasında istatistiksel anlamlı fark saptanmadı (Tablo 1). Seminal vezikül invazyonu ve biyokimyasal nüks görülme oranı, GGG yükselmesi olan grupta daha fazla olmakla beraber iki grup arasında istatistiksel anlamlı fark izlenmedi. Patolojik bulgulardan kapsül invazyonunun ise GGG yükselmesi olan grupta istatistiksel olarak anlamlı düzeyde daha fazla olduğu saptandı (p=0,039)(Tablo 1).SONUÇ: Biyopsi patolojisi prostat kanseri GGG 1 ve 2 olarak raporlanan hastaların önemli bir kısmında ameliyat materyalinin patolojisinde daha yüksek bir GGG ile karşılaşılabileceği akılda tutulmadır. Biyopsi ve RRP patolojileri arasındaki farklılıkların azaltılabilmesi için özgüllük ve duyarlılığı yüksek moleküler belirteçler ve hedef odaklı biyopsi yöntemleri üzerine yapılacak çalışmalar büyük önem taşımaktadır.Anahtar Kelimeler: Prostat Kanseri, Prostat Biyopsisi, Gleason Grade Grubu, Radikal ProstatektomiTablo 1: İki grubun biyopsi öncesi ve nihai patolojik bulguları ve onkolojik takiplerinin karşılaştırılması: GGG Yükselmesi (+) (n=20) GGG Yükselmesi (-) (n=81) Yaş 65.0 (61.75-70.5) 63.0 (60.0-68.0) 0,1801 PSA 9.26 (5.94-12.66) 8.0 (5.2-11.74) 0,0931 Toplam Kor Sayısı 12.0 (12.0-12.5) 12.0 (12.0-18.0) 0,3001 Tümör Pozitif Kor Sayısı 4.5 (2.75-6.5) 5.0 (3.0-8.0) 0,3001 Tümör Pozitif Kor Yüzdesi 37.5 (22.92-51.78) 32.05 (16.67-50.0) 0,7911 Biyopsi Kor Sayısı 12 odak >12 odak 15 (75.0) 51 (66.23) 0,4542 5 (25.0) 26 (33.77) Kapsül İnvazyonu (+) (-) 15 (75.0) 40 (49.38) 0,03922 5 (25.0) 41 (50.62) Seminal Vezikül İnvazyonu (+) (-) 5 (25.0) 12 (14.81) 0,2762 15 (75.0) 69 (85.19) Biyokimyasal Nüks (+) (-) 2 (10.0) 5 (6.25) 0,5322 16 (80.0) 69 (86.25) 1 Mann-Whitney U Testi2 x2 Testi.Publication Open Access Oncological outcomes of papillary versus clear cell renal cell carcinoma in pT1 and pT2 stage: Results from a contemporary Turkish patient cohort(2023-05-29) TİNAY, İLKER; Cetin T., Celik S., Sozen S., AKDOĞAN B., İZOL V., ASLAN G., SÜER E., BAYAZIT Y., Karakoyunlu N., Ozen H., et al.OBJECTIVES: To compare overall survival (OS), recurrence free survival (RFS), and cancer-specific survival (CSS) in the long-term follow-up of T1 and T2 clear-cell-Renal Cell Carcinoma (ccRCC) and papillary Renal Cell Carcinoma (pRCC) patients, as well as to determine the risk factors for recurrence and overall mortality. MATERIAL AND METHOD: Data of patients with kidney tumors obtained from the Urologic Cancer Database - Kidney (UroCaD-K) of Turkish Urooncology Association (TUOA) were evaluated retrospectively. Out of them, patients who had pathological T1-T2 ccRCC and pRCC were included in the study. According to the two histological subtype, recurrence and mortality status, RFS, OS and CSS data were analyzed. RESULTS: RFS, OS and CSS of pRCC and ccRCC were found to be similar. Radiological local invasion was shown to be a risk factor for recurrence in pRCC, and age was the only independent factor affecting overall mortality. CONCLUSIONS: There were no differences in survivals (RFS, OS and CSS) of patients with localized papillary and clear cell RCC. While age was the only factor affecting overall mortality, radiological local invasion was a risk factor for recurrence in papillary RCC.Publication Open Access Oncological Outcomes of Chromophobe Versus Clear Cell Renal Cell Carcinoma: Results from A Contemporary Turkish Patient Cohort(2024-01-01) TİNAY, İLKER; Cetin T., Celik S., Sozen S., Ozen H., AKDOĞAN B., ASLAN G., BALTACI S., SÜER E., Bayazit Y., Izol V., et al.Purpose: To compare the oncological outcomes of clear cell RCC (ccRCC), which is common in renal cell carcinomas (RCC), and chromophobic RCC (chRCC), which is less common, and to define the factors affecting survival in the Turkish patient population for both RCC subclassifications. Materials and Methods: Patients with a pathologically confirmed RCC diagnosis after radical or partial nephrectomy in the Turkish Urooncology Association (TUOA), Urological Cancers Database-Kidney (UroCaD-K), were retrospectively reviewed. Patients with ccRCC and chRCC were included in the study. Primary outcomes of this study are recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) for each histological subtype. Results: Data from 5300 patients in the TUOA UroCaD-K are reviewed and a total of 2560 patients (2225 in the ccRCC group and 335 in the chRCC group) are included in the final analysis. In the comparison of the groups, tumor size was greater both radiologically and pathologically in chRCC (p=0.019 vs 0.002 respectively). Recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) rates are worse in ccRCC subgroup. In the evaluation of risk factors; pathological stage, local invasion and Fuhrmann grade were found to be significant for recurrence in ccRCC. Age, body mass index and pathological stage were the risk factors affecting overall mortality (OM). Pathological tumor size was an independent risk factor for recurrence in chRCC, while age was analyzed as the only parameter affecting OM. Conclusion: chRCC oncological data and OS, CSS and RFS rates were found to be better than ccRCC in the Turkish patient population.