Background: Synovial sarcoma (SyS) is a rare malignancy that is typically located on the limbs and occurs predominantly in adolescents. A study in a large population for SyS comparing subtypes has not yet been reported. Methods: National Cancer Institute’s Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with SyS between January 1975 and December 2016. Patients were classified demographically according to gender, age, race/ethnicity, and marital status, and they were also classified by tumors, subtypes, localization, grade, year of diagnosis, laterality, type of treatment, and follow-up results. Results: A total of 3228 patients were included, with a mean age of 39.3 ± 18.8 (range: 1–94), of which 1521 (47.1%) were females and 1707 (52.9%) were males. According to its subtypes, 47.2% were SyS not otherwise specified, 32.3% were spindle cell, 19.9% were biphasic, and 0.6% were epithelioid type. The overall survival period is 138.0 (95% confidence interval: 113.2–162.8) months. Survival duration was found to be significantly different between groups according to gender (log-rank test; p < 0.001), age groups (log-rank test; p < 0.001), race (log-rank test; p = 0.001), marital status (log-rank test; p < 0.001), tumor subtypes (log-rank test; p < 0.001), tumor location (log-rank test; p < 0.001), tumor laterality (log-rank test; p < 0.001), date of diagnosis (log-rank test; p = 0.025), tumor grade (log-rank test; p < 0.001), historic stage (log-rank test; p < 0.001), state of chemotherapy (log-rank test; p < 0.001), state of radiotherapy (log-rank test; p < 0.001), presence of metastasis (log-rank test; p < 0.001), and total number of malignant tumors (log-rank test; p < 0.001). Conclusion: Male gender, being colored individual, being over 35 years at the time of diagnosis, epithelioid type, non-head and neck region localization is associated with poor prognosis. While radiotherapy improves survival, benefit of chemotherapy is unclear. Level of Evidence: III retrospective analysis.

Objectives: This study aims to evaluate the diagnostic and prognostic significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) values in patients with osteosarcoma. Patients and methods: A total of 172 patients (111 males, 61 females; mean age: 24.3±15.3 years; range, 7 to 82 years) diagnosed with osteosarcoma in our institution between January 2002 and December 2018 were retrospectively analyzed. A total of 165 healthy individuals (115 males, 50 females; mean age: 20.2±9.2 years; range, 10 to 65 years) who did not have infectious, rheumatological or hematological diseases or any pathological finding were assigned as the control group. The clinical, laboratory, and demographic findings of the patients were obtained from hospital records. Pre-treatment NLR, PLR, and LMR values were calculated in all patients. Diagnostic and prognostic values of pre-treatment NLR, PLR and LMR were assessed using receiver operating curve (ROC) analysis. The Kaplan-Meier method was used for survival analysis. Results: For diagnostic approach, the highest significance in area under the curve (AUC) values was obtained for NLR (AUC=0.763). The AUC for PLR and LMR was statistically significant, while the statistical power was weak compared to NLR (AUC=0.681 and 0.603). The NLR, PLR, and LMR were found to be predictors of mortality. The cut-off value was found to be 3.28 for NLR, 128 for PLR, and 4.22 for LMR. The prognostic value of NLR for mortality was higher than (AUC=0.749) PLR (AUC=0.688) and LMR (AUC=0.609). The NLR, PLR, and LMR were associated with overall survival (OS). There was a significant difference in the median OS time among the NLR, PLR, and LMR values (log-rank test order p<0.001, p=0.001, and p=0.004, respectively). Conclusion: Based on our study results, pre-treatment NLR, PLR and MLR have diagnostic and prognostic values in osteosarcoma.

ÖZAmaç: Bu çalışmada femoral subtrokanterik bölge kanaldiyafiz oranının kalça kırığı öncesi riskin belirlenmesinde yararlı olup olmadığı araştırıldı. Hastalar ve yöntemler: Çalışma grubu osteoporotik kalça kırıklı 116 hastadan (26 erkek, 90 kadın; ort. yaş 77.8 yıl; dağılım, 61-89 yıl), kontrol grubu ise 56 bireyden (11 erkek, 45 kadın; ort. yaş 75.3 yıl; dağılım, 60-83 yıl) oluştu. Çalışma grubundaki hastaların düz radyografilerinde kanaldiyafiz oranı ölçüldü. Etkilenen taraf ve sağlam tarafın sonuçları karşılaştırıldı. Ölçümlerin gözlemciler arasında güvenilirliğini sağlamak ve teknik hataları en aza indirmek için değerlendirmeler iki farklı ortopedik cerrah tarafından iki kere (iki hafta ara ile) yapıldı. Bulgular: Kalça kırıklı hastalarda kanal-diyafiz oranı aynı hastanın sağlam tarafına (p<0.001) ve kontrol deneklerine (p<0.001) göre anlamlı olarak artmıştı. Alıcı işletim karakteristik analizinin sonuçlarına göre, osteoporoz hastalarında kalça kırığını öngörmede kanal diyafiz oranı tanısal bir değere sahipti ve sınır değer yaklaşık 0.53 (duyarlılık: %81, özgüllük: %86) idi. 0.53'lük indeks, %89'luk intertrokanterik kalça kırığı riskini temsil eder. Sonuç: X-ışını cihazına düşük maliyetle rahatlıkla erişilebildiği için bu yöntem tüm hekimler tarafından kolayca uygulanabilir. Yüksek riskli hastalarda kalça kırığı riski belirlenmeli, osteoporoz değerlendirilmeli ve kırık gelişmeden gerekli önlemleri almak için tedaviye başlanmalıdır.Anahtar sözcükler: Kanal-diyafiz oranı, kırık riski, kalça kırığı, osteoporoz. ABSTRACTObjectives: This study aims to investigate whether the ratio of the canal-to-diaphysis in femoral subtrochanteric region is helpful in determining risk before hip fracture. Patients and methods: The study group consisted of 116 patients with osteoporotic hip fractures (26 males, 90 females; mean age 77.8 years; range, 61 to 89 years) and the control group consisted of 56 subjects (11 males, 45 females; mean age 75.3 years; range, 60 to 83 years). The canal-to-diaphysis ratio of patients in the study group was measured on plain radiographs. The results of the affected side and intact side were compared. To ensure the interobserver reliability of the measurements and to minimize technical errors, the assessments were performed twice (two weeks apart) by two different orthopedic surgeons.

Cartilaginous tumors of the skeleton are amongst the most common; however, differential diagnosis remains to be a challenge. [1,2] These neoplasms range from enchondromas to chondrosarcomas with diagnostic margin being rather vague, particularly between enchondromas and low-grade chondrosarcomas where misdiagnosis may bring burdensome consequences. Currently, clinical discrimination mainly relies on location, radiologic, and pathologic properties of the tumor which yield little agreement between different clinicians for each patient. The need for a reliable and easily generalizable criteria is evident; however, there are no specific biomarkers available in the clinical setting despite ongoing studies. [3,4] Recent decade has seen many reports delivering evidence on the role of inflammation in the development and carcinogenic advancement of neoplasms, although pathways remain mainly unknown up to this date. [5,6] Therefore, blood-based markers of inflammation such as inflammatory cell counts and rates which are derived from those, Objectives: This study aims to evaluate the role of elevated neutrophil-to-lymphocyte ratio (NLR) and monocyte-tolymphocyte ratio (MLR) in differential diagnosis of enchondroma and low-grade chondrosarcoma. Patients and methods: One-hundred-and-one patients (44 males, 57 females; mean age 53.6±11.5 years; range, 21 to 85 years) diagnosed with enchondroma and low-grade chondrosarcoma in Ankara Oncology Training and Research Hospital between January 2010 and December 2019 were included in this retrospective study. Patients' age, gender, location and type of tumor, and pre-treatment complete blood count results were acquired. One-hundred patients (48 males, 52 females; mean age 50.9±13.6 years; range, 19 to 76 years) with complete blood count results admitted to the same center for reasons other than fracture, infection or tumors with similar age and gender to the aforementioned study group were included as healthy controls. Results: Neutrophil-to-lymphocyte ratio and MLR of the study group were found to be significantly higher than the control group (p<0.001). Neutrophil-to-lymphocyte ratio and MLR held diagnostic importance with statistically significant cutoff values. Statistically significant cutoffs for NLR and MLR were ≥2.0 (sensitivity=73.3%, specificity=67%) and ≥0.2 (sensitivity=76.2%, specificity=63%), respectively. Multivariate logistic regression analysis was performed adjusting for age and gender and NLR ≥2 [odds ratio (OR)=3.1] or MLR ≥0.2 (OR=2.9) were found to be associated with approximately threefold risk for diagnosis of enchondroma or low-grade chondrosarcoma. Conclusion: The NLR and MLR have diagnostic value in cartilaginous tumors such as enchondroma and low-grade chondrosarcoma. However, our results do not support utilization of NLR and MLR as diagnostic value for differentiation of enchondroma and low-grade chondrosarcoma.

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