Background: PD-L1 and VISTA are important checkpoint control stations and play an immunomodulatory role in patients with non-small-cell lung cancer. Method: The expression levels of PD-L1 and VISTA between pre- and post-treatment tumor tissue were compared. Results: While PD-L1 expression was >1% in 35% of patients before neoadjuvant therapy, PD-L1 expression was >1% in 65% of patients after treatment (p = 0.004). VISTA expression was >1% in 41% of patients before treatment, and this rate was 65% after treatment (p = 0.025). Conclusion: Chemotherapy and chemoradiotherapy can be used as immunizers by increasing PD-L1 and VISTA expression levels.

Objectives:The aim of this study was to evaluate the effect of the serum albumin/ globulin ratio (AGR) on the 30-day mortality of febrile neutropenia (FEN). The second aim of the study was to evaluate the effect of the combination of the AGR with the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) risk indexes on 30-day mortality of FEN.Methods: A retrospective study evaluating the effect of serum AGR, MASCC and CISNE scores on 30-day FEN mortality.Results: A total of 137 FEN episodes in 120 patients were included in this study.Nineteen patients (14%) died within the first 30 days of FEN episodes. The 30day mortality rate was calculated as 4% in patients with high AGR and 23% in patients with low AGR (P = .002). According to the MASCC and CISNE risk scores, the mortality rates in low-risk patients were 8% and 6%, respectively, and in the high-risk group 22% and 29%, respectively (P = .024 vs P < .001). In the group of patients with MASCC <21 and CISNE ≥3, the 30-day mortality rate was 7%, when the AGR was >1.13, and in those with AGR ≤1.13 mortality rate increased to 50% (P = .012). Conclusion:A low AGR in a patient with FEN was found to be associated with an increased risk of 30-day mortality. Combining the AGR with MASCC and CISNE risk indexes might increase the predictive value of these scoring systems on 30-day mortality. What's known• MASCC and CISNE risk indices are used in the prognosis of febrile neutropenia.• However, the specificity and sensitivity of both indexes are limited.• More effective risk scoring is needed in the management of febrile neutropenia. What's new• Combining the AGR with MASCC and CISNE risk indexes might increase the predictive value of these scoring systems on 30-day mortality. How to cite this article: Sütcüoğlu O, Akdoğan O, Gürler F, et al. The role of serum albumin/globulin ratio in combination with prognostic risk indexes of febrile neutropenia. Int J Clin

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Background: The aim of this study was to evaluate the effect of the serum albumin/ globulin (ALG) ratio on the 30-day mortality of febrile neutropenia (FEN). The second aim of the study was to evaluate the effect of combination of the ALG ratio with the MASCC and CISNE risk indexes on 30-day mortality of FEN.Methods: Between January 2016 and May 2020, the files of patients with a diagnosis of febrile neutropenia were retrospectively evaluated, the data of MASCC and CISNE risk indexes and serum ALG ratios at the time of admission were recorded.The patients who were received at least one cycle of chemotherapy and diagnosed with FEN were screened. Patients with diseases that may affect serum albumin and globulin levels were not included in the study (e.g. chronic liver disease, multiple myeloma, nephrotic syndrome). Patients with MASCC score < 21 and CISNE score ! 3 were identified as a high-risk group. The median ALG ratio value was 1.13 and patients were divided into two groups according to this value. Patients with ALG ratio value 1.13 were identified as a high-risk group.Results: One hundred and thirty-seven FEN episodes were included in the study. Nineteen patients (14%) had exitus within the first 30 days. The 30-day mortality rate was 96% in patients with high ALG ratios and 77% in patients with low ALG ratios (p ¼ 0.002). According to the MASCC and CISNE risk scores, the mortality rates were 92% and 94%, respectively, in low-risk patients and 78% and 71%, respectively, in the highrisk group (p ¼ 0.026 vs p < 0.001). A multivariate analysis with parameters that affect 30-day mortality revealed that CISNE scores ! 3 (OR: 4.55, CI 95% 1.61 e 12.86, p ¼ 0.004) and ALG ratios <1.13 (OR:3.94, CI 95% 1.11 e 13.93, p ¼ 0.033) were associated with increased 30-day mortality. In patients with MASCC<21 and CISNE >3 scores group if the ALG ratio was > 1.13, 30-day mortality rate was 93% and in those with ALG ratios 1.13 mortality rate decreased to 50% (p ¼ 0.012). Conclusions:A low ALG ratio in a patient with FEN associated with an increased risk of 30-day mortality. Combining the ALG ratio with MASCC and CISNE risk indexes might increase the predictive value of the scores on mortality.

Discussions regarding the treatment of stage III non-small cell lung cancer (NSCLC) are still ongoing in the literature. It is important to evaluate the developments in radiotherapy and surgery along with the data in real life regarding stage III NSCLC. The aim of this study is to evaluate the treatment approaches and real-life data in stage IIIA and IIIB local advanced NSCLC. Method: The files of 47 patients with local advanced stage IIIA and IIIB NSCLC, who were followed up in the Gazi University Faculty of Medicine, Medical Oncology Clinic between February 2016 and May 2018, were retrospectively evaluated. Results: As the primary treatment, definitive chemoradiotherapy (CRT) to 27 (57%) patients and surgical treatment to 20 (43%) patients were applied. It was observed that the performance status (p=0.010) of the patients who underwent CRT was statistically significantly worse, active smoking (p=0.033) was higher, and had a more advanced lymph node stage (p=0.052). In the univariate analysis, it was determined that lymph node status (p=0.011), performance status of the patients (p=0.0247), and treatment modality of patients (p=0.001) were the prognostic factors affecting survival. The 1-year overall survival rates and median survival of the patients were 85% and 23 months in the surgical group respectively, and 41% and 10 months in the definitive CRT group. In the multivariate analysis, surgery was found to be a better independent prognostic factor than CRT (HR: 2.72, 95% CI: 1.27-5.82, p=0.010). Conclusions: It was observed that the results of the patients, who were found to be respectable as a result of the clinical experience in stage III NSCLC patient group, were better. The mediastinal lymph node involvement site, especially N3 lymph node site, and the patient performance are among the important factors that determine the prognosis in stage III NSCLC.