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    A case of pathologic complete response after neoadjuvant triplet chemotherapy for locally advanced colon cancer with mismatch repair enzyme proficiency
    (Via Medica, 2023) Kocak, Mehmet Zahid; Cakir, Murat; Kerimoglu, Ulku; Araz, Murat; Eryilmaz, Melek Karakurt; Yumuk, Perran Fulden; Artac, Mehmet
    Patients with potentially resectable colon cancer and expected to have negative margins should undergo resection rather than neoadjuvant chemotherapy. Recent studies have suggested that neoadjuvant immunotherapy may be an option for tumors with mismatch repair enzyme deficiency (dMMR), but standard treatment for locally advanced colon cancer with mismatch repair enzyme proficiency (pMMR) is still unclear. A 37-year-old male patient was diagnosed with clinical stage IIIC (T4b N1a M0) transverse colon cancer. Mismatch repair proteins were proficient. After 3 cycles of oxaliplatin (85 mg/m(2), day 1), irinotecan (150 mg/m2, IV, day 1), leucovorin (200 mg/m(2), IV, day 1), and 5-fluorouracil (3000 mg/m(2), 46 hours of continuous infusion initiating from day 1), there was a remarkable reduction in the tumoral mass on the abdominal computed tomography. A right hemicolectomy was performed. A pathologic complete response was obtained. Although there is no consensus on which patients are suitable for neoadjuvant therapy in pMMR locally advanced colon cancer, triplet chemotherapy may be a reasonable option in selected patients.
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    Comment on Comparison of neutrophil lymphocyte ratio, platelet lymphocyte ratio and mean platelet volume and PCR test in Covid-19 patients
    (Assoc Medica Brasileira, 2021) Kocak, Mehmet Zahid
    [Abstract Not Availabe]
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    Comment on Comparison of neutrophil lymphocyte ratio, platelet lymphocyte ratio and mean platelet volume and PCR test in Covid-19 patients
    (Assoc Medica Brasileira, 2021) Kocak, Mehmet Zahid
    [Abstract Not Availabe]
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    Could the concomitant use of beta blockers with bevacizumab improve survival in metastatic colon cancer?
    (Springer Heidelberg, 2023) Kocak, Mehmet Zahid; Er, Muhiddin; Ugrakli, Muzaffer; Hendem, Engin; Araz, Murat; Eryilmaz, Melek Karakurt; Artac, Mehmet
    AimDrug-drug interactions are sometimes neglected in oncology practice. Due to drug pharmacokinetic and pharmacodynamic interactions, clinically increased or decreased drug effects and increased or decreased adverse effects may occur. Considering that the concomitant use of these two drugs that affect vascular endothelial growth factor receptor (VEGFR) may cause pharmacological potentiation or additive interaction, we aimed to evaluate the survival outcomes of concomitant use of bevacizumab and beta blockers in patients with metastatic colorectal cancer (mCRC).MethodsIn total, 181 patients with mCRC administered with bevacizumab plus cytotoxic chemotherapy regimen in a first-line setting were divided into two groups: concomitant beta-blocker user and nonuser.ResultsThe median overall survival (mOS) was 35.9 (95% CI: 27.9-43.9) months in the beta-blocker-using group and 29.6 (95% CI: 27.9-43.9) months in the beta-blocker-non-using group (p = 0.054). The median progression-free survival (mPFS) was 16.1 (95% CI: 12.4-19.9) months in the beta-blocker-using group and 12.8 (95% CI: 10.6-15.0) months in the beta-blocker-non-using group (p = 0.006). The multivariate analysis revealed that beta-blocker use was an independent predictor of mPFS (HR: 0.66, 95% CI: 0.46-0.93, p = 0.018) and mOS (HR: 0.57, 95% CI: 0.36-0.91, p = 0.02).ConclusionThis study demonstrated that concomitant usage of beta blockers improved both survival outcomes, irrespective of the kind of beta blocker.
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    Early-stage gastric cancer presenting with tripe palm and acanthosis nigricans
    (Via Medica, 2021) Kocak, Mehmet Zahid; Araz, Murat; Korkmaz, Mustafa; Demirkiran, Aykut
    Tripe palm is a rare cutaneous paraneoplastic syndrome that can be overlooked and frequently appears with acanthosis nigricans. If tripe palm and acanthosis nigricans occur in a patient together, gastric cancer should come to mind. A 50-year-old female patient had signs of abdominal pain and velvety thickening in the palms and soles. Tripe palm and acanthosis nigricans were considered as paraneoplastic syndrome after other benign causes were excluded. It was determined that the underlying malignancy was gastric cancer. After neoadjuvant FLOT chemotherapy regimen, gastrectomy was performed, and the patient received adjuvant chemotherapy. With the recognition of tripe palm, a rare cutaneous paraneoplastic syndrome, patients can be diagnosed and treated early.
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    The effect of BMI on the outcomes of CDK 4/6 inhibitor therapy in HR-positive metastatic breast cancer patients.
    (Lippincott Williams & Wilkins, 2022) Caglayan, Dilek; Kocak, Mehmet Zahid; Geredeli, Caglayan; Tatli, Ali Murat; Eryolmaz, Melek Karakurt; Goksu, Sema Sezgin; Araz, Murat
    [Abstract Not Availabe]
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    The effect of concomitant proton pump inhibitor use on survival outcomes of Nivolumab-treated renal cell carcinoma patients: a multicenter study
    (Springer, 2023) Ugrakli, Muzaffer; Kocak, Mehmet Zahid; Dinc, Gulhan; Genc, Tugrul Burak; Caglayan, Melek; Ugrakli, Selin; Hendem, Engin
    AimWe aimed to evaluate the effect of concomitant proton pump inhibitors (PPI) use with nivolumab on survival outcomes in metastatic renal cell carcinoma (mRCC) in second-line setting.MethodsThe study was designed as a multicenter and retrospective involving patients with metastatic renal cell carcinoma receiving second-line nivolumab therapy. One hundred and nine patients with mRCC were divided into two groups based on whether they use PPI concomitantly with nivolumab: concomitant PPI users and non-users. Overall survival (OS) and progression-free survival (PFS) were compared between the groups with and without concurrent PPIs.ResultsOf 109 patients in our study, 59 were not using PPI concomitantly with nivolumab and 50 were using PPI concomitantly. The median PFS was 6.37 (5.2-7.5) months in the concomitant PPI group and 9.7 (4.5-15) months in the non-users (p = 0.03). The median OS was 14.6 (7.1-22.1) months in patients on PPI concurrently with nivolumab and 29.9 (17.1-42.7) months in the non-users (p = 0.01). Accordingly, PPI use for PFS (Non-use vs. Use = HR: 0.44, 95%Cl 0.28-0.96, p = 0.014) and PPI use for OS (Non-use vs. Use = HR: 0.68, 95%Cl 0.22-0.88, p = 0.01) were found to be as independent risk factors.ConclusionsConcomitant use of PPIs is associated with worse survival outcomes in patients with mRCC treated with nivolumab. Clinicians should carefully consider the concomitant use of PPIs in such patients.
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    The effect of concomitant use of proton pump inhibitors with CDK 4/6 inhibitors on survival in metastatic breast cancer
    (Springer Heidelberg, 2023) Caglayan, Dilek; Kocak, Mehmet Zahid; Geredeli, Caglayan; Tatli, Ali Murat; Goksu, Sema Sezgin; Eryilmaz, Melek Karakurt; Araz, Murat
    Aim To evaluate the difference of progression free survival between the patients using concomitant proton pump inhibitors and non-users in the patients using CDK 4/6 inhibitors with HR + and HER2 negative mBC. Methods We included 86 patients with HR + and HER 2 negative mBC treated with CDK 4/6 inhibitors in this study. Patients were divided into two categories according to their status of PPI use. The primary end points was progression free survival (PFS). We compared PPI users and non-users. Results Forty-five (52.3%) patients used a PPI concomitantly with a CDK 4/6 inhibitor, and 41 (47.7%) did not. The median duration of follow-up was 10.68 (1.94-27.56) months. Of the patients, 50 (58.1%) palbociclib and 36 (41.9%) received ribociclib. The median progression free survival (mPFS) was 10.9 months (95% CI: 7.5-14.27) in the group with concomitant PPI use with a CDK 4/6 inhibitor, whereas the median progression free survival could not be reached in the group without concomitant PPI use (p = 0.04). In addition, concomitant PPI use with palbociclib was associated with a shorter PFS; there was no significant difference between the concomitant PPI users and non-users in terms of PFS in the patients using ribociclib. Conclusion Palbociclib and ribociclib are weak base drugs so their bioavailability is pH-dependent. PPIs can affect their solubility and their concentration in the plasma. Therefore, we must avoid concomitant use of PPIs and CDK 4/6 inhibitors. If we need to use concomitant PPI and CDK 4/6 inhibitors, we should prefer ribociclib than palbociclib.
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    The Effect of RAS/BRAF Mutation Status on Prognosis and Relapse Pattern in Early Stage Colon Cancers
    (Springer, 2023) Kunt, Nazli; Araz, Murat; Yildirim, Mahmut Selman; Findik, Siddika; Kocak, Mehmet Zahid; Eryilmaz, Melek Karakurt; Artac, Mehmet
    PurposeIt is known that the RAS and BRAF mutations are predictive for targeted therapies in treating metastatic colon cancer and negatively affect the prognosis of the disease. However, there are limited studies in early-stage colon cancer about the relationship of this mutational condition with the prognosis and relapse pattern of the disease. In this study, we evaluated the effects of mutational status on the clinical pattern of recurrence and survival in early-stage colon cancer in addition to classical risk factors.MethodsPatients with early-stage colon cancer at the first time of diagnosis and developing recurrence or metastasis on following up were included in this study. Patients were divided into two groups according to the at the time of relapse RAS/BRAF mutation status: mutant or non-mutant/wild types. Then, mutation analysis was performed again from the early-stage tissue of the patients if available. The relationship between early-stage mutation status and progression-free survival (PFS), overall survival (OS), and relapse pattern was analyzed.ResultsThe number of patients with mutant and non-mutations in the early stage was 39 and 40, respectively. Mutant and non-mutant patients with stage 3 disease were similar (69% and 70%, respectively). OS (47.27 months vs. 67.53 months; p = 0.02) and PFS (25.12 vs. 38.13 months; p = 0.049) were statistically significantly lower in mutant patients, respectively. Most patients had distant metastases on both sides at recurrence (61.5% vs. 62.5%, respectively). There was no significant difference between mutant and non-mutant patients regarding distant metastasis and local recurrence rates (p = 0.657). A discordance of 11.4% between early-stage and late-stage tissue mutation status.ConclusionThe presence of mutation in early-stage colon cancer is associated with shorter OS and PFS. The mutational status did not have a significant effect on the recurrence pattern. Because of the discordance of early-stage and late-stage mutational status, it is recommended to perform mutation analysis from tissue at relapse.
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    The goal of primary therapy in non-metastatic nasopharyngeal cancer should be radiological complete response
    (Springer, 2022) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Kocak, Mehmet Zahid; Demirkiran, Aykut; Karaagac, Mustafa; Artac, Mehmet
    Background: We aimed to investigate the effect of radiological complete response on survival outcomes in patients with non-metastatic nasopharyngeal cancer. This study is conducted as a retrospective cohort. Of the 185 patients screened, 60 were metastatic, 25 patients' data was not available, and as a result, 92 patients were included in the study. Among the complete response (CR) and incomplete response (IR) groups, overall survival (OS), distant metastasis-free survival (DMFS), and locoregional failure-free survival (LRFFS) were evaluated. Results: Of the 92 patients, 54 (58.6%) were CR and 38 (41.4%) were IR patients. Of the whole study group, the 5-year OS, DMFS, and LRFFS rates were 75%, 78%, and 95%, respectively. A significant difference was found between the 5-year OS (90% vs. 60%, p= 0.001) and DMFS (87% vs. 65%, p= 0.02) rates. However, there was no significant difference in the 5-year LRFFS rate (97% vs. 92%, p= 0.16). Complete response were determined as an independent predictor for OS (HR: 0.13, 95% CI: 0.045-0.36, p <0.001) and DMFS (HR: 0.26, 95% CI: 0.095-0.744, p= 0.012). Conclusion: As a result, the survival benefit in patients with CR after primary treatment is evident as shown in the above studies. Therefore, the aim of primary treatment should be to increase the CR rates. It is important to evaluate early tumor response to determine poor tumor regression.
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    The goal of primary therapy in non-metastatic nasopharyngeal cancer should be radiological complete response
    (Springer, 2022) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Kocak, Mehmet Zahid; Demirkiran, Aykut; Karaagac, Mustafa; Artac, Mehmet
    Background: We aimed to investigate the effect of radiological complete response on survival outcomes in patients with non-metastatic nasopharyngeal cancer. This study is conducted as a retrospective cohort. Of the 185 patients screened, 60 were metastatic, 25 patients' data was not available, and as a result, 92 patients were included in the study. Among the complete response (CR) and incomplete response (IR) groups, overall survival (OS), distant metastasis-free survival (DMFS), and locoregional failure-free survival (LRFFS) were evaluated. Results: Of the 92 patients, 54 (58.6%) were CR and 38 (41.4%) were IR patients. Of the whole study group, the 5-year OS, DMFS, and LRFFS rates were 75%, 78%, and 95%, respectively. A significant difference was found between the 5-year OS (90% vs. 60%, p= 0.001) and DMFS (87% vs. 65%, p= 0.02) rates. However, there was no significant difference in the 5-year LRFFS rate (97% vs. 92%, p= 0.16). Complete response were determined as an independent predictor for OS (HR: 0.13, 95% CI: 0.045-0.36, p <0.001) and DMFS (HR: 0.26, 95% CI: 0.095-0.744, p= 0.012). Conclusion: As a result, the survival benefit in patients with CR after primary treatment is evident as shown in the above studies. Therefore, the aim of primary treatment should be to increase the CR rates. It is important to evaluate early tumor response to determine poor tumor regression.
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    Is the Prognostic Nutritional Index a Prognostic Marker for the Survival of Patients with Lymph-Node Positive Stage II-III Gastric Cancer Who Receive Adjuvant Chemotherapy?
    (Springer, 2023) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Er, Muhammed Muhiddin; Kocak, Mehmet Zahid; Demirkiran, Aykut; Karaagac, Mustafa; Araz, Murat
    Purpose The prognostic nutritional index (PNI), like other systemic inflammatory markers, has been shown to be a prognostic factor in various cancer patients. In this study, we aimed to show whether PNI calculated before adjuvant chemotherapy is a prognostic factor for overall survival (OS) and disease-free survival (DFS) in patients with lymph node-positive stage II-III gastric cancer.Methods The PNI was calculated using the albumin and lymphocyte count. The PNI cut-off value was found to be 39.5. They were divided into two groups as being = 39.5 (PNI low group) and > 39.5 (PNI high group).Results Our study included 168 patients with lymph node-positive stage II-III gastric cancer who received adjuvant chemotherapy. Of the patients, 116 (69.0%) were 65 years or younger, and 52 (31.0%) were over 65 years old. Of the patients, 117 (69.6%) were pT3, 51 (30.4%) were pT4. Seventy-three (43.4%) patients had pN1-2 disease and 95 (56.6%) patients had pN3 disease. The number of stage II patients was 73 (43.5%) and the number of stage III patients was 95 (56.5%). There were 73 patients with PNI = 39.5 and 95 patients with PNI > 39.5. The mOS of the patients with low PNI group was 39.5 months, while the OS of the patients with high PNI group was 96.8 months (p = 0.002). In the group of patients with PNI low group, mDFS 24.4 months was significantly higher than those with PNI high group was 50.7 months (p = 0.021). The PNI score was statistically significant in univariate and multivariate analyzes for both DFS and OS.Conclusion PNI can be used as an independent prognostic factor for both OS and DFS in patients lymph node-positive, stage II-III gastric cancer who will receive adjuvant chemotherapy.
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    Letter to the editor regarding the article 'Frailty and skeletalmuscle in older adults with cancer'
    (Elsevier, 2020) Kocak, Mehmet Zahid
    [Abstract Not Availabe]
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    Low-dose (7.5 mg/kg) bevacizumab may be a viable option in recurrent ovarian cancer: A retrospective study
    (Wolters Kluwer Medknow Publications, 2023) Demirkiran, Aykut; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Araz, Murat; Korkmaz, Mustafa; Kocak, Mehmet Zahid; Artac, Mehmet
    Objective: Bevacizumab (BEV) is a humanized monoclonal antibody of vascular endothelial growth factor receptors and, as a result of clinical trials, was approved for the treatment of recurrent ovarian cancer (ROC). The aim of this study was to assess the clinical utility of BEV in patients with ROC in real-world practice beyond clinical trials. Materials and Methods: In this single-center retrospective cohort study, we evaluated the medical data of all patients with ROC who were treated with BEV between October 2013 and March 2020. Results: A total of 76 females were evaluated. Forty-nine (64.5%) patients were platinum sensitive and 27 (35.5%) patients were platinum resistant. BEV was used in combination with chemotherapy agents in all patients, and the most preferred combinations were gemcitabine/carboplatin (GC) (78.9%) and carboplatin/paclitaxel (14.5%). In all patients, the BEV dose was 7.5 mg/kg every 3 weeks. The median progression-free survival (PFS) was 11.1 months (95% confidence interval [CI]: 9.6-12.6), and the median overall survival (OS) was 22.3 months (95% CI: 17.5-27.2). In multivariate analysis, serous histological type (P = 0.01), maintenance BEV administration (P = 0.001), and combination of GC-BEV (P < 0.001) were associated with better PFS, while serous histological type (P = 0.016) and good performance status (P = 0.006) were associated with prolonged OS. Conclusions: Low-dose (7.5 mg/kg) BEV was found to be effective in the second-line treatment of patients with ROC in our real-life study. In addition, the combination of BEV with GC was shown to be a viable option, especially in the treatment selection of platinum-resistant patients.
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    Prognostic biomarkers in metastatic colorectal cancer: delta prognostic nutritional index, delta neutrophil to lymphocyte ratio, and delta platelet to lymphocyte ratio
    (Springer, 2023) Kocak, Mehmet Zahid; Coban, Seda; Araz, Murat; Eryilmaz, Melek Karakurt; Artac, Mehmet
    BackgroundThe aim of this study is to determine the prognostic value of the prognostic nutritional index (PNI), the neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio (PLR) and their dynamic changes on survival outcomes in metastatic colorectal cancers (mCRC).MethodsThe data of 199 patients with mCRC were retrospectively analyzed. To evaluate the temporal relation between the PNI, NLR, and PLR values and survival, pre-chemotherapy PNI, NLR, and PLR levels were assessed from peripheral blood cell counts on admission; post-chemotherapy PNI, NLR, and PLR levels were assessed with follow-up blood cell counts within two weeks after chemotherapy; and the difference between pre-chemotherapy PNI, NLR, and PLR levels and post-chemotherapy PNI, NLR, and PLR levels was evaluated as delta PNI, delta NLR, and delta PLR.ResultsThe median PNI, PLR, and NLR were 39.01, 150.2 and 2.53 before chemotherapy and 38.2, 146.6, and 3.31 after chemotherapy, respectively. The median OS was 23.7 months (95%CI:17.8-29.7) and 28.9 months (95%CI:24.8-33.08) for pre-chemotherapy PNI level < 39.01 vs. PNI level >= 39.01, respectively(p = 0.035) The positive delta PNI was significantly higher for OS than the negative delta PNI(p < 0.009). Delta PLR and delta NLR were not significant for OS and PFS(p > 0.05 for all).ConclusionsThe results of this study clearly show that the negative delta PNI to be an independent predictor of poor OS and poor PFS in patients with colon cancer who received first line treatment. In addition, delta NLR and delta PLR were shown not to predict survival outcomes.
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    The prognostic role of HIF-1? and NF-?B expression in RAS wild-type metastatic colorectal cancer: A Turkish Oncology Group (TOG) study
    (Springer, 2023) Demirkiran, Aykut; Kilinc, Fahriye; Kocak, Mehmet Zahid; Demirkiran, Deniz; Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Araz, Murat
    Background Not all RAS wild-type metastatic colorectal cancer (mCRC) patients experience the same benefit from anti-epidermal growth factor receptor (EGFR) treatments. Studies have shown that nuclear factor-kappa B (NF-kappa B), hypoxia-inducible factor-1 alpha (HIF-1 alpha), interleukin 8 (IL-8) and transforming growth factor beta (TGF-beta) may be therapeutic targets for mCRC. The aim of this study was to clarify the prognostic value of NF-kappa B, HIF-1 alpha, IL-8, and TGF-beta expression in patients with left-sided mCRC receiving EGFR inhibitors. Methods Patients with RAS wild-type, left-sided mCRC treated with anti-EGFR on the first line between September 2013 and April 2022 were included. Immunohistochemical staining for NF-kappa B, HIF-1 alpha, IL-8 and TGF-beta was performed from tumor tissues of 88 patients. Patients were divided into NF-kappa B, HIF-1 alpha, IL-8 and TGF-beta expression positive and negative group, moreover, expression positive group were also divided into two group as expression intensity low and high group. The median follow-up was 25.2 months. Results Median progression-free survival (PFS) was 8.1 (6-10.2) months in the cetuximab group, 11.3 (8.5-14) months in the panitumumab group (p = 0.09). Median overall survival (OS) was 23.9 (4.3-43.4) months in the cetuximab group, 26.9 (15.9-31.9) months in the panitumumab group (p = 0.8). Cytoplasmic NF-kappa B expression was present in all patients. The mOS was 19.8 (11-28.6) months in NF-kappa B expression intensity low group and 36.5 (20.1-52.8) months in high group (p = 0.03). The mOS of the HIF-1 alpha expression negative group was significantly longer compared with expression positive group (p = 0.014). There was no significant difference in IL-8 and TGF-beta expression status on mOS and mPFS (for all, p > 0.05). Positive expression of HIF-1 alpha was poor prognostic for mOS in the univariate analysis (HR:2.7, 95% CI 1.18-6.52, p = 0.02) and in multivariate analysis (HR 3.69, 95% CI 1.41-9.6, p = 0.008). High cytoplasmic expression intensity of NF-kappa B was found to have a good prognostic value for mOS (HR 0.47, 95% CI 0.26-0.85, p = 0.01). Conclusion High cytoplasmic expression intensity of NF-kappa B and negative expression of HIF-1 alpha could be a good prognostic marker for mOS in RAS wild-type left-sided mCRC.
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    Recurrent Her-2 positive occult breast cancer presenting with zosteriform cutaneous metastases: a case report
    (Via Medica, 2021) Kocak, Mehmet Zahid; Araz, Murat; Karaagac, Mustafa; Caglayan, Duck; Korkmaz, Mustafa; Demirkiran, Aykut
    Various cutaneous metastasis patterns are described in breast cancer. Zosteriform metastases are rare cutaneous metastases, which appear in a dermatomal distribution. A 66-year woman presented with a 1-month history of nodular lesions on the left posterior hemithorax area. Biopsy was reported as human epidermal growth factor receptor (Her) 2 positive, hormone receptor-negative breast carcinoma metastasis. Dual blockade therapy targeting Her-2 overexpression was initiated for the patient. Treatment response was obtained after 3 cycles. There was a significant improvement in skin lesions. Zosteriform cutaneous metastases can be the early sign of systemic spread and can show an initial response to therapy. Therefore, physicians should perform an exhaustive physical examination including that of skin.
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    Sunitinib-induced small bowel wall edema as a prognostic marker in metastatic renal cell carcinoma
    (Wolters Kluwer Medknow Publications, 2023) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Kerimoglu, Ulku; Karaagac, Mustafa; Kocak, Mehmet Zahid; Demirkiran, Aykut; Araz, Murat
    Aim: The aim of this study was to evaluate the presence of small bowel wall edema (SBWE) on computed tomography (CT) images in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib and to investigate the relationship between the presence of SBWE and survival. Materials and Methods: We retrospectively evaluated the presence of SBWE on CT images of 27 mRCC patients who received at least one cycle of sunitinib. Then, we analyzed the relationship between the presence of SBWE and progression-free survival (PFS) and overall survival (OS). Results: All 27 patients had SBWE on at least one CT scan. The median value of SBWE thickness was 2.5 mm. SBWE thickness was <= 2.5 mm in 13 patients (group A) and >2.5 mm in 14 patients (group B). The median OS was significantly higher in group B (55 vs. 18 months, respectively, P = 0.02). Although it was not statistically significant (13 vs. 8 months, respectively, P = 0.69), the median PFS was longer in group B than in group A. Conclusions: This study showed that sunitinib treatment caused SBWE in all patients with mRCC who received the drug. Also, this study demonstrated an association between higher SBWE thickness and better survival outcomes.