{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:53:00Z","timestamp":1781650380314,"version":"3.54.5"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":42,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Discov Onc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the predictive value of the mean platelet volume\u2013to\u2013albumin (MPV\/Alb) ratio for pathological complete response (pCR) in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) treated with neoadjuvant chemotherapy (NACT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective single-center study, 139 consecutive patients with HER2-positive breast cancer who received dual anti-HER2 therapy combined with anthracycline- and taxane-based neoadjuvant chemotherapy between December 2022 and February 2025 were included. Clinicopathological variables, immuno-inflammatory parameters, and the MPV\/Alb ratio were analyzed. Predictors of pCR were assessed using univariable and multivariable logistic regression. Discriminative performance and an optimal cut-off for MPV\/Alb were determined by receiver operating characteristic (ROC) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age was 50 years (range, 26\u201379), and pCR was achieved in 54.7% of patients. On univariable analyses, estrogen receptor (ER) status, progesterone receptor (PR) status, and MPV\/Alb were associated with pCR. In multivariable analysis, only MPV\/Alb remained an independent predictor of pCR (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012; odds ratio [OR], 0.388; 95% confidence interval [CI], 0.185\u20130.813). ROC analysis identified an optimal MPV\/Alb cutoff of 2.32 (AUC 0.626; 95% CI 0.535\u20130.720;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048), yielding 64.5% sensitivity and 58.7% specificity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The MPV\/Alb ratio may serve as an independent predictor of pCR in HER2-positive BC undergoing NACT. As a readily obtainable, low-cost composite derived from routine laboratory tests, MPV\/Alb could aid risk stratification and treatment decision-making in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12672-026-04938-w","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T09:47:02Z","timestamp":1776160022000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mean platelet volume-to-albumin ratio as a predictor of pathological complete response in HER2-positive breast cancer undergoing neoadjuvant chemotherapy"],"prefix":"10.1007","volume":"17","author":[{"given":"Hatice","family":"Ayy\u0131ld\u0131z Sevim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmetcan","family":"Atak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Altunda\u011f Derin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selahattin","family":"\u00c7elik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130smail Burak","family":"G\u00fcltekin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do\u011fan","family":"Yaz\u0131l\u0131ta\u015f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"issue":"9","key":"4938_CR1","doi-asserted-by":"publisher","first-page":"963","DOI":"10.3109\/07357907.2010.496759","volume":"28","author":"KA Cronin","year":"2010","unstructured":"Cronin KA, Harlan LC, Dodd KW, Abrams JS, Ballard-Barbash R. Population-based estimate of the prevalence of HER2-positive breast cancer tumors for early-stage patients in the US. Cancer Invest. 2010;28(9):963\u20138. https:\/\/doi.org\/10.3109\/07357907.2010.496759.","journal-title":"Cancer Invest"},{"issue":"1","key":"4938_CR2","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/S1470-2045(11)70336-9","volume":"13","author":"L Gianni","year":"2012","unstructured":"Gianni L, Pienkowski T, Im YH, Roman L, Tseng LM, Liu MC, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13(1):25\u201332. https:\/\/doi.org\/10.1016\/S1470-2045(11)70336-9.","journal-title":"Lancet Oncol"},{"issue":"9","key":"4938_CR3","doi-asserted-by":"publisher","first-page":"2278","DOI":"10.1093\/annonc\/mdt182","volume":"24","author":"A Schneeweiss","year":"2013","unstructured":"Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Hegg R, et al. Pertuzumab plus trastuzumab in combination with anthracycline-containing and anthracycline-free neoadjuvant chemotherapy regimens in HER2-positive early breast cancer (TRYPHAENA): a randomized phase II cardiac safety study. Ann Oncol. 2013;24(9):2278\u201384. https:\/\/doi.org\/10.1093\/annonc\/mdt182.","journal-title":"Ann Oncol"},{"issue":"1","key":"4938_CR4","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/S1470-2045(21)00589-1","volume":"23","author":"C Yau","year":"2022","unstructured":"Yau C, Osdoit M, van der Noordaa M, Shad S, Wei J, de Croze D, et al. Residual cancer burden after neoadjuvant chemotherapy and long-term survival in breast cancer: pooled analysis of 5161 patients. Lancet Oncol. 2022;23(1):149\u201360. https:\/\/doi.org\/10.1016\/S1470-2045(21)00589-1.","journal-title":"Lancet Oncol"},{"issue":"6","key":"4938_CR5","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1097\/CCO.0000000000000234","volume":"27","author":"D Bedognetti","year":"2015","unstructured":"Bedognetti D, Hendrickx W, Marincola FM, Miller LD. Prognostic and predictive immune gene signatures in breast cancer. Curr Opin Oncol. 2015;27(6):433\u201344. https:\/\/doi.org\/10.1097\/CCO.0000000000000234.","journal-title":"Curr Opin Oncol"},{"issue":"4","key":"4938_CR6","doi-asserted-by":"publisher","first-page":"4671","DOI":"10.3892\/mmr.2017.7157","volume":"16","author":"T Zheng","year":"2017","unstructured":"Zheng T, Wang A, Hu D, Wang Y. Molecular mechanisms of breast cancer metastasis by gene expression profile analysis. Mol Med Rep. 2017;16(4):4671\u20137. https:\/\/doi.org\/10.3892\/mmr.2017.7157.","journal-title":"Mol Med Rep"},{"issue":"6","key":"4938_CR7","doi-asserted-by":"publisher","first-page":"886","DOI":"10.21037\/tlcr.2019.11.16","volume":"8","author":"H Mandaliya","year":"2019","unstructured":"Mandaliya H, Jones M, Oldmeadow C, Nordman II. Prognostic biomarkers in stage IV non-small cell lung cancer: neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio and advanced lung cancer inflammation index. Transl Lung Cancer Res. 2019;8(6):886\u201394. https:\/\/doi.org\/10.21037\/tlcr.2019.11.16.","journal-title":"Transl Lung Cancer Res"},{"issue":"3","key":"4938_CR8","doi-asserted-by":"publisher","first-page":"863","DOI":"10.31557\/APJCP.2019.20.3.863","volume":"20","author":"IPY Prabawa","year":"2019","unstructured":"Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictive hematologic markers in cervical cancer. Asian Pac J Cancer Prev. 2019;20(3):863\u20138. https:\/\/doi.org\/10.31557\/APJCP.2019.20.3.863.","journal-title":"Asian Pac J Cancer Prev"},{"issue":"9","key":"4938_CR9","doi-asserted-by":"publisher","first-page":"4135","DOI":"10.1002\/cam4.2281","volume":"8","author":"W Guo","year":"2019","unstructured":"Guo W, Lu X, Liu Q, Zhang T, Li P, Qiao W, et al. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for breast cancer: an updated meta-analysis of 17,079 individuals. Cancer Med. 2019;8(9):4135\u201348. https:\/\/doi.org\/10.1002\/cam4.2281.","journal-title":"Cancer Med"},{"issue":"2","key":"4938_CR10","doi-asserted-by":"publisher","first-page":"104120","DOI":"10.1016\/j.esmoop.2024.104120","volume":"10","author":"I Schlam","year":"2025","unstructured":"Schlam I, Loi S, Salgado R, Swain SM. Tumor-infiltrating lymphocytes in HER2-positive breast cancer: potential impact and challenges. ESMO Open. 2025;10(2):104120. https:\/\/doi.org\/10.1016\/j.esmoop.2024.104120.","journal-title":"ESMO Open"},{"key":"4938_CR11","doi-asserted-by":"publisher","first-page":"9213074","DOI":"10.1155\/2019\/9213074","volume":"2019","author":"A Korniluk","year":"2019","unstructured":"Korniluk A, Koper-Lenkiewicz OM, Kami\u0144ska J, Kemona H, Dymicka-Piekarska V. Mean platelet volume: new perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators Inflamm. 2019;2019:9213074. https:\/\/doi.org\/10.1155\/2019\/9213074.","journal-title":"Mediators Inflamm"},{"issue":"6","key":"4938_CR12","doi-asserted-by":"publisher","first-page":"775","DOI":"10.3390\/jcm8060775","volume":"8","author":"U Keller","year":"2019","unstructured":"Keller U. Nutritional laboratory markers in malnutrition. J Clin Med. 2019;8(6):775. https:\/\/doi.org\/10.3390\/jcm8060775.","journal-title":"J Clin Med"},{"issue":"1","key":"4938_CR13","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s40795-023-00694-0","volume":"9","author":"A Enkobahry","year":"2023","unstructured":"Enkobahry A, Sime T, Kene K, Mateos T, Dilnesa S, Zawdie B. Blood biomarkers as potential malnutrition screening alternatives among adult patients with cancer on treatment in the oncology unit of Jimma tertiary hospital: a cross-sectional analysis. BMC Nutr. 2023;9(1):38. https:\/\/doi.org\/10.1186\/s40795-023-00694-0.","journal-title":"BMC Nutr"},{"key":"4938_CR14","doi-asserted-by":"publisher","first-page":"759387","DOI":"10.3389\/fmed.2021.759387","volume":"8","author":"X Yan","year":"2022","unstructured":"Yan X, Zhang S, Jia J, Yang J, Song Y, Duan H. Total parenteral nutrition improves nutritional status of gynecological cancer patients by increasing serum albumin level. Front Med (Lausanne). 2022;8:759387. https:\/\/doi.org\/10.3389\/fmed.2021.759387.","journal-title":"Front Med (Lausanne)"},{"issue":"2","key":"4938_CR15","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/jpen.1451","volume":"43","author":"PB Soeters","year":"2019","unstructured":"Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enter Nutr. 2019;43(2):181\u201393. https:\/\/doi.org\/10.1002\/jpen.1451.","journal-title":"JPEN J Parenter Enter Nutr"},{"key":"4938_CR16","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/1475-2891-9-69","volume":"9","author":"D Gupta","year":"2010","unstructured":"Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9:69. https:\/\/doi.org\/10.1186\/1475-2891-9-69.","journal-title":"Nutr J"},{"issue":"5","key":"4938_CR17","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1007\/s12282-015-0635-6","volume":"23","author":"M Gu","year":"2016","unstructured":"Gu M, Zhai Z, Huang L, Zheng W, Zhou Y, Zhu R, et al. Pretreatment mean platelet volume associates with worse clinicopathologic features and prognosis in invasive breast cancer. Breast Cancer. 2016;23(5):752\u201360. https:\/\/doi.org\/10.1007\/s12282-015-0635-6.","journal-title":"Breast Cancer"},{"issue":"4","key":"4938_CR18","doi-asserted-by":"publisher","first-page":"601","DOI":"10.3390\/medicina61040601","volume":"61","author":"J Dimitrijevi\u0107","year":"2025","unstructured":"Dimitrijevi\u0107 J, \u010calama\u0107 M, \u0110urmez O, Stojanovi\u0107 M. Mean platelet volume-to-albumin ratio as a predictor of mortality in febrile neutropenia: an observational study. Med (Kaunas). 2025;61(4):601. https:\/\/doi.org\/10.3390\/medicina61040601.","journal-title":"Med (Kaunas)"},{"issue":"1","key":"4938_CR19","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.jncc.2024.01.004","volume":"4","author":"A Nicolini","year":"2024","unstructured":"Nicolini A, Ferrari P, Silvestri R, Gemignani F. The breast cancer tumor microenvironment and precision medicine: immunogenicity and conditions favoring response to immunotherapy. J Natl Cancer Cent. 2024;4(1):14\u201324. https:\/\/doi.org\/10.1016\/j.jncc.2024.01.004. Published 2024 Jan 26.","journal-title":"J Natl Cancer Cent"},{"issue":"1","key":"4938_CR20","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s12885-024-11871-0","volume":"24","author":"ZJ Yang","year":"2024","unstructured":"Yang ZJ, Xin F, Chen ZJ, Yu Y, Wang X, Cao XC. Real-world outcomes of dual anti-HER2 neoadjuvant therapy in HER2-positive breast cancer. BMC Cancer. 2024;24(1):134. https:\/\/doi.org\/10.1186\/s12885-024-11871-0.","journal-title":"BMC Cancer"},{"issue":"9938","key":"4938_CR21","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/S0140-6736(13)62422-8","volume":"384","author":"P Cortazar","year":"2014","unstructured":"Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164\u201372. https:\/\/doi.org\/10.1016\/S0140-6736(13)62422-8.","journal-title":"Lancet"},{"issue":"3","key":"4938_CR22","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1007\/s10549-018-4801-3","volume":"170","author":"W Haque","year":"2018","unstructured":"Haque W, Verma V, Hatch S, Klimberg VS, Butler EB, Teh BS. Response rates and pathologic complete response by breast cancer molecular subtype following neoadjuvant chemotherapy. Breast Cancer Res Treat. 2018;170(3):559\u201367. https:\/\/doi.org\/10.1007\/s10549-018-4801-3.","journal-title":"Breast Cancer Res Treat"},{"issue":"4","key":"4938_CR23","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.3390\/ijms19041246","volume":"19","author":"S Wang","year":"2018","unstructured":"Wang S, Li Z, Xu R. Human cancer and platelet interaction: a potential therapeutic target. Int J Mol Sci. 2018;19(4):1246. https:\/\/doi.org\/10.3390\/ijms19041246.","journal-title":"Int J Mol Sci"},{"issue":"10","key":"4938_CR24","doi-asserted-by":"publisher","first-page":"133","DOI":"10.3390\/cancers9100133","volume":"9","author":"M Lavergne","year":"2017","unstructured":"Lavergne M, Janus-Bell E, Schaff M, Gachet C, Mangin PH. Platelet integrins in tumor metastasis: do they represent a therapeutic target? Cancers (Basel). 2017;9(10):133. https:\/\/doi.org\/10.3390\/cancers9100133.","journal-title":"Cancers (Basel)"},{"issue":"1","key":"4938_CR25","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s13045-018-0669-2","volume":"11","author":"M Schlesinger","year":"2018","unstructured":"Schlesinger M. Role of platelets and platelet receptors in cancer metastasis. J Hematol Oncol. 2018;11(1):125. https:\/\/doi.org\/10.1186\/s13045-018-0669-2.","journal-title":"J Hematol Oncol"},{"issue":"2","key":"4938_CR26","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1245\/s10434-006-9093-x","volume":"14","author":"LF O\u00f1ate-Oca\u00f1a","year":"2007","unstructured":"O\u00f1ate-Oca\u00f1a LF, Aiello-Crocifoglio V, Gallardo-Rinc\u00f3n D, Herrera-Goepfert R, Brom-Valladares R, Carrillo JF, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14(2):381\u20139. https:\/\/doi.org\/10.1245\/s10434-006-9093-x.","journal-title":"Ann Surg Oncol"},{"issue":"11","key":"4938_CR27","doi-asserted-by":"publisher","first-page":"2698","DOI":"10.1002\/cncr.22300","volume":"107","author":"P Seve","year":"2006","unstructured":"Seve P, Ray-Coquard I, Trillet-Lenoir V, Sawyer M, Hanson J, Broussolle C, et al. Low serum albumin levels and liver metastasis are powerful prognostic markers for survival in patients with carcinomas of unknown primary site. Cancer. 2006;107(11):2698\u2013705. https:\/\/doi.org\/10.1002\/cncr.22300.","journal-title":"Cancer"},{"issue":"4","key":"4938_CR28","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.21873\/invivo.12003","volume":"34","author":"T Fujii","year":"2020","unstructured":"Fujii T, Tokuda S, Nakazawa Y, Kurozumi S, Obayashi S, Yajima R, et al. Implications of low serum albumin as a prognostic factor of long-term outcomes in patients with breast cancer. Vivo. 2020;34(4):2033\u20136. https:\/\/doi.org\/10.21873\/invivo.12003.","journal-title":"Vivo"},{"key":"4938_CR29","doi-asserted-by":"publisher","first-page":"9067","DOI":"10.2147\/CMAR.S221976","volume":"11","author":"MM Li","year":"2019","unstructured":"Li MM, Yue CX, Fu S, Zhang X, Zhao CJ, Wang RT. Platelet volume is reduced in metastasizing breast cancer: blood profiles reveal significant shifts. Cancer Manag Res. 2019;11:9067\u201372. https:\/\/doi.org\/10.2147\/CMAR.S221976.","journal-title":"Cancer Manag Res"},{"issue":"2","key":"4938_CR30","doi-asserted-by":"publisher","first-page":"155","DOI":"10.14744\/ejmi.2020.93661","volume":"4","author":"H Sahinli","year":"2020","unstructured":"Sahinli H, Turker S, Eren T, Cilbir E, Altinbas M. The Mean Platelet Volume to Lymphocyte Ratio: A New Prognostic Marker in Resected Gastric Cancer. EJMI. 2020;4(2):155\u201360. https:\/\/doi.org\/10.14744\/ejmi.2020.93661.","journal-title":"EJMI"},{"issue":"1","key":"4938_CR31","doi-asserted-by":"publisher","first-page":"6","DOI":"10.3892\/ijmm.2024.5447","volume":"55","author":"W Hao","year":"2024","unstructured":"Hao W, Rajendran BK, Cui T, Sun J, Zhao Y, Palaniyandi T, Selvam M. Advances in predicting breast cancer driver mutations: Tools for precision oncology (Review). Int J Mol Med. 2024;55(1):6. https:\/\/doi.org\/10.3892\/ijmm.2024.5447.","journal-title":"Int J Mol Med"}],"container-title":["Discover Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12672-026-04938-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12672-026-04938-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12672-026-04938-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:00:41Z","timestamp":1781647241000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12672-026-04938-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4938"],"URL":"https:\/\/doi.org\/10.1007\/s12672-026-04938-w","relation":{},"ISSN":["2730-6011"],"issn-type":[{"value":"2730-6011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"assertion":[{"value":"9 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Etlik City Hospital Ethics Committee (Date: 27 November 2024; Approval No: AE\u015eH-BADEK-2024-1102). The study was conducted as a retrospective analysis of anonymized routinely collected clinical and laboratory data. No additional blood sampling or study-specific procedures were performed. Due to the retrospective design of the study and the use of anonymized patient data, the requirement for informed consent was waived by the Etlik City Hospital Ethics Committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"792"}}