Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Preoperatif Sistemik İnflamasyon Belirteçlerinin Nefrektomi Patolojisini Öngörmedeki Rolü: Retrospektif Kohort Çalışması
Predictive Role of Preoperative Systemic Inflammatory Markers in Nephrectomy Pathology: Retrospective Cohort Study
Abdullah GÜLa , Özgür EKİCİb , Salim ZENGİNa , Çağlar BOYACIa
aSağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Bursa, Türkiye
bNusaybin Devlet Hastanesi, Üroloji Kliniği, Mardin, Türkiye
J Reconstr Urol. 2023;13(2):53-9
doi: 10.5336/urology.2023-96926
Article Language: TR
Full Text
ÖZET
 Amaç: Böbrek kitlesi tespit edilen hastalarda, preoperatif kan bazlı belirteçlerin kitle patolojisi tahmininde kullanılabilirliğini araştırmaktır. Gereç ve Yöntemler: Kliniğimizde Haziran 2016-Ocak 2023 tarihleri arasında böbrek kitlesi nedeniyle radikal ya da parsiyel nefrektomi yapılmış hastalar geriye dönük tarandı. Preoperatif kan grubu, hemogram parametreleri, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), üre/kreatinin, glomerüler filtrasyon hızı değerleri, nötrofil lenfosit oranı, platelet lenfosit oranı, lenfosit monosit oranı [lymphocyte monocyte ratio (LMR)], De Ritis oranı (AST/ALT), bilgisayarlı tomografi ve manyetik rezonans görüntüleme bulguları, nefrektomi histopatoloji bulguları kaydedildi. Hastalar nefrektomi patolojisine göre malign (Grup 1) ve benign (Grup 2) olmak üzere iki gruba ayrıldı. Gruplar arasında başlangıçta kaydedilen veriler karşılaştırıldı. Bulgular: Çalışmaya 216 hasta dâhil edildi. Ortalama yaş 59,60±11,62 yıl, erkek/kadın oranı 131/85 idi. Nefrektomi patolojilerinin 194'ü (%89,8) malign, 22'si (%10,2) ise benign olarak raporlandı. Her iki grup arasında cinsiyet, tümör tarafı, cerrahi sınır pozitifliği ve kan grubu açısından istatistiksel anlamlı farklılık izlenmezken, iki grup arasında preoperatif verilerden tümör boyutu ve LMR (p değerleri sırasıyla 0,010 ve 0,003) istatistiksel anlamlı farklı bulundu. Subgrup analizinde, kitle boyutu ≤4 cm ve ≤7 cm alt gruplarında, tüm parametreler benzerdi. Sonuç: Özellikle T1 evre böbrek tümörlerinde önem arz eden malign/benign ayırımında, preoperatif kitle patolojisini öngörebilen herhangi bir parametre bulunamamıştır.

Anahtar Kelimeler: Alanin transaminaz; aspartat aminotransferazlar; böbrek neoplazileri; lenfositler; nötrofiller
ABSTRACT
 Objective: To investigate the usefullness of preoperative blood-based parameters in the prediction of histopathology reports of the kidney masses. Material and Methods: Patients who underwent radical or partial nephrectomy due to kidney mass in our clinic between June 2016 and January 2023 were retrospectively reviewed. Preoperative hemogram parameters, aspartate aminotransferases (AST), alanine transaminase (ALT), urea/creatinine, glomerular filtration rate values, neutrophil lymphocyte ratio, platelet lymphocyte ratio, lymphocyte monocyte ratio (LMR), De Ritis ratio (AST/ALT), blood groups, computed tomography and magnetic resonance imaging findings, nephrectomy histopathology reports were recorded. The patients were divided into two groups as malignant (Group 1) and benign (Group 2) according to nephrectomy pathology. Initial data were compared between the groups. Results: Two hundred sixteen patients were included in the study. The mean age was 59.60±11.62 years and the male/female ratio was 131/85. The number of the malignant and benign pathology was 194 (89.8%) and 22 (10.2%), respectively. While no statistically significant difference was observed between the two groups in terms of gender, tumor side, surgical margin positivity and blood group, tumor size and LMR (p values 0.010 and 0.003, respectively) were found to be statistically different between the two groups. In the subgroup analysis, all parameters were comparable in patients with mass size ≤4 cm and ≤7 cm. Conclusion: We did not find any parameter that could predict the mass pathology for the differentiation of malignant and benign, which is especially essential for T1 stage renal tumors in our study.

Keywords: Alanine transaminase; aspartate aminotransferases; kidney neoplasms; lymphocytes; neutrophils
REFERENCES:
  1. Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of renal cell carcinoma. Eur Urol. 2019;75(1):74-84. [Crossref]  [PubMed]  [PMC] 
  2. Sasaguri K, Takahashi N. CT and MR imaging for solid renal mass characterization. Eur J Radiol. 2018;99:40-54. [Crossref]  [PubMed] 
  3. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO classification of tumours of the urinary system and male genital organs-part a: renal, penile, and testicular tumours. Eur Urol. 2016;70(1):93-105. [Crossref]  [PubMed] 
  4. Choudhary S, Rajesh A, Mayer NJ, Mulcahy KA, Haroon A. Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms. Clin Radiol. 2009;64(5):517-22. [Crossref]  [PubMed] 
  5. Özkaçmaz S, Dündar İ, Kankılıç NA, Özgökçe M, Gül A, Aslan R. Effectiveness of computed tomography density value in the differential diagnosis of benign and malignant renal lesions. Ahi Evran Medical Journal. 2021;5(1):38-42. [Crossref] 
  6. Macklin PS, Sullivan ME, Tapping CR, Cranston DW, Webster GM, Roberts ISD, et al. Tumour seeding in the tract of percutaneous renal tumour biopsy: a report on seven cases from a UK tertiary referral centre. Eur Urol. 2019;75(5):861-7. [Crossref]  [PubMed] 
  7. Marconi L, Dabestani S, Lam TB, Hofmann F, Stewart F, Norrie J, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol. 2016;69(4):660-73. [Crossref]  [PubMed] 
  8. Coy H, Young JR, Douek ML, Brown MS, Sayre J, Raman SS. Quantitative computer-aided diagnostic algorithm for automated detection of peak lesion attenuation in differentiating clear cell from papillary and chromophobe renal cell carcinoma, oncocytoma, and fat-poor angiomyolipoma on multiphasic multidetector computed tomography. Abdom Radiol (NY). 2017;42(7):1919-28. [Crossref]  [PubMed] 
  9. Gentili F, Bronico I, Maestroni U, Ziglioli F, Silini EM, Buti S, et al. Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta-lesion attenuation difference (ALAD) on contrast-enhanced CT. Radiol Med. 2020;125(12):1280-7. [Crossref]  [PubMed] 
  10. Ng KL, Rajandram R, Morais C, Yap NY, Samaratunga H, Gobe GC, et al. Differentiation of oncocytoma from chromophobe renal cell carcinoma (RCC): can novel molecular biomarkers help solve an old problem? J Clin Pathol. 2014;67(2):97-104. [Crossref]  [PubMed] 
  11. von Brandenstein M, Herden J, Köditz B, Huerta M, Nestler T, Heidenreich A, et al. Non-invasive urine markers for the differentiation between RCCs and oncocytoma. J Clin Lab Anal. 2021;35(5):e23762. [Crossref]  [PubMed]  [PMC] 
  12. Gu L, Li H, Gao Y, Ma X, Chen L, Li X, Zhang Y, et al. The association of platelet count with clinicopathological significance and prognosis in renal cell carcinoma: a systematic review and meta-analysis. PLoS One. 2015;10(5): e0125538. [Crossref]  [PubMed]  [PMC] 
  13. Templeton AJ, McNamara MG, ?eruga B, Vera-Badillo FE, Aneja P, Oca-a A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124. [Crossref]  [PubMed] 
  14. Wu Y, Fu X, Zhu X, He X, Zou C, Han Y, et al. Prognostic role of systemic inflammatory response in renal cell carcinoma: a systematic review and meta-analysis. J Cancer Res Clin Oncol. 2011;137(5):887-96. [Crossref]  [PubMed] 
  15. Canat L, Ataly HA, Agalarov S, Alkan I, Altunrende F. The effect of AST/ALT (De Ritis) ratio on survival and its relation to tumor histopathological variables in patients with localized renal cell carcinoma. Int Braz J Urol. 2018;44(2):288-95. [Crossref]  [PubMed]  [PMC] 
  16. Li J, Cao D, Peng L, Meng C, Xia Z, Li Y, et al. Potential clinical value of pretreatment de ritis ratio as a prognostic biomarker for renal cell carcinoma. Front Oncol. 2021;11:780906. [Crossref]  [PubMed]  [PMC] 
  17. Corcoran AT, Russo P, Lowrance WT, Asnis-Alibozek A, Libertino JA, Pryma DA, et al. A review of contemporary data on surgically resected renal masses--benign or malignant? Urology. 2013;81(4):707-13. [Crossref]  [PubMed] 
  18. Pierorazio PM, Patel HD, Johnson MH, Sozio SM, Sharma R, Iyoha E, et al. Distinguishing malignant and benign renal masses with composite models and nomograms: a systematic review and meta-analysis of clinically localized renal masses suspicious for malignancy. Cancer. 2016;122(21):3267-76. [Crossref]  [PubMed] 
  19. Ball MW, Gorin MA, Bhayani SB, Rogers CG, Stifelman MD, Kaouk JH, et al. Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: a multi-institutional analysis. Urol Oncol. 2015;33(3):112.e9-14. [Crossref]  [PubMed]  [PMC] 
  20. Selvi I, Basar H. Can we avoid the unnecessary loss of nephrons in the management of small solid renal masses? Additional clinical parameters to predict benign-malign distinction. Sisli Etfal Hastan Tip Bul. 2021;55(1):53-61. [PubMed]  [PMC] 
  21. Li M, Deng Q, Zhang L, He S, Rong J, Zheng F. The pretreatment lymphocyte to monocyte ratio predicts clinical outcome for patients with urological cancers: a meta-analysis. Pathol Res Pract. 2019;215(1):5-11. [Crossref]  [PubMed] 
  22. D'Andrea D, Moschini M, Gust KM, Abufaraj M, Özsoy M, et al. Lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio as biomarkers for predicting lymph node metastasis and survival in patients treated with radical cystectomy. J Surg Oncol. 2017;115(4):455-61. [Crossref]  [PubMed] 
  23. Hutterer GC, Stoeckigt C, Stojakovic T, Jesche J, Eberhard K, Pummer K, et al. Low preoperative lymphocyte-monocyte ratio (LMR) represents a potentially poor prognostic factor in nonmetastatic clear cell renal cell carcinoma. Urol Oncol. 2014;32(7):1041-8. [Crossref]  [PubMed] 
  24. Wang X, Su S, Guo Y. The clinical use of the platelet to lymphocyte ratio and lymphocyte to monocyte ratio as prognostic factors in renal cell carcinoma: a systematic review and meta-analysis. Oncotarget. 2017;8(48):84506-14. [Crossref]  [PubMed]  [PMC] 
  25. Gorgel SN, Ozer K, Kose O, Dindar AS. Can preoperative neutrophil lymphocyte ratio predict malignancy in patients undergoing partial nephrectomy because of renal mass? Int Braz J Urol. 2018;44(3):461-6. [Crossref]  [PubMed]  [PMC] 
  26. Viers BR, Thompson RH, Lohse CM, Cheville JC, Leibovich BC, Boorjian SA, et al. Pre-treatment neutrophil-to-lymphocyte ratio predicts tumor pathology in newly diagnosed renal tumors. World J Urol. 2016;34(12):1693-9. [Crossref]  [PubMed] 
  27. Liu H, Tang K, Chen Z, Li Z, Meng X, Xia D. Comparison and development of preoperative systemic inflammation markers-based models for the prediction of unfavorable pathology in newly diagnosed clinical T1 renal cell carcinoma. Pathol Res Pract. 2021;225:153563. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com