42 research outputs found
Impact of a surgeon on the relapse-free survival of patients with non-muscle-invasive bladder cancer
Background. The high rate of recurrences after visual complete transurethral resection (TUR) is a main problem in the treatment of nonmuscle-invasive bladder cancer (NMIBC). One of the factors influencing the long-term results of treatment for this pathology may beΒ the quality of TUR, which depends on a surgeonβs experience.Objective: to evaluate the impact of a surgeon on relapse-free survival rates after radical treatment in patients with NMIBC and to searchΒ the optimal quality criteria for TUR in this disease.Materials and methods. The data of patients with primary or recurrent NMIBC treated using TUR with and without intravesical therapyΒ at the N. N. Aleksandrov Republican Research and Practical Center for Oncology and Medical Radiology in 2004 to 2013 were retrospectivelyΒ analyzed. The investigation included a total of 949 cases of performing organ-sparing treatment in 784 patients. The operations wereΒ made by 5 surgeons with comparable experience with TUR.Results. At a median follow-up of 64.3 (3β124) months, the 5-year relapse-free survival rates in 5 surgical groups were 62.9 (95 % confidenceΒ interval (CI) 56.2β69.7), 53.6 (95 % CI 47.4β59.9), 51.0 (95 % CI 39.6β62.4), 46.2 (95 % CI 36.4β56.0), and 44.2 % (95 % CIΒ 36.8β51.7), respectively (p < 0.0001). According to the data of multivariate analysis including all potential factors, the prognostic role of a surgeonβs experience retained a high level of statistical significance (p = 0.0013). The differences between the surgeons were less pronounced after resection of tumors at a low risk for recurrence. Analysis of the distribution of the recurrence rates within the first 3, 6, and 12 months after TUR in relation to the surgeon, which were stratified according to recurrence risk groups, showed that the most differing rates were observed 12 months after TUR.Conclusion. An operating surgeon has a significant effect on the risk of recurrence after radical treatment in patients with NMIBC. In ourΒ investigation, this effect was observed in spite of the relative much experience with surgical treatment of this disease by all surgeons andΒ the performance of operations in one highly specialized center. The differences between the surgeons are less pronounced after resectionΒ of tumors at low recurrence risk. The recurrence rates for primary single (below 10 %), recurrent or multiple (below 19 %), and for recurrentΒ and multiple (below 32 %) tumors within the first year after surgery can be taken for the quality criteria of TUR
ΠΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΡΡΠ°Π½ΡΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΏΠΎΠ΄ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ ΡΠΎΡΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΈ Π²Π½ΡΡΡΠΈΠΏΡΠ·ΡΡΠ½ΡΡ ΠΈΠ½ΡΡΠΈΠ»Π»ΡΡΠΈΠΉ Π±Π°ΡΠΈΠ»Π»Ρ ΠΠ°Π»ΡΠΌΠ΅ΡΡΠ°-ΠΠ΅ΡΠ΅Π½Π° ΠΏΡΠΈ Π½ΠΈΠ·ΠΊΠΎΠ΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΌ ΡΠ°ΠΊΠ΅ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ
Background. High-grade non-muscle-invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence, progression, and mortality associated with this disease. Organ-preserving treatment by transurethral resection and immunotherapy with bacillus Calmette-Guerin (BCG) is an initial approach to therapy in these patients. However, the efficacy of such therapy is limited. This justifies the use of other methods of treatment, such as TUR under the control of photodynamic diagnosis (PDD). Aim of this study was to evaluate the effectiveness of therapeutic interventions in patients with high-grade NMIBC.Materials and methods. We have retrospectively analyzed results of follow-up of patients with primary or recurrent high-grade transitional cell NMIBC, treatment by TUR in conjunction with BCG or without it N.N. Alexandrov National Cancer Centre in the period from 2004 to 2013. In total, the study included 113 patients (27 women and 86 men), in the median age of 72 years. We have evaluated 5-year recurrence- and progression-free survival, analyzed an influence of prognostic factors and methods of treatment on the risk of recurrence and progression with Cox model and KaplanβMeier method.Results. With a median of follow up of 59 (12β116) months the rates of 5-year recurrence- and progression-free survival were respectively 42.5 and 71.6 %. Statistically significant association with the risk of recurrence was observed in multivariate Cox regression analysis for recurrent tumors (hazard ratio (HR) 2.73; 95 % confidence interval (CI) 1.61β4.62) and immunotherapy with BCG (HR 0.56; 95 % CI 0.31β0.99). BCG significantly increased recurrence-free survival in patients with both primary tumors, and with recurrent ones. Significant factors in the multivariate analysis with regard to the risk of progression were suspicion for muscle-invasive tumors according to the cystoscopic picture (HR 3.36; 95 % CI 1.09β10.4), abnormal tumor-free bladder mucosa, suspicious for carcinoma in situ (HR 7.23; 95 % CI 2.64β19.8), localization of tumor in the bladder neck, orifice zone, prostatic urethra (HR 2.91; 95 % CI 1.17β7.25) and PDD-assisted TUR (HR 0.10; 95 % CI 0.01β0.78). TUR under the control of photodynamic diagnosis significantly increased the survival to progression, regardless of the risk of progression, while BCG did not significantly affect the progression-free survival.Conclusions. 6-week course of BCG therapy in patients with high-grade NMIBC significantly reduces the risk of recurrence and has no effect on the risk of tumor progression. PDD-assisted TUR provides a significant reduction in the risk of progression, but not recurrence. The findings justify the inclusion of both modalities in the treatment of high-grade NMIBC.Β ΠΠΠΠΠΠΠΠ: ΠΠΈΠ·ΠΊΠΎΠ΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ ΡΠ°ΠΊ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ (Π ΠΠΠΠΠ) Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ΅ΡΡΡ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΠ°ΡΡΠΎΡΠΎΠΉ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΠΎΠ²Π°Π½ΠΈΡ, ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ, ΡΠ²ΡΠ·Π°Π½Π½ΠΎΠΉ Ρ Π΄Π°Π½Π½ΡΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ΠΌ. ΠΠ°ΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ°ΠΊΡΠΈΠΊΠΎΠΉ Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° ΡΠ°ΠΊΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΡΠ³Π°Π½ΠΎΡΠΎΡ
ΡΠ°Π½ΡΡΡΠ΅Π΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΡΠ°Π½ΡΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ (Π’Π£Π ) ΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π±Π°ΡΠΈΠ»Π»ΠΎΠΉ ΠΠ°Π»ΡΠΌΠ΅ΡΡΠ°-ΠΠ΅ΡΠ΅Π½Π° (ΠΠ¦Π), ΠΎΠ΄Π½Π°ΠΊΠΎ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΡΠ°ΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½Ρ, ΡΡΠΎ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²ΡΠ²Π°Π΅Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ², Π½Π°ΠΏΡΠΈΠΌΠ΅Ρ ΡΠΎΡΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ (Π€ΠΠ). Π¦Π΅Π»ΡΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΡΠ°Π»Π° ΠΎΡΠ΅Π½ΠΊΠ° ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π»Π΅ΡΠ΅Π±Π½ΡΡ
Π²ΠΎΠ·Π΄Π΅ΠΉΡΡΠ²ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΡΡΡΠ°Π΄Π°ΡΡΠΈΡ
Π½ΠΈΠ·ΠΊΠΎΠ΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ Π ΠΠΠΠΠ.ΠΠΠ’ΠΠ ΠΠΠ Π ΠΠΠ’ΠΠΠ«: Π Π΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π·Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠΌ ΠΈΠ»ΠΈ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΠΌ ΠΏΠ΅ΡΠ΅Ρ
ΠΎΠ΄Π½ΠΎ-ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΠΌ Π½ΠΈΠ·ΠΊΠΎΠ΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ Π ΠΠΠΠΠ, Π»Π΅ΡΠ΅Π½Π½ΡΠΌ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π’Π£Π Β± ΠΠ¦Π Π² Π ΠΠΠ¦ ΠΠΠ ΠΈΠΌ. Π.Π. ΠΠ»Π΅ΠΊΡΠ°Π½Π΄ΡΠΎΠ²Π° Ρ 2005 ΠΏΠΎ 2013 Π³Π³. ΠΡΠ΅Π³ΠΎ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΎ 113 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (27 ΠΆΠ΅Π½ΡΠΈΠ½ ΠΈ 86 ΠΌΡΠΆΡΠΈΠ½), ΠΌΠ΅Π΄ΠΈΠ°Π½Π° Π²ΠΎΠ·ΡΠ°ΡΡΠ° 72 Π³ΠΎΠ΄Π°. Π Π°ΡΡΡΠΈΡΠ°Π½Ρ 5-Π»Π΅ΡΠ½ΠΈΠ΅ Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½Π°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΈ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Π΄ΠΎ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π΄Π°Π½Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½ΠΎ Π²Π»ΠΈΡΠ½ΠΈΠ΅ ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ Π½Π° ΡΠΈΡΠΊ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΠΠΎΠΊΡΠ° ΠΈ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΠ°ΠΏΠ»Π°Π½Π°-ΠΠ΅ΠΉΠ΅ΡΠ°.Π ΠΠΠ£ΠΠ¬Π’ΠΠ’Π«: ΠΡΠΈ ΠΌΠ΅Π΄ΠΈΠ°Π½Π΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ 59 ΠΌΠ΅Ρ. (12-116 ΠΌΠ΅Ρ.) ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ 5-Π»Π΅ΡΠ½Π΅ΠΉ Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΈ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ Π΄ΠΎ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ 42,5% ΠΈ 71,6%.Π ΠΌΡΠ»ΡΡΠΈΠ²Π°ΡΠΈΠ°Π½ΡΠ½ΠΎΠΌ ΡΠ΅Π³ΡΠ΅ΡΡΠΈΠΎΠ½Π½ΠΎΠΌ Π°Π½Π°Π»ΠΈΠ·Π΅ ΠΠΎΠΊΡΠ° ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠ°Ρ ΡΠ²ΡΠ·Ρ Ρ ΡΠΈΡΠΊΠΎΠΌ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΎΡΠΌΠ΅ΡΠ°Π»Π°ΡΡ Π΄Π»Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ (ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΡΠΈΡΠΊΠΎΠ² (ΠΠ ) 2,73; 95% ΠΠ 1,61-4,62) ΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΈΠΌΠΌΡΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠ¦Π (ΠΠ 0,56; 95% ΠΠ 0,31-0,99). ΠΠ¦Π ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΡΠ²Π΅Π»ΠΈΡΠΈΠ²Π°Π»ΠΎ Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΊΠ°ΠΊ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ, ΡΠ°ΠΊ ΠΈ Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΠΌΠΈ. Π ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ ΡΠΈΡΠΊΠ° ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π·Π½Π°ΡΠΈΠΌΡΠΌΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ Π² ΠΌΡΠ»ΡΡΠΈΠ²Π°ΡΠΈΠ°Π½ΡΠ½ΠΎΠΌ Π°Π½Π°Π»ΠΈΠ·Π΅ ΠΎΠΊΠ°Π·Π°Π»ΠΈΡΡ ΠΏΠΎΠ΄ΠΎΠ·ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΠΌΡΡΠ΅ΡΠ½ΠΎ-ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΡ ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΡΠΈΡΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½Ρ (ΠΠ 3,36; 95% ΠΠ 1,09-10,4), ΠΈΠ·ΠΌΠ΅Π½Π΅Π½Π½Π°Ρ ΡΠ²ΠΎΠ±ΠΎΠ΄Π½Π°Ρ ΠΎΡ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΡΠ»ΠΈΠ·ΠΈΡΡΠ°Ρ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ, ΠΏΠΎΠ΄ΠΎΠ·ΡΠΈΡΠ΅Π»ΡΠ½Π°Ρ Π½Π° CIS (ΠΠ 7,23; 95% ΠΠ 2,64-19,8), Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΡ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π² ΡΠ΅ΠΉΠΊΠ΅, Π·ΠΎΠ½Π΅ ΡΡΡΡΠ΅Π², ΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΠ΅ΡΡΠ΅ (ΠΠ 2,91; 95% ΠΠ 1,17-7,25) ΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π’Π£Π ΠΏΠΎΠ΄ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ Π€ΠΠ (ΠΠ 0,10; 95% ΠΠ 0,01-0,78). ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π€ΠΠ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ ΠΏΠΎΠ²ΡΡΠ°Π»ΠΎ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Π΄ΠΎ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π²Π½Π΅ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΡΠΈΡΠΊΠ° ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ, ΡΠΎΠ³Π΄Π° ΠΊΠ°ΠΊ ΠΠ¦Π ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ Π½Π΅ Π²Π»ΠΈΡΠ»Π° Π½Π° Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Π΄ΠΎ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ.ΠΠ«ΠΠΠΠ«: Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΡΡΡΠ°Π΄Π°ΡΡΠΈΡ
Π½ΠΈΠ·ΠΊΠΎΠ΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ Π ΠΠΠΠΠ, ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ 6-Π½Π΅Π΄Π΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΡΡΡΠ° ΠΠ¦Π ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΡΠ½ΠΈΠΆΠ°Π΅Ρ ΡΠΈΡΠΊ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΈ Π½Π΅ Π²Π»ΠΈΡΠ΅Ρ Π½Π° ΡΠΈΡΠΊ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π’Π£Π ΠΏΠΎΠ΄ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ Π€ΠΠ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ²Π°Π΅Ρ Π·Π½Π°ΡΠΈΠΌΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΠΈΡΠΊΠ° ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ, Π½ΠΎ Π½Π΅ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π°. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²ΡΠ²Π°ΡΡ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ ΠΎΠ±Π΅ΠΈΡ
Π²ΠΎΠ·Π΄Π΅ΠΉΡΡΠ²ΠΈΠΉ Π² Π°Π»Π³ΠΎΡΠΈΡΠΌ ΠΎΡΠ³Π°Π½ΠΎΡΠΎΡ
ΡΠ°Π½ΡΡΡΠ΅Π³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π½ΠΈΠ·ΠΊΠΎΠ΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π ΠΠΠΠΠ
ΠΠ»ΠΈΡΠ½ΠΈΠ΅ Ρ ΠΈΡΡΡΠ³Π° Π½Π° Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΡΡΡΠ°Π΄Π°ΡΡΠΈΡ ΡΠ°ΠΊΠΎΠΌ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ
Background. The high rate of recurrences after visual complete transurethral resection (TUR) is a main problem in the treatment of nonmuscle-invasive bladder cancer (NMIBC). One of the factors influencing the long-term results of treatment for this pathology may beΒ the quality of TUR, which depends on a surgeonβs experience.Objective: to evaluate the impact of a surgeon on relapse-free survival rates after radical treatment in patients with NMIBC and to searchΒ the optimal quality criteria for TUR in this disease.Materials and methods. The data of patients with primary or recurrent NMIBC treated using TUR with and without intravesical therapyΒ at the N. N. Aleksandrov Republican Research and Practical Center for Oncology and Medical Radiology in 2004 to 2013 were retrospectivelyΒ analyzed. The investigation included a total of 949 cases of performing organ-sparing treatment in 784 patients. The operations wereΒ made by 5 surgeons with comparable experience with TUR.Results. At a median follow-up of 64.3 (3β124) months, the 5-year relapse-free survival rates in 5 surgical groups were 62.9 (95 % confidenceΒ interval (CI) 56.2β69.7), 53.6 (95 % CI 47.4β59.9), 51.0 (95 % CI 39.6β62.4), 46.2 (95 % CI 36.4β56.0), and 44.2 % (95 % CIΒ 36.8β51.7), respectively (p < 0.0001). According to the data of multivariate analysis including all potential factors, the prognostic role of a surgeonβs experience retained a high level of statistical significance (p = 0.0013). The differences between the surgeons were less pronounced after resection of tumors at a low risk for recurrence. Analysis of the distribution of the recurrence rates within the first 3, 6, and 12 months after TUR in relation to the surgeon, which were stratified according to recurrence risk groups, showed that the most differing rates were observed 12 months after TUR.Conclusion. An operating surgeon has a significant effect on the risk of recurrence after radical treatment in patients with NMIBC. In ourΒ investigation, this effect was observed in spite of the relative much experience with surgical treatment of this disease by all surgeons andΒ the performance of operations in one highly specialized center. The differences between the surgeons are less pronounced after resectionΒ of tumors at low recurrence risk. The recurrence rates for primary single (below 10 %), recurrent or multiple (below 19 %), and for recurrentΒ and multiple (below 32 %) tumors within the first year after surgery can be taken for the quality criteria of TUR.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΡΠ½ΠΎΠ²Π½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΠΉ ΠΏΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΡΠ°ΠΊΠ° ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ (Π ΠΠΠΠΠ) ΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΡΡΠΎΠΊΠ°Ρ ΡΠ°ΡΡΠΎΡΠ°Β ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠ² ΠΏΠΎΡΠ»Π΅ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½ΠΎ ΠΏΠΎΠ»Π½ΠΎΠΉ ΡΡΠ°Π½ΡΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ (Π’Π£Π ). ΠΠ΄Π½ΠΈΠΌ ΠΈΠ· ΡΠ°ΠΊΡΠΎΡΠΎΠ², Π²Π»ΠΈΡΡΡΠΈΡ
Π½Π° ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡΒ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ, ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π’Π£Π , ΠΊΠΎΡΠΎΡΠΎΠ΅ Π·Π°Π²ΠΈΡΠΈΡ ΠΎΡ ΠΎΠΏΡΡΠ° Ρ
ΠΈΡΡΡΠ³Π°.Π¦Π΅Π»Ρ ΡΠ°Π±ΠΎΡΡ β ΠΎΡΠ΅Π½ΠΊΠ° Π²Π»ΠΈΡΠ½ΠΈΡ Ρ
ΠΈΡΡΡΠ³Π° Π½Π° Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΏΠΎΡΠ»Π΅ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π ΠΠΠΠΠ,Β Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΠΎΠΈΡΠΊ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π’Π£Π ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ ΠΏΡΠΈ ΡΡΠΎΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· Π΄Π°Π½Π½ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠΌ ΠΈΠ»ΠΈ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΠΌ Π ΠΠΠΠΠ, Π»Π΅ΡΠ΅Π½Π½ΡΡ
Β Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π’Π£Π Ρ ΠΈΠ»ΠΈ Π±Π΅Π· ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π²Π½ΡΡΡΠΈΠΏΡΠ·ΡΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π½Π° Π±Π°Π·Π΅ Π ΠΠΠ¦ ΠΠΠ ΠΈΠΌ. Π.Π. ΠΠ»Π΅ΠΊΡΠ°Π½Π΄ΡΠΎΠ²Π° Ρ 2004 ΠΏΠΎ 2013 Π³.Β ΠΡΠ΅Π³ΠΎ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 949 ΡΠ»ΡΡΠ°Π΅Π² ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΎΡΠ³Π°Π½ΠΎΡΠΎΡ
ΡΠ°Π½ΡΡΡΠ΅Π³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ 784 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ 5 Ρ
ΠΈΡΡΡΠ³ΠΎΠ² ΡΠΎ ΡΡΠ°Π²Π½ΠΈΠΌΡΠΌ ΠΎΠΏΡΡΠΎΠΌ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π’Π£Π .Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠΈ ΠΌΠ΅Π΄ΠΈΠ°Π½Π΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ 64,3 (3β124) ΠΌΠ΅Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ 5-Π»Π΅ΡΠ½Π΅ΠΉ Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ Π² 5 Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Β Π³ΡΡΠΏΠΏΠ°Ρ
ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 62,9 (95 % Π΄ΠΎΠ²Π΅ΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π» (ΠΠ) 56,2β69,7), 53,6 (95 % ΠΠ 47,4β59,9), 51,0 (95 % ΠΠ 39,6β62,4),Β 46,2 (95 % ΠΠ 36,4β56,0) ΠΈ 44,2 % (95 % ΠΠ 36,8β51,7) ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ (p < 0,0001). ΠΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΌΡΠ»ΡΡΠΈΠ²Π°ΡΠΈΠ°Π½ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π°Β Ρ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π²ΡΠ΅Ρ
ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΡΠΈΡΠΊΠ° ΡΠΎΡ
ΡΠ°Π½ΡΠ»Π°ΡΡ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠΎΠ»Ρ ΠΎΠΏΡΡΠ° Ρ
ΠΈΡΡΡΠ³Π° Ρ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΡΡ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π·Π½Π°ΡΠΈΠΌΠΎΡΡΠΈ (Ρ = 0,0013). Π Π°Π·Π»ΠΈΡΠΈΡ ΠΌΠ΅ΠΆΠ΄Ρ Ρ
ΠΈΡΡΡΠ³Π°ΠΌΠΈ Π±ΡΠ»ΠΈ ΠΌΠ΅Π½Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Ρ ΠΏΡΠΈ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ Ρ Π½ΠΈΠ·ΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌΒ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π°.Β ΠΠ½Π°Π»ΠΈΠ· ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ°ΡΡΠΎΡΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠ² Π² ΠΏΠ΅ΡΠ²ΡΠ΅ 3, 6 ΠΈ 12 ΠΌΠ΅Ρ ΠΏΠΎΡΠ»Π΅ Π’Π£Π Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ Ρ
ΠΈΡΡΡΠ³Π°, ΡΡΡΠ°ΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Β ΠΏΠΎ Π³ΡΡΠΏΠΏΠ°ΠΌ ΡΠΈΡΠΊΠ° ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π°, ΠΏΠΎΠΊΠ°Π·Π°Π», ΡΡΠΎ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°Π·Π»ΠΈΡΠ°ΡΡΠΈΠ΅ΡΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ ΡΠ΅ΡΠ΅Π· 12 ΠΌΠ΅Ρ ΠΏΠΎΡΠ»Π΅ Π’Π£Π .ΠΡΠ²ΠΎΠ΄Ρ. Π₯ΠΈΡΡΡΠ³-ΠΎΠΏΠ΅ΡΠ°ΡΠΎΡ ΠΎΠΊΠ°Π·ΡΠ²Π°Π΅Ρ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ΅ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° ΡΠΈΡΠΊ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΏΠΎΡΠ»Π΅ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π ΠΠΠΠΠ.Β Π Π½Π°ΡΠ΅ΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠΎΡ ΡΡΡΠ΅ΠΊΡ Π½Π°Π±Π»ΡΠ΄Π°Π»ΡΡ Π½Π΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎ Π±ΠΎΠ»ΡΡΠΎΠΉ ΠΎΠΏΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π΄Π°Π½Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Π²ΡΠ΅ΠΌΠΈ Ρ
ΠΈΡΡΡΠ³Π°ΠΌΠΈ ΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΎΠ΄Π½ΠΎΠ³ΠΎ Π²ΡΡΠΎΠΊΠΎΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΡΠ΅Π½ΡΡΠ°. Π Π°Π·Π»ΠΈΡΠΈΡ ΠΌΠ΅ΠΆΠ΄Ρ Ρ
ΠΈΡΡΡΠ³Π°ΠΌΠΈΒ ΠΌΠ΅Π½Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Ρ ΠΏΡΠΈ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ Ρ Π½ΠΈΠ·ΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π°. ΠΠ° ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π’Π£Π ΠΌΠΎΠΆΠ½ΠΎ ΠΏΡΠΈΠ½ΡΡΡ ΡΠ°ΡΡΠΎΡΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠ² Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 1-Π³ΠΎ Π³ΠΎΠ΄Π° ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π΄Π»Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΡ
ΠΎΠ΄ΠΈΠ½ΠΎΡΠ½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ (Π΄ΠΎ 10 %), Π΄Π»Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ
ΠΈΠ»ΠΈ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ (Π΄ΠΎ 19 %) ΠΈ Π΄Π»Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ
ΠΈ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
(Π΄ΠΎ 32 %)
The opposite association of HRAS and KRAS mutations with clinical variables of bladder cancer
HRAS, KRAS and NRAS gene products belong to the superfamily of small GTPases. These proteins regulate cellular response to extracellular stimuli by means of activation of different signaling pathways. Although the role of RAS gene mutations in theΒ pathogenesis of various human cancers has been established, the clinical significance of these molecular alterations in bladder cancer remains unclear. The aim of this study was to determine the frequency and spectrum of HRAS, KRAS and NRAS mutations, to analyze their relationships with clinicopathological variables and to determine the prognostic value of these alterations in terms of recurrence, progression and mortality, in aΒ prospective cohort of 249 bladder cancer patients. The frequency of RAS mutations detected by the SNaPshot method, was found to be 11.2 %, of which HRAS mutations accounted for 64.3 %, KRAS, for 28.6 % and NRAS, for 7.1 %. We failed to find any correlation between all RAS mutations and pathomorphological characteristics. However, when analyzed separately, HRAS and KRAS mutations were for the first time shown to be associated with the opposite clinical parameters of bladder cancer: HRAS mutations were significantly associated with low-stage low-grade papillary tumors of a small size (Ρ < 0.05), whereas KRAS mutations were associated with non-papillary urothelial carcinomas and the presence of metastasis (Ρ < 0.05). Analysis of the prognostic value of molecular alterations revealed an association of KRAS mutations with decreased cancer-specific survival in both the whole group of patients and the subgroup with non-muscle invasive disease. The data obtained suggest that HRAS and KRAS gene mutations may characterize alternative pathways of bladder cancer pathogenesis: HRAS mutations indicating benign and KRAS mutations, aggressive disease course
ΠΡΠ΅Π½ΠΊΠ° ΡΠΈΡΠΊΠ° ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΈ ΡΠ°ΠΊΠ΅ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ
A retrospective analysis of monitoring of patients with primary or recurrent non-muscle invasive bladder cancer (NMIBC) treated with transurethral resection (TUR) with or without restaging TUR or intravesical therapy in State Institution N.N. Alexandrov National Cancer Centre of Belarus in 2004β2012 was performed with an objective to develop a prognostic classification for NMIBC. The analysis included 921 patients. In the multivatiate analysis independent predictors of recurrence were recurrence rate, number of tumors, tumor size, grade, and tumor location in the trigone, anterior wall, dome, and prostatic urethra; predictors of progression were age, recurrence rate, tumor size, grade, and tumor location in the trigone and prostatic urethra. The patients were divided into 4 groups with low, intermediate, high and very high risk. Corrected C-index values for the developed classifications of recurrence and progression risks were 0.635 and 0.740 respectively, which were significantly higher than C-indices for the European Organization for Research and Treatment of Cancer tables.ΠΠ»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ΡΠ°ΠΊΠ° ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ (Π ΠΠΠΠΠ) ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ Π±ΡΠ»ΠΈ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π·Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠΌ ΠΈΠ»ΠΈ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΠΌ Π ΠΠΠΠΠ, Π»Π΅ΡΠ΅Π½Π½ΡΠΌΠΈ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΡΠ°Π½ΡΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ (Π’Π£Π ) Ρ ΡΠ΅ΡΡΠ°Π΄ΠΈΡΡΡΡΠ΅ΠΉ Π’Π£Π ΠΈΠ»ΠΈ Π±Π΅Π· ΠΈΠ»ΠΈ Π²Π½ΡΡΡΠΈΠΏΡΠ·ΡΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π² Π ΠΠΠ¦ ΠΠΠ ΠΈΠΌ. Π.Π. ΠΠ»Π΅ΠΊΡΠ°Π½Π΄ΡΠΎΠ²Π° Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 2004 ΠΏΠΎ 2012 Π³Π³. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ 921 ΠΏΠ°ΡΠΈΠ΅Π½Ρ. Π ΠΌΡΠ»ΡΡΠΈΠ²Π°ΡΠΈΠ°Π½ΡΠ½ΠΎΠΌ Π°Π½Π°Π»ΠΈΠ·Π΅ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΡΠΌΠΈ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° Π±ΡΠ»ΠΈ ΡΠ°ΡΡΠΎΡΠ° ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΠΎΠ²Π°Π½ΠΈΡ, ΡΠΈΡΠ»ΠΎ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ, ΡΠ°Π·ΠΌΠ΅Ρ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ, ΡΡΠ΅ΠΏΠ΅Π½Ρ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΊΠΈ ΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΡ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π² ΠΎΠ±Π»Π°ΡΡΠΈ ΡΡΠ΅ΡΠ³ΠΎΠ»ΡΠ½ΠΈΠΊΠ°, ΠΏΠ΅ΡΠ΅Π΄Π½Π΅ΠΉ ΡΡΠ΅Π½ΠΊΠΈ, Π΄Π½Π° ΠΈ ΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ°ΡΡΠΈ ΡΡΠ΅ΡΡΡ; ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ β Π²ΠΎΠ·ΡΠ°ΡΡ, ΡΠ°ΡΡΠΎΡΠ° ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΠΎΠ²Π°Π½ΠΈΡ, ΡΠ°Π·ΠΌΠ΅Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ, ΡΡΠ΅ΠΏΠ΅Π½Ρ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΊΠΈ ΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΡ Π² ΠΎΠ±Π»Π°ΡΡΠΈ ΡΡΠ΅ΡΠ³ΠΎΠ»ΡΠ½ΠΈΠΊΠ° ΠΈ ΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ°ΡΡΠΈ ΡΡΠ΅ΡΡΡ. ΠΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° 4 Π³ΡΡΠΏΠΏΡ: Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠ³ΠΎ, ΠΏΡΠΎΠΌΠ΅ΠΆΡΡΠΎΡΠ½ΠΎΠ³ΠΎ, Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠ³ΠΎ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π°. Π‘ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ Π‘-ΠΈΠ½Π΄Π΅ΠΊΡΠΎΠ² Π΄Π»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½ΡΡ
ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΉ ΡΠΈΡΠΊΠ° ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 0,635 ΠΈ 0,740 ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ, ΡΡΠΎ Π±ΡΠ»ΠΎ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ Π²ΡΡΠ΅, ΡΠ΅ΠΌ Π‘-ΠΈΠ½Π΄Π΅ΠΊΡΡ Π΄Π»Ρ ΡΠ°Π±Π»ΠΈΡ ΠΠ²ΡΠΎΠΏΠ΅ΠΉΡΠΊΠΎΠΉ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΈ ΠΏΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°ΠΊΠ°
ΠΠ΅ΠΆΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠ°Ρ Π²ΠΎΡΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΠΏΡΠΈ ΡΠ°ΠΊΠ΅ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ Ρ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΌ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΎΠΌ
The purpose of our study was to assess the interobserver variability in tumor stage and grade in patients with non-muscle invasive transitional cell bladder cancer. The prognostic relevance of grade and stage from both the initial and review diagnosis were determined. Pathological slides from 154 superficial bladder carcinomas were reviewed. Progression-free survival and hazard ratios for each stage and grade were calculated with Kaplan-Meyer method and Cox proportional model. There were significant interobserver differences in both the grading and staging of tumours. In pathology review overgrading was more frequent than undergrading, pathology review downstaged T category to stage Ta in 60,0 % of cases originally classified as stage T1.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΊΠ° ΠΌΠ΅ΠΆΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠΎΠΉ ΠΈΠ·ΠΌΠ΅Π½ΡΠΈΠ²ΠΎΡΡΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΡΡΠΈ ΠΈ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΈ ΡΠ’ ΠΏΡΠΈ ΠΏΠ΅ΡΠ΅Ρ
ΠΎΠ΄Π½ΠΎ-ΠΊΠ»Π΅ΡΠΎΡΠ½ΠΎΠΌ ΡΠ°ΠΊΠ΅ (ΠΠΠ ) ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Β ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ², ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΠΏΡΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΌ ΠΏΠ΅ΡΠ΅ΡΠΌΠΎΡΡΠ΅. Π Ρ
ΠΎΠ΄Π΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΎΡΡΡΠ΅ΡΡΠ²Π»Π΅Π½Π° ΠΏΠΎΠ²ΡΠΎΡΠ½Π°Ρ ΡΠ²Π΅ΡΠΎΠ²Π°Ρ ΠΌΠΈΠΊΡΠΎΡΠΊΠΎΠΏΠΈΡ Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠΈΠΊΡΠΎΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² 154 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΎΠ±ΡΠ°Π±ΠΎΡΠΊΠ° ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ², ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΠΏΡΠΈ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΌΒ ΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΌ ΠΏΠ΅ΡΠ΅ΡΠΌΠΎΡΡΠ°Ρ
. Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ Π½Π°Π»ΠΈΡΠΈΠ΅ Π²ΡΡΠΎΠΊΠΎΠΉ Π²Π°ΡΠΈΠ°Π±Π΅Π»ΡΠ½ΠΎΡΡΠΈ Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠΉ ΠΈ Π½ΠΈΠ·ΠΊΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΌΠ΅ΠΆΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠΎΠ³ΠΎ ΡΠΎΠ³Π»Π°ΡΠΈΡ ΠΏΡΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠΈ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ: ΠΏΡΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΌ ΠΏΠ΅ΡΠ΅ΡΠΌΠΎΡΡΠ΅ ΠΌΠΈΠΊΡΠΎΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² ΠΈΠΌΠ΅Π»Π°ΡΡ ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΡΡΠΈ ΠΠΠ , ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΡ ΡΠ’1 ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½Π° Ρ 40%Β ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Ρ 60 % ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΡ ΡT1 ΠΏΠΎΠ½ΠΈΠ·ΠΈΠ»Π°ΡΡ Π΄ΠΎ ΡΠ’Π°
Π ΠΎΠ»Ρ ΠΌΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° Π³Π΅Π½Π° FGFR3 Π² ΠΏΡΠ΅Π΄ΡΠΊΠ°Π·Π°Π½ΠΈΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ°ΠΊΠ° ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ
A prospective study was conducted to assess the prognostic value of FGFR3 gene mutation status in patients with non-muscle invasive bladderΒ cancer. A total of 265 patients were included in the study. FGFR3 gene mutations were found in 168 (63.4 %) cases. FGFR3 mutation rateΒ was significantly higher in low-grade tumors (p = 0.00 004). With a median follow-up of 34 months hazard ratio of progression in FGFR3Β mutant cases compared to FGFR3 wild type was 0.50 (95 % CI 0.17β1.49; p = 0.21). In the subgroup analysis, it was found that FGFR3Β mutations in patients with T1 high grade tumors (n = 41) were associated with a significantly better prognosis: 3-year progression-free survivalΒ (PFS) in FGFR3 mutant cases (n = 17) was 100 % compared to 71.2 % (95 % CI 42.8β99.6 %) in the absence of mutations (n = 24).Β For other subgroups (Ta, T1 low grade) no statistically significant difference in PFS by FGFR3 mutation status was noted.ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠΎ ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΌΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° Π³Π΅Π½Π° FGFR3 Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²Β Ρ ΡΠ°ΠΊΠΎΠΌ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΎ 265 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Ρ 168 (63,4 %) ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Ρ ΠΌΡΡΠ°ΡΠΈΠΈΒ Π³Π΅Π½Π° FGFR3. Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΡΠ°ΡΡΠΎΡΠ° ΠΌΡΡΠ°ΡΠΈΠΉ Π³Π΅Π½Π° FGFR3 Π±ΡΠ»Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π²ΡΡΠ΅ Π² Π²ΡΡΠΎΠΊΠΎΠ΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Β ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ
(Ρ = 0,00004). ΠΡΠΈ ΠΌΠ΅Π΄ΠΈΠ°Π½Π΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ 34 ΠΌΠ΅Ρ Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎΠ³ΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ°Β ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ°ΠΊΠ° ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π±Π΅Π· ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ ΠΌΡΡΠ°ΡΠΈΠΈ Π³Π΅Π½Π° FGFR3 ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ Π΅Π΅ ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ΠΌΒ (0,50; 95 % Π΄ΠΎΠ²Π΅ΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π» (ΠΠ) 0,17β1,49; p = 0,21). ΠΡΠΈ Π°Π½Π°Π»ΠΈΠ·Π΅ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΌΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΈΠ·ΠΌΠ΅Π½ΡΠΈΠ²ΠΎΡΡΠΈ Π³Π΅Π½Π° FGFR3 Π² ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΠΏΠΎΠ΄Π³ΡΡΠΏΠΏΠ°Ρ
Π±ΡΠ»ΠΎ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½ΠΎ, ΡΡΠΎ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ T1 high grade (n = 41) ΠΌΡΡΠ°ΡΠΈΠΈ Π³Π΅Π½Π°Β FGFR3 Π±ΡΠ»ΠΈ ΡΠ²ΡΠ·Π°Π½Ρ ΡΠΎ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π»ΡΡΡΠΈΠΌ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΎΠΌ: 3-Π»Π΅ΡΠ½ΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Π΄ΠΎ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈΒ ΠΌΡΡΠ°ΡΠΈΠΈ (n = 17) ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 100 % ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ 71,2 % (95 % ΠΠ 42,8β99,6 %) ΠΏΡΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ ΠΌΡΡΠ°ΡΠΈΠΈ (n = 24). ΠΡΠΈ ΠΎΡΡΠ°Π»ΡΠ½ΡΡ
ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ (Ta, T1 low grade) ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ Π² Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ Π΄ΠΎ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΠΌΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° FGFR3 Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ
Π€ΠΠΠ’ΠΠ Π« ΠΠ ΠΠΠΠΠΠ Π£ ΠΠΠ¦ΠΠΠΠ’ΠΠ Π‘ ΠΠ«Π¨ΠΠ§ΠΠ-ΠΠΠΠΠΠΠΠΠ«Π Π ΠΠΠΠ ΠΠΠ§ΠΠΠΠΠ ΠΠ£ΠΠ«Π Π― ΠΠΠ‘ΠΠ Π ΠΠΠΠΠΠΠ¬ΠΠΠ Π¦ΠΠ‘Π’ΠΠΠ’ΠΠΠΠ
Purpose. Assessment of predictors of cancer-specific survival (CSS) in patients at high risk of progression of muscle-invasive bladder cancer (MIBC) after radical cystectomy that have been included in a prospective, randomized study to assess efficacy of shortened course of adjuvant chemotherapy.Material and methods. A total of 92 patients were included in the study. Prognostic significance of age, gender, recurrent status of urinary diversion, pT category and pN, the number of distant lymph nodes (LN), the degree of differentiation and the presence of metaplasia, the number of metastatic lesions of the LN and LN-density lesion on CSS were evaluated with Cox proportional hazard model.Results. Factors significantly associated with the probability of death from bladder cancer were number of metastatic lymph nodes (hazard ratio (HR) 1.128; 95 % confidence interval (CI) 1.018β1.251; p = 0.022) and the density of LN involvement (HR 1.011; 95 % CI 1.001β1.022; p = 0.039).Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΊΠ° ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° ΡΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎ-Π²Π°Π½ΠΈΡ ΠΌΡΡΠ΅ΡΠ½ΠΎ-ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΠ°ΠΊΠ° ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ (ΠΠΠ ΠΠ) ΠΏΠΎΡΠ»Π΅ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΈΡΡΡΠΊΡΠΎΠΌΠΈΠΈ, Π²ΠΊΠ»ΡΡΠ΅Π½Π½ΡΡ
Π² ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠΎ ΠΎΡΠ΅Π½ΠΊΠ΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠΊΠΎΡΠΎΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΊΡΡΡΠ° Π°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Ρ
ΠΈΠΌΠΈΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ (Π₯Π’).ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 92 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°, ΠΊΠΎΡΠΎΡΡΠΌ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ 2 ΠΊΡΡΡΠ° Π°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Π₯Π’. ΠΠ·ΡΡΠ΅Π½ΠΎ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π²ΠΎΠ·ΡΠ°ΡΡΠ°, ΠΏΠΎΠ»Π°, ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ°, ΠΌΠ΅ΡΠΎΠ΄Π° ΠΎΡΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΌΠΎΡΠΈ, ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΉ pT ΠΈ pN, ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΡΠ΄Π°Π»Π΅Π½Π½ΡΡ
Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ·Π»ΠΎΠ² (ΠΠ£), ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΊΠΈ ΠΈ Π½Π°Π»ΠΈΡΠΈΡ ΠΌΠ΅ΡΠ°ΠΏΠ»Π°Π·ΠΈΠΈ, ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈ ΠΏΠΎΡΠ°ΠΆΠ΅Π½Π½ΡΡ
ΠΠ£ ΠΈ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΠΈ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΠ£ Π½Π° ΡΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠΠ ΠΠ Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π€Π°ΠΊΡΠΎΡΠ°ΠΌΠΈ, ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ ΡΠ²ΡΠ·Π°Π½Π½ΡΠΌΠΈ Ρ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡΡ ΡΠΌΠ΅ΡΡΠΈ ΠΎΡ ΡΠ°ΠΊΠ° ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ, Π±ΡΠ»ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅-ΡΡΠ²ΠΎ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈ ΠΏΠΎΡΠ°ΠΆΠ΅Π½Π½ΡΡ
ΠΠ£ (Π½Π΅ΠΏΡΠ΅ΡΡΠ²Π½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ, ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΡΠΈΡΠΊΠΎΠ² (ΠΠ ) 1,13; 95 % Π΄ΠΎΠ²Π΅ΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π» (ΠΠ) 1,02β1,25; p = 0,022) ΠΈ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΡ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΠ£ (Π½Π΅ΠΏΡΠ΅ΡΡΠ²Π½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΠ 1,01; 95 % ΠΠ 1,00β1,02; p = 0,039)
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ ΡΠ°ΠΊΠΎΠΌ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Ρ ΠΌΠ΅ΡΠ°ΡΡΠ°Π·Π°ΠΌΠΈ Π² ΡΠ΅Π³ΠΈΠΎΠ½Π°ΡΠ½ΡΡ Π»ΠΈΠΌΡΠΎΡΠ·Π»Π°Ρ
The data of 668 radical cystectomies were used to study the results of treatment in 151 (22,6%) patients with urinary bladder cancer (UBC) metastasizing to the regional lymph nodes and to evaluate the impact of lymphodissection extent on the detection rate of metastases and on survival.In UBC, routine lymphodissection significantly increases the detection rate of regional metastases as compared with limited lymphodissection from 17,8 to 24,8% (p = 0,04). Expanded lymphodissection in patients with UBC with regional metastases could significantly increase overall 5-year survival (p = 0,006).In patients with UBC metastasizing to the regional lymph nodes, the survival rates found after cystectomy using the currently available urine derivation techniques suggest that orthotopic urine derivation may be used in this group of patients after radical operation. Among all factors influencing survival in such patients, the degree of involvement of regional lymph nodes (p = 0,04) and the extent of lymphodissection (p = 0,02) are of independent prognostic value.
ΠΠ½ΡΡΡΠΈΠΏΡΠ·ΡΡΠ½ΡΠΉ ΡΠ»Π΅ΠΊΡΡΠΎΡΠΎΡΠ΅Π· Π΄ΠΎΠΊΡΠΎΡΡΠ±ΠΈΡΠΈΠ½Π° ΠΏΡΠΈ ΠΏΠΎΠ²Π΅ΡΡ Π½ΠΎΡΡΠ½ΠΎΠΌ ΡΠ°ΠΊΠ΅ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ
The data of prospective randomized trial including comparative analysis of two treatment arm results are reported. The patients of group A underwent TUR with following intravesical electrophoresis of 50 mg of chemotherapeutic drug Doxorubicin whereas patients of group B were treated with TUR which followed by intravesical instillation of Doxorubicin. Each group included 17 patients with superficial bladder cancer. In group A complete remission were registered in 11 (64,7%), partial regression in 3 (17,6%) and stabilization in 3 (17,6%) patients. In group A complete remission were found in 6 (35,3%), partial regression in 2 (11,8%) and stabilization in 9 (52,9%) patients. Intravesical electrochemotherapy with Doxorubicin is more effective in comparison to standard intravesical chemotherapy with the same drug, which was expressed by higher rate of positive responses to treatment. The positive response rate were 82,4% in group A verse 47,1% in group B, 2-year survival rate was also better in group A (75% verse 51,9%).