37 research outputs found
Electron transport in a slot-gate Si MOSFET
The transversal and longitudinal resistance in the quantum Hall effect regime
was measured in a Si MOSFET sample in which a slot-gate allows one to vary the
electron density and filling factor in different parts of the sample. In case
of unequal gate voltages, the longitudinal resistances on the opposite sides of
the sample differ from each other because the originated Hall voltage
difference is added to the longitudinal voltage only on one side depending on
the gradient of the gate voltages and the direction of the external magnetic
field. After subtracting the Hall voltage difference, the increase in
longitudinal resistance is observed when electrons on the opposite sides of the
slot occupy Landau levels with different spin orientations.Comment: To appear in Europhys. Let
The impact of the time interval from diagnosis to radical prostatectomy on oncological outcomes in high-risk prostate cancer
Introduction. To date, the impact of the time interval from diagnostic prostate biopsy to radical prostatectomy on treatment outcomes remains a topical issue.Objective. To evaluate the effect of the timespan from diagnosis to radical treatment of prostate cancer (PCa) patients on tumor morphology and long-term oncological outcomes.Materials and methods. A retrospective analysis of the results of treatment of patients with high-risk PCa who underwent radical prostatectomy with extended lymphadenectomy from 2001 to 2019 in three St. Petersburg clinics was performed. The influence of the time interval from prostate biopsy to radical treatment on long-term outcomes was assessed.Results. An increase in the time interval before surgical treatment over three months did not affect the tumor morphology. Five-year biochemical relapse-free survival was 79.7%, 67.8% and 52.5% among patients with time interval from biopsy to surgical treatment less than 30 days, 30 β 90 days and more than 90 days, respectively. The time interval prior to radical treatment did not have any effect on overall and cancer-specific survival.Conclusion. The time interval from prostate biopsy to surgical intervention, not exceeding 3 months, is the most favorable with respect to long-term outcomes
Π ΠΏΠΎΠΈΡΠΊΠ°Ρ ΠΡΠ»Π°Π½ΡΠΈΠ΄Ρ: ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΈΠ²Π½ΡΠ΅ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΡ ΠΎΡΠ²Π΅ΡΠ° Π½Π° ΠΈΠΌΠΌΡΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ
The emergence and continuous development of immune checkpoint inhibitors (ICIs) therapy brings a revolution in cancer therapy history including urothelial carcinoma. Early accurate targeting and adequate treatment are critical to patient prognosis and overall survival. To overcome these limitations, two strategies are actively being pursued: identification of predictive biomarkers for clinical response to ICIs and multi-pronged combination therapies. Biomarkers might allow clinicians to practice a precision medicine approach in ICIs (biomarkerbased patient selection). The development of predictive biomarkers is needed to optimize patient benefit, minimize risk of toxicities, and guide combination approaches.The greatest focus in clinical trials and reviews has been on tumor-cell PD-L1 expression. Although PD-L1 positivity enriches for populations with clinical benefit, PD-L1 testing alone is insufficient for patient selection in most malignancies. In this review, we discuss the status of PD-L1 testing and explore emerging data on new biomarker strategies with tumor-infiltrating lymphocytes, mutational burden, immune gene signatures, microsatellite instability and molecular subtypes.ΠΠΎΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΈ ΠΏΠΎΡΡΠΎΡΠ½Π½ΠΎΠ΅ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΠΎΠ² ΠΈΠΌΠΌΡΠ½Π½ΡΡ
ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΡΡ
ΡΠΎΡΠ΅ΠΊ (ICI) ΡΠΎΠ²Π΅ΡΡΠΈΠ»ΠΈ ΡΠ΅Π²ΠΎΠ»ΡΡΠΈΡ Π² ΠΈΡΡΠΎΡΠΈΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°ΠΊΠ°, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΡΡΠΎΡΠ΅Π»ΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΡ. Π Π°Π½Π½ΠΈΠΉ ΡΠΎΡΠ½ΡΠΉ ΠΏΠΎΠ΄Π±ΠΎΡ ΠΌΠΈΡΠ΅Π½ΠΈ ΠΈ Π°Π΄Π΅ΠΊΠ²Π°ΡΠ½ΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΈΠΌΠ΅ΡΡ ΡΠ΅ΡΠ°ΡΡΠ΅Π΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π΄Π»Ρ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΈ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΎΠ±ΡΠ΅ΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ. ΠΠ»Ρ ΠΏΡΠ΅ΠΎΠ΄ΠΎΠ»Π΅Π½ΠΈΡ ΡΡΠΈΡ
ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½ΠΈΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΡΡΡΡ 2 ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΈ: ΠΈΠ΄Π΅Π½ΡΠΈΡΠΈΠΊΠ°ΡΠΈΡ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Π΄Π»Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΡΠ²Π΅ΡΠ° ΠΏΡΠΈ ICI-ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ ΠΏΡΠΎΠ»ΠΎΠ½Π³ΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ. ΠΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΡ ΠΌΠΎΠ³ΡΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠΈΡΡΠ°ΠΌ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΎΠ²Π°ΡΡ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ ΠΏΡΠ΅ΡΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½Ρ ΠΏΡΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ ICI-ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΎΡΠ±ΠΎΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ²).ΠΠ°ΠΈΠ±ΠΎΠ»ΡΡΠ΅Π΅ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΠΏΡΡΠ°Π½ΠΈΡΡ
ΠΈ ΠΎΠ±Π·ΠΎΡΠ°Ρ
ΡΠ΄Π΅Π»ΡΠ΅ΡΡΡ ΡΠΊΡΠΏΡΠ΅ΡΡΠΈΠΈ PD-L1 Π² ΠΎΠΏΡΡ
ΠΎΠ»Π΅Π²ΡΡ
ΠΊΠ»Π΅ΡΠΊΠ°Ρ
. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΡΠΎ ΡΡΠΎ ΡΠ»ΡΡΠ°ΠΈ ΡΡΠΎΡΠ΅Π»ΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ°ΠΊΠ° Ρ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠΊΡΠΏΡΠ΅ΡΡΠΈΠ΅ΠΉ PD-L1 ΠΌΠΎΠ³ΡΡ ΠΈΠΌΠ΅ΡΡ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ Π²ΡΠ³ΠΎΠ΄Ρ ΠΏΡΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ PD-L1 Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ Π΄Π»Ρ ΠΎΡΠ±ΠΎΡΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠΈ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π΅ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
Π½ΠΎΠ²ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠΉ. Π Π΄Π°Π½Π½ΠΎΠΌ ΠΎΠ±Π·ΠΎΡΠ΅ ΠΌΡ ΠΎΠ±ΡΡΠΆΠ΄Π°Π΅ΠΌ ΡΡΠ°ΡΡΡ ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ PD-L1 ΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅ΠΌ Π½ΠΎΠ²ΡΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΠΎ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΈΠ²Π½ΡΡ
Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠ°Ρ
ΠΏΡΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ ICI-ΡΠ΅ΡΠ°ΠΏΠΈΠΈ: ΡΠ°ΠΊΡΠΎΡΡ ΠΏΡΠΎΡΠΈΠ²ΠΎΠΎΠΏΡΡ
ΠΎΠ»Π΅Π²ΠΎΠ³ΠΎ ΠΈΠΌΠΌΡΠ½ΠΈΡΠ΅ΡΠ°, ΠΌΡΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ Π½Π°Π³ΡΡΠ·ΠΊΡ ΠΈ ΡΠΈΠ³Π½Π°ΡΡΡΡ Π³Π΅Π½ΠΎΠ², ΠΌΠΈΠΊΡΠΎΡΠ°ΡΠ΅Π»Π»ΠΈΡΠ½ΡΡ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΡ ΠΈ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΡΠ΅ ΠΏΠΎΠ΄ΡΠΈΠΏΡ ΡΠ°ΠΊΠ° ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ
ΠΡΠ²Π΅Ρ Π½Π° ΡΠ΅ΡΠ΅Π½Π·ΠΈΡ ΠΊ ΡΡΠ°ΡΡΠ΅ "Π Π°Π½Π½Π΅Π΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° ΠΏΠΎΡΠ»Π΅ ΡΠΊΡΡΡΠ°ΠΏΠ΅ΡΠΈΡΠΎΠ½Π΅ΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΡΠ°ΡΡΠΊΡΠΎΠΌΠΈΠΈ"
.Β Β ΠΠ»ΡΠ±ΠΎΠΊΠΎΡΠ²Π°ΠΆΠ°Π΅ΠΌΡΠ΅ ΠΊΠΎΠ»Π»Π΅Π³ΠΈ!Β Β Β Β Β Β Β Β Β Β Β Β ΠΡ ΡΠΎΠ²Π΅ΡΡΠ΅Π½Π½ΠΎ ΡΠΎΠ³Π»Π°ΡΠ½Ρ, ΡΡΠΎ ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΊΠΎΠ³ΠΎΡΡΡ β Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΠΊ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ, ΠΎΠ΄Π½Π°ΠΊΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ Ρ Π³ΡΡΠΏΠΏΠΎΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π±ΠΎΠ»Π΅Π΅ ΠΏΠΎΠ·Π΄Π½ΠΈΠΌ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° Π½Π΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΏΠΎ ΠΏΡΠΈΡΠΈΠ½Π΅ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π½Π΅ΠΎΠ΄Π½ΠΎΡΠΎΠ΄Π½ΠΎΡΡΠΈ Π³ΡΡΠΏΠΏ ΠΏΠΎ ΠΏΡΠΈΡΠΈΠ½Π΅ ΡΠ°Π·Π½ΠΎΠΉ ΡΠ΅Ρ
Π½ΠΈΠΊΠΈ (Π² ΠΏΠΎΡΠ»Π΅Π΄Π½Π΅ΠΌ ΡΠ»ΡΡΠ°Π΅ Π±ΠΎΠ»ΡΠ½ΡΠ΅ ΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π»ΠΈΡΡ Π² ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΌ ΡΡΠ΅Π·Π±ΡΡΡΠΈΠ½Π½ΠΎ) ΠΈ ΡΠ°Π·Π½ΡΠΌ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌ (Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠΎΠΊΠ°Ρ ΡΡΠ°Π΄ΠΈΡ, Π½ΠΈΠ·ΠΊΠ°Ρ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΊΠ° ΠΈ Ρ.ΠΏ.).Β Β Β Β Β Β Β Β Β Β ΠΠ΅ΠΉΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎ,Β ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΡΠ°Π½Π½ΠΈΠ΅ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ Π½Π΅ ΡΠ²Π»ΡΠ»ΠΈΡΡ ΠΎΡΠ½ΠΎΠ²Π½ΡΠΌΠΈ ΠΈ ΠΏΡΠΈΠ²Π΅Π΄Π΅Π½Ρ ΠΎΠ½ΠΈ Π² ΡΡΠ°ΡΡΠ΅ Π΄Π»Ρ ΠΎΡΠΎΠ±ΡΠ°ΠΆΠ΅Π½ΠΈΡ ΡΠΎΠ³ΠΎ, ΡΡΠΎ Π½Π΅ΠΊΠΎΡΠΎΡΡΠ΅ ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠΎΠΌΠ΅Π½ΡΡ (Π½Π°ΠΏΡΠΈΠΌΠ΅Ρ, ΡΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΠ΅ ΡΠ΅ΠΉΠΊΠΈ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ, Π½Π΅ΡΠ²ΠΎΡΠ±Π΅ΡΠ΅ΠΆΠ΅Π½ΠΈΠ΅ ΠΈΒ ΠΏΡΠΎΡΠ΅Π΅) ΠΌΠΎΠ³ΡΡ ΠΎΠΊΠ°Π·Π°ΡΡ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ (Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΡΡΠ½ΠΊΡΠΈΡ Π²Π΅Π·ΠΈΠΊΠΎΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π° ΠΏΠΎΡΠ»Π΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΡ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ°) ΠΈ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ (ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ, ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΡΠ°Ρ, ΠΈ Ρ.ΠΏ.).Β Β Β Β Β Β Β Β ΠΠ°ΡΠ°ΡΠ΅Π»ΡΠ½ΠΎ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ ΡΠ²ΡΠ·Π°Π½Π½ΡΠ΅ Ρ ΡΠ°Π½Π½ΠΈΠΌ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ΠΌ Π£Π ΠΎΡΠΌΠ΅ΡΠ΅Π½Ρ Ρ 5 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (17,9%), ΡΡΠΎ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΠ΅Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉΒ ECaRemAΒ (11%) ΠΈΒ RiprecaΒ (13,9%)
ΠΡΠΎΠ³ΡΠ°ΠΌΠΌΠ° ΡΠ°Π½Π½Π΅Π³ΠΎ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΌ Ρ ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ ΡΠ°ΠΊΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ: ΠΎΠΏΡΡ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ°
Background. Currently, there are sufficient data on the favorable role of fast track program on the course of postoperative period. Nevertheless, the role of these protocols being already included in the standards of the surgical treatment of many cancers is not clear to date in oncourology in general and in the prostate cancer (PC).Objective: to determine the effect of fast track program elements for the results of treatment in patients after radical prostatectomy.Materials and methods. 86 radical minimally invasive (laparoscopic or endoscopic extraperitoneal) prostatectomies were performed for prostate cancer in the period from May 2015 to February 2016 in the Oncological Research Institute named after N.N. Petrov. Patients were divided into 2 groups: in patients of the 1st (n = 44) group included those with traditional surgical management fast track elements were not used at all or were used partly; in the 2nd group (n = 42) these elements were used in a whole volume. We have assessed an influence of fast track elements on the frequency of perioperative and early postoperative complications, operative time, duration of the hospitalization and duration of the stay in intensive care unit, frequency of the repeated surgical interventions, and frequency of the repeated hospitalizations within 30 days of the postoperative period.Results. The presence and the absence of preoperative preparation did not affect an incidence of intraoperative complications. Intraoperative blood loss did not lead to blood transfusions. There were no significant differences in the incidence of 30-day complications between groups. WhenΒ evaluating postoperative parameters there was difference between 1st and 2nd groups in the pelvis drainage (3.3 and 0.9 days, respectively, p = 0.002), an average duration of catheterization (11.2 and 5.2 days, respectively, p = 0.0003) and duration of hospitalization (15.1 and 6.5 days, respectively, p = 0.0008).Conclusion. Application of fast track program of perioperative management of patients with prostate cancer does not affect the frequency of intraand postoperative complications, but economically it is potentially more feasible, primarily by reducing the term of the patient stay in hospital.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΡΡΡΠ΅ΡΡΠ²ΡΠ΅Ρ Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ Π΄Π°Π½Π½ΡΡ
ΠΎ Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠΉ ΡΠΎΠ»ΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ ΡΠ°Π½Π½Π΅Π³ΠΎ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ (fast track) Π½Π° ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π°. Π’Π΅ΠΌ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ ΡΠΎΠ»Ρ ΡΡΠΈΡ
ΠΏΡΠΎΡΠΎΠΊΠΎΠ»ΠΎΠ², ΡΠΆΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½Π½ΡΡ
Π² ΡΡΠ°Π½Π΄Π°ΡΡΡ ΠΏΡΠΈ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΌΠ½ΠΎΠ³ΠΈΡ
ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ, Π½Π° ΡΠ΅Π³ΠΎΠ΄Π½ΡΡΠ½ΠΈΠΉ Π΄Π΅Π½Ρ Π² ΠΎΠ½ΠΊΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Π² ΡΠ΅Π»ΠΎΠΌ ΠΈ ΠΏΡΠΈ ΡΠ°ΠΊΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ (Π ΠΠ) Π² ΡΠ°ΡΡΠ½ΠΎΡΡΠΈ Π½Π΅ ΡΡΠ½Π°.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ Π²Π»ΠΈΡΠ½ΠΈΠ΅ ΡΠ»Π΅ΠΌΠ΅Π½ΡΠΎΠ² ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ fast track Π½Π° ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠΎΡΠ»Π΅ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΡΠ°ΡΡΠΊΡΠΎΠΌΠΈΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ ΠΌΠ°Ρ 2015 Π³. ΠΏΠΎ ΡΠ΅Π²ΡΠ°Π»Ρ 2016 Π³. Π² ΠΠΠ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΈΠΌ. Π.Π. ΠΠ΅ΡΡΠΎΠ²Π° ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ 86 ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΡΡ
ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΠΎ ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΡ
(Π»Π°ΠΏΠ°ΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΠ»ΠΈ Π²Π½Π΅Π±ΡΡΡΠΈΠ½Π½ΡΡ
ΡΠ½Π΄ΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
) ΠΏΡΠΎΡΡΠ°ΡΡΠΊΡΠΎΠΌΠΈΠΉ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ Π ΠΠ. ΠΠΎΠ»ΡΠ½ΡΠ΅ Π±ΡΠ»ΠΈ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° 2 Π³ΡΡΠΏΠΏΡ: Π² 1-ΠΉ Π³ΡΡΠΏΠΏΠ΅ (n = 44) ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π²Π΅Π΄Π΅Π½ΠΈΡ ΡΠ»Π΅ΠΌΠ΅Π½ΡΡ fast track Π½Π΅ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ»ΠΈ ΡΠΎΠ²ΡΠ΅ΠΌ ΠΈΠ»ΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΡΠ°ΡΡΠΈΡΠ½ΠΎ; Π²ΠΎ 2-ΠΉ (n = 42) β Π² ΠΏΠΎΠ»Π½ΠΎΠΌ ΠΎΠ±ΡΠ΅ΠΌΠ΅. ΠΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠΉ fast track Π½Π° ΡΠ°ΡΡΠΎΡΡ ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΈ ΡΠ°Π½Π½ΠΈΡ
ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, ΡΡΠΎΠΊΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΈ Π½Π°Ρ
ΠΎΠΆΠ΄Π΅Π½ΠΈΡ Π² ΠΎΡΠ΄Π΅Π»Π΅- Π½ΠΈΠΈ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΡΠ°ΡΡΠΎΡΡ ΠΏΠΎΠ²ΡΠΎΡΠ½ΡΡ
Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ², Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΠΎΠ²ΡΠΎΡΠ½ΡΡ
Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΉ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 30 Π΄Π½Π΅ΠΉ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π°.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ°Π»ΠΈΡΠΈΠ΅ ΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΏΠΎΠ΄Π³ΠΎΡΠΎΠ²ΠΊΠΈ Π½Π΅ ΠΏΠΎΠ²Π»ΠΈΡΠ»ΠΈ Π½Π° ΡΠ°ΡΡΠΎΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ. ΠΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½Π°Ρ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΡ Π½Π΅ ΠΏΡΠΈΠ²Π΅Π»Π° ΠΊ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π³Π΅ΠΌΠΎΡΡΠ°Π½ΡΡΡΠ·ΠΈΠΉ. ΠΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ Π² ΡΠ°ΡΡΠΎΡΠ΅ ΡΠ°Π·Π²ΠΈΡΠΈΡ 30-Π΄Π½Π΅Π²Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ Π½Π΅ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈ. ΠΡΠΈ ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΎΡΠΌΠ΅ΡΠ΅Π½Π° ΡΠ°Π·Π½ΠΈΡΠ° ΠΌΠ΅ΠΆΠ΄Ρ 1-ΠΉ ΠΈ 2-ΠΉ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ Π² Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π΄ΡΠ΅Π½ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ°Π·Π° (3,3 ΠΈ 0,9 ΡΡΡ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ, p = 0,002), ΡΡΠ΅Π΄Π½Π΅ΠΉ Π΄Π»ΠΈ- ΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΠΈ (11,2 ΠΈ 5,2 ΡΡΡ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ, p = 0,0003) ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ (15,1 ΠΈ 6,5 ΡΡΡ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ, p = 0,0008).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΏΡΠΈΠ½ΡΠΈΠΏΠΎΠ² ΡΡΠΊΠΎΡΠ΅Π½Π½ΠΎΠΉ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ ΠΏΠ΅ΡΠΈΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (fast track) ΠΏΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
Π ΠΠ Π½Π΅ Π²Π»ΠΈΡΠ΅Ρ Π½Π° ΡΠ°ΡΡΠΎΡΡ ΠΈΠ½ΡΡΠ°- ΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, ΠΎΠ΄Π½Π°ΠΊΠΎ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈ Π±ΠΎΠ»Π΅Π΅ ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎ ΠΏΡΠ΅ΠΆΠ΄Π΅ Π²ΡΠ΅Π³ΠΎ Π·Π° ΡΡΠ΅Ρ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ ΡΡΠΎΠΊΠ° Π½Π°Ρ
ΠΎΠΆΠ΄Π΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ Π² ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ΅
Effect of taxanes on the miR-106 and miR-200c expression in prostate cancer cells in vivo and in vitro
Introduction. A combination of antiandrogen and cytostatic drugs was justified in the neoadjuvant therapy of patients with high-risk prostate cancer (HiRPCa) in some clinical trials. The effectiveness of such therapy in each individual case depends on the sensitivity of cancer cells to the applied drugs. It makes possible the development of the new technologies to personalize therapeutic approach. MicroRNAs (miRNAs) are a class of regulatory molecules whose expression is altered in PCa cells and can be associated with the sensitivity/resistance of cancer cells to specific cytostatics, for instance, taxanes.Objective. To identify the potential-marker miRNAs of PCa cells sensitivity to taxanes.Materials and methods. Samples of PCa tissue (n. 56) obtained from patients underwent neo-adjuvant therapy (antiandrogen and taxanes) and radical prostatectomy; PCa cell lines (PC-3, DU-145, LNCap). Total RNAs isolation was carried out using miRNeasy FFPE Kit, LRU-100-50; miRCURY LNA miRNA Focus PCR Panel, All-MIR kits were used for semi-quantitative analysis of potentially marker microRNA molecules using sequential reverse transcription and PCR.Results. The effect of taxanes on PCa cells is associated with up-regulation of miR-106b expression and down-regulation of miR-200c expression in both in vivo and in vitro conditions.Conclusion. MiR-106b and miR-200c miRNAs are involved in the response of PCa cells to taxanes, and therapeutic modification of these molecules in PCa cells may present a potential strategy to increase their sensitivity to taxane-containing therapy. Appropriate innovative technology may be in demand in the treatment of HiRPCa-patients
Π Π°Π½Π½Π΅Π΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° ΠΏΠΎΡΠ»Π΅ ΡΠΊΡΡΡΠ°ΠΏΠ΅ΡΠΈΡΠΎΠ½Π΅ΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΡΠ°ΡΡΠΊΡΠΎΠΌΠΈΠΈ
Background. Extraperitoneal radical prostatectomy (RP) in patients with prostate cancer is useful when there are no oncological indications to lymph node dissection (e.g. in low and intermediate-low risk of the disease), and allows to perform precise anastomosis and facilitates the early postoperative period. However, even minimally invasive approach does not avoid such factors as a urinary catheter that may disturb patients.Objective. We assessed the possibility to remove the urinary catheter as early as possible.Materials and methods. 28 patients with low (n = 22) and low-intermediate (n = 6) prostate cancer risk (according to NCCN (National Comprehensive Cancer Network) criteria) underwent an extraperitoneal laparoscopic RP from March 2017 to November 2018. All operations were performed by the same surgeon (A. Nosov). The inclusion criteria were the following: localized prostate cancer, prostate specific antigen (PSA) <10 ng/ml, ISUP group 1β2, life expectancy of more than 10 years and preoperative patientβs counseling (awareness about early catheter removal and discharge). All patients were continent before surgery. During surgery, the prostate and seminal vesicles were removed extraperitoneally without peritoneal cavity opening and conversion. Bladder neck sparing was performed in all cases but nerve-vascular bundles were spared according to indication (preoperative International Index of Erectile Function (IIEF), oncological reasons). Vesicourethral anastomosis was performed by two V-Loc circular sutures. No drainage tubes were inserted to control bleeding/urinary leakage. A urinary catheter Foley 20 Fr was inserted into the bladder after anastomosis completion. No other urinary drainage (suprapubic tubes, etc) was used. Anastomosis resistance and completeness were checked at the end of surgery by filling the bladder with 150 ml of saline through the catheter. Except for cases with macroscopic hematuria, urinary catheters were removed on the 1st postoperative dayβs morning (<24 hours) with an active followup (daily voiding assessment, pelvic ultrasound and postvoided residual volume assessment) on Day 1. Immediately after the catheter removal, alpha-blockers (for urination alleviation) and PDE-5 inhibitors (in patients with neurovascular sparing) were prescribed. All patients were available for a 3-month follow-up. During the follow-up, a monthly combined assessment was performed, including IPSS, QoL, PSA analysis, pelvic ultrasound and urofloumetry.Results. The average patientβs age was 63 years (52β71 years). The median preoperative PSA level was 7.6 ng/ml. The intraoperative technique was unremarkable with no blood transfusion or conversion. All early postoperative complications were classified as minor β grade I, II and IIIa in 2 (7.2 %), 5 (17.8 %) and 1 (3.6 %) patients, respectively. Related to the early catheter removal complications included 1 (3.6 %) patient with urinary leakage (resolved by repeated prolonged urinary catheter insertion) and 4 (14.3 %) with urinary obstruction β resolved by single catheterization (n = 2), percutaneous suprapubic cystostomy (n = 2). No major complications were noticed during the follow-up. Totally, 22 (78.6 %) patients were discharged on the next day after the catheter removal β on the 2nd postoperative day. All discharged patients did not need readmission during the follow-up. Remained 6 (21.4 %) patients stayed at the hospital for 5β18 days. The pathological investigation showed upgrading in 9 (32.1 %) patients with low risk and in 1 (3.6 %) patient with low-intermediate risk. Upstaging to locally advanced forms was noticed in 6 (21.4 %) patients. All patients had the PSA level of <0.2 ng/ml 30β90 days after surgery. Postoperative assessment showed improvement in urinary function and erectile function sparing in selected patients, with no compromising functional results due to the early catheter removal.Conclusion. Despite the common widespread of minimally invasive RP, there is no consensus on the terms of a urinary catheter removal. According to our data, we suggested it might be of some benefit to remove a urinary catheter early in selected and well-informed patients. A thorough vesicourethral anastomosis pursuance, nerve-sparing, bladder neck sparing and Retzius sparing procedure, intraand postoperative assessment is necessary in all cases.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΠΊΡΡΡΠ°ΠΏΠ΅ΡΠΈΡΠΎΠ½Π΅Π°Π»ΡΠ½Π°Ρ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½Π°Ρ ΠΏΡΠΎΡΡΠ°ΡΡΠΊΡΠΎΠΌΠΈΡ (Π ΠΠ) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ°ΠΊΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅ΡΡΡ ΠΏΡΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠΉ Π΄Π»Ρ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΡΠ°Π·ΠΎΠ²ΠΎΠΉ Π»ΠΈΠΌΡΠ°Π΄Π΅Π½ΡΠΊΡΠΎΠΌΠΈΠΈ, Ρ. Π΅. ΠΏΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΈ Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ ΠΈ ΠΏΡΠΎΠΌΠ΅ΠΆΡΡΠΎΡΠ½ΠΎΠ½ΠΈΠ·ΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ°. ΠΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΠΎ ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΠ΅ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΏΡΠΈ Π΅Π΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡ ΠΎΡΡΡΠ΅ΡΡΠ²ΠΈΡΡ ΠΏΡΠ΅ΡΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠ΅ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π²Π΅Π·ΠΈΠΊΠΎΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π° ΠΈ Π·Π°ΡΠ°ΡΡΡΡ ΠΎΠ±Π»Π΅Π³ΡΠΈΡΡ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΡΠ°Π½Π½Π΅Π³ΠΎ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π°. Π’Π΅ΠΌ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ Π΄Π°ΠΆΠ΅ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΠΎ ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ Π½Π΅ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΈΠ·Π±Π΅ΠΆΠ°ΡΡ ΡΠ°ΠΊΡΠΎΡΠΎΠ², ΡΡ
ΡΠ΄ΡΠ°ΡΡΠΈΡ
ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅, ΡΠ°ΠΊΠΈΡ
ΠΊΠ°ΠΊ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΡΠΉ ΠΊΠ°ΡΠ΅ΡΠ΅Ρ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΊΠ° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΡΠ΄Π°Π»Π΅Π½ΠΈΡ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° Π² ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎ ΡΠ°Π½Π½ΠΈΠ΅ ΡΡΠΎΠΊΠΈ ΠΏΠΎΡΠ»Π΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π ΠΠ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π‘ ΠΌΠ°ΡΡΠ° 2017 Π³. ΠΏΠΎ Π½ΠΎΡΠ±ΡΡ 2018 Π³. Π² ΠΠΠΠ¦ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΈΠΌ. Π. Π. ΠΠ΅ΡΡΠΎΠ²Π° 28 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ ΡΠ°ΠΊΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ (n = 22) ΠΈ ΠΏΡΠΎΠΌΠ΅ΠΆΡΡΠΎΡΠ½ΠΎ-Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ (n = 6) ΡΠΈΡΠΊΠ° (ΡΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ NCCN (National Comprehensive Cancer Network)) Π±ΡΠ»Π° ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΡΠΊΡΡΡΠ°ΠΏΠ΅ΡΠΈΡΠΎΠ½Π΅Π°Π»ΡΠ½Π°Ρ Π»Π°ΠΏΠ°ΡΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠ°Ρ Π ΠΠ. ΠΡΠ΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Ρ ΠΎΠ΄Π½ΠΈΠΌ Ρ
ΠΈΡΡΡΠ³ΠΎΠΌ (Π. Π. ΠΠΎΡΠΎΠ²). ΠΡΠΈΡΠ΅ΡΠΈΡΠΌΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ²ΠΈΠ»ΠΈΡΡ Π»ΠΎΠΊΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΠΉ ΡΠ°ΠΊ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, ΡΡΠΎΠ²Π΅Π½Ρ ΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠ³Π΅Π½Π° (ΠΠ‘Π) <10 Π½Π³ / ΠΌΠ», ΡΡΠΌΠΌΠ° Π±Π°Π»Π»ΠΎΠ² ΠΏΠΎ ΡΠΊΠ°Π»Π΅ ΠΠ»ΠΈΡΠΎΠ½Π° β€7, ΠΎΠΆΠΈΠ΄Π°Π΅ΠΌΠ°Ρ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΆΠΈΠ·Π½ΠΈ Π±ΠΎΠ»Π΅Π΅ 10 Π»Π΅Ρ ΠΈ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ΅ ΠΊΠΎΠ½ΡΡΠ»ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° (ΠΎΡΠ²Π΅Π΄ΠΎΠΌΠ»Π΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΎ ΡΠ°Π½Π½Π΅ΠΌ ΡΠ΄Π°Π»Π΅Π½ΠΈΠΈ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ°). ΠΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΏΠ΅ΡΠ΅Π΄ Π ΠΠ ΠΏΠΎΠ»Π½ΠΎΡΡΡΡ ΡΠ΄Π΅ΡΠΆΠΈΠ²Π°Π»ΠΈ ΠΌΠΎΡΡ. Π Ρ
ΠΎΠ΄Π΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΡΠΊΡΡΡΠ°ΠΏΠ΅ΡΠΈΡΠΎΠ½Π΅Π°Π»ΡΠ½ΠΎΠ΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
ΠΏΡΠ·ΡΡΡΠΊΠΎΠ², Π²ΠΎ Π²ΡΠ΅Ρ
ΡΠ»ΡΡΠ°ΡΡ
Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΡΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΠ΅ ΡΠ΅ΠΉΠΊΠΈ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ ΠΈ ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠΉ (Π½ΠΎΡΠΌΠ°Π»ΡΠ½Π°Ρ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½Π°Ρ ΡΡΠ½ΠΊΡΠΈΡ ΠΏΠΎ ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠ° ΠΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΈΠ½Π΄Π΅ΠΊΡΠ° ΡΡΠ΅ΠΊΡΠΈΠ»ΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ (ΠΠΠΠ€-5), ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΡΡΠΈΠ΅ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ) Π½Π΅ΡΠ²ΠΎΡΠ±Π΅ΡΠ΅ΠΆΠ΅Π½ΠΈΠ΅. Π€ΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π²Π΅Π·ΠΈΠΊΠΎΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π°, ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΈ ΠΏΡΠ΅ΡΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΡΡΡ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ ΡΡΠΈΡΠ°Π»ΠΈΡΡ ΠΊΠ»ΡΡΠ΅Π²ΡΠΌ ΠΌΠΎΠΌΠ΅Π½ΡΠΎΠΌ Π² Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΡΠ°Π½Π½Π΅Π³ΠΎ ΡΠ΄Π°Π»Π΅Π½ΠΈΡ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ°, ΠΎΡΡΡΠ΅ΡΡΠ²Π»ΡΠ»ΠΈ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΡΠΈΡΠΊΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ ΡΠ²Π° Π½ΠΈΡΡΠΌΠΈ V-Loc. ΠΠΎΡΠ»Π΅ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π° Π΅Π³ΠΎ Π³Π΅ΡΠΌΠ΅ΡΠΈΡΠ½ΠΎΡΡΡ ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Π²Π²Π΅Π΄Π΅Π½ΠΈΠ΅ΠΌ ΠΏΠΎ ΡΡΡΠ°Π½Π°Π²Π»ΠΈΠ²Π°Π΅ΠΌΠΎΠΌΡ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠΌΡ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΡ Π€ΠΎΠ»Π΅Ρ β 20 Ch 150 ΠΌΠ» ΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ°ΡΡΠ²ΠΎΡΠ°. ΠΡΡΠ³ΠΈΠ΅ ΠΌΠΎΡΠ΅Π²ΡΠ΅ / ΡΡΡΠ°Ρ
ΠΎΠ²ΡΠ΅ Π΄ΡΠ΅Π½Π°ΠΆΠΈ Π½Π΅ ΡΡΡΠ°Π½Π°Π²Π»ΠΈΠ²Π°Π»ΠΈ. ΠΠ° ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠ»ΡΡΠ°Π΅Π² ΠΌΠ°ΠΊΡΠΎΠ³Π΅ΠΌΠ°ΡΡΡΠΈΠΈ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΡΠΉ ΠΊΠ°ΡΠ΅ΡΠ΅Ρ ΡΠ΄Π°Π»ΡΠ»ΠΈ Π½Π° 1βΠ΅ ΡΡΡΠΊΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π° (<24 Ρ) Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ Π°ΠΊΡΠΈΠ²Π½ΡΠΌ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ΠΌ Π·Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΌ β ΡΡΠ±ΡΠ΅ΠΊΡΠΈΠ²Π½Π°Ρ ΠΈ ΠΎΠ±ΡΠ΅ΠΊΡΠΈΠ²Π½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ° ΠΌΠΎΡΠ΅ΠΈΡΠΏΡΡΠΊΠ°Π½ΠΈΡ (Π΄Π½Π΅Π²Π½ΠΈΠΊ ΠΌΠΎΡΠ΅ΠΈΡΠΏΡΡΠΊΠ°Π½ΠΈΠΉ, ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ΅ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΌΠΎΡΠΈ). Π‘ΡΠ°Π·Ρ ΠΏΠΎΡΠ»Π΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΡ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° Π½Π°Π·Π½Π°ΡΠ°Π»ΠΈ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΡ Π€ΠΠ-5 (ΠΏΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ Π½Π΅ΡΠ²ΠΎΡΠ±Π΅ΡΠ΅Π³Π°ΡΡΠ΅ΠΉ Π ΠΠ) ΠΈ Ξ±-Π°Π΄ΡΠ΅Π½ΠΎΠ±Π»ΠΎΠΊΠ°ΡΠΎΡΡ. ΠΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ Π΄ΠΎΡΡΡΠΏΠ½Ρ Π΄Π»Ρ 3βΠΌΠ΅ΡΡΡΠ½ΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ. Π ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ Π΅ΠΆΠ΅ΠΌΠ΅ΡΡΡΠ½ΡΡ ΠΎΡΠ΅Π½ΠΊΡ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ: Π°Π½Π°Π»ΠΈΠ· ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠΎΠ² IPSS, QoL, ΡΡΠΎΠ²Π½Ρ ΠΠ‘Π, ΠΎΡΠ΅Π½ΠΊΡ ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΌΠΎΡΠΈ, ΡΡΠΎΡΠ»ΠΎΡΠΌΠ΅ΡΡΠΈΡ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎΡΡΠ°Π²ΠΈΠ» 63 Π³ΠΎΠ΄Π° (52β71 Π³ΠΎΠ΄). Π‘ΡΠ΅Π΄Π½ΠΈΠΉ ΡΡΠΎΠ²Π΅Π½Ρ ΠΠ‘Π ΠΏΠ΅ΡΠ΅Π΄ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ΠΌ Π ΠΠ β 7,6 Π½Π³ / ΠΌΠ». ΠΠΎ Π²ΡΠ΅ΠΌΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π½ΠΈ Ρ ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π½Π΅ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎΡΡ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π³Π΅ΠΌΠΎΡΡΠ°Π½ΡΡΡΠ·ΠΈΠΈ ΠΈΠ»ΠΈ ΠΊΠΎΠ½Π²Π΅ΡΡΠΈΠΈ. Π ΡΡΠΈΠ½Π½Π°Ρ ΡΠΈΡΡΠΎΠ³ΡΠ°ΡΠΈΡ ΠΏΠ΅ΡΠ΅Π΄ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ΠΌ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° Π½Π΅ Π²ΡΠΏΠΎΠ»Π½ΡΠ»Π°ΡΡ. ΠΡΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΡΠ°Π½Π½Π΅Π³ΠΎ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π° ΠΎΡΠ½Π΅ΡΠ΅Π½Ρ ΠΊ Π½Π΅Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠΌ I, II ΠΈ IIIa ΡΡΠ΅ΠΏΠ΅Π½ΡΠΌ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ Ρ 2 (7,2 %), 5 (17,8 %) ΠΈ 1 (3,6 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°. Π‘Π²ΡΠ·Π°Π½Π½ΡΠ΅ Ρ ΡΠ°Π½Π½ΠΈΠΌ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ΠΌ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ Π²ΠΊΠ»ΡΡΠ°Π»ΠΈ Π·Π°ΡΠ΅ΠΊ ΠΌΠΎΡΠΈ ΠΈΠ· Π·ΠΎΠ½Ρ Π²Π΅Π·ΠΈΠΊΠΎΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π° (Ρ 1 (3,6 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΡΠ°Π·ΡΠ΅ΡΠ΅Π½ΠΎ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΉ ΡΡΡΠ°Π½ΠΎΠ²ΠΊΠΎΠΉ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° ΠΈ ΠΏΡΠΎΠ»ΠΎΠ½Π³ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΠ΅ΠΉ) ΠΈ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΡ ΠΌΠΎΡΠ΅ΠΈΡΠΏΡΡΠΊΠ°Π½ΠΈΡ (Ρ 4 (14,3 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΈΠ· Π½ΠΈΡ
2 Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° ΠΏΠΎΠ²ΡΠΎΡΠ½Π°Ρ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΡ ΠΈ 2 β ΡΡΠΎΠ°ΠΊΠ°ΡΠ½Π°Ρ ΡΠΏΠΈΡΠΈΡΡΠΎΡΡΠΎΠΌΠΈΡ). ΠΠ° ΡΠ»Π΅Π΄ΡΡΡΠΈΠΉ Π΄Π΅Π½Ρ ΠΏΠΎΡΠ»Π΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΡ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° (2βΠΉ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ Π΄Π΅Π½Ρ) Π±ΡΠ»ΠΈ Π²ΡΠΏΠΈΡΠ°Π½Ρ 22 (78,6 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°. ΠΠΎΠ²ΡΠΎΡΠ½ΡΡ
Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΉ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΡΠΎΠΉ Π³ΡΡΠΏΠΏΡ Π½Π΅ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎΡΡ. Π£ 6 (21,4 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 5β18 Π΄Π½Π΅ΠΉ. ΠΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ΅ Π·Π°Π½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΊΠΈ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Ρ 9 (32,1 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠ· Π³ΡΡΠΏΠΏΡ Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΈ Ρ 1 (3,6 %) Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ ΠΈΠ· Π³ΡΡΠΏΠΏΡ ΠΏΡΠΎΠΌΠ΅ΠΆΡΡΠΎΡΠ½ΠΎ-Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ. Π 6 ΡΠ»ΡΡΠ°ΡΡ
ΠΈΠ·Π½Π°ΡΠ°Π»ΡΠ½ΠΎ Π»ΠΎΠΊΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΠΉ ΠΏΡΠΎΡΠ΅ΡΡ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈ ΠΎΡΠ΅Π½Π΅Π½ ΠΊΠ°ΠΊ ΠΌΠ΅ΡΡΠ½ΠΎ-ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΠΉ Ρ ΠΈΠ½Π²Π°Π·ΠΈΠ΅ΠΉ Π² ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΠΏΡΠ·ΡΡΡΠΊΠΈ (n = 2) ΠΈΠ»ΠΈ Ρ ΡΠΊΡΡΡΠΎΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΠ΅ΠΌ (n = 4). ΠΡΠ΅ ΠΏΡΠΎΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈΠΌΠ΅Π»ΠΈ ΡΡΠΎΠ²Π΅Π½Ρ ΠΠ‘Π <0,2 Π½Π³ / ΠΌΠ» Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 90 Π΄Π½Π΅ΠΉ ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ. ΠΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ° ΠΏΠΎΠΊΠ°Π·Π°Π»Π° ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΌΠΎΡΠ΅ΠΈΡΠΏΡΡΠΊΠ°Π½ΠΈΡ ΠΈ Ρ ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΠ΅ ΡΡΠ΅ΠΊΡΠΈΠ»ΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠΎΡΠ»Π΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π ΠΠ Ρ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΌ Π²Π΅Π΄Π΅Π½ΠΈΠ΅ΠΌ ΠΏΠΎ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π½ΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ΅.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅Ρ
Π½ΠΈΠΊΠΈ ΠΈ ΡΠΈΡΠΎΠΊΠΎΠ΅ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΠ΅ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΠΎ ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π° Π² Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΡΠ°ΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, Π΅Π΄ΠΈΠ½ΠΎΠ³ΠΎ ΠΌΠ½Π΅Π½ΠΈΡ ΠΎ ΡΡΠΎΠΊΠ°Ρ
ΡΠ΄Π°Π»Π΅Π½ΠΈΡ ΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° Π½Π΅Ρ. ΠΠ°ΡΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ, ΡΡΠΎ ΠΏΡΠΈ Π°Π΄Π΅ΠΊΠ²Π°ΡΠ½ΠΎΠΌ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ Π²Π΅Π·ΠΈΠΊΠΎΡΡΠ΅ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π° Ρ ΡΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠ΅ΠΉΠΊΠΈ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ, ΡΠ΅ΡΡΠΈΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π°, ΠΏΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ Π½Π΅ΡΠ²ΠΎΡΠ±Π΅ΡΠ΅ΠΆΠ΅Π½ΠΈΡ, ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΌ ΠΏΡΠ΅ΡΠΈΠ·ΠΈΠΎΠ½Π½ΠΎΠΌ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π°, ΠΎΠ±ΡΠ·Π°ΡΠ΅Π»ΡΠ½ΠΎΠΌ ΠΈΠ½ΡΡΠ°ΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ ΠΈ Ρ ΠΏΡΠΎΠΈΠ½ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎ ΡΠ°Π½Π½Π΅Π΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ°
ΠΡΠΎΠ±Π»Π΅ΠΌΠ° Π²ΡΠ±ΠΎΡΠ° ΡΠ°ΠΊΡΠΈΠΊΠΈ Π²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΡΠ°ΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ: ΠΎΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ
Prostate cancer is the largest problem among the male population of the planet, despite the slow development of the disease, thousands of men die from this disease every year. Taking into account the following facts, we can say about the importance and relevance of this problem. This review highlights the results of different treatment strategies for high and very high risk prostate cancer.Π Π°ΠΊ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ΅ΡΡΠ΅Π·Π½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΠΉ ΡΡΠ΅Π΄ΠΈ ΠΌΡΠΆΡΠΊΠΎΠ³ΠΎ Π½Π°ΡΠ΅Π»Π΅Π½ΠΈΡ ΠΏΠ»Π°Π½Π΅ΡΡ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΌΠ΅Π΄Π»Π΅Π½Π½ΠΎΠ΅ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, ΠΊΠ°ΠΆΠ΄ΡΠΉ Π³ΠΎΠ΄ ΠΎΡ ΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΡΠΌΠΈΡΠ°ΡΡ ΡΡΡΡΡΠΈ ΠΌΡΠΆΡΠΈΠ½. ΠΠΎΡΡΠΎΠΌΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΡΠ°ΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ ΠΎΡΡΠ°Π΅ΡΡΡ Π²Π°ΠΆΠ½ΡΠΌ ΠΈ Π°ΠΊΡΡΠ°Π»ΡΠ½ΡΠΌ Π²ΠΎΠΏΡΠΎΡΠΎΠΌ. Π Π½Π°ΡΡΠΎΡΡΠ΅ΠΌ ΠΎΠ±Π·ΠΎΡΠ΅ ΠΎΡΠ²Π΅ΡΠ΅Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΉ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°ΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ°.
ΠΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Ρ ΠΈΠΌΠΈΠΎΠ³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ ΡΠ°ΠΊΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ°
Tolsotogo St., Saint Petersburg 197022, RussiaBackground. Prostate cancer (PCa) of a high and very high risk is a potentially fatal disease that requires an active multimodal approach, including the use of neoadjuvant drug treatment. As option for this treatment is neoadjuvant chemohormonal therapy (NCHT) followed by radical prostatectomy (RPE). However, data on the oncological results of treatment of such patients are still limited and the role of neoadjuvant therapy in the treatment of high and very high-risk PCa remains not fully understood.Objective: to assess the oncological results of treatment patients with localized and locally advanced PCa of high and very high risk after NCHT. Materials and methods. This was a prospective randomized study: patients with PCa of high and very high-risk groups (prostate specific antigen levels (PSA) >20 ng/ml and/or Gleason score Β³8 and/or clinical stage >T2c) were treated with RPE only (group RPE; n = 35) or NCHT followed by RPE (NCHT/RPE group; n = 36). The neoadjuvant course included the intravenous administration of docetaxel once every 21 days (75 mg/m2Β up to 6 cycles) and the antagonist of the gonadotropin releasing hormone degarelix according to the standard scheme (6 subcutaneous injections every 28 days). After a follow-up examination evaluating the result of the neoadjuvant regimen, patients underwent RPE with extanded lymphadenectomy.Results. A mean follow-up was 37.08 Β± 20.46 months. A statistically significant reduction of prostate specific antigen >50 % post-chemohormonal therapy was observed in all 36 cases. Lower postoperative stage was noticed in 38.5 % in NCHT/RPE group compared with 2.7 % in RPE group. Similarly, positive surgical margin rate was higher in group without neoadjuvant therapy β 40 and 25 % (RPE group). Cancerspecific survival was 97.2 % in NCHT/RPE group and 87.56 % in the RP group (p = 0.037), cancer specific survival rate β 91.4 % and 97.2 % respectively (log-rank test p = 0.22). At the same time, no statistically significant differences were obtained in 3-year recurrence free survival between groups: 38.8 % in NCHT/RPE group versus 43.6 % in the RPE group (log-rank test p = 0.36).Conclusion. Conducting NCHT before RPE is a safe and effective strategy in patients with PCa of high and very high risk groups and could improve oncological results.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π Π°ΠΊ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ (Π ΠΠ) Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° β ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅, ΡΡΠ΅Π±ΡΡΡΠ΅Π΅ Π°ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΌΡΠ»ΡΡΠΈΠΌΠΎΠ΄Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π°, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ. ΠΠ°ΡΠΈΠ°Π½ΡΠΎΠΌ ΡΠ°ΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Ρ
ΠΈΠΌΠΈΠΎΠ³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΠ₯ΠΠ’) Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΡΠ°ΡΡΠΊΡΠΎΠΌΠΈΠΈ (Π ΠΠ). ΠΠ΄Π½Π°ΠΊΠΎ Π΄Π°Π½Π½ΡΠ΅ ΠΎΠ± ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°Ρ
Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°ΠΊΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½Ρ ΠΈ ΡΠΎΠ»Ρ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π ΠΠ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΎΡΡΠ°Π΅ΡΡΡ Π΄ΠΎ ΠΊΠΎΠ½ΡΠ° Π½Π΅ ΠΈΠ·ΡΡΠ΅Π½Π½ΠΎΠΉ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΈΡΡ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π»ΠΎΠΊΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΠΌ ΠΈ ΠΌΠ΅ΡΡΠ½ΠΎ-ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΠΌ Π ΠΠ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΏΠΎΡΠ»Π΅ ΠΠ₯ΠΠ’.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΡΠ°ΠΌΠΊΠ°Ρ
ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ Π ΠΠ Π³ΡΡΠΏΠΏ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° (ΡΡΠΎΠ²Π΅Π½Ρ ΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠ³Π΅Π½Π° >20 Π½Π³/ΠΌΠ», ΠΈ/ΠΈΠ»ΠΈ ΡΡΠΌΠΌΠ° Π±Π°Π»Π»ΠΎΠ² ΠΏΠΎ ΡΠΊΠ°Π»Π΅ ΠΠ»ΠΈΡΠΎΠ½Π° Β³8, ΠΈ/ΠΈΠ»ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΡΠ°Π΄ΠΈΡ >T2c) ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π² ΠΎΠ±ΡΠ΅ΠΌΠ΅ ΡΠΎΠ»ΡΠΊΠΎ Π ΠΠ (Π³ΡΡΠΏΠΏΠ° Π ΠΠ; n = 35) ΠΈΠ»ΠΈ ΠΠ₯ΠΠ’ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΉ Π ΠΠ (Π³ΡΡΠΏΠΏΠ° ΠΠ₯ΠΠ’/Π ΠΠ; n = 36). ΠΠ΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΡΠΉ ΠΊΡΡΡ Π²ΠΊΠ»ΡΡΠ°Π» Π²Π½ΡΡΡΠΈΠ²Π΅Π½Π½ΠΎΠ΅ Π²Π²Π΅Π΄Π΅Π½ΠΈΠ΅ Π΄ΠΎΡΠ΅ΡΠ°ΠΊΡΠ΅Π»Π° 1 ΡΠ°Π· Π² 21 Π΄Π΅Π½Ρ (75 ΠΌΠ³/ΠΌ2Β Π΄ΠΎ 6 ΡΠΈΠΊΠ»ΠΎΠ²) ΠΈ Π°Π½ΡΠ°Π³ΠΎΠ½ΠΈΡΡΠ° Π³ΠΎΠ½Π°Π΄ΠΎΡΡΠΎΠΏΠΈΠ½-ΡΠΈΠ»ΠΈΠ·ΠΈΠ½Π³-Π³ΠΎΡΠΌΠΎΠ½Π° Π΄Π΅Π³Π°ΡΠ΅Π»ΠΈΠΊΡΠ° ΠΏΠΎ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠΉ ΡΡ
Π΅ΠΌΠ΅ (6 ΠΏΠΎΠ΄ΠΊΠΎΠΆΠ½ΡΡ
Π²Π²Π΅Π΄Π΅Π½ΠΈΠΉ ΠΊΠ°ΠΆΠ΄ΡΠ΅ 28 Π΄Π½Π΅ΠΉ). ΠΠΎΡΠ»Π΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Ρ ΠΎΡΠ΅Π½ΠΊΠΎΠΉ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅ΠΆΠΈΠΌΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Π²ΡΠΏΠΎΠ»Π½ΡΠ»Π°ΡΡ Π ΠΠ Ρ ΡΠ°ΡΡΠΈΡΠ΅Π½Π½ΠΎΠΉ Π»ΠΈΠΌΡΠ°Π΄Π΅Π½ΡΠΊΡΠΎΠΌΠΈΠ΅ΠΉ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΡΠ΅Π΄Π½Π΅Π΅ Π²ΡΠ΅ΠΌΡ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π·Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 37,08 Β± 20,46 ΠΌΠ΅Ρ. ΠΠ° ΡΠΎΠ½Π΅ ΠΠ₯ΠΠ’ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Ρ ΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠ³Π΅Π½Π° Π½Π° 50 % ΠΈ Π±ΠΎΠ»Π΅Π΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Ρ Π²ΡΠ΅Ρ
36 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠ΅Π½ΡΡΠ°Ρ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ ΠΏΠΎΡΠ»Π΅ ΠΠ₯ΠΠ’ ΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π²ΡΡΠ²Π»Π΅Π½Π° Π² 38,5 % ΡΠ»ΡΡΠ°Π΅Π² ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ 2,7 % Π² Π³ΡΡΠΏΠΏΠ΅ Π ΠΠ. ΠΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΊΡΠ°ΠΉ Π±ΡΠ» ΡΠ°ΡΠ΅ Π·Π°ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½ Π² Π³ΡΡΠΏΠΏΠ΅ Π ΠΠ β Π² 40 % ΡΠ»ΡΡΠ°Π΅Π² ΠΏΡΠΎΡΠΈΠ² 25 % Π² Π³ΡΡΠΏΠΏΠ΅ ΠΠ₯ΠΠ’/Π ΠΠ (Ο2Β = 4,1;Β df = 1; p = 0,043). Π Π³ΡΡΠΏΠΏΠ΅ Π ΠΠ 3-Π»Π΅ΡΠ½ΡΡ ΠΎΠ±ΡΠ°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 87,56 %, Π² Π³ΡΡΠΏΠΏΠ΅ ΠΠ₯ΠΠ’/Π ΠΠ β 97,2 % (log-rank-ΡΠ΅ΡΡ Ρ = 0,037), ΡΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ β 91,4 ΠΈ 97,2 % ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ (log-rank-ΡΠ΅ΡΡ Ρ = 0,22). ΠΡΠΈ ΡΡΠΎΠΌ Π½Π΅ ΠΏΠΎΠ»ΡΡΠ΅Π½ΠΎ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ ΠΏΠΎ ΡΡΠΎΠ²Π½Ρ 3-Π»Π΅ΡΠ½Π΅ΠΉ Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ: 38,8 % Π² Π³ΡΡΠΏΠΏΠ΅ ΠΠ₯ΠΠ’/Π ΠΠ ΠΏΡΠΎΡΠΈΠ² 43,6 % Π² Π³ΡΡΠΏΠΏΠ΅ Π ΠΠ (log-rank-ΡΠ΅ΡΡ Ρ = 0,36).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ ΠΠ₯ΠΠ’ ΠΏΠ΅ΡΠ΅Π΄ Π ΠΠ ΡΠ²Π»ΡΠ΅ΡΡΡ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΠΉ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΉ ΡΡΡΠ°ΡΠ΅Π³ΠΈΠ΅ΠΉ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Π ΠΠ Π³ΡΡΠΏΠΏ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ°, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠ΅ΠΉ ΡΠ»ΡΡΡΠΈΡΡ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ
ΠΠ΅ΡΠ΅Π±Π½ΡΠΉ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ· ΠΏΠΎΡΠ»Π΅ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Ρ ΠΈΠΌΠΈΠΎΠ³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ ΡΠ°ΠΊΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ
Background. The role of pathological response, which develops as a result of systemic therapy for localized and locally advanced high risk prostate cancer, is not still fully understood. There are no clear indications for neoadjuvant therapy and no data on the relationship between neoadjuvant therapy and median of overall or progression free survival. According to increasing interest for neoadjuvant chemohormonal therapy followed by radical prostatectomy, we evaluated the features of pathological response and its effects on overall and progression free survival rates.Objective. Estimating residual disease and pathologic response to neoadjuvant therapy of high risk prostate cancer and its relationship with oncological results.Materials and methods. This was a prospective randomized study: patients with prostate cancer of high and very high-risk groups (prostate specific antigen levels >20 ng/ml and/or Gleason score β₯8 and/or clinical stage β₯T2c) were treated with neoadjuvant chemohormonal therapy followed by radical prostatectomy (n = 36). The neoadjuvant course included the intravenous administration of docetaxel once every 21 days (75 mg/m2 up to 6 cycles) and the antagonist of the gonadotropin releasing hormone degarelix according to the standard scheme (6subcutaneous injections every 28 days). The prostate tissue was evaluated for the residual disease, features of pathological response according to the ABC system. Additionally, the expression of IHC markers (p53, bcl-2, p16, Ki-67, androgen receptors, c-MYC, ERG, PTEN) was evaluated on postoperative material using tissue microarray.Results. A totally of 480 H&Epostoperative and 775 H&E biopsy slides were analyzed. Group A included 10 (32.3 %) cases, group B β 16 (51.6 %), and group C β 5 (16.1 %). The variance analysis revealed a significant difference in the frequency of more localized forms of prostate cancer in group B (43.7 %) (p = 0.028). During assessment we did not found any relationship ABC system assignment and preoperative prostate specific antigen level, the presence of a positive surgical margin, the pathological stage of diseases or regional lymph nodes involvement. However, the values of relapse-free survival vary sharply between groups: the highest median of relapse-free survival was found in group B β 23.02 Β± 12.61 months, patients of groups A/C could not achieve the level of median relapse-free survival β 11.7 Β± 6.43 and 16.19 Β± 16.54 months respectively.Conclusion. The effectiveness of neoadjuvant chemohormonal therapy for high risk prostate cancer can be assessed by the features of pathologic response through ABC system which has demonstrated own versatility and reproducibility in presented material. Neoadjuvant therapy with docetaxel and degarelix can improve the treatment outcomes of prostate cancer patients at high and very high risk of disease progression. The data on changes in the prostate tissue can be helpful in predicting the duration of the effect after chemohormonal therapy with subsequent surgery.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π ΠΎΠ»Ρ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ·Π°, ΡΠ°Π·Π²ΠΈΠ²Π°ΡΡΠ΅Π³ΠΎΡΡ Π² ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΈ ΠΌΠ΅ΡΡΠ½ΠΎ-ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΠ³ΠΎ ΡΠ°ΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, Π΄ΠΎ ΠΊΠΎΠ½ΡΠ° Π½Π΅ ΠΈΠ·ΡΡΠ΅Π½Π°. ΠΡΡΡΡΡΡΠ²ΡΡΡ ΡΠ΅ΡΠΊΠΈΠ΅ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ·Π° ΠΈ Π΄Π°Π½Π½ΡΠ΅ ΠΎ Π΅Π³ΠΎ ΡΠ²ΡΠ·ΠΈ Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ ΠΎΠ±ΡΠ΅ΠΉ ΠΈΠ»ΠΈ Π±Π΅Π·ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ (ΠΠ Π). Π£ΡΠΈΡΡΠ²Π°Ρ Π²ΠΎΠ·ΡΠΎΡΡΠΈΠΉ ΠΈΠ½ΡΠ΅ΡΠ΅Ρ ΠΊ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Ρ
ΠΈΠΌΠΈΠΎΠ³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΡΠ°ΡΡΠΊΡΠΎΠΌΠΈΠΈ, ΠΌΡ ΠΎΡΠ΅Π½ΠΈΠ»ΠΈ ΡΠ°ΡΡΠΎΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ·Π° Π½Π° ΡΠΎΠ½Π΅ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, Π΅Π³ΠΎ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° ΠΎΠ±ΡΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΈ ΠΠ Π Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ°ΠΊΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΈΡΡ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ ΡΠΊΠ°Π½ΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Π½Π° ΡΠΎΠ½Π΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΠΎΠΉ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·Ρ ΡΡΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ Ρ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ΅ΡΠ΅Π½ΠΈΠ΅ Π² ΠΎΠ±ΡΠ΅ΠΌΠ΅ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Ρ
ΠΈΠΌΠΈΠΎΠ³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΉ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΡΠ°ΡΡΠΊΡΠΎΠΌΠΈΠ΅ΠΉ Π±ΡΠ»ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ 36 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ ΡΠ°ΠΊΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ (ΡΡΠΎΠ²Π΅Π½Ρ ΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠ³Π΅Π½Π° >20Π½Π³/ΠΌΠ», ΠΈ/ΠΈΠ»ΠΈ ΡΡΠΌΠΌΠ° Π±Π°Π»Π»ΠΎΠ² ΠΏΠΎ ΡΠΊΠ°Π»Π΅ ΠΠ»ΠΈΡΠΎΠ½Π° β₯8, ΠΈ/ΠΈΠ»ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΡΠ°Π΄ΠΈΡ β₯T2c). ΠΡΡΡ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Ρ
ΠΈΠΌΠΈΠΎΠ³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π²ΠΊΠ»ΡΡΠ°Π» Π²Π½ΡΡΡΠΈΠ²Π΅Π½Π½ΠΎΠ΅ Π²Π²Π΅Π΄Π΅Π½ΠΈΠ΅ Π΄ΠΎΡΠ΅ΡΠ°ΠΊΡΠ΅Π»Π° 1 ΡΠ°Π· Π² 21 Π΄Π΅Π½Ρ (75ΠΌΠ³/ΠΌ2 Π΄ΠΎ 6 ΡΠΈΠΊΠ»ΠΎΠ²) ΠΈ Π°Π½ΡΠ°Π³ΠΎΠ½ΠΈΡΡΠ° Π³ΠΎΠ½Π°Π΄ΠΎΡΡΠΎΠΏΠΈΠ½ ΡΠΈΠ»ΠΈΠ·ΠΈΠ½Π³-Π³ΠΎΡΠΌΠΎΠ½Π° Π΄Π΅Π³Π°ΡΠ΅Π»ΠΈΠΊΡΠ° ΠΏΠΎ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠΉ ΡΡ
Π΅ΠΌΠ΅ (6 ΠΏΠΎΠ΄ΠΊΠΎΠΆΠ½ΡΡ
Π²Π²Π΅Π΄Π΅Π½ΠΈΠΉ ΠΊΠ°ΠΆΠ΄ΡΠ΅ 28 Π΄Π½Π΅ΠΉ). ΠΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΏΠΎΠ΄Π²Π΅ΡΠ³Π°Π»ΡΡ ΠΎΡΠ΅Π½ΠΊΠ΅ Π½Π° ΠΏΡΠ΅Π΄ΠΌΠ΅Ρ Π½Π°Π»ΠΈΡΠΈΡ ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ, ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ·Π° ΠΏΠΎ ΡΠΈΡΡΠ΅ΠΌΠ΅ ΠΠΠ‘. ΠΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΎΡΠ΅Π½Π΅Π½Π° ΡΠΊΡΠΏΡΠ΅ΡΡΠΈΡ ΡΡΠ΄Π° ΠΈΠΌΠΌΡΠ½ΠΎΠ³ΠΈΡΡΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² (p53, bcl-2, p16, Ki-67, Π°Π½Π΄ΡΠΎΠ³Π΅Π½ΠΎΠ²ΡΠ΅ ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΡ, c-MYC, ERG, PTEN) Π½Π° ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»Π΅ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΏΠΎΡΡΡΠΎΠ΅Π½ΠΈΡ ΡΠΊΠ°Π½Π΅Π²ΡΡ
ΠΌΠ°ΡΡΠΈΡ (tissue microarray, Π’ΠΠ) ΡΠΎΠ³Π»Π°ΡΠ½ΠΎ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠΌΡ ΠΏΡΠΎΡΠΎΠΊΠΎΠ»Ρ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠ΅Π³ΠΎ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½ΠΎ 480 ΠΌΠΈΠΊΡΠΎΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² Π±ΠΈΠΎΠΏΡΠΈΠΉΠ½ΠΎΠ³ΠΎ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»Π° ΠΈ 775 ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»Π°. Π Π³ΡΡΠΏΠΏΠ΅ Π Π±ΡΠ»ΠΈ ΠΎΡΠ½Π΅ΡΠ΅Π½Ρ 10 (32,3 %) ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ, ΠΊ Π³ΡΡΠΏΠΏΠ΅ Π β 16 (51,6 %), ΠΊ Π³ΡΡΠΏΠΏΠ΅ Π‘ β 5 (16,1 %). ΠΠΈΡΠΏΠ΅ΡΡΠΈΠΎΠ½Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· Π²ΡΡΠ²ΠΈΠ» Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎΠ΅ ΡΠ°Π·Π»ΠΈΡΠΈΠ΅ ΡΠ°ΡΡΠΎΡΡ Π±ΠΎΠ»Π΅Π΅ Π»ΠΎΠΊΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΡΡ
ΡΠΎΡΠΌ ΡΠ°ΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Π² Π³ΡΡΠΏΠΏΠ΅ B (43,7 %) (p = 0,028). ΠΡΠΈ Π°Π½Π°Π»ΠΈΠ·Π΅ Π½Π΅ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½ΠΎ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·ΠΈ ΠΌΠ΅ΠΆΠ΄Ρ ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ·Π° ΠΏΠΎ ΡΠΈΡΡΠ΅ΠΌΠ΅ ΠΠΠ‘ ΠΈ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΌ ΡΡΠΎΠ²Π½Π΅ΠΌ ΠΏΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠ³Π΅Π½Π°, Π½Π°Π»ΠΈΡΠΈΠ΅ΠΌ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΡΠ°Ρ, ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΎΠ°Π½Π°ΡΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΡΠ°Π΄ΠΈΠ΅ΠΉ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΈΠ»ΠΈ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΠ΅ΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π½Π° ΡΠ΅Π³ΠΈΠΎΠ½Π°ΡΠ½ΡΠ΅ Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ·Π»Ρ. ΠΠ΄Π½Π°ΠΊΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΠ Π ΡΠ΅Π·ΠΊΠΎ Π²Π°ΡΡΠΈΡΠΎΠ²Π°Π» ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ: Π½Π°ΠΈΠ±ΠΎΠ»ΡΡΠ°Ρ ΠΌΠ΅Π΄ΠΈΠ°Π½Π° ΠΠ Π Π²ΡΡΠ²Π»Π΅Π½Π° Π² Π³ΡΡΠΏΠΏΠ΅ Π β 23,02 Β± 12,61 ΠΌΠ΅Ρ, Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈΠ· Π³ΡΡΠΏΠΏ Π ΠΈ Π‘ Π½Π΅ ΡΠΌΠΎΠ³Π»ΠΈ Π΄ΠΎΡΡΠΈΡΡ ΡΡΠΎΠ²Π½Ρ ΠΎΠ±ΡΠ΅ΠΉ ΠΌΠ΅Π΄ΠΈΠ°Π½Ρ ΠΠ Π β 11,7 Β± 6,43 ΠΈ 16,19 Β± 16,54 ΠΌΠ΅Ρ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠ°ΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΎΡΠ΅Π½Π΅Π½Π° ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²ΠΎΠΌ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ Π»Π΅ΡΠ΅Π±Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ·Π° ΠΏΠΎ ΡΠΈΡΡΠ΅ΠΌΠ΅ ΠΠΠ‘, ΠΊΠΎΡΠΎΡΠ°Ρ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π»Π° ΡΠ²ΠΎΡ ΡΠ½ΠΈΠ²Π΅ΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ ΠΈ Π²ΠΎΡΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π½Π° ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΌ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»Π΅. ΠΠ΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π΄ΠΎΡΠ΅ΡΠ°ΠΊΡΠ΅Π»Π° ΠΈ Π΄Π΅Π³Π°ΡΠ΅Π»ΠΈΠΊΡΠ° ΠΌΠΎΠΆΠ΅Ρ ΡΠ»ΡΡΡΠΈΡΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°ΠΊΠ° ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Π³ΡΡΠΏΠΏ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΠΈ ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΡΡΠ²Π»Π΅Π½Π½ΡΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΠΎΠ± ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΡ
Π² ΡΠΊΠ°Π½ΠΈ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ ΠΌΠΎΠ³ΡΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡΡ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΡΡΡΠ΅ΠΊΡΠ° ΠΏΠΎΡΠ»Π΅ Ρ
ΠΈΠΌΠΈΠΎΠ³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΡΠΌ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎΠΌ