АНДРОГЕНОВЫЕ РЕЦЕПТОРЫ КАК ФАКТОР ПРОГНОЗА В РАЗЛИЧНЫХ МОЛЕКУЛЯРНО-БИОЛОГИЧЕСКИХ ПОДТИПАХ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ

In the literature there has been increased interest in the study of androgenetic receptors (AR) in different molecular subtypes of breast cancer (BC) but we haven’t found consensus about the role of levels of androgens and their metabolites in samples of biological fluids for the development of breast cancer. Determination of the level of androgenetic receptors in the tumor in patients with breast cancer is very relevant and promising direction in the study of the prognosis of the disease and the search for new complementary approaches to endocrine therapy of breast cancer, especially when basal-like molecular subtype.В литературе отмечается повышенный интерес к изучению андрогеновых рецепторов (АР) при различных молекулярных подтипах рака молочной железы (РМЖ), но мы не нашли единого мнения о влиянии уровня андрогенов и их метаболитов в образцах биологических жидкостей на развитие РМЖ. Определение уровня андрогеновых рецепторов в опухоли у пациенток с раком молочной железы является весьма актуальным и перспективным направлением в изучении прогноза заболевания и поиска новых дополнительных подходов к эндокринной терапии РМЖ, особенно при базальноподобном молекулярном подтипе.

Лучевые методы в диагностике и стадировании рака желудка

Purpose. To assess the possibilities of methods of radiation diagnosis in the recognition and staging of gastric cancer.Material and methods. The results of inspection of 307 patients with cancer of a stomach at which endoscopic, radiological and computer tomography researches on purpose, both primary diagnosis of gastric cancer, and establishment of a staging of process have been executed have been analyzed from 2014 to 2017.Results. At a radiological research proximal cancer of a stomach is revealed at 63 (20,5%) patients, a body – at 202 (65.8%) and distally – at 42 (13.7%) patients. In all cases we managed to diagnose precisely stomach cancer, its localization and distribution on stomach walls. MSCT allowed to determine the spread of the tumor beyond the organ. Results of comprehensive examination of patients with cancer of a stomach have allowed to stage the process. The first stage has been established at 40 (13.0%) patients, second – at the 117 (38.2%), third – at the 102 (33.2%), fourth – at 48 (15.6%). Of the 307 patients with gastric cancer, various types of interventions were subsequently performed in 254 (83%), chemotherapy, as an independent type of treatment was performed in 49 (16%), refused any treatment of 4 (1%) patients.Conclusion. Complex radiation diagnosis is highly informative for the detection and staging of stomach cancer.Цель исследования: оценить возможности лучевой диагностики в распознавании и стадировании рака желудка.Материал и методы. Проанализированы результаты обследования 307 больных раком желудка, у которых были выполнены эндоскопические, рентгенологические и компьютерно-томографические исследования с целью как первичной диагностики рака желудка, так и установления стадии процесса, пролеченных за период с 2014 по 2017 г.Результаты. При рентгенологическом исследовании проксимальный рак желудка выявлен у 63 (20,5%) больных, тела – у 202 (65,8%) и дистальный – у 42 (13,7%) больных. Во всех случаях нам удалось точно диагностировать рак желудка, установить его локализацию и распространение по стенкам желудка. МСКТ позволила определить распространение опухоли за пределы органа. В результате комплексного лучевого обследования больных раком желудка удалось установить стадию процесса. I стадия была выявлена у 40 (13,0%) больных, II – у 117 (38,2%), III – у 102 (33,2%), IV – у 48 (15,6%). Из 307 больных раком желудка в последующем были выполнены различные виды хирургических вмешательств у 254 (83%), химиотерапия, как самостоятельный вид лечения выполнялась у 49 (16%), отказались от какого-либо лечения, 4 (1%) больных.Заключение. Комплексная лучевая диагностика высокоинформативна для выявления и стадирования рака желудка

Heterogeneous treatment effects of therapeutic-dose heparin in patients hospitalized for COVID-19

Importance Randomized clinical trials (RCTs) of therapeutic-dose heparin in patients hospitalized with COVID-19 produced conflicting results, possibly due to heterogeneity of treatment effect (HTE) across individuals. Better understanding of HTE could facilitate individualized clinical decision-making. Objective To evaluate HTE of therapeutic-dose heparin for patients hospitalized for COVID-19 and to compare approaches to assessing HTE. Design, Setting, and Participants Exploratory analysis of a multiplatform adaptive RCT of therapeutic-dose heparin vs usual care pharmacologic thromboprophylaxis in 3320 patients hospitalized for COVID-19 enrolled in North America, South America, Europe, Asia, and Australia between April 2020 and January 2021. Heterogeneity of treatment effect was assessed 3 ways: using (1) conventional subgroup analyses of baseline characteristics, (2) a multivariable outcome prediction model (risk-based approach), and (3) a multivariable causal forest model (effect-based approach). Analyses primarily used bayesian statistics, consistent with the original trial. Exposures Participants were randomized to therapeutic-dose heparin or usual care pharmacologic thromboprophylaxis. Main Outcomes and Measures Organ support–free days, assigning a value of −1 to those who died in the hospital and the number of days free of cardiovascular or respiratory organ support up to day 21 for those who survived to hospital discharge; and hospital survival. Results Baseline demographic characteristics were similar between patients randomized to therapeutic-dose heparin or usual care (median age, 60 years; 38% female; 32% known non-White race; 45% Hispanic). In the overall multiplatform RCT population, therapeutic-dose heparin was not associated with an increase in organ support–free days (median value for the posterior distribution of the OR, 1.05; 95% credible interval, 0.91-1.22). In conventional subgroup analyses, the effect of therapeutic-dose heparin on organ support–free days differed between patients requiring organ support at baseline or not (median OR, 0.85 vs 1.30; posterior probability of difference in OR, 99.8%), between females and males (median OR, 0.87 vs 1.16; posterior probability of difference in OR, 96.4%), and between patients with lower body mass index (BMI 90% for all comparisons). In risk-based analysis, patients at lowest risk of poor outcome had the highest propensity for benefit from heparin (lowest risk decile: posterior probability of OR >1, 92%) while those at highest risk were most likely to be harmed (highest risk decile: posterior probability of OR <1, 87%). In effect-based analysis, a subset of patients identified at high risk of harm (P = .05 for difference in treatment effect) tended to have high BMI and were more likely to require organ support at baseline. Conclusions and Relevance Among patients hospitalized for COVID-19, the effect of therapeutic-dose heparin was heterogeneous. In all 3 approaches to assessing HTE, heparin was more likely to be beneficial in those who were less severely ill at presentation or had lower BMI and more likely to be harmful in sicker patients and those with higher BMI. The findings illustrate the importance of considering HTE in the design and analysis of RCTs. Trial Registration ClinicalTrials.gov Identifiers: NCT02735707, NCT04505774, NCT04359277, NCT0437258

Current problems of postoperative radiotherapy for non-small cell lung cancer

The review considers the history of evolution and the present state of the problem of postoperative radiotherapy for non-small cell lung cancer. The randomized trials and meta-analyses given in recent publications provide evidence that it should be usedin radically operated patients with morphologically verified regional metastases. The paper also shows promises of hypofractionation and a postoperative radiation/chemotherapy ratio for non-small cell lung cancer

Criteria for 5 years survival prognosis in patients with thymus tumors

Thymoma is a rare tumor of mediastinum, which incidence is less than 1% of all oncological diseases, and 10-20% of primary mediastinum lesions. Current WHO classification (Masaoka staging and histological tumor type) does not allow to determine the necessity for additional methods of treatment and to predict the further development of disease. The developed individual prognostic system for disease progression probability assessment, based on certain criteria, is a simple and cheap prognostic method in patients with thymoma

ANDROGEN RECEPTORS AS A FACTOR OF PROGNOSIS IN VARIOUS MOLECULAR-BIOLOGICAL SUBTYPES OF BREAST CANCER

In the literature there has been increased interest in the study of androgenetic receptors (AR) in different molecular subtypes of breast cancer (BC) but we haven’t found consensus about the role of levels of androgens and their metabolites in samples of biological fluids for the development of breast cancer. Determination of the level of androgenetic receptors in the tumor in patients with breast cancer is very relevant and promising direction in the study of the prognosis of the disease and the search for new complementary approaches to endocrine therapy of breast cancer, especially when basal-like molecular subtype

Role of oncomarkers in diagnosis of multiple primary neoplasms of female reproductive tract

Complex measurements of tumor markers help to improve the diagnosis of multiple primary neoplasms (MPN) significantly. For breast- ovarian MPN CA-125 was increased in 92.6 % and CA-153 — in 81.6 %. In patients with ovarian-colorectal MPN CA-125 was increased in 79.0 % and carcinoembryonic antigen — in 90.0 %

Breast sarcomas. Literature review

The article presents an overview of the literature about breast sarcomas (nonepithelial malignances). Primary sarcomas are extremely rare, with less than 1 % of all malignant tumors of the breast. Breast carcinomas cause an increased interest of the scientists due to their unique clinical and pathological features and unpredictable prognosis

Methylation of the RASSF1A, RARβ2, and SEMA3B genes in epithelial breast and ovarian tumors, and in patients with polyneoplasia

The methylation status of the tumor suppressor genes RASSF1A, RARβ2, and SEMA3B was studied in the samples of cancer and its histologically normal tissue of the breast and ovaries. The high rate of abnormal methylation of the CpG islet in the RASSF1A, RARβ2, and SEMA3B genes was found in the tumors of the breast (78% (32/41), 46% (26/56), and 35% (22/65), respectively) and ovaries 73% (33/45), 30% (15/50), and 50% (25/51). Hypermethylation in the CpG islets belonging to the RASSF1A and RARβ2 genes was first ascertained in 90% of the patients with polyneoplasms involving the breast and ovaries. Abnormal methylation of the promotor region of the RASSF1A gene was shown to be detectable in preclinical-stage and anaplasia-degree breast and ovarian cancer. There was a correlation of the rate of methylation in the promoter regions of the RARβ2 and SEMA3B genes with clinical-stage and anaplasia-degree breast and ovarian cancer. Analysis of gene methylation in biological fluids provides considerable opportunity to use methylation of DNA as a marker in clinical practice