Органосохраняющее лечение с использованием неоадъювантной химиотерапии на фоне внутрипузырной иммунотерапии ронколейкином (интерлейкин-2) при инвазивном раке мочевого пузыря

The results of a prospective randomized study of the efficacy of neoadjuvant chemoimmunotherapy with intravesical roncoleukin (interleukin- 2) versus the standard M-VAC chemotherapy regimen are analyzed. The study protocol included 60 patients. Additional intravesical administration of roncoleukin failed to affect the frequency and severity of the toxic effects of multidrug therapy. The immediate and long-term results of the proposed regimen were better than those of the standard one. Complete regressions were 53.3±9.1 and 26.7±8.1, respectively (p = 0.049; Mann—Whitney U-test). Organ-preserving surgery was made in 24 (80.0%) study-group patients and in 16 (53.3%) control ones; the difference being significant (p = 0.03, χ2). In the study group, cumulative survival was significantly higher than that in the control group (p = 0.02, log-rank-test). In the groups, overall 5-year survival was 81.4±7.6 and 46.5±12.5%, respectively.The results of a prospective randomized study of the efficacy of neoadjuvant chemoimmunotherapy with intravesical roncoleukin (interleukin- 2) versus the standard M-VAC chemotherapy regimen are analyzed. The study protocol included 60 patients. Additional intravesical administration of roncoleukin failed to affect the frequency and severity of the toxic effects of multidrug therapy. The immediate and long-term results of the proposed regimen were better than those of the standard one. Complete regressions were 53.3±9.1 and 26.7±8.1, respectively (p = 0.049; Mann—Whitney U-test). Organ-preserving surgery was made in 24 (80.0%) study-group patients and in 16 (53.3%) control ones; the difference being significant (p = 0.03, χ2). In the study group, cumulative survival was significantly higher than that in the control group (p = 0.02, log-rank-test). In the groups, overall 5-year survival was 81.4±7.6 and 46.5±12.5%, respectively

Результаты скрининга рака предстательной железы и проблема гипердиагностики заболевания в Республике Беларусь

The prostate cancer (PC) screening program elaborated in the Republic of Belarus, which envisages the determination of prostate-specific antigen (PSA) levels once every two years among 50–65-year-old men and 6-point lateralized transrectal ultrasound-guided biopsy at a PSA level of > 4.0 ng / ml, could rule out the probability of diagnosing clinically insignificant PC. Out of 20,786 male examinees, 249 (1.2 %) patients were found to have PC. Of them, 190 patients underwent D»Amico cancer risk stratification. A low-risk group included 11 (5.6 %) patients, for whom follow-up tactics might be selected; the other patients should receive appropriate treatment. Therefore, the problem of hyperdiagnosis is not relevant during the first PC screening round in Belarus and cannot constrain the further introduction of the screening program.Разработанная программа скрининга рака предстательной железы (РПЖ) в Республике Беларусь, предусматривающая определение уровня простатспецифического антигена (ПСА) 1 раз в 2 года среди мужчин в возрасте 50–65 лет и выполнение 6-точечной латерализованной биопсии предстательной железы под трансректальным ультразвуковым контролем при уровне ПСА > 4,0 нг / мл, позволила исключить вероятность диагностики клинически незначимого РПЖ. Из обследованных 20 786 мужчин РПЖ выявлен у 249 (1,2 %). Из них у 190 проведена стратификация онкологического риска по D’Amico. К группе низкого риска отнесено 11 (5,6 %) пациентов, в отношении которых может быть избрана тактика наблюдения, остальным пациентам должно быть проведено соответствующее лечение. Таким образом, первый раунд скрининга РПЖ в Беларуси показал, что проблема гипердиагностики не является актуальной и не может ограничивать дальнейшее внедрение скрининговой программы

Результаты лечения больных раком мочевого пузыря с метастазами в регионарных лимфоузлах

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.

Роль мутационного статуса гена FGFR3 в предсказании прогрессирования рака мочевого пузыря без мышечной инвазии

A prospective study was conducted to assess the prognostic value of FGFR3 gene mutation status in patients with non-muscle invasive bladder cancer. A total of 265 patients were included in the study. FGFR3 gene mutations were found in 168 (63.4 %) cases. FGFR3 mutation rate was significantly higher in low-grade tumors (p = 0.00 004). With a median follow-up of 34 months hazard ratio of progression in FGFR3 mutant cases compared to FGFR3 wild type was 0.50 (95 % CI 0.17–1.49; p = 0.21). In the subgroup analysis, it was found that FGFR3 mutations in patients with T1 high grade tumors (n = 41) were associated with a significantly better prognosis: 3-year progression-free survival (PFS) in FGFR3 mutant cases (n = 17) was 100 % compared to 71.2 % (95 % CI 42.8–99.6 %) in the absence of mutations (n = 24). For other subgroups (Ta, T1 low grade) no statistically significant difference in PFS by FGFR3 mutation status was noted.Проведено проспективное исследование по оценке прогностического значения мутационного статуса гена FGFR3 у пациентов с раком мочевого пузыря без мышечной инвазии. В исследование включено 265 пациентов, у 168 (63,4 %) обнаружены мутации гена FGFR3. Установлено, что частота мутаций гена FGFR3 была статистически значимо выше в высокодифференцированных опухолях (р = 0,00004). При медиане наблюдения 34 мес не выявлено статистически значимого показателя относительного риска прогрессирования рака мочевого пузыря без мышечной инвазии при наличии мутации гена FGFR3 по сравнению с ее отсутствием (0,50; 95 % доверительный интервал (ДИ) 0,17–1,49; p = 0,21). При анализе прогностического значения мутационной изменчивости гена FGFR3 в различных подгруппах было обнаружено, что у пациентов с опухолями T1 high grade (n = 41) мутации гена FGFR3 были связаны со статистически значимо лучшим прогнозом: 3-летняя выживаемость до прогрессирования при наличии мутации (n = 17) составила 100 % по сравнению с 71,2 % (95 % ДИ 42,8–99,6 %) при отсутствии мутации (n = 24). При остальных категориях опухолей (Ta, T1 low grade) статистически значимых различий в выживаемости до прогрессирования в зависимости от мутационного статуса FGFR3 не выявлено

Результаты органосохраняющего лечения при почечно-клеточном раке

Objective: The immediate and long-term results of nephron-sparing treatment for renal-cell carcinoma (RCC) were retrospectively assessed. The impact of several prognostic factors on treatment results was analyzed.Material and Methods: All cases of partial nephrectomy in RCC performed at the N.N. Alexandrov Research Institute of Oncology and Medical Radiology in 1993 and 2005 were collected. The data on the patients' deaths were selected from the Byelorussian cancer register. Mono- and multivariant analyses were made by using the Kaplan-Meier method and the Cox proportional hazard model.Results: A total of 298 operations were performed in 292 patients, 271 being in RCC. Complications developed in 5.5% of the patients. The follow-up averaged 30.0±28.2 months. A local relapse was diagnosed in 4 (1.5%) patients. Five- and 10-year crude survival rate was 87.2%. The results of partial nephrectomy in pT3a tumors more than 4 cm were found significantly worse than those in pT1-2 and pT3a 4 cm or less (p = 0.03). The Cox proportional hazard model revealed the significance of pT, size and grade combination (p = 0.03). Three groups of patients were formed by the significantly different 10-year survival rates.Conclusion: Partial nephrectomy is a safe and effective treatment for localized RCC. Elective operation can be performed in patients with T3a RCC 4 cm or less. It is possible to divide patients into 3 prognostic groups with different survival rates in relation to the treatment results in pT, tumour size and grade.

Симультанное хирургическое лечение больных почечно-клеточным раком с конкурирующей патологией сердца

The authors analyze the immediate results of 8 simultaneous operations, 4 of these under conditions of artificial circulation, in patients with renal cell carcinoma concomitant with heart diseases. The immediate results were satisfactory, with good functional parameters. Due to simultaneous operations the incidence of intra- and postoperative cardiovascular complications is reduced, the progress of the tumor process between different stages of treatment is arrested, early radical interventions for tumor removal becomes possible, and the hospitalization period is shorter in comparison with staged operations.

Organ-preserving treatment using neoadjuvant chemotherapy during intravesical immunotherapy with roncoleukin (interleukin-2) for invasive bladder carcinoma

The results of a prospective randomized study of the efficacy of neoadjuvant chemoimmunotherapy with intravesical roncoleukin (interleukin- 2) versus the standard M-VAC chemotherapy regimen are analyzed. The study protocol included 60 patients. Additional intravesical administration of roncoleukin failed to affect the frequency and severity of the toxic effects of multidrug therapy. The immediate and long-term results of the proposed regimen were better than those of the standard one. Complete regressions were 53.3±9.1 and 26.7±8.1, respectively (p = 0.049; Mann—Whitney U-test). Organ-preserving surgery was made in 24 (80.0%) study-group patients and in 16 (53.3%) control ones; the difference being significant (p = 0.03, χ2). In the study group, cumulative survival was significantly higher than that in the control group (p = 0.02, log-rank-test). In the groups, overall 5-year survival was 81.4±7.6 and 46.5±12.5%, respectively

The results of prostate cancer screening and the problem of the hyperdiagnosis of the disease in the Republic of Belarus

The prostate cancer (PC) screening program elaborated in the Republic of Belarus, which envisages the determination of prostate-specific antigen (PSA) levels once every two years among 50–65-year-old men and 6-point lateralized transrectal ultrasound-guided biopsy at a PSA level of > 4.0 ng / ml, could rule out the probability of diagnosing clinically insignificant PC. Out of 20,786 male examinees, 249 (1.2 %) patients were found to have PC. Of them, 190 patients underwent D»Amico cancer risk stratification. A low-risk group included 11 (5.6 %) patients, for whom follow-up tactics might be selected; the other patients should receive appropriate treatment. Therefore, the problem of hyperdiagnosis is not relevant during the first PC screening round in Belarus and cannot constrain the further introduction of the screening program