Репозиторий Университета

© 2019 Elsevier Inc. Purpose: To identify preoperative risk factors for disease recurrence, following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), and to create a predictive nomogram. Materials and methods: Based on a multicenter database, we identified patients who underwent RNU due to high grade UTUC. Urothelial carcinoma of the bladder or contralateral UTUC was not considered as recurrence. Cox regression model was used to determine the effect of different preoperative variables as predictors of recurrence. Results: Two hundred and forty-five patients were included in the analysis. The 2 and 5 years recurrence rates were 16.3% and 19.2%, respectively. Factors associated with recurrence on univariable analysis were sessile architecture hazard ratio (HR) 3.16 (95% CI, 1.38–7.26, P = 0.006), ≥cT3 disease HR 2.30 (95% CI, 1.12–4.72, P= 0.023), age >65 HR 2.02 (95% CI, 1.00–4.05, P= 0.048), Eastern Cooperative Group > 0 HR 1.98 (95% CI, 1.09–3.57, P= 0.023), hydronephrosis HR 1.93 (95% CI, 1.04–3.57, P= 0.035). Higher hemoglobin levels HR 0.81 (95% CI, 0.69–0.96, P= 0.013) and preoperative estimated glomerular filtration rate ≥ 50 HR 0.48 (95% CI, 0.25–0.92, P = 0.028) were associated with lower probability for recurrence. Multivariable analysis identified sessile architecture as the only independent predictor of recurrence HR 2.52 (95% CI, 1.09–5.86, P= 0.0308). C-index of 0.71 was calculated for a predictive model including all variables in the multivariable analysis, indicating good predictive accuracy. A nomogram predicting 2 and 5 year recurrence free probability was developed accordingly. Conclusions: Based on a multicenter database, we developed a nomogram with good predictive accuracy for recurrence following RNU. This may serve as an aid in decision-making regarding the use of neoadjuvant chemotherapy.

© 2019 Elsevier Inc. Objectives: The role of adjuvant radiotherapy (ART) in patients with bladder cancer (BCa) and upper tract urothelial carcinoma (UTUC) is controversial. We systematically evaluated the oncologic efficacy of ART and its associated toxicity in patients treated with surgery and ART for BCa and UTUC. Materials and method: We performed a literature search on December 2018 using MEDLINE, Web of Science, Cochrane databases and Scopus according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Fourteen BCa studies and 14 UTUC studies were included in this systematic review. The data were too scarce and heterogeneous for meta-analytical analysis. Results: The quality and quantity of the data on ART in BCa and UTUC patients are limited. The combination of ART and chemotherapy appears to be beneficial in patients with locally advanced BCa or UTUC. The early and late adverse effects of ART are decreasing reflecting the progress in radiation technology. Conclusions: According to the currently available literature, there is no clear benefit of ART after radical surgery in BCa and UTUC. Future efforts should focus on evaluating multimodal approach using ART with chemotherapy. Until that time comes, ART should be used carefully in patients with BCa and UTUC on a case-by-case basis.

© 2019 Elsevier Inc. Objectives: To assess the role of the urokinase plasminogen activator (uPA) system as a prognostic biomarker in patients with nonmuscle invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB) with or without adjuvant intravesical therapy. Material and methods: We stained TURB tissue from 827 NMIBC patients with uPA, its receptor (uPAR) and its inhibitor (PAI-1). The status of these markers was categorized as normal vs. overexpressed using the cutoffs of 30% for uPA, 50% for uPAR, and 30% for PAI-1. Multivariable Cox regression analyses were performed to evaluate the prognostic value of these markers. Results: uPA was overexpressed in 37.7% of patients, uPAR in 44.7% and PAI-1 in 44.6%. Overexpression of these markers was associated with high tumor grade. Within a median follow-up was 60 months (interquartile range: 22–109), uPA (hazard ratio [HR]: 1.40; P = 0.006), uPAR (HR: 1.70; P < 0.001), PAI-1 (HR: 1.35; P = 0.014), and the combination of all 3 markers (HR: 3.38; P < 0.001) were associated with recurrence-free survival (RFS); uPA (HR: 1.68; P = 0.035) and the combination of all 3 markers (HR: 8.79; P = 0.005) were associated with progression-free survival (PFS). The addition of the uPA system to a base model improved the discrimination by 1.3% for RFS and 2.1% for PFS. In subgroup analyses, uPA (HR: 2.19; P = 0.018) was associated with PFS in T1G3 patients and its addition to a base model improved the discrimination by 2.5%. uPA (HR: 1.44; P = 0.019), uPAR (HR: 1.54; P = 0.006), PAI-1 (HR: 1.46; P = 0.013) and the combination of all 3 markers (HR: 3.48; P < 0.001) were associated with RFS in TaG1-2 patients and their addition to a base model improved the discrimination by 2.1%. Conclusion: uPA, uPAR, and PAI-1 are overexpressed in one-third to half of patients with NMIBC. Their overexpression is an independent prognosticator of RFS and PFS which improved the predictive accuracy of current clinicopathological characteristics. Biomarkers that capture the biological and clinical behavior of individual tumors may help personalize clinical decision-making in patients with NMIBC.

© 2019, The Author(s). Purpose: To assess the accuracy of [68Ga]-PSMA-11 PET/CT or [68Ga]-PSMA-11 PET/MRI (PSMA-11 PET/CT(MRI)) for lymph node (LN) staging using salvage LN dissection (SLND) in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). Patients and methods: In a prospective study, 65 consecutive patients who developed BCR after RP underwent SLND after PSMA-11 PET/CT(MRI) between 2014 and 2018. Extended SLND up to the inferior mesenteric artery was performed in all patients. Regional and template-based correlations between the presence of LN metastases on histopathology and whole-body PSMA-11 PET/CT(MRI) results were evaluated. The diagnostic accuracy of PSMA-11 PET/CT(MRI) was also evaluated in relation to PSA level at the time of SLND. Results: The median age of the patients at the time of SLND was 65 years (IQR 63–69 years) and the median PSA level was 1.4 ng/ml (IQR 0.8–2.9 ng/ml). Before SLND, 50 patients (77%) had additional therapy after RP (26.2% androgen-deprivation therapy and 50.8% radiotherapy). The median number of LNs removed on SLND was 40 (IQR 33–48) and the median number of positive nodes was 4 (IQR 2–6). LN metastases were seen in 13.8% of resected LNs (317 of 2,292). LNs positive on PSMA-11 PET/CT(MRI) had a median diameter of 7.2 mm (IQR 5.3–9 mm). Metastatic LNs in regions negative on PSMA-11 PET had a median diameter of 3.4 mm (IQR 2.1–5.4 mm). In a regional analysis, the sensitivity of PSMA-11 PET/CT(MRI) ranged from 72% to 100%, and the specificity from 96% to 100%. Region-specific positive and negative predictive values ranged from 95% to 100% and 93% to 100%, respectively. Conclusion: PSMA-11 PET/CT(MRI) has a very good performance for the identification of LN metastases in patients with BCR after RP. The high diagnostic accuracy in the regional and subregional analyses demonstrates the potential of this approach to enable a region-directed instead of a complete bilateral therapeutic intervention. The performance of PSMA-11 PET/CT(MRI) is dependent on the PSA level and the size of the metastatic deposit.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To study the effectiveness and long-term outcomes of sclerotherapy for ovarian endometriomas and to substantiate the conditions and indications for minimally invasive intervention. Patients and methods: We analysed 124 interventions performed by the technique of aspiration (sclerosing) therapy of endometrioid ovarian cysts. The patients' age varied from 18 to 42 years, averaging 26.4 ± 4.2 years. The mean diameter of ovarian endomeriomas varied from 25 to 65 mm. In 84 (67.7%) of observations, pathological process was unilateral, in 72.3% - bilateral. 43 (34.6%) women had disease recurrence after previously performed cystectomy, in 28 (22.6%) endometrioid cysts were located in the only ovary and in 7 (5.6%) patients ultrasonography found that the ovary contralateral to endometrioid tumour was sharply decreased and its sections lacked the signs of antral follicles after preceding cystectomy. In fact, in 35 (28.2%) patients endometrioma was diagnosed in the only ovary. All patients after aspiration therapy of endometriomas received dienogest (2 mg) + ethinylestradiol (0.03 mg) (Siluette®, «Gedeon Richter»). Results: The recurrence rate of endometriomas during the first 12 months of follow-up was 38.7%, during the first 3 months of follow-up this parameter did not exceed 9.7%. Within 7-12 months after intervention spontaneous pregnancy occurred in 36.3% (46) of women, ending with childbirth in all cases (with the use of contraception 25 patients - 46%). Conclusion: Sclerotherapy of ovarian endometriomas with ultrasound monitoring of intervention is a minimally invasive method of treating women of reproductive age, ensuring preservation of ovarian reserve. It is not a monotherapy, its outcome is in many respects determined by the adequacy of postoperative hormonal treatment.

© 2018 Medical Radiology and Radiation Safety. All rights reserved. Introduction: The highest priority for modern clinical oncology is functionally-sparing and organ-conserving treatment. In Russia, breast cancer (BC), among all malignant tumors, accounted for 21.1 % of women in 2017. Oncoplastic radical resections (OPS-BCS = oncoplastic surgery – breast conserving surgery) have been widely used. This term means resection of the breast for cancer using plastic surgery to restore the shape of the breast, in most cases with one-stage correction of the contralateral breast. Purpose: It was the creation of various techniques of oncoplastic breast surgery, applicable for the appropriate localization of breast cancer and the evaluation of surgical, oncological and aesthetic results. Methods: From 2013 to 2017, in the P.A. Hertsen Moscow Oncology Research Center, organ-conserving surgery were performed in 570 patients with BC with an average age of 54.2. Stage 0 was diagnosed in 4.6 %, I – 5.9 %, IIA – 28.7 %, IIB – 6 %, IIIA – 5.1 %, IIIC – 3.3 %, IIIB – 0.2 %, IV – 0.2 %. Radical resection in the standard version was performed in 290 patients with breast cancer, oncoplastic breast surgery in various modifications – in 280. All patients after the organ-conserving surgical treatment received radiation therapy. Patients received chemotherapy, targeted therapy and hormone therapy according to the indications in depending the disease stage and the immunohistochemical type of the tumor. Results: After an urgent and planned morphological study positive margins of resection were revealed in 10 patients, which required reresection of the edges to a negative state of them in case of an urgent intraoperative response and mastectomy – in case of a planned response. Within 4 years, local recurrences were detected in 4 patients (0.7 %), which required a mastectomy with a one-stage reconstruction. In 1 patient (0.2 %), the disease progressed as metastases to the lung – in this case lobectomy and a necessary chemotherapy were conducted. Cosmetic results were defined as excellent in 70 % cases, good – 25 %, satisfactory – 5 %. Conclusion: If there are indications for organ-conserving treatment of breast cancer and the patient’s decision concerning this surgery, the patient should be offered methods of oncoplastic surgery for the prevention of psychological and emotional stress, effective rehabilitation, and a quick return to active social life.

© 2018 Media Sphera Publishing Group. All rights reserved. This article presents current views on the classification, diagnosis, treatment, and prevention of drug dependence caused by the co-use of several psychoactive substances (PASs). It describes the fundamental regularities of the development and course of the disease, the patterns of consumption, and the issues of laboratory diagnosis. Particular attention is paid to the clinical diagnosis of the most common patterns of use of various PASs. In order to make and propose the reader the most complete basis for evidencebased strategies for the treatment of various variants of polydrug abuse, the authors studied the results of investigations that enrolled patients using more than one PAS at least 1 month before the start of treatment. The section on therapy is presented as clinical recommendations, taking into account the levels of evidence and the grades of recommendations.