Vol 12, No 4 (2016)

Background. On the pace of growth in Russia, renal carcinoma takes the 1st place. Approximately one third of patients at time of diagnosis have distant metastases, and relapse of the disease occurs in 30–40 %. Renal carcinoma does not manifest until later stage of the disease. More than in 50 % of cases renal carcinoma is revealed occasionally. Therefore, development of methods for quick and efficient diagnosis of the tumor is actual.

Materials and methods. The level of messenger RNA expression for several genes was studied in the surgical material of paired samples (normal tissue and a malignant renal carcinoma). Quantification of gene expression was performed by using real-time polymerase chain reaction on Step One Plus instrument (Applied Biosystems, USA) by using TaqMan® Gene Expression Assays kits (Applied Biosystems, USA).

Results. As a result of screening analysis of 200 genes expression in paired samples of renal carcinoma/normal renal tissue we selected 5 genes showing the highest frequency of increased expression in stages I–III of the development of clear renal cell carcinoma: CA9, EGLN3, HIG2, NDUFA4L2, STC2.

Conclusion. As a result of the expression study we developed a new panel, including CA9, HIG2 and STC2 genes which has high sensitivity (96.8 %) and specificity (92.9 %) for differential diagnosis of the early clear cell renal cell carcinoma on the basis of determining the level of messenger RNA expression by real-time polymerase chain reaction. This approach allows you to diagnose clear cell renal cell carcinoma quickly (within 1 day), and differentiate it from other types of renal cell cancer. In addition, it opens the possibility of non-invasive diagnosis of renal carcinoma in the future.

Background. The article presents the analysis of morbidity from prostate cancer (PC) with consideration of regional differences in the level of the health and environmental safety.

Materials and methods. Analysis was conducted of the level of incidence of PC in the Rostov region for the period 2001 to 2014. Model of conditionality of distribution of oncological diseases as ecology dependent pathologies is based on software ArcGIS 10. The constructed model has provided a number of results, significantly expanding the scope and use of medical and environmental monitoring.

Results. It has been shown that in the regions and cities of the Rostov region with a low level of medical-ecological safety observed a statistically significant increase in the incidence of PC. On the example of the Rostov region it has been shown that the level of cancer is an indicator of health and environmental safety of the area.

Conclusions. The results can serve as a basis for the directional analysis of factors causing increase risk of cancer and development on these basis strategies for monitoring and prevention of cancer diseases in the Rostov region.

Background. Introduction to the clinical practice of new criteria for the diagnosis and monitoring of neoplastic processes in the prostate based on the identification of informative predictors and markers of prostate cancer (PC), especially its aggressive forms, is one of the priority directions of scientific research in oncological urology. The goal – the search of new markers of aggressive forms of PC.

Materials and methods. For identification associated with PC progression indicators – potential markers clinically aggressive forms of PC was determined activity kininase II (angiotensin-converting enzyme (ACE), EC 3.4.15.1) in serum of blood with using as substrate N-(3-(2-furyl) acryloyl)-L-phenylalanyl-glycyl-glycine (FAPGG). Retrospectively evaluated ACE activity in patients with the development of biochemical recurrence and without after hormone-radiation therapy.

Results. It has been shown that the development of PC recurrence is associated with an increase in ACE activity, and the ACE activity starts to grow sooner than noted the development of biochemical recurrence. Joint determination of prostate-specific antigen and the activity of the enzyme after a month of treatment allows to select a group of patients with high risk of biochemical recurrence with sensitivity, specificity of 78.6 % (p < 0.001), respectively 94,6 % (p < 0.001).

Conclusions. There is every reason to believe that ACE is a promising predictive marker of clinically aggressive forms of PC. The renin-angiotensin system in PC can be considered as a new therapeutic target for targeted therapy.

Цель исследования – изучение целесообразности и безопасности спасительной цистэктомии после органосохраняющего лечения у больных мышечно-инвазивным раком мочевого пузыря.

Материалы и методы. В исследование ретроспективно отобраны данные 130 больных переходно-клеточным раком мочевого пузыря, получавших лечение в РОНЦ им. Н.Н. Блохина в период с 1981 по 2016 г. В основную группу вошли 66 пациентов, подвергнутых спасительной цистэктомии после безуспешного органосохраняющего лечения, основанного на лучевой терапии. Лимфодиссекцию произвели 42 (63,6 %) пациентам. С целью отведения мочи выполнялись: операция Бриккера (42 (63,6 %)), операция Штудера (7 (10,6 %)), другое (17 (25,8 %)). Морфологически рак мочевого пузыря верифицирован в 62 (93,9 %) препаратах (категория Р1 – 6 (9,1 %), Р2 – 21 (31,8 %), Р3 – 25 (37,9 %), Р4 – 18 (27,2 %)); метастазы в лимфатические узлы выявлены в 11 (16,6 %) случаях. Степень анаплазии расценена как G3 в 35 (56,5 %) из 62 препаратов, содержавших опухоль. В группу сравнения включены 64 пациента, которым была выполнена радикальная цистэктомия без предшествующего лечения. Частота категорий Т3a–4b и степени анаплазии G3 была достоверно выше для всех пациентов основной группы (р < 0,0001).

Результаты. Частота интраоперационных осложнений спасительных цистэктомий составила 10,6 %, послеоперационных – 42,7 % (28 из 65) (I–II степени тяжести – 27,3 % (18 из 28), III–V степени тяжести – 15,4 % (10 из 28)). Пятилетняя общая, специфическая и безрецидивная выживаемость пациентов основной группы составила 43,7; 58,6 и 54,7 % соответственно. Независимыми факторами благоприятного прогноза выживаемости явились степень анаплазии G1–2, гидронефроз и лимфодиссекция. Рецидивы после спасительных операций развивались реже, чем после цистэктомий, выполненных без предшествующего лечения (19 (30,6 %) и 31 (48,4 %) соответственно, р = 0,031). Других статистически значимых различий результатов спасительной и радикальной цистэктомий не выявлено.

Заключение. Спасительная цистэктомия после безуспешного органосохраняющего лечения у больных мышечно-инвазивным раком мочевого пузыря ассоциирована с приемлемым операционным риском и обеспечивает удовлетворительные отдаленные результаты, сопоставимые с радикальной цистэктомией.