Cancer Urology
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Published By Publishing House Abv Press

1996-1812, 1726-9776

2021 ◽  
Vol 17 (3) ◽  
pp. 130-139
Author(s):  
V. Yu. Startsev ◽  
A. E. Balashov ◽  
A. S. Merzlyakov ◽  
S. L. Vorobiov ◽  
E. S. Kozorezova

Background. Urothelial carcinoma (UTC) is an aggressive disease with a known propensity for frequent recurrence. It is difficult to predict the velocity of the development of UTC recur using modern means of clinical diagnostics. Therefore, the development of the capabilities of histo-morphological study of tumor tissues is of particular relevance.Materials and methods. The materials of publications (PubMed, CrossRef) for 1990-2021, devoted to the choice of biomarkers for the diagnosis of UTC, the analysis of molecular pathways, progression and metastasis, were studied. The search was carried out for the key phrases "urothelial carcinoma", "recurrent UTK", "stem cells", "biomarkers of bladder cancer", "genetic changes in urothelium", "circulating tumor DNA".Results. Cancer stem cells serve as a source of UTC recurrence after removal from the primary focus, localizing in any areas of the urothelium, as well as outside the main tumor focus and are characterized by a common genotype, but different phenotypic manifestations. To predict the recurrence of the tumour is advisable to use gene expression signatures, since the subtypes of UTC are characterized by clear gene expression profiles. A larger sample and independent dataset is needed to confirm the clinical significance of the findings. Combined biomarkers predict UTC behavior, and FGFR3 and TP53 mutations can be components for a panel for predicting UTC recurrence. The use of the liquid biopsy method with the determination of the level of circulating tumor DNA is a promising diagnostic method that needs to evaluate the results of an initiated randomized trial.Conclusion. The accumulation of knowledge base about the molecular patterns of UTC will help bridge the gap between the results of molecular genetic and clinical diagnostics. Molecular changes in the transitional cell UTC demonstrates a high potential for determining the timing of tumor recurrence, assessing disease-free survival of patients and for planning the resource base of the healthcare system.


2021 ◽  
Vol 17 (3) ◽  
pp. 121-128
Author(s):  
K. K. Ramazanov ◽  
K. B. Kolontarev ◽  
G. P. Gens ◽  
A. V. Govorov ◽  
A. O. Vasilyev ◽  
...  

Prostate cancer (РСа), being one of the leading causes of cancer mortality in men in Russia and in a number of other countries of the world, remains an urgent problem for modern oncourology, and the choice of surgical method is an important task for a surgeon. Such a pronounced interest in robot-assisted radical prostatectomy (RARP) in patients is driven by good tolerance and effectiveness of these surgical interventions, despite the fact that radical prostatectomy is considered to be the "gold standard" for treatment of patients with clinically localized РСа with regard to European Association of Urology data. The long-term oncological and functional results and the quality of life of patients after RARP deserve close attention and thorough study. According to the data presented in this article, it is obvious that RARP is the preferred method for surgical treatment of РСа, since oncological and functional results in the long-term follow-up are comparable to the results after radical prostatectomy, and according to some authors, these results are superior to the results of radical prostatectomy. The results of the study will allow to continue further introduction of RARP into clinical practice and its popularization as a method of surgical treatment of patients with localized PCa, which will reduce the length of hospital stay of patients, accelerate their medical and social rehabilitation, and improve the quality of medical care.The amount of data on the study of distant oncological and functional results of RARP as well as its superiority over other treatment methods is limited in medical literature, which prompted us to conduct our own research. Currently the urological clinic of the A.I. Evdokimov Moscow State University of Medicine and Dentistry continues work aimed at studying the longterm results of RARP in the first patients in Russia.


2021 ◽  
Vol 17 (3) ◽  
pp. 95-101
Author(s):  
S. A. Krasny ◽  
I. F. Shishlo

Background. Surgical morbidities of radical cystectomy, which are, as a rule, complicated intraabdominal infections, appear to be the main causes of repeated surgeries and fatal outcomes. The elimination of the infection Indus and an-timicrobic therapy are the currently accepted standard of treatment for postoperative peritonitis in cancer urology, as well as in general surgery hospital.Objective: defining the most reasonable option of surgical aid for peritonitis developing after cystectomy.Materials and methods. In the time period from 2000 through 2014, 58 cancer patients with postoperative peritonitis developing after cystectomy received indoor treatment at N.N. Alexandrov Republican Research and Practical Center for Oncology and Medical Radiology. Their mean age was 64.9 years, the range 44-90 years, 53 (91.4 %) of them being male. Primary urinary bladder cancer was present in 51 (87.9 %) patients. Peritoneal infection was microbiologically verified in 57 (98.3 %) patients. Each case of fatal outcome was associated with ineffective treatment of peritonitis. Depending on the intraoperative findings (presence or absence of a hollow organ defect) and the surgical approach undertaken (obstructive resection or operation maintaining the continuity of the intestinal and/or urinary tract), the patients were stratified into three groups: group 1 (n = 28), group 2 (n = 20) and group 3 (n = 10). There were no significant differences in the basic parameters specifying peritoneal infection severity between the patients of groups 1 and 2 vs group 3 (p >0.05).Results. Overall mortality amounted to 25.9 %, 15 patients died. Among the 28 (48.3 %) patients (group 1) who underwent obstructive elimination of the peritonitis focus by means of urointestinal reservoir ablation, resection of small or large intestine with ileo- or colostomy, 6 patients died, mortality 21.4 %. In the 10 (17.2 %) patients (group 3) who succeeded in preserving the urinary conduit or continuity of the bowels by anastomosis defect closure, resection of enteroentero-anastomosis or urointestinal reservoir with repeated anastomosing or defect closure, mortality was higher (60 %) (p = 0.045); 6 patients died.Conclusion. The most effective option of surgical treatment of postoperative peritonitis developing after cystectomy is obstructive reoperation on the bowels and urinary tracts: compared with the intervention consisting in preserving the urinary conduit and/or continuity of the intestinal tract, this type of surgery caused a 2.8-fold lower mortality.


2021 ◽  
Vol 17 (3) ◽  
pp. 102-109
Author(s):  
I. V. Tsimafeyeu ◽  
G. N. Alekseeva ◽  
V. V. Petkau ◽  
R. A. Zukov ◽  
M. S. Mazhbich ◽  
...  

Background. Data on the overall survival (OS) of patients with metastatic bladder cancer (BCa) is rarely published.The objective of the URRU register study is to assess OS and collect information on the administration of different treatments in patients with metastatic BCa in routine clinical practice in Russia.Materials and methods. Patients were retrospectively identified in 9 oncology centers in different regions of Russia and included in the study if they were diagnosed with metastatic BCa between January 2017 and January 2018. We collected anonymized data online, including demographic characteristics of patients, details of their therapy, and outcomes.Results. This study included 246 patients. Their mean age upon the diagnosis of metastatic BCa was 72 years with 60.6 % of patients over 70 years of age. The proportion of males was 74.8 %. The histological subtype of BCa (urothelial carcinoma, etc.) was identified in 70.3 % of cases. Ninety-two patients (37.4 %) received pharmacotherapy. The most common treatment option was chemotherapy (76 %); the most common drug combination was gemcitabine and cisplatin (41.3 %). Immunotherapy was used in 19.6 % of patients; 13.6 % of participants received more than two lines of therapy. Three-year OS rate was 10.6 %; median OS was 7 months (95 % confidence interval (CI) 5.4-8.6). Patients receiving systemic therapy demonstrated significantly longer survival than those receiving no therapy (21 months; 95 % CI 17.38-24.62 vs 3 months; 95 % CI 1.79-4.22; p <0.0001). Patients receiving immunotherapy had better survival than individuals receiving chemotherapy (median OS 34.5 months vs 18 months; p = 0.003).Conclusion. The survival rates in the URRU study were relatively low, which can be attributed to the fact that only one-third of patients received pharmacotherapy and very few patients received immunotherapy. Second and subsequent lines of therapy were rarely used in patients with progressive disease. The implementation of novel treatments, including immune checkpoint inhibitors, will increase the survival of BCa patients.


2021 ◽  
Vol 17 (3) ◽  
pp. 110-120
Author(s):  
V. Yu. Startsev ◽  
E. V. Shpof ◽  
D. I. Krivonosov

Background. Prostate cancer (PCa) is well-known as the 2nd leading cause of death from malignant neoplasms among the males from developed countries. One of the variants of the disease - neuroendocrine carcinoma of the prostate (NECP) -manifests itself as the form of castration-resistant PCa. Distinctive manifestations of NECP include a low level of serum prostate specific antigen (PSA), a high potential rate of metastasis, and resistance to hormone replacement therapy. There are very few medical publications on the possibilities of diagnosis and therapy of this type of tumor.The objective of the study is to review the current foundations of pathogenesis, methods of diagnosis and treatment of patients with NECP.Materials and methods. The data of modern medical literature from the PubMed/Crossref archives, from the Elsevier and Scopus databases for 1991-2020 were studied. The materials on the epidemiology and pathogenesis of NECP, as well as the methods of diagnosis and treatment of patients with this pathology are summarized. A comparative analysis of the levels of neuroendocrine markers in castration-resistant and localized forms of PCa was carried out. The schemes of combination therapy of NECP with the use of somatostatin analogs are considered.Results. The detection rate of NECP is reduced due to the blurred clinical picture and morphological characteristics similar to poorly differentiated carcinoma. The basis for the diagnosis of NECP is the determination of the levels of neuronal markers - chromogranin A, neuron-specific enolase, and a number of potentially mitogenic hormones, including PTHrP, NT, serotonin, bombesin, calcitonin, and thyroid-stimulating hormone. The worst prognosis was observed in patients with initially high levels of chromogranin A, which emphasizes the high significance of this indicator for monitoring NECP. The drug of choice in the treatment of patients with this pathology is the somatostatin analogue octreotide-depot, the use of which in combination with hormone replacement therapy leads to stabilization of PCa in 50 % of cases. During therapy with an analogue of somatostatin alone or in cases of tumor progression against the background of chemotherapy, a decrease in PSA level is noted in 50-60 % of cases, and PSA level stabilization - in 41.7-53.3 %.Conclusion. We founded an insufficient number of randomized clinical trials of NECP, therefore, the prognosis of the development of this pathology remains completely unclear. The use of somatostatin analogues, along with targeted therapy, is the main choice of therapy for NECP, but requires further study in the program of randomized trials. If a positive result is obtained, it will be possible to use somatostatin analogs more widely to improve the quality and increase the life expectancy of patients with NECP.


2021 ◽  
Vol 17 (3) ◽  
pp. 19-28
Author(s):  
M. I. Volkova ◽  
N. L. Vashakmadze ◽  
A. V. Klimov ◽  
A. K. Begaliev ◽  
K. P. Kuznetsov ◽  
...  

Objective: to identify independent risk factors affecting survival of patients with renal cell carcinoma (RCC) and tumor venous thrombosis who have undergone nephrectomy and thrombectomy.Materials and methods. This study included 768 patients with RCC complicated by tumor venous thrombosis who have undergone nephrectomy and thrombectomy. Median age was 58 years (range: 16-82 years); the male to female ratio was 2.3:1. The symptoms of tumor venous thrombosis were identified in 232 patients (30.2 %); laboratory abnormalities at baseline were observed in 456 patients (59.3 %). Grade I and II tumor thrombosis was diagnosed in 456 (59.3 %) and 201 (26.2 %) patients, respectively; grade III and IV thrombosis was found in 171 (22.3 %) and 177 (23.0 %) patients, respectively. One hundred and twenty-nine participants (16.8 %) had infrarenal inferior vena cava thrombosis. Regional metastases were detected in 188 individuals (24.4 %), distant metastases were registered in 274 patients (35.7 %). All patients have undergone surgery: either radical (n = 555; 72.3 %) or cytoreductive (n = 213; 27.7 %). All primary tumors were histologically classified as RCC (G3-4 in 337 cases; 43.9 %). A total of 719 patients (93.6 %) survived the perioperative period; 183 patients with metastasis (23.8 %) received systemic antitumor therapy.Results. The median follow-up was 24 months (range: 1-200 months). The 24-month overall and cancer-specific survival of all patients were 96.9 and 99.7 %, respectively; recurrence-free survival of patients after radical surgery reached 92.9 %. Progression-free survival among those patients who underwent cytoreductive surgery and received first-line therapy/follow-up was 41.7 %. Negative predictive factors of overall survival included hepatomegaly (p = 0.024), ascites (p = 0.033), level IV tumor thrombosis (p <0.0001), infrarenal inferior vena cava thrombosis (p = 0.002), regional metastases (p <0.0001), and cytoreductive surgery (p = 0.012). Depending on the number of risk factors, we have identified 3 prognostic groups: favorable (0 factors), intermediate (1-2 factors), and poor (3-6 factors). Median overall survival differed significantly between the groups and was 128.6 ± 11.8; 40.9 ± 6.7 and 12.3 ± 2.2 months, respectively (p <0.0001 for all).Conclusion. Stratification of patients operated on for RCC and venous tumor thrombosis with their allocation to prognostic groups will ensure the choice of an optimal management strategy.


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