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The state of cancer care in Russia: epidemiology and survival in patients with the most common and life-threatening solid malignant tumors. Part 1. (Population study) 俄罗斯的癌症治疗状况:最常见、最危及生命的实体恶性肿瘤患者的流行病学和存活率。第一部分(人口研究)
Pub Date : 2024-07-02 DOI: 10.17816/onco626385
Vakhtang Mikhailovich Merabishvili
Solid tumors [solid - firm, non-hematopoietic, i.e. developing not from cells of the hematopoietic system] constitute the majority of malignant tumors. The most important factors for their development are: size, degree of sprouting into surrounding tissues, spread throughout the body in the form of regional and distant metastases. The most common, i.e. have the highest incidence rate, solid malignant tumors (SMT) in Russia are three ones: lung, stomach and breast cancer. The most life-threatening (i.e. have the worst survival rates (among those detected, the largest proportion dies)) are liver and pancreatic cancer. We paid particular attention to the impact of coronavirus infection pandemia on morbidity, mortality as well as registration quality of patients with SMT. In order to evaluate the effectiveness of conducted anticancer measures, we calculated survival rates of patients.
实体瘤[实体--坚实、非造血,即不是由造血系统细胞发展而来]占恶性肿瘤的大多数。肿瘤发生的最重要因素是:大小、向周围组织萌发的程度、以区域和远处转移的形式扩散到全身。在俄罗斯,最常见(即发病率最高)的实体恶性肿瘤(SMT)有三种:肺癌、胃癌和乳腺癌。肝癌和胰腺癌对生命威胁最大(即存活率最差(在发现的患者中,死亡比例最高))。我们特别关注冠状病毒感染大流行对 SMT 患者发病率、死亡率和登记质量的影响。为了评估所采取的抗癌措施的有效性,我们计算了患者的存活率。
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引用次数: 0
The problem of pancreatic fistula development after pancreatic surgery in oncological patients 肿瘤患者胰腺手术后出现胰瘘的问题
Pub Date : 2024-07-02 DOI: 10.17816/onco625700
M. B. Potievskiy, L. Petrov, S. Ivanov, P. V. Sokolov, V. Trifanov, Nikolai A. Grishin, R. I. Moshurov, Lidia Aleksandrovna Nekrasova, P. Shegai, A. Kaprin
Pancreaticoduodenal and distal resections considered crucial components of pancreatic cancer treatment. Pancreatic fistula is one of the most common complications these surgeries. The main criterion for the diagnosis of pancreatic fistula is the increase of amylase drain level more than 3 norms of the blood level. Pancreatic fistulas worsen the long-term results of cancer treatment and increase the risk of bleeding per an erosion of visceral vessels, pancreatitis and peritonitis, as well as increase the duration hospitalization. Risk factors for pancreatic fistula may be distinguished into patient-related and surgical factors. The patient-related factors are male sex, age more than 70 years, small diameter of the pancreatic duct, epithelial type of the malignancy, comorbidities and a high volume of drainage fluid in the postoperative period. Surgical risk factors are the severity of intraoperative blood loss, soft pancreas, duration of surgery and surgical techniques. At the same time, it is possible to use medical glues and pharmacological methods for prevention and treatment of postoperative pancreatic fistulas, but further investigations are required. Thus, prevention and treatment of postoperative pancreatic fistulas is a crucial component of management of patients who undergo surgery for pancreatic malignancies.
胰十二指肠和远端切除术被认为是胰腺癌治疗的重要组成部分。胰瘘是这些手术最常见的并发症之一。诊断胰瘘的主要标准是淀粉酶引流液水平升高超过血液水平的 3 倍。胰瘘会恶化癌症治疗的长期效果,增加内脏血管侵蚀出血、胰腺炎和腹膜炎的风险,并延长住院时间。胰瘘的风险因素可分为患者相关因素和手术因素。患者相关因素包括男性、年龄超过 70 岁、胰管直径小、恶性肿瘤上皮类型、合并症以及术后引流液量大。手术风险因素包括术中失血严重程度、软胰腺、手术持续时间和手术技术。同时,可以使用医用胶水和药物方法预防和治疗术后胰瘘,但还需要进一步研究。因此,预防和治疗术后胰瘘是胰腺恶性肿瘤手术患者管理的重要组成部分。
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引用次数: 0
Роль нейтрофилов опухолевого микроокружения в прогрессии люминального HER2-негативного раннего рака молочной железы 肿瘤微环境中性粒细胞在腔内 HER2 阴性早期乳腺癌进展中的作用
Pub Date : 2024-07-02 DOI: 10.17816/onco624111
E. Zakurdaev, Zurab Antonovich Bagateliya
Background. Luminal Her2-negative breast cancers is the most common type of tumor in women diagnosed with early-stage breast cancer. Stromal cells and immune cells in tumor microenvironment have been reported to have significant value in prognosis of cancers. The prognostic role of tumor-associated neutrophils in early breast cancer remains mostly unclear. Materials. The dataset consisted of 60 patients with early luminal HER2-negative breast cancer treated in Botkin Hospital. We first estimated basic morphological signs: tumor size, tumor grade by Nottingham Score, tumor-infiltrating lymphocytes, lymphovascular invasion, hormonal receptors status, proliferative index, regional lymph nodes status. The expressions of intratumoral CD15-neutrophyls was studied using immunohistochemistry. Results. High tumor-associated neutrophils concentration was correlated with tumor size, high grade tumors, proliferative index, tumor-infiltrating lymphocytes, lymphovascular invasion and positive regional lymph nodes. Conclusions: Tumor-associated neutrophils predicted a worse prognosis in early luminal Her2-negative breast cancer.
背景腔隙性 Her2 阴性乳腺癌是早期乳腺癌妇女中最常见的肿瘤类型。据报道,肿瘤微环境中的基质细胞和免疫细胞对癌症预后有重要价值。肿瘤相关中性粒细胞在早期乳腺癌中的预后作用仍不明确。材料数据集包括在 Botkin 医院接受治疗的 60 例早期管腔型 HER2 阴性乳腺癌患者。我们首先估计了基本形态学指标:肿瘤大小、诺丁汉评分肿瘤分级、肿瘤浸润淋巴细胞、淋巴管侵犯、激素受体状态、增殖指数、区域淋巴结状态。使用免疫组化方法研究了瘤内 CD15 中性粒细胞的表达。结果显示肿瘤相关中性粒细胞的高浓度与肿瘤大小、高级别肿瘤、增殖指数、肿瘤浸润淋巴细胞、淋巴管侵犯和区域淋巴结阳性相关。结论肿瘤相关中性粒细胞预示着早期管腔Her2阴性乳腺癌的预后较差。
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引用次数: 0
Diagnosis of metastatic melanoma by fine-needle aspiration biopsy (FNAB) and primary melanoma using the skin and mucousa imprints 通过细针穿刺活检 (FNAB) 诊断转移性黑色素瘤,利用皮肤和粘膜印迹诊断原发性黑色素瘤
Pub Date : 2024-07-02 DOI: 10.17816/onco626586
O. Grigoruk, Е. E. Pupkova, L. M. Bazulina, I. V. Vikhlyanov
BACKGROUND: Determination of the cytogenetic origin and morphological type of metastatic or primary tumor determines the prescription of therapy and affects to the patient’s efficiency treatment. Currently, a number of publications evaluate the potential of cytological diagnostics of melanoma.AIM: To evaluate the significance of diagnostics of metastatic melanoma by fine-needle aspiration biopsy (FNAB) and primary melanoma using the skin and mucosa imprints. MATERIALS AND METHODS In a retrospective study, a comparative analysis of cytological “melanoma” samples, in comparison with clinical and anamnestic information and the results of histological, immunohistochemical, and molecular genetic studies were carried out.Information about 109 patients from the cancer registry of the Altai Regional Oncology Dispenser (Barnaul) for 2022 was used in the work. Traditional and liquid based methods for patterns preparing were used. The samples were stained using Pappenheim and Papanicolaou methods. In some observations, cytological material was used for molecular genetic studies. Using the cancer registry data of the dispensary, the results of histological and of molecular genetic studies, and a final conclusion was given about each patient. RESULTS: Fine needle biopsy (FNA) was carried out in 80 patients. Tumor smears were obtained from 29 patients. The cytological diagnose “melanoma” was consistent with the data of histological and immunohistochemical studies (p 0.001) for all 109 patients. Melanoma was diagnosed for the first time in 64 (58.7%) patients. In other cases, the process of progression was noted from one year to 20 years. Epidermal melanoma was noted in 101 (92.7%) cases, including 9 patients with acral melanoma, and 2 cases on the vulva. Melanomas of mucosa were found in 5 cases (4.5%): in the rectum and anal canal, vagina, and in 2 cases on the hard palate. Non-epidermal (uveal) melanomas metastases were diagnosed in liver by FNAB in 3 patients (2.8%). Based on the cellular composition, epithelioid cell melanoma was determined in 91 (83.5%) patients, mixed cell in 10 (9.2%) cases, spindle cell in 6 (5.5%), pigmentless in two (1.8%) cases and nevoid melanoma(0.9%) in 1 case. The mutation status was determined in 96 patients (88.1%). Of these, in 8 patients the study was determined using cytological material. In epidermal melanomas, mutations in codon 600 of exon 15 of the BRAF gene were found in 43 (44.8%) patients, including 2 cases of acral melanoma. Mutations V600K, V600E/Ec were found in one observation (1.1; 1.1%). In mucousal melanomas: vaginal melanoma, the Q61R mutation was found in exon 3 of the NRAS gene; In anal canal melanoma, the G12C mutation was identified in exon 2 of the NRAS gene. In uveal melanomas, the assessed mutations were absent (the determining GNAQ11 and BAP1 mutations is necessary). CONCLUSIONS: Cytological diagnosis of melanoma by fine-needle aspiration biopsies and imprints from the tumor mass is a highly in
背景:确定转移性或原发性肿瘤的细胞遗传学来源和形态学类型决定了治疗方案的制定,并影响患者的治疗效率。目的:评估通过细针穿刺活检(FNAB)诊断转移性黑色素瘤和使用皮肤与粘膜印记诊断原发性黑色素瘤的意义。材料与方法 在一项回顾性研究中,对细胞学 "黑色素瘤 "样本进行了比较分析,并将其与临床和解剖学信息以及组织学、免疫组化和分子遗传学研究结果进行了比较。研究采用了传统的和基于液体的模式制备方法。样本采用帕本海姆法和巴氏染色法染色。在某些观察中,细胞学材料被用于分子遗传学研究。利用医务室的癌症登记数据、组织学和分子遗传学研究结果,对每位患者做出最终结论。结果:对 80 名患者进行了细针活检(FNA)。29 名患者获得了肿瘤涂片。所有 109 名患者的细胞学诊断 "黑色素瘤 "与组织学和免疫组化研究数据一致(P 0.001)。黑色素瘤在 64 例(58.7%)患者中是首次确诊。在其他病例中,黑色素瘤的发展过程从 1 年到 20 年不等。表皮黑色素瘤有 101 例(92.7%),包括 9 例尖锐湿疣黑色素瘤患者和 2 例外阴黑色素瘤患者。粘膜黑色素瘤有 5 例(4.5%),分别位于直肠和肛管、阴道,还有 2 例位于硬腭。有 3 名患者(2.8%)通过 FNAB 诊断出肝脏中的非表皮(葡萄膜)黑色素瘤转移。根据细胞组成,91 例(83.5%)患者确定为上皮样细胞黑色素瘤,10 例(9.2%)为混合细胞黑色素瘤,6 例(5.5%)为纺锤形细胞黑色素瘤,2 例(1.8%)为无色素黑色素瘤,1 例为痣样黑色素瘤(0.9%)。96名患者(88.1%)的基因突变状态得到确定。其中,8 例患者的研究是通过细胞学材料确定的。在表皮黑色素瘤中,43 例(44.8%)患者发现 BRAF 基因第 15 号外显子第 600 密码子发生突变,其中包括 2 例尖锐湿疣黑色素瘤。有 1 例患者(1.1;1.1%)发现 V600K、V600E/Ec 突变。在粘膜黑色素瘤中:阴道黑色素瘤的NRAS基因第3外显子中发现了Q61R突变;肛管黑色素瘤的NRAS基因第2外显子中发现了G12C突变。在葡萄膜黑色素瘤中,所评估的突变均不存在(需要确定 GNAQ11 和 BAP1 突变)。结论:通过细针穿刺活检和瘤块印迹对黑色素瘤进行细胞学诊断是一种信息量很大的方法,可以诊断黑色素瘤并验证肿瘤亚型。在选择个体化治疗时,黑色素瘤的分子分类非常重要。
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引用次数: 0
Immunophenotype of dendritic cell differentiation markers in breast cancer in in vitro conditions 体外条件下乳腺癌树突状细胞分化标记的免疫表型
Pub Date : 2024-03-20 DOI: 10.17816/onco625825
A. Golderova, Irina E. Nikolaeva, Tatiana N. Jarnikova, P. Nikiforov, Ivan P. Troev
During maturation, dendritic cells begin to synthesize peptides that are MHC-II co-stimulatory molecules CD40, CD80 and CD86, as well as CD83 proteins. In cancer patients, DC dysfunction can lead to serious consequences in the form of deficiency of antitumor immunity, tumor progression, and decreased response to immunotherapy. All this is important to take into account to rethink the tumor immunotherapy strategy. Thus, approaches aimed at enhancing the viability of DCs and preventing their dysfunction and polarization should be considered as a necessary step in the work to increase the effectiveness of DC-based vaccines. The study is conducted to evaluate the expression characteristics of differentiation markers of dendritic cell maturation obtained from peripheral blood monocytes under culture conditions in patients with breast cancer. With informed voluntary consent, 19 patients diagnosed with breast cancer were examined. Mononuclear cells were isolated on a Ficoll density gradient. For adhesion of monocytes to the bottom of culture flasks with a volume of 75 cm2, they were pre-incubated for 1.5 hours in conditions of 5% CO2 at 37˚C. Growth and differentiation factors – GM-CSF (40 µl) and IL-4 (40 µl) – were added to the attached monocytes, which were added on the 1st, 3rd and 5th days of cultivation. Immunophenotyping of dendritic cells was carried out on days 7 and 9 of cultivation using flow cytometry. Flow cytometry data indicate that the viability of cultured dendritic cells in cancer patients is significantly reduced on day 9 compared to day 7 of culture. On day 9, there was a significant increase (p=0.028) in CD80+ expression (2.40 times) and a decrease in CD83+ (1.65 times) compared to day 7 (p=0.036). In general, significant signs of maturation are observed: loss of the monocyte marker CD14, increased expression of CD80+, CD83+, CD86+ - the main markers. A decrease in CD83+ can be considered as a suppression of excessive activation of immune responses. In the future, a more in-depth study of the characteristics of maturation and activation of cultured dendritic cells is necessary to understand the mechanisms and factors influencing the decrease in the effectiveness of immunotherapy with an autologous dendritic cell vaccine.
在成熟过程中,树突状细胞开始合成多肽,这些多肽是 MHC-II 协同刺激分子 CD40、CD80 和 CD86 以及 CD83 蛋白。在癌症患者中,DC 功能障碍可导致严重后果,表现为抗肿瘤免疫力不足、肿瘤进展和对免疫疗法的反应减弱。所有这些都是重新考虑肿瘤免疫疗法策略时必须考虑的因素。因此,在提高基于直流电的疫苗有效性的工作中,应将旨在增强直流电活力、防止其功能障碍和极化的方法视为必要步骤。本研究旨在评估乳腺癌患者外周血单核细胞培养条件下树突状细胞成熟分化标志物的表达特征。在知情自愿同意的情况下,19 名确诊为乳腺癌的患者接受了检查。用 Ficoll 密度梯度分离单核细胞。为使单核细胞粘附在容量为 75 平方厘米的培养瓶底部,在 5%二氧化碳、37℃条件下预育 1.5 小时。向附着的单核细胞添加生长和分化因子--GM-CSF(40 µl)和 IL-4(40 µl),分别在培养的第 1 天、第 3 天和第 5 天添加。在培养的第 7 天和第 9 天,使用流式细胞仪对树突状细胞进行免疫分型。流式细胞仪数据表明,与培养第 7 天相比,癌症患者培养的树突状细胞在第 9 天的存活率明显降低。与第 7 天相比(p=0.036),第 9 天 CD80+ 表达明显增加(p=0.028)(2.40 倍),CD83+ 减少(1.65 倍)。一般来说,可观察到明显的成熟迹象:单核细胞标记 CD14 消失,CD80+、CD83+、CD86+--主要标记表达增加。CD83+ 的减少可视为对免疫反应过度激活的抑制。今后,有必要对培养树突状细胞的成熟和活化特征进行更深入的研究,以了解影响自体树突状细胞疫苗免疫治疗效果下降的机制和因素。
{"title":"Immunophenotype of dendritic cell differentiation markers in breast cancer in in vitro conditions","authors":"A. Golderova, Irina E. Nikolaeva, Tatiana N. Jarnikova, P. Nikiforov, Ivan P. Troev","doi":"10.17816/onco625825","DOIUrl":"https://doi.org/10.17816/onco625825","url":null,"abstract":"During maturation, dendritic cells begin to synthesize peptides that are MHC-II co-stimulatory molecules CD40, CD80 and CD86, as well as CD83 proteins. In cancer patients, DC dysfunction can lead to serious consequences in the form of deficiency of antitumor immunity, tumor progression, and decreased response to immunotherapy. All this is important to take into account to rethink the tumor immunotherapy strategy. Thus, approaches aimed at enhancing the viability of DCs and preventing their dysfunction and polarization should be considered as a necessary step in the work to increase the effectiveness of DC-based vaccines. The study is conducted to evaluate the expression characteristics of differentiation markers of dendritic cell maturation obtained from peripheral blood monocytes under culture conditions in patients with breast cancer. With informed voluntary consent, 19 patients diagnosed with breast cancer were examined. Mononuclear cells were isolated on a Ficoll density gradient. For adhesion of monocytes to the bottom of culture flasks with a volume of 75 cm2, they were pre-incubated for 1.5 hours in conditions of 5% CO2 at 37˚C. Growth and differentiation factors – GM-CSF (40 µl) and IL-4 (40 µl) – were added to the attached monocytes, which were added on the 1st, 3rd and 5th days of cultivation. Immunophenotyping of dendritic cells was carried out on days 7 and 9 of cultivation using flow cytometry. Flow cytometry data indicate that the viability of cultured dendritic cells in cancer patients is significantly reduced on day 9 compared to day 7 of culture. On day 9, there was a significant increase (p=0.028) in CD80+ expression (2.40 times) and a decrease in CD83+ (1.65 times) compared to day 7 (p=0.036). In general, significant signs of maturation are observed: loss of the monocyte marker CD14, increased expression of CD80+, CD83+, CD86+ - the main markers. A decrease in CD83+ can be considered as a suppression of excessive activation of immune responses. In the future, a more in-depth study of the characteristics of maturation and activation of cultured dendritic cells is necessary to understand the mechanisms and factors influencing the decrease in the effectiveness of immunotherapy with an autologous dendritic cell vaccine.","PeriodicalId":509207,"journal":{"name":"Russian Journal of Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140224408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
MATRIX METALLOPROTEINASE MMP7 AS NEW PROGNOSTIC BIOMARKER FOR GASTRIC CANCER 基质金属蛋白酶 mmp7 作为新的胃癌预后生物标志物
Pub Date : 2024-03-20 DOI: 10.17816/onco624049
Alevtina Eduardovna Kiseleve, M. A. Antsupova, Aleksey Vladimirovich Semenkov, Igor Igorevich Bykov
Background. According to statistics, gastric cancer is in a leading position among all gastrointestinal cancers. The most effective treatment for gastric cancer is surgical. There are now heterogeneous clinical outcomes for patients of the same stage. The main causes are the differences in gastric cancer not only at the histological level, but also at the molecular level. Finding the universal biomarkers that can provide information about patient prediction is a subject of interest to scientists around the world. MMP7 is the smallest molecule in the family of matrix metalloproteinase that contributes significantly to oncogenesis by affecting apoptosis and degradation of the extracellular matrix. MMP-7 hyperexpression is associated with aggressive tumor phenotype and worsens prognosis in patients with gastric cancer. Therefore, MMP-7 can be a promising biomarker in the treatment of gastric cancer. Aim. To identify possible correlations between the expression of MMP-7 in patients with gastric cancer and their prognosis. Materials and Methods. The study included samples of 80 patients diagnosed with diffuse gastric cancer, who were selected based on our inclusion and exclusion criteria. 30 sectional stomach samples were taken as a comparison group. Of the 80 patients included in the study, gastrectomy was performed by 55% (44 people) and gastric resection was performed by 45% (36 people). Results. In our work, the expression level of MMP-7 0.8 ±0.07 was indicated as high, and the expression rate of 0.40± 0.067 as low. During the study, we assessed the link between the level of MMP7 expression and the clinical characteristics of the tumor. We evaluated the following indicators: the disease stage (TNM0), the presence of lesions of lymph nodes, the size of the tumor. Patients with increased MMR7 expression in tumor tissue have a better prognosis than patients with low MMR7 expression. Conclusions. The results of our study showed high MMP7 expression in tumor tissue, which allowed us to establish a correlation between MMP7 expression and adverse clinical outcomes. The data obtained may indicate the possible use of MMP7 as a biomarker for gastric cancer.
背景。据统计,胃癌在所有消化道癌症中居首位。胃癌最有效的治疗方法是手术。目前,同一分期的患者临床疗效各不相同。主要原因是胃癌不仅在组织学层面存在差异,在分子层面也存在差异。寻找能够提供患者预测信息的通用生物标志物是全世界科学家都感兴趣的课题。MMP7是基质金属蛋白酶家族中最小的分子,它通过影响细胞凋亡和细胞外基质降解而对肿瘤发生起着重要作用。MMP-7 的高表达与侵袭性肿瘤表型有关,并会恶化胃癌患者的预后。因此,MMP-7 可作为治疗胃癌的一种有前景的生物标志物。研究目的确定胃癌患者体内 MMP-7 的表达与预后之间可能存在的相关性。材料和方法。本研究根据纳入和排除标准选取了 80 例弥漫性胃癌患者样本。30 份切片胃样本作为对比组。在纳入研究的 80 名患者中,55%(44 人)进行了胃切除术,45%(36 人)进行了胃切除术。研究结果在我们的研究中,MMP-7 的表达水平为 0.8 ±0.07 为高,表达率为 0.40±0.067 为低。在研究过程中,我们评估了 MMP7 表达水平与肿瘤临床特征之间的联系。我们评估了以下指标:疾病分期(TNM0)、淋巴结有无病变、肿瘤大小。肿瘤组织中MMR7表达量增加的患者比MMR7表达量低的患者预后更好。结论我们的研究结果表明,肿瘤组织中的MMP7表达量较高,这使我们能够确定MMP7表达量与不良临床预后之间的相关性。获得的数据可能表明,MMP7 可用作胃癌的生物标记物。
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引用次数: 0
Comparative evaluation of the perioperative anesthesia methods for cancer patients undergoing pancreaticoduodenectomy 对接受胰十二指肠切除术的癌症患者围手术期麻醉方法的比较评估
Pub Date : 2024-03-20 DOI: 10.17816/onco623528
Yu.S. Zakharenkova, V. Khoronenko, V. Trifanov
Background. Pancreatoduodenal resections (PDR) are one of the most traumatic and technically complex interventions in abdominal surgery. The correct anesthetic management correct and pain relief allow to substantially reduce the risk of perioperative complications, which remains high even in high-volume oncology centers with extensive experience. Finding new components and methods of anesthesia combined with evaluation of their effectiveness and safety remains actual issue. Aim. To evaluate the efficacy and safety of using intravenous lidocaine infusion as a component of anesthesia and postoperative analgesia in cancer patients during PDR. Material and methods. We analyzed the course of anesthesia, operation and postoperative period of 43 patient (mean age 63.2 ± 7.1 years) undergoing pancreaticoduodenectomy. For the purposes of the study, patients were randomly divided into 2 groups: epidural anesthesia (EA group, n=19) and lidocaine (L group, n=24). For EA group (n=19) we used epidural analgesia as a component of perioperative anesthesia, for L group (n=24) we used prolonged intravenous infusion of lidocaine at an average dose of 1 mg/kg/h. We analyzed the severity of pain syndrome according to NRS in postoperative period, opioid requirement, the time of gastrointestinal function recovery, post-operative complications frequency. In order to prevent systemic toxicity, drug monitoring was carried out - the determination of the plasma concentration of lidocaine. Results. Perioperative opioid requirement was comparable between groups, with no statistically significant differences observed. The degree of pain syndrome according to the NRS scale did not differ statistically, except for the number of NRS scores during activation on day 3, which was significantly lower in the lidocaine group: EA 4.00 (95% CI [3.49 - 4.51] and lidocaine 3, 12 (95% CI [2.64 – 3.61], p = 0.014. In the EA group, there was a statistically significant increase in infusion volume (8.83 ml/kg/h [[(Q1) 7.90 – (Q3) 10 .06] and 7.33 [(Q1) 6.28 - (Q3) 8.49], p = 0.034) and the need for intraoperative vasopressor support than in the lidocaine group (15 (78.9%) and 10 (43 .5%), respectively, p = 0.029. In the lidocaine group, the time to onset of peristalsis was significantly shorter than in the EA group (Me 48.0 h [(Q1) 48.00 - (Q3) 72.00] and Me 60 0 h [(Q1) 36.00 - (Q3) 64.50], p=0.042) The frequency of postoperative complications did not differ between the groups. Conclusions. Based on a comparative analysis of the study results, it can be concluded that prolonged intravenous infusion of lidocaine as a component of perioperative anesthetic protection during pancreatoduodental resections is safe and comparable in terms of analgesic efficacy to epidural blockade.
背景。胰十二指肠切除术(PDR)是腹部手术中创伤最大、技术最复杂的手术之一。正确的麻醉管理和镇痛可以大大降低围手术期并发症的风险,即使在经验丰富的大容量肿瘤中心,这种风险也仍然很高。寻找新的麻醉成分和方法并对其有效性和安全性进行评估仍然是一个实际问题。目的评估将静脉注射利多卡因作为 PDR 期间癌症患者麻醉和术后镇痛组成部分的有效性和安全性。材料和方法。我们分析了 43 名接受胰十二指肠切除术的患者(平均年龄 63.2 ± 7.1 岁)的麻醉、手术和术后过程。为便于研究,患者被随机分为两组:硬膜外麻醉组(EA 组,19 人)和利多卡因组(L 组,24 人)。硬膜外麻醉组(19 人)采用硬膜外镇痛作为围手术期麻醉的一部分,利多卡因组(24 人)采用长时间静脉输注利多卡因,平均剂量为 1 毫克/千克/小时。我们根据术后 NRS 分析了疼痛综合征的严重程度、阿片类药物需求量、胃肠功能恢复时间、术后并发症发生频率。为了防止全身毒性,我们进行了药物监测--测定利多卡因的血浆浓度。结果显示各组围手术期阿片类药物需求量相当,无统计学差异。根据 NRS 量表得出的疼痛综合征程度没有统计学差异,但第 3 天激活时的 NRS 评分次数在利多卡因组明显较低:EA组为4.00(95% CI [3.49 - 4.51]),利多卡因组为3.12(95% CI [2.64 - 3.61]),P = 0.014。与利多卡因组相比,EA 组的输液量(8.83 ml/kg/h [[(Q1)7.90 - (Q3) 10 .06] 和 7.33 [(Q1)6.28 - (Q3) 8.49],p = 0.034)和术中血管加压支持的需求有显著增加(分别为 15 (78.9%) 和 10 (43.5%),p = 0.029)。利多卡因组的蠕动开始时间明显短于 EA 组(Me 48.0 h [(Q1) 48.00 - (Q3) 72.00] 和 Me 60 0 h [(Q1) 36.00 - (Q3) 64.50],p=0.042)。结论。根据对研究结果的比较分析,可以得出结论:在胰十二指肠切除术中,长时间静脉输注利多卡因作为围手术期麻醉保护的一部分是安全的,其镇痛效果与硬膜外阻滞相当。
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引用次数: 0
Early diagnostics of prostate cancer based on a comprehensive analysis of risk factors 基于风险因素综合分析的前列腺癌早期诊断方法
Pub Date : 2024-03-20 DOI: 10.17816/onco624300
Alexander Lazarev
Research objective was to improve the quality and efficiency of diagnostic measures for prostate cancer through a personalized approach to patients based on an analysis of a set of risk factors. The methodology was developed using the data from the population-based Cancer Registry of the Altai Territory, created at the Altai Regional Oncology Center in Barnaul, Russia. At the moment the Cancer Registry included information on 308,550 patients with malignant neoplasms, including 15,167 males with prostate cancer. On the basis of the method of prostate cancer risk assessment proposed by Lazarev A.F. (patent number: RU 2692987 C1) an automated program for early diagnosis of prostate cancer has been developed (state registration certificate for computer program No. 2019663514). Testing of this technique included assessment of 532 patients (age between 23 and 82 y.o.). 128 patients were determined to belong to the high risk pre-cancer group. A high-risk precancer registry was created which included the patients having individual risk of developing prostate cancer either increased or high or absolute. Upon having a complex of in-depth examinations 7 of 128 patients (9.3%) were diagnosed with prostate cancer, all at early stages (I or II). Thus, the incidence of prostate cancer among the patients from the high risk pre-cancer registry was significantly higher than the average observed during prophylactic examinations (0.01%). It allows to suggest implementation of the method with the aim to assign in-depth examination in more targeted manner to patients at high risk of prostate cancer and to contribute to detection the cancer in the early stages.
研究目标是通过基于一系列风险因素分析的个性化方法提高前列腺癌诊断措施的质量和效率。该方法是利用俄罗斯巴尔瑙尔阿尔泰地区肿瘤中心建立的阿尔泰边疆区人口癌症登记处的数据开发的。目前,该癌症登记处包括 308550 名恶性肿瘤患者的信息,其中包括 15167 名男性前列腺癌患者。在拉扎列夫-A.F.提出的前列腺癌风险评估方法(专利号:RU 2692987 C1)的基础上,开发了前列腺癌早期诊断自动程序(计算机程序国家注册证书编号:2019663514)。该技术的测试包括对 532 名患者(年龄在 23 至 82 岁之间)进行评估。128名患者被确定为高风险癌前病变群体。我们建立了一个高风险癌前病变登记册,其中包括个人罹患前列腺癌风险增高或绝对增高的患者。在进行综合深入检查后,128 名患者中有 7 人(9.3%)被确诊为前列腺癌,且均处于早期阶段(I 期或 II 期)。因此,高风险癌前病变登记患者的前列腺癌发病率明显高于预防性检查期间观察到的平均值(0.01%)。因此,建议采用该方法,以便更有针对性地对前列腺癌高危患者进行深入检查,从而有助于早期发现癌症。
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引用次数: 0
The effect of active patient management, on life expectancy, in cancer of the tongue T2N0M0 积极管理患者对舌癌 T2N0M0 患者预期寿命的影响
Pub Date : 2023-12-29 DOI: 10.17816/onco456471
S. D. Fokeev, S.Yu. Kapitulin, E. S. Kazantseva, Elina K Kapitulinа, Yu.G. Belokrylova, A. F. Lazarev
The result of the treatment of tongue cancer, which includes surgical treatment at the first stage followed by radiation therapy, is presented. Carrying out radical combined treatment of tongue cancer in the future leads to the appearance of a post-radiation ulcer in the area of surgery, followed by the development of a recurrence of tongue cancer in it and metastasis to regional lymph nodes or submandibular salivary glands. All of the above requires oncologists to actively monitor this group of patients. With the development of a post-radiation chronic long-term non-healing ulcer in the area of surgery, surgical rehabilitation should be carried out. Surgical removal of such an ulcer prevents the further development of cancer recurrence. Regular examination, neck ultrasound, cytological examination of suspicious areas of the tongue, regional lymph nodes allows timely detection of relapse and metastases and radical surgical treatment. Such an active tactic of managing this pathology affected the patient's life expectancy 17 years.
本文介绍了舌癌的治疗结果,包括第一阶段的手术治疗和随后的放射治疗。今后进行舌癌根治性综合治疗会导致手术区域出现放射治疗后溃疡,继而出现舌癌复发以及区域淋巴结或颌下腺转移。所有这些都要求肿瘤学家积极监测这类患者。如果手术区域出现放疗后长期不愈合的慢性溃疡,应进行手术康复治疗。手术切除此类溃疡可防止癌症进一步复发。定期检查、颈部超声波检查、舌头可疑部位细胞学检查、区域淋巴结检查可以及时发现复发和转移,并进行根治性手术治疗。这种积极的病理管理策略使患者的预期寿命延长了 17 年。
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引用次数: 0
Analysis of complications of surgical treatment of patients diagnosed with pancreatic cancer. 胰腺癌患者手术治疗并发症分析。
Pub Date : 2023-12-29 DOI: 10.17816/onco584050
Nikita Mikolenko
The main treatment for pancreatic cancer (PPC) is surgery. The topography of the pancreas, its direct contact with the aorta, portal vein, inferior vena cava is a risk factor for the prevalence of the process, even with relatively small tumor sizes. Often, invasion into neighboring anatomical structures requires reconstructive intervention on adjacent vessels, aggravating the complexity of surgical intervention and its outcomes. The operation of choice for cancer of the head of the pancreas is gastropacreatoduodenal resection, and for a malignant tumor of the tail, distal resection of the pancreas with splenectomy. These operations, especially GPDR, are characterized by a high level of complications and mortality. Complications such as destructive pancreatitis (DP) and failure of the pancreatodigestive anastomosis remain the main cause of death. In our article, we will analyze the various complications that we encountered in our practice.
胰腺癌(PPC)的主要治疗方法是手术。胰腺的地形,其与主动脉、门静脉、下腔静脉的直接接触是胰腺癌发病的危险因素,即使肿瘤相对较小。通常情况下,如果肿瘤侵犯邻近的解剖结构,就需要对邻近的血管进行重建干预,从而增加了手术干预的复杂性和手术效果。胰头癌的首选手术是胃-胰-十二指肠切除术,胰尾恶性肿瘤的首选手术是胰腺远端切除加脾切除术。这些手术,尤其是胃-胰十二指肠切除术,并发症和死亡率都很高。破坏性胰腺炎(DP)和胰腺消化道吻合术失败等并发症仍是死亡的主要原因。本文将分析我们在实践中遇到的各种并发症。
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引用次数: 0
期刊
Russian Journal of Oncology
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