Pub Date : 2022-05-13DOI: 10.18786/2072-0505-2022-50-014
S. P. Semitko, D. Asadov, A. Rogatova, A. Stepanov, Natalya S. Mesyats, Natalya Pak, T. S. Sandodze, Viktoria V. Fomenko, I. K. Kamolov, A. N. Pankov, O. Zakharova, A. V. Azarov, I. E. Chernysheva, D. G. Ioseliani
Mitral regurgitation is one of the most common valvular heart diseases, with the gold standard of its treatment being an open surgical intervention. However, it is not always performed in patients with a high surgical risk. Atrial fibrillation is a frequent companion of mitral valve regurgitation. It significantly increases the risk of ischemic strokes and systemic thromboembolism and required the administration of anticoagulants. Long-term use of anticoagulants entails an increased risk of hemorrhagic complications. Surgical endovascular closure of the left atrial appendage allows for reduction of the risks both of embolic and hemorrhagic complications. This paper presents a clinical case of the first in Russia successful simultaneous endovascular remodeling of the mitral valve by edge-to-edge leaflet clipping and closure of the left atrial appendage with an Amplatzer Amulet occluder. This was an 85-year old patient with advanced mitral regurgitation, who was not considered a candidate for an open surgery due to his high surgical risk. The severity of the patients condition was related to atrial fibrillation, rectal cancer and severe anemia. The patient underwent simultaneous sequential clipping of the mitral valve leaflets and closure of the left atrial appendage. Control trans-esophageal echocardiography showed a significant decrease in the mitral regurgitation grade. There were no complications during the hospital stay and in the early postoperative period. The lack of convincing data and research makes it impossible to delineate clear indications and contraindications for the combination of two procedures within one surgical session. However, simultaneous endovascular clipping of the mitral valve leaflets and an occluder implantation into the left atrial appendage may become the method of choice in the treatment of patients with severe mitral valve regurgitation, prevention of embolic and hemorrhagic complications in high risk comorbid patients.
{"title":"Simultaneous endovascular \"edge-to-edge\" clipping of the mitral valve leaflets and closure of the left atrial appendage in a high surgical risk patient","authors":"S. P. Semitko, D. Asadov, A. Rogatova, A. Stepanov, Natalya S. Mesyats, Natalya Pak, T. S. Sandodze, Viktoria V. Fomenko, I. K. Kamolov, A. N. Pankov, O. Zakharova, A. V. Azarov, I. E. Chernysheva, D. G. Ioseliani","doi":"10.18786/2072-0505-2022-50-014","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-014","url":null,"abstract":"Mitral regurgitation is one of the most common valvular heart diseases, with the gold standard of its treatment being an open surgical intervention. However, it is not always performed in patients with a high surgical risk. Atrial fibrillation is a frequent companion of mitral valve regurgitation. It significantly increases the risk of ischemic strokes and systemic thromboembolism and required the administration of anticoagulants. Long-term use of anticoagulants entails an increased risk of hemorrhagic complications. Surgical endovascular closure of the left atrial appendage allows for reduction of the risks both of embolic and hemorrhagic complications. \u0000This paper presents a clinical case of the first in Russia successful simultaneous endovascular remodeling of the mitral valve by edge-to-edge leaflet clipping and closure of the left atrial appendage with an Amplatzer Amulet occluder. This was an 85-year old patient with advanced mitral regurgitation, who was not considered a candidate for an open surgery due to his high surgical risk. The severity of the patients condition was related to atrial fibrillation, rectal cancer and severe anemia. The patient underwent simultaneous sequential clipping of the mitral valve leaflets and closure of the left atrial appendage. Control trans-esophageal echocardiography showed a significant decrease in the mitral regurgitation grade. There were no complications during the hospital stay and in the early postoperative period. \u0000The lack of convincing data and research makes it impossible to delineate clear indications and contraindications for the combination of two procedures within one surgical session. However, simultaneous endovascular clipping of the mitral valve leaflets and an occluder implantation into the left atrial appendage may become the method of choice in the treatment of patients with severe mitral valve regurgitation, prevention of embolic and hemorrhagic complications in high risk comorbid patients.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75445864","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}
Pub Date : 2022-04-29DOI: 10.18786/2072-0505-2022-50-013
A. Strutynskaya, M. Karnaushkina, D. Ovsyannikov, Sergey A. Filippov, I. Tyurin
Adult Still's disease is a rare systemic disorder of unknown etiology. Its course is often complicated by interstitial pneumonia and fulminant hepatitis. Published data have indicated some common mechanisms of systemic inflammation in patients with autoimmune disorders and SARS-COV-19. We present a clinical case of a 74-year old female patient with a long standing, slowly progressive Stills disease, who developed honeycomb lung and severe liver injury as major syndromes after a novel coronavirus infection. Within 10 months, she developed increasing dyspnea, progressive fibrous pulmonary abnormalities with formation of a "honeycomb lung" and signs of liver failure. Due to late medical referral, these symptoms have led to the patients death. According to the literature, lung tissue abnormalities that persist after a new coronavirus infection in patients with autoimmune disorders can be both a manifestation of residual post-covid injury and a systemic disease-associated lung injury with COVID-19-triggered progression. By this clinical example, we intended to illustrate that the key to a correct diagnosis is multiple organ damage persisting after a novel coronavirus infection irrespective of the severity of the coronavirus lung injury. Such symptoms indicate the need to assess immunological markers to exclude an autoimmune disease exacerbation or onset. Clinicians should aim at rapid diagnosis and timely initiation of specific therapy.
{"title":"Worsening of a progressive interstitial lung disease in a patient with adult Still's disease after a novel coronavirus infection","authors":"A. Strutynskaya, M. Karnaushkina, D. Ovsyannikov, Sergey A. Filippov, I. Tyurin","doi":"10.18786/2072-0505-2022-50-013","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-013","url":null,"abstract":"Adult Still's disease is a rare systemic disorder of unknown etiology. Its course is often complicated by interstitial pneumonia and fulminant hepatitis. Published data have indicated some common mechanisms of systemic inflammation in patients with autoimmune disorders and SARS-COV-19. We present a clinical case of a 74-year old female patient with a long standing, slowly progressive Stills disease, who developed honeycomb lung and severe liver injury as major syndromes after a novel coronavirus infection. Within 10 months, she developed increasing dyspnea, progressive fibrous pulmonary abnormalities with formation of a \"honeycomb lung\" and signs of liver failure. Due to late medical referral, these symptoms have led to the patients death. According to the literature, lung tissue abnormalities that persist after a new coronavirus infection in patients with autoimmune disorders can be both a manifestation of residual post-covid injury and a systemic disease-associated lung injury with COVID-19-triggered progression. By this clinical example, we intended to illustrate that the key to a correct diagnosis is multiple organ damage persisting after a novel coronavirus infection irrespective of the severity of the coronavirus lung injury. Such symptoms indicate the need to assess immunological markers to exclude an autoimmune disease exacerbation or onset. Clinicians should aim at rapid diagnosis and timely initiation of specific therapy.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84574240","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}
Pub Date : 2022-04-28DOI: 10.18786/2072-0505-2022-50-009
Galina E. Chernova, V. Kozlov, L. Gulyaeva
Rationale: Lung cancer is the leader in high mortality rates among other malignancies. This is largely due to the asymptomatic course of the disease and, as a consequence, to its late diagnosis. To optimize the oncology service of the Novosibirsk region in terms of diagnosis, treatment, follow-up and management of this patient category, it seems prudent to study the epidemiological characteristics of non-small cell lung cancer (NSCLC) with consideration of its histologic types. Aim: To perform the survival analysis in patients with squamous cell lung cancer (SCLC) and adenocarcinoma of the lung (ACL) depending on their age, sex and disease stage. Materials and methods: We analyzed medical files of patients diagnosed with SCLC (n = 3007) and ACL (n = 3049) who were treated in the Novosibirsk Regional Oncologic Dispensary from 2015 to 2019. The study included 4758 men and 1298 women (mean age, 68 years; men 66.8 years, women 69.1 years). Results: The majority (96%) of the NSCLC patients were above 50 years of age. The 5-year survival rate of the patients with SCLC and ACL was below 20%. Median survival of the SCLC patients was 443 days (interquartile range [IQR] 138; 1241), of those with ACL, 552 (IQR 107; 1511) days. At the diagnosis of NSCLC, 67% of the patients had stage III/IV of the disease. Maximal survival (10 to 15 years) was found in the NSCLC patients aged 61 years who had been diagnosed at stage III of the disease. Testing of the hypothesis on the impact of histological type of NSCLC on survival at a particular disease stage (Wilcoxon-Gehan test for unpaired samples) showed an association between the survival and histological type only for stage IV (p = 0.000001); median survival in ACL IV was 80 days and in SCLC IV, 104 days. Men comprised 87% of the SCLC group and 73% of the ACL one. In SCLC, there was no gender difference in the median survival rates (log rank test, p = 0.48). The median survival of the female patients with ACL was longer than that of the male ones (329 vs 169 days, log rank test, p = 0.000001). The major proportion of the SCLC and ACL patients was in the age range of 61 to 75 years (59% and 50%, respectively). The least favorable outcomes were seen in the patients below 50 years of age, and the most favorable, in those above 75 years. In SCLC, the median survival was 156 days in the patients below 50 years of age, 238.5 days in those aged from 51 to 60 years, 300 days in the age of 61 to 75 years, and 487 days in the patients above 75 years of age (chi-square test 98.77097; df = 3; p = 0.000001). In ACL, the respective values were 143, 201, 210.5, and 230 days (chi-square test 23.93492; df = 3; p = 0.00003). Conclusion: The analysis of survival of the patients with SCLC and ACL in the Novosibirsk region has shown that the disease stage and age significantly impact the median survival. These are the characteristic features of the general morbidity and mortality from NSCLC.
{"title":"Survival analysis of patients with non-small cell lung cancer in Novosibirsk region from 2015 to 2019","authors":"Galina E. Chernova, V. Kozlov, L. Gulyaeva","doi":"10.18786/2072-0505-2022-50-009","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-009","url":null,"abstract":"Rationale: Lung cancer is the leader in high mortality rates among other malignancies. This is largely due to the asymptomatic course of the disease and, as a consequence, to its late diagnosis. To optimize the oncology service of the Novosibirsk region in terms of diagnosis, treatment, follow-up and management of this patient category, it seems prudent to study the epidemiological characteristics of non-small cell lung cancer (NSCLC) with consideration of its histologic types. \u0000Aim: To perform the survival analysis in patients with squamous cell lung cancer (SCLC) and adenocarcinoma of the lung (ACL) depending on their age, sex and disease stage. \u0000Materials and methods: We analyzed medical files of patients diagnosed with SCLC (n = 3007) and ACL (n = 3049) who were treated in the Novosibirsk Regional Oncologic Dispensary from 2015 to 2019. The study included 4758 men and 1298 women (mean age, 68 years; men 66.8 years, women 69.1 years). \u0000Results: The majority (96%) of the NSCLC patients were above 50 years of age. The 5-year survival rate of the patients with SCLC and ACL was below 20%. Median survival of the SCLC patients was 443 days (interquartile range [IQR] 138; 1241), of those with ACL, 552 (IQR 107; 1511) days. At the diagnosis of NSCLC, 67% of the patients had stage III/IV of the disease. Maximal survival (10 to 15 years) was found in the NSCLC patients aged 61 years who had been diagnosed at stage III of the disease. Testing of the hypothesis on the impact of histological type of NSCLC on survival at a particular disease stage (Wilcoxon-Gehan test for unpaired samples) showed an association between the survival and histological type only for stage IV (p = 0.000001); median survival in ACL IV was 80 days and in SCLC IV, 104 days. \u0000Men comprised 87% of the SCLC group and 73% of the ACL one. In SCLC, there was no gender difference in the median survival rates (log rank test, p = 0.48). The median survival of the female patients with ACL was longer than that of the male ones (329 vs 169 days, log rank test, p = 0.000001). \u0000The major proportion of the SCLC and ACL patients was in the age range of 61 to 75 years (59% and 50%, respectively). The least favorable outcomes were seen in the patients below 50 years of age, and the most favorable, in those above 75 years. In SCLC, the median survival was 156 days in the patients below 50 years of age, 238.5 days in those aged from 51 to 60 years, 300 days in the age of 61 to 75 years, and 487 days in the patients above 75 years of age (chi-square test 98.77097; df = 3; p = 0.000001). In ACL, the respective values were 143, 201, 210.5, and 230 days (chi-square test 23.93492; df = 3; p = 0.00003). \u0000Conclusion: The analysis of survival of the patients with SCLC and ACL in the Novosibirsk region has shown that the disease stage and age significantly impact the median survival. These are the characteristic features of the general morbidity and mortality from NSCLC.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89008948","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}
Pub Date : 2022-04-28DOI: 10.18786/2072-0505-2022-50-008
O. Kovaleva, P. Podlesnaya, A. Gratchev
Macrophages, natural killers and T cells play the central role in tumor cells destruction. The purpose of this review is to summarize the state-of-the-art perspectives of the interplay between tumor cells and tumor stroma leading both to the formation of a macrophage population incapable of effective antitumor activity and to the selection of tumor cells resistant to macrophage cytotoxicity. Macrophages are highly versatile cells that can both stimulate the inflammatory response (type 1 macrophages, M1) and suppress it (type 2 macrophages, M2). Tumor-associated macrophages (TAMs) are considered the main regulator of the antitumor immune response and usually have anti-inflammatory properties, that is, they belong to M2 type. Tumor cells are able to affect macrophages, "reprogramming" them to perform an immunosuppressive function. In addition, TAMs stimulate angiogenesis and remodelling of the extracellular matrix necessary for metastasis. Recently, more and more studies have been published describing a mixed TAMs phenotype with characteristics of both M2 and M1. M1 is characterized by production of pro-inflammatory cytokines, reactive oxygen species, bactericidal and cytotoxic activity. M1 can destroy tumor cells both directly and indirectly by attracting other cells. Despite the mechanisms of direct cytotoxic activity are quite variable, their effectiveness is largely dependent on the properties of a particular tumor. The cytotoxic activity of macrophages is a powerful factor that inhibits tumor initiation and progression. However, in some cases, it is not sufficient to control the tumor process. Activation of the cytotoxic activity of TAMs is one of the strategies to use macrophages for cancer treatment. Understanding the mechanisms of macrophage cytotoxic activity and specific patterns of its manifestation in a tumor environment is of critical importance for better effectiveness of existing cancer treatments and development of promising methods for tumor immunotherapy.
{"title":"Macrophage cytotoxic activity and its role in the tumor pathogenesis","authors":"O. Kovaleva, P. Podlesnaya, A. Gratchev","doi":"10.18786/2072-0505-2022-50-008","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-008","url":null,"abstract":"Macrophages, natural killers and T cells play the central role in tumor cells destruction. The purpose of this review is to summarize the state-of-the-art perspectives of the interplay between tumor cells and tumor stroma leading both to the formation of a macrophage population incapable of effective antitumor activity and to the selection of tumor cells resistant to macrophage cytotoxicity. \u0000Macrophages are highly versatile cells that can both stimulate the inflammatory response (type 1 macrophages, M1) and suppress it (type 2 macrophages, M2). Tumor-associated macrophages (TAMs) are considered the main regulator of the antitumor immune response and usually have anti-inflammatory properties, that is, they belong to M2 type. Tumor cells are able to affect macrophages, \"reprogramming\" them to perform an immunosuppressive function. In addition, TAMs stimulate angiogenesis and remodelling of the extracellular matrix necessary for metastasis. \u0000Recently, more and more studies have been published describing a mixed TAMs phenotype with characteristics of both M2 and M1. M1 is characterized by production of pro-inflammatory cytokines, reactive oxygen species, bactericidal and cytotoxic activity. M1 can destroy tumor cells both directly and indirectly by attracting other cells. Despite the mechanisms of direct cytotoxic activity are quite variable, their effectiveness is largely dependent on the properties of a particular tumor. The cytotoxic activity of macrophages is a powerful factor that inhibits tumor initiation and progression. However, in some cases, it is not sufficient to control the tumor process. Activation of the cytotoxic activity of TAMs is one of the strategies to use macrophages for cancer treatment. \u0000Understanding the mechanisms of macrophage cytotoxic activity and specific patterns of its manifestation in a tumor environment is of critical importance for better effectiveness of existing cancer treatments and development of promising methods for tumor immunotherapy.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90205818","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}
Pub Date : 2022-04-28DOI: 10.18786/2072-0505-2022-50-011
A. Balkanov, A. Vinogradov, V. Bazaev, E. Stepanova, S. V. Garmash
The urethral recurrence (UR) of invasive bladder cancer (iBC) after cystectomy is observed in 6% of patients at highest. In this clinical observation of a 38-year old man, a mass (103 38 mm) was found in the proximal urethra by magnetic resonance imaging at 15 months after radical (R0) cystectomy for iBC pT4aN0M0. The clinical picture of UR was characterized by urethrorrhagia and priapism with associated advanced pain syndrome. At 3 months after surgical resection of the UR and subsequent chemotherapy, distant lung, liver and bone metastases were found, which led to the patient's death at 5 months after penectomy. This clinical case indicates that after radical cystectomy, the occurrence of a big-sized urethral recurrence of iBC can cause rapid development of distant metastatic disease.
{"title":"A clinical case of a big urethral recurrence after cystectomy in a patient with invasive bladder cancer","authors":"A. Balkanov, A. Vinogradov, V. Bazaev, E. Stepanova, S. V. Garmash","doi":"10.18786/2072-0505-2022-50-011","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-011","url":null,"abstract":"The urethral recurrence (UR) of invasive bladder cancer (iBC) after cystectomy is observed in 6% of patients at highest. In this clinical observation of a 38-year old man, a mass (103 38 mm) was found in the proximal urethra by magnetic resonance imaging at 15 months after radical (R0) cystectomy for iBC pT4aN0M0. The clinical picture of UR was characterized by urethrorrhagia and priapism with associated advanced pain syndrome. At 3 months after surgical resection of the UR and subsequent chemotherapy, distant lung, liver and bone metastases were found, which led to the patient's death at 5 months after penectomy. This clinical case indicates that after radical cystectomy, the occurrence of a big-sized urethral recurrence of iBC can cause rapid development of distant metastatic disease.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74423771","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}
Pub Date : 2022-04-28DOI: 10.18786/2072-0505-2022-50-010
A. Zhabina, F. Moiseenko, N. Volkov, N. Abduloeva, V. Egorenkov, N. V. Levchenko, E. Artemeva, E. О. Stepanova, Ekaterina O. Nesterova, V. Moiseyenko
Background: Iron has dual properties: it may promote both tumor growth and cell apoptosis. Compared to healthy cells, cancer cells are more dependent on the iron levels. Ferroptosis can be triggered directly in cancer cells, which would result in their self-destruction. Identification of iron balance abnormalities and their correction could impact the effects of specific treatments in cancer patients. Aim: To assess the prevalence of iron deficiency in patients with metastatic colorectal cancer (mCRC) and to identify an association of low serum iron levels with clinical and morphological characteristics of the disease. Materials and methods: The study included 69 treatment-nave patients with mCRC. Iron deficiency was defined as low serum iron levels before the initiation of any specific therapy: serum iron concentration 10.7 mcmol/L in men and 9.0 mcmol/L in women. Results: The mean age of the mCRC patients was 61.1 years (range, 28 to 83 years), 35/69 (50.7%) were men. The bigger proportion of the tumors was left-sided (62.3%). In 48.3% of the patients, the disease was diagnosed at the metastatic stage. The most frequent locations of metastasis were liver (41.3%) and lungs (32.1%). 55.1% (38/69) of the patients had undergone a non-radical resection or primary curative surgery. KRAS mutations were found in 37.7% of the patients. Low serum iron levels were found in 53.6% (37/69) of the total sample of the mCRC patients and in 72.4% (19/38) of the patients with a non-resected primary tumor (p = 0.05). Conclusion: Irrespective on the clinical and morphological characteristics, the majority of patients with metastatic colorectal cancer have iron deficiency anemia before the initiation of specific anti-tumor therapy.
{"title":"Prevalence of iron deficiency anemia in patients with metastatic colorectal cancer","authors":"A. Zhabina, F. Moiseenko, N. Volkov, N. Abduloeva, V. Egorenkov, N. V. Levchenko, E. Artemeva, E. О. Stepanova, Ekaterina O. Nesterova, V. Moiseyenko","doi":"10.18786/2072-0505-2022-50-010","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-010","url":null,"abstract":"Background: Iron has dual properties: it may promote both tumor growth and cell apoptosis. Compared to healthy cells, cancer cells are more dependent on the iron levels. Ferroptosis can be triggered directly in cancer cells, which would result in their self-destruction. Identification of iron balance abnormalities and their correction could impact the effects of specific treatments in cancer patients. \u0000Aim: To assess the prevalence of iron deficiency in patients with metastatic colorectal cancer (mCRC) and to identify an association of low serum iron levels with clinical and morphological characteristics of the disease. \u0000Materials and methods: The study included 69 treatment-nave patients with mCRC. Iron deficiency was defined as low serum iron levels before the initiation of any specific therapy: serum iron concentration 10.7 mcmol/L in men and 9.0 mcmol/L in women. \u0000Results: The mean age of the mCRC patients was 61.1 years (range, 28 to 83 years), 35/69 (50.7%) were men. The bigger proportion of the tumors was left-sided (62.3%). In 48.3% of the patients, the disease was diagnosed at the metastatic stage. The most frequent locations of metastasis were liver (41.3%) and lungs (32.1%). 55.1% (38/69) of the patients had undergone a non-radical resection or primary curative surgery. KRAS mutations were found in 37.7% of the patients. Low serum iron levels were found in 53.6% (37/69) of the total sample of the mCRC patients and in 72.4% (19/38) of the patients with a non-resected primary tumor (p = 0.05). \u0000Conclusion: Irrespective on the clinical and morphological characteristics, the majority of patients with metastatic colorectal cancer have iron deficiency anemia before the initiation of specific anti-tumor therapy.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74279641","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}
Pub Date : 2022-04-28DOI: 10.18786/2072-0505-2022-50-007
Zulfiya R. Shafigullina, L. Velikanova, N. Vorokhobina, E. Malevanaya, E. Strelnikova, V. Y. Bokhian, T. Britvin, I. Stilidi
Background: Prolonged episodes of uncontrolled congenital adrenal hyperplasia (CAH) have been shown to result in the occurrence of secondary adrenal neoplasms. Prevalence of adrenal incidentalomas in the patients with 21-hydroxylase deficiency ranges from 11% to 82%. As assessed by gas chromatography-mass spectrometry (GC-MS), patients with adrenocortical cancer (ACC) have increased level of steroid hormone precursors due to decreased activity of adrenal steroidogenesis enzymes, mainly that of 21-hydroxylase and 11-hydroxylase. It seems relevant to compare the specific characteristics of steroid metabolism by GC-MS in ACC patients and in patients with adrenal incidentalomas and CAH associated with 21-hydroxylase deficiency (21-OHD). Aim: To identify (by GC-MS) common abnormalities in steroid metabolism and differential diagnostic biomarkers in ACC patients and CAH patients with 21-OHD and adrenal masses. Materials and methods: The study included 41 patients with adrenal cortex neoplasms aged 18 to 65 years without clinical and laboratory signs of endogenous hypercortisolism. Twenty three (23) patients had non-metastatic ACC and 18 patients had CAH due to 21-OHD. The control group included 26 healthy blood donors aged 20 to 59 years. Urine steroid profiles were measured by GC-MS with a gas chromatograph-mass spectrometer (Shimadzu GCMS-QP2020). Results: In the ACC patients, there was an increase in urinary excretion of tetrahydro-11-deoxycortisol, dehydroepiandrosterone, androstenediol-17, etiocholanolone, pregnenediol, and 3,16,20-pregnenetriol (3,16,20-dP3), as well as a decrease in the 3,16,20-dP3/3,16,20-dP3 ratio, compared to the values in the patients with CAH due to 21-OHD. Compared to the healthy control, 21-hydroxylase, 11-hydroxylase, 5-reductase and 11-hydroxysteroid-dehydrogenase (11-HSDH) type 2 activities were lower. Compared to the ACC patients, those with CAH due to 21-OHD had higher urinary excretion of 11-oxo-pregnanetriol (11-oxo-P3) and 21-deoxy-tetrahydrocortisol and lower 5-THF+5-THF+THE)/11-oxo-P3 ratio of 9.0, determination of 11-oxo-dP3, signs higher 5-reductase activity and lower 11-HSDH type 1 activity. The ACC patients and the patients with CAH due to 21-OHD had common abnormalities of steroid metabolism, such as lower activities of 21-hydroxylase, 3-hydroxysteroid-dehydrogenase and 11-hydroxylase, and no differences in urinary excretion of a number of ACC biomarkers (androgens, pregnanediol, and 5-ene-pregnenes). Conclusion: The assessment of urinary excretion of androgens, progestagens, and glucocorticoids by GC-MS made it possible to identify common abnormalities in steroid metabolism in the patients with ACC and CAH due to 21-OHD, which confirms the role of disordered steroidogenesis in the formation of adrenocortical tumors.
{"title":"Specific characteristics of metabolomics as assessed by gas chromatography-mass spectrometry in patients with adrenocortical cancer and with adrenal incidentalomas in congenital adrenal hyperplasia","authors":"Zulfiya R. Shafigullina, L. Velikanova, N. Vorokhobina, E. Malevanaya, E. Strelnikova, V. Y. Bokhian, T. Britvin, I. Stilidi","doi":"10.18786/2072-0505-2022-50-007","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-007","url":null,"abstract":"Background: Prolonged episodes of uncontrolled congenital adrenal hyperplasia (CAH) have been shown to result in the occurrence of secondary adrenal neoplasms. Prevalence of adrenal incidentalomas in the patients with 21-hydroxylase deficiency ranges from 11% to 82%. As assessed by gas chromatography-mass spectrometry (GC-MS), patients with adrenocortical cancer (ACC) have increased level of steroid hormone precursors due to decreased activity of adrenal steroidogenesis enzymes, mainly that of 21-hydroxylase and 11-hydroxylase. It seems relevant to compare the specific characteristics of steroid metabolism by GC-MS in ACC patients and in patients with adrenal incidentalomas and CAH associated with 21-hydroxylase deficiency (21-OHD). \u0000Aim: To identify (by GC-MS) common abnormalities in steroid metabolism and differential diagnostic biomarkers in ACC patients and CAH patients with 21-OHD and adrenal masses. \u0000Materials and methods: The study included 41 patients with adrenal cortex neoplasms aged 18 to 65 years without clinical and laboratory signs of endogenous hypercortisolism. Twenty three (23) patients had non-metastatic ACC and 18 patients had CAH due to 21-OHD. The control group included 26 healthy blood donors aged 20 to 59 years. Urine steroid profiles were measured by GC-MS with a gas chromatograph-mass spectrometer (Shimadzu GCMS-QP2020). \u0000Results: In the ACC patients, there was an increase in urinary excretion of tetrahydro-11-deoxycortisol, dehydroepiandrosterone, androstenediol-17, etiocholanolone, pregnenediol, and 3,16,20-pregnenetriol (3,16,20-dP3), as well as a decrease in the 3,16,20-dP3/3,16,20-dP3 ratio, compared to the values in the patients with CAH due to 21-OHD. Compared to the healthy control, 21-hydroxylase, 11-hydroxylase, 5-reductase and 11-hydroxysteroid-dehydrogenase (11-HSDH) type 2 activities were lower. Compared to the ACC patients, those with CAH due to 21-OHD had higher urinary excretion of 11-oxo-pregnanetriol (11-oxo-P3) and 21-deoxy-tetrahydrocortisol and lower 5-THF+5-THF+THE)/11-oxo-P3 ratio of 9.0, determination of 11-oxo-dP3, signs higher 5-reductase activity and lower 11-HSDH type 1 activity. The ACC patients and the patients with CAH due to 21-OHD had common abnormalities of steroid metabolism, such as lower activities of 21-hydroxylase, 3-hydroxysteroid-dehydrogenase and 11-hydroxylase, and no differences in urinary excretion of a number of ACC biomarkers (androgens, pregnanediol, and 5-ene-pregnenes). \u0000Conclusion: The assessment of urinary excretion of androgens, progestagens, and glucocorticoids by GC-MS made it possible to identify common abnormalities in steroid metabolism in the patients with ACC and CAH due to 21-OHD, which confirms the role of disordered steroidogenesis in the formation of adrenocortical tumors.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83011545","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}
Pub Date : 2022-03-23DOI: 10.18786/2072-0505-2022-50-006
I. Kondakova, G. Kakurina, E. Kolegova, O. Cheremisina, D. A. Korshunov, Islombek A. Bakhronov, E. Choinzonov
Rationale: During neoplastic transformation, epithelial cells become mobile, which is one of the main mechanisms of metastatic disease and recurrence. Cell motility is regulated by actin-binding proteins, which ensure the association/dissociation of actin filaments and their interaction with the cell membrane. Previously, we have shown the presence of actin-binding proteins in the serum from patients with squamous cell carcinoma of the head and neck (HNSCC); however, their association with the development of metastases and relapses in cancer patients has not been sufficiently studied. Aim: To evaluate the serum levels of actin-binding proteins fascin-1 and ezrin in patients with HNSCC depending on the disease recurrence and lymphatic metastasis. Materials and methods: Serum fascin-1 and ezrin levels before combination therapy were measured with ELISA assay in 30 HNSCC (T1-4N0-2M0) patients (mean age 56 7 years). Results: The median fascin-1 level was significantly higher in the patients with lymphatic metastases, compared to those without metastases: 0.64 (0.40; 5.89) vs 6.35 (1.72; 8.35) ng/mL, respectively (p 0.001). At 12 to 36 months after combination therapy, the disease relapsed in 12 (40%) patients. Ezrin levels were significantly higher in the relapsed patients, compared to those without a relapse within 3 years after combination therapy: 2.55 (2.35; 2.75) vs 1.93 (1.87; 2.5) ng/mL (p = 0.02). The ROC analysis showed an association between fascin-1 serum levels with metastatic disease (AUC = 0.71, 95% confidence interval 0.570.85) and an association between ezrin levels and the disease relapse (AUC = 0.76, 95% confidence interval 0.570.94). Conclusion: These indicators can be used for the development of minimally invasive early detection of metastases in lymphatic nodes and for the prognosis of HNSCC recurrence.
{"title":"The prognostic value of actin-binding proteins fascin and ezrin in patients with squamous cell carcinoma of the head and neck","authors":"I. Kondakova, G. Kakurina, E. Kolegova, O. Cheremisina, D. A. Korshunov, Islombek A. Bakhronov, E. Choinzonov","doi":"10.18786/2072-0505-2022-50-006","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-006","url":null,"abstract":"Rationale: During neoplastic transformation, epithelial cells become mobile, which is one of the main mechanisms of metastatic disease and recurrence. Cell motility is regulated by actin-binding proteins, which ensure the association/dissociation of actin filaments and their interaction with the cell membrane. Previously, we have shown the presence of actin-binding proteins in the serum from patients with squamous cell carcinoma of the head and neck (HNSCC); however, their association with the development of metastases and relapses in cancer patients has not been sufficiently studied. \u0000Aim: To evaluate the serum levels of actin-binding proteins fascin-1 and ezrin in patients with HNSCC depending on the disease recurrence and lymphatic metastasis. \u0000Materials and methods: Serum fascin-1 and ezrin levels before combination therapy were measured with ELISA assay in 30 HNSCC (T1-4N0-2M0) patients (mean age 56 7 years). \u0000Results: The median fascin-1 level was significantly higher in the patients with lymphatic metastases, compared to those without metastases: 0.64 (0.40; 5.89) vs 6.35 (1.72; 8.35) ng/mL, respectively (p 0.001). At 12 to 36 months after combination therapy, the disease relapsed in 12 (40%) patients. Ezrin levels were significantly higher in the relapsed patients, compared to those without a relapse within 3 years after combination therapy: 2.55 (2.35; 2.75) vs 1.93 (1.87; 2.5) ng/mL (p = 0.02). The ROC analysis showed an association between fascin-1 serum levels with metastatic disease (AUC = 0.71, 95% confidence interval 0.570.85) and an association between ezrin levels and the disease relapse (AUC = 0.76, 95% confidence interval 0.570.94). \u0000Conclusion: These indicators can be used for the development of minimally invasive early detection of metastases in lymphatic nodes and for the prognosis of HNSCC recurrence.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84462488","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}
Pub Date : 2022-03-11DOI: 10.18786/2072-0505-2022-50-003
K. Pereverzeva, N. P. Agaltsova, I. E. Tishkina, Christina S. Shopina, Yuliya O. Kosolapova, Alena K. Figol, S. Yakushin
Aim: To assess an impact of clinical and medical history factors and antithrombotic therapy on the prognosis in patients with non-valvular atrial fibrillation (AF) admitted to the cardiology in-patient clinic for myocardial infarction (MI). Materials and methods: This was a retro-prospective study. Two hundred and fifty six (256) patients with AF plus MI (median age 71.0 [65.0; 79.3] years; men, 143 (55.8%)) were included into the retrospective part of the study in 20182019. Data on their clinical and medical history particulars, as well as on antithrombotic therapy were collected from their medical files. Nineteen (19) [13; 25] months after the index event (MI), telephone contact was made with patients or their relatives in order to assess the patient's life status, as well as record the frequency of non-fatal MI and cerebral strokes (MI). Contact was established with 253 patients. The completeness of the sample coverage is 99.0%. Results: During the follow-up after discharge from the hospital, 29.6% (n = 75) of patients died, 40.7% (n = 103) of patients reached the composite endpoint (CЕ), which included deaths, non-fatal MI and brain strokes. The patients who died, compared to those who survived, were older (77.0 [62.0; 82.0] vs 68.0 [62.0;76.7] years, respectively, p 0.001), with a smaller proportion of men (44.0% vs 61.2%, respectively, p = 0.012). They were also more likely to have had type 2 diabetes mellitus (50.7% vs 37.1%, p = 0.04) and the history of acute stroke (24.0% vs 8.4%, p 0.001), and less likely to have had percutaneous coronary intervention (48.0% vs 64.0%, p 0.001). Serum creatinine levels in those who have died were higher than in the surviving patients (114.0 [95.0; 139.0] mmol/l vs 99.5 [85.0; 120.0] mmol/l, p 0.001). The patients who have achieved CE, compared to those who have not, were older (75.0 [67.0; 81.0] vs 65.0 [50.0; 82.0] years, respectively, p 0.001), with a smaller proportion of men (48.5% vs 61.3%, respectively, p = 0.045), higher proportion of patients with past history of stroke (20.4% vs 8.0%, p = 0.005) and fewer patients who had underwent percutaneous coronary intervention (52.4% vs 66.0%, p 0.03). There was no significant association between the administration of anti-platelet agents and/or oral anticoagulants and outcomes in the patients with AF and MI. Conclusion: In the patients with AF and MI, a higher death risk and achievement of CE were significantly associated with age and a history of stroke. The use of anti-platelet agents and oral anticoagulants in various combinations had no significant impact on the outcomes in this patient group, which is likely related to small duration of the follow-up and small patient sample.
目的:探讨非瓣膜性心房颤动(AF)患者因心肌梗死(MI)而在心内科住院的临床、病史因素及抗栓治疗对预后的影响。材料与方法:本研究为回顾性前瞻性研究。256例房颤合并心肌梗死患者(中位年龄71.0 [65.0;79.3)年;2018 - 2019年，143名男性(55.8%)被纳入回顾性研究。从他们的医疗档案中收集了他们的临床和病史细节以及抗血栓治疗的数据。十九(19)[13;[25]指数事件(index event, MI)发生数月后，与患者或其亲属进行电话联系，评估患者的生活状况，记录非致死性MI和脑卒中(cerebral stroke, MI)的发生频率。与253名患者建立了接触。样品覆盖率的完备性为99.0%。结果:出院后随访期间，29.6% (n = 75)的患者死亡，40.7% (n = 103)的患者达到复合终点(CЕ)，包括死亡、非致死性心肌梗死和脑卒中。与存活患者相比，死亡患者年龄较大(77.0 [62.0;[62.0;76.7]年，分别为68.0[62.0;76.7]年，p = 0.001)，男性比例较小(分别为44.0%对61.2%，p = 0.012)。他们也更有可能患有2型糖尿病(50.7% vs 37.1%， p = 0.04)和急性中风史(24.0% vs 8.4%， p = 0.001)，更不可能接受经皮冠状动脉介入治疗(48.0% vs 64.0%， p = 0.001)。死亡患者血清肌酐水平高于存活患者(114.0 [95.0;139.0] mmol/l vs . 99.5 [85.0];120.0] mmol/l, p 0.001)。与未达到CE的患者相比，达到CE的患者年龄更大(75.0 [67.0;81.0] vs 65.0 [50.0;82.0]年，p 0.001)，其中男性比例较小(分别为48.5%对61.3%，p = 0.045)，有卒中史的患者比例较高(20.4%对8.0%，p = 0.005)，接受过经皮冠状动脉介入治疗的患者较少(52.4%对66.0%，p = 0.03)。抗血小板药物和/或口服抗凝剂与房颤和心肌梗死患者预后无显著相关性。结论:房颤和心肌梗死患者较高的死亡风险和实现CE与年龄和卒中史显著相关。抗血小板药物和口服抗凝剂的各种联合使用对该患者组的预后无显著影响，这可能与随访时间短、患者样本小有关。
{"title":"The influence of clinical and medical history factors and anti-thrombotic therapy on the prognosis in patients with atrial fibrillation and myocardial infarction","authors":"K. Pereverzeva, N. P. Agaltsova, I. E. Tishkina, Christina S. Shopina, Yuliya O. Kosolapova, Alena K. Figol, S. Yakushin","doi":"10.18786/2072-0505-2022-50-003","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-003","url":null,"abstract":"Aim: To assess an impact of clinical and medical history factors and antithrombotic therapy on the prognosis in patients with non-valvular atrial fibrillation (AF) admitted to the cardiology in-patient clinic for myocardial infarction (MI). \u0000Materials and methods: This was a retro-prospective study. Two hundred and fifty six (256) patients with AF plus MI (median age 71.0 [65.0; 79.3] years; men, 143 (55.8%)) were included into the retrospective part of the study in 20182019. Data on their clinical and medical history particulars, as well as on antithrombotic therapy were collected from their medical files. Nineteen (19) [13; 25] months after the index event (MI), telephone contact was made with patients or their relatives in order to assess the patient's life status, as well as record the frequency of non-fatal MI and cerebral strokes (MI). Contact was established with 253 patients. The completeness of the sample coverage is 99.0%. \u0000Results: During the follow-up after discharge from the hospital, 29.6% (n = 75) of patients died, 40.7% (n = 103) of patients reached the composite endpoint (CЕ), which included deaths, non-fatal MI and brain strokes. \u0000The patients who died, compared to those who survived, were older (77.0 [62.0; 82.0] vs 68.0 [62.0;76.7] years, respectively, p 0.001), with a smaller proportion of men (44.0% vs 61.2%, respectively, p = 0.012). They were also more likely to have had type 2 diabetes mellitus (50.7% vs 37.1%, p = 0.04) and the history of acute stroke (24.0% vs 8.4%, p 0.001), and less likely to have had percutaneous coronary intervention (48.0% vs 64.0%, p 0.001). Serum creatinine levels in those who have died were higher than in the surviving patients (114.0 [95.0; 139.0] mmol/l vs 99.5 [85.0; 120.0] mmol/l, p 0.001). \u0000The patients who have achieved CE, compared to those who have not, were older (75.0 [67.0; 81.0] vs 65.0 [50.0; 82.0] years, respectively, p 0.001), with a smaller proportion of men (48.5% vs 61.3%, respectively, p = 0.045), higher proportion of patients with past history of stroke (20.4% vs 8.0%, p = 0.005) and fewer patients who had underwent percutaneous coronary intervention (52.4% vs 66.0%, p 0.03). \u0000There was no significant association between the administration of anti-platelet agents and/or oral anticoagulants and outcomes in the patients with AF and MI. \u0000Conclusion: In the patients with AF and MI, a higher death risk and achievement of CE were significantly associated with age and a history of stroke. The use of anti-platelet agents and oral anticoagulants in various combinations had no significant impact on the outcomes in this patient group, which is likely related to small duration of the follow-up and small patient sample.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77882604","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}
Pub Date : 2022-03-11DOI: 10.18786/2072-0505-2022-50-004
F. Moiseenko, M. Fedyanin, N. Volkov, N. Abduloeva, N. V. Levchenko, V. Chubenko, A. Zhabina, Maria L. Stepanova, M. Kramchaninov, E. Artemeva, V. Moiseyenko
Rationale: Non-small cell lung cancer (NSCLC) is an aggressive disease with median survival of 1214 months in inoperable patients in the pre-immunotherapy era. Nowadays, under treatment with checkpoint inhibitors median survival is 1922 months. However, only a proportion of patients are sensitive to immune therapy. In this regard, inclusion into clinical trials remains a priority option for patients from medical perspective. Aim: To compare the results in NSCLC patients treated in accordance with the current clinical guidelines and in international clinical trials using the propensity score matching. Materials and methods: The study included data from 344 patients with histologically verified unresectable advanced NSCLC without activating mutations, who received the 1st line systemic medical therapy at various combinations (single agent chemotherapy, platinum doublet-based therapy, chemoimmunotherapy, single agent immunotherapy) within the compulsory health insurance (CHI), and from 90 patients, who received therapy in clinical trials. A direct comparison of long-term treatment results was carried out with the log-rank method. To exclude any influence of individual factors on survival rates, an univariate regression analysis and pseudorandomization accounting for these factors were carried out. Results: The direct comparison of the treatment results showed a higher progression-free survival rate in the patients treated according to clinical trial protocols, than in those treated under CHI (13.3 [95% confidence interval (CI) 8.118.5] months vs 6.4 [95% CI 5.96.9] months). Pseudorandomization of patients based on a combination of statistically significant parameters from the CHI and clinical trial groups showed a significantly longer time to progression in the trial group (13.3 [95% CI 8.318.3] vs 6.3 [95% CI 4.87.7] months). Conclusion: Participation in clinical trials is per se a factor that can significantly impact the longer duration of the treatment effect. This indicates the necessity of the most active use of this tool in clinical practice.
理由:非小细胞肺癌(NSCLC)是一种侵袭性疾病，在免疫治疗前不能手术的患者中位生存期为1214个月。如今，接受检查点抑制剂治疗的患者中位生存期为1922个月。然而，只有一部分患者对免疫治疗敏感。在这方面，从医学角度来看，纳入临床试验仍然是患者的优先选择。目的:比较按照现行临床指南和国际临床试验使用倾向评分匹配治疗的非小细胞肺癌患者的结果。材料和方法:该研究纳入了344例经组织学证实不可切除的无激活突变的晚期NSCLC患者，这些患者在强制健康保险(CHI)范围内接受了各种组合的一线全身药物治疗(单药化疗、铂双药治疗、化学免疫治疗、单药免疫治疗)，以及90例在临床试验中接受治疗的患者。采用对数秩法对长期治疗结果进行直接比较。为了排除个体因素对生存率的任何影响，对这些因素进行了单变量回归分析和伪随机化处理。结果:治疗结果的直接比较显示，根据临床试验方案治疗的患者的无进展生存率高于CHI治疗的患者(13.3[95%可信区间(CI) 8.118.5]个月对6.4[95%可信区间(CI) 5.96.9]个月)。基于CHI组和临床试验组具有统计学意义的参数组合的患者伪随机化显示，试验组的进展时间明显更长(13.3 [95% CI 8.318.3] vs 6.3 [95% CI 4.87.7]个月)。结论:参与临床试验本身是影响治疗效果持续时间的一个重要因素。这表明在临床实践中最积极地使用这一工具的必要性。
{"title":"Comparison of the treatment results in patients with inoperable non-small cell lung cancer in clinical trials and in standard clinical practice using the pseudorandomization method","authors":"F. Moiseenko, M. Fedyanin, N. Volkov, N. Abduloeva, N. V. Levchenko, V. Chubenko, A. Zhabina, Maria L. Stepanova, M. Kramchaninov, E. Artemeva, V. Moiseyenko","doi":"10.18786/2072-0505-2022-50-004","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-004","url":null,"abstract":"Rationale: Non-small cell lung cancer (NSCLC) is an aggressive disease with median survival of 1214 months in inoperable patients in the pre-immunotherapy era. Nowadays, under treatment with checkpoint inhibitors median survival is 1922 months. However, only a proportion of patients are sensitive to immune therapy. In this regard, inclusion into clinical trials remains a priority option for patients from medical perspective. \u0000Aim: To compare the results in NSCLC patients treated in accordance with the current clinical guidelines and in international clinical trials using the propensity score matching. \u0000Materials and methods: The study included data from 344 patients with histologically verified unresectable advanced NSCLC without activating mutations, who received the 1st line systemic medical therapy at various combinations (single agent chemotherapy, platinum doublet-based therapy, chemoimmunotherapy, single agent immunotherapy) within the compulsory health insurance (CHI), and from 90 patients, who received therapy in clinical trials. A direct comparison of long-term treatment results was carried out with the log-rank method. To exclude any influence of individual factors on survival rates, an univariate regression analysis and pseudorandomization accounting for these factors were carried out. \u0000Results: The direct comparison of the treatment results showed a higher progression-free survival rate in the patients treated according to clinical trial protocols, than in those treated under CHI (13.3 [95% confidence interval (CI) 8.118.5] months vs 6.4 [95% CI 5.96.9] months). Pseudorandomization of patients based on a combination of statistically significant parameters from the CHI and clinical trial groups showed a significantly longer time to progression in the trial group (13.3 [95% CI 8.318.3] vs 6.3 [95% CI 4.87.7] months). \u0000Conclusion: Participation in clinical trials is per se a factor that can significantly impact the longer duration of the treatment effect. This indicates the necessity of the most active use of this tool in clinical practice.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80295759","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}
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