卷 29, 编号 2 (2024)

Background: The only radical method of treating malignant neoplasms of the stomach is surgery. To date, sporadic studies have been published that are freely available, aimed at a comparative study of the features of the course of gastric cancer in young (<45 years old) and older patients. The features of disease progression in each of the described age groups remain unstudied.

Aim: To improve the outcomes of surgical treatment for gastric cancer patients across different age groups.

Materials and Methods: A non-randomized prospective study was carried out. The objects of the study were radical surgical interventions performed for gastric cancer from 2018 to 2021. A total of 477 patients with a verified diagnosis of malignant neoplasm of the stomach were operated on at the Volgograd Regional Clinical Oncology Dispensary during that period.

Results: Elderly and senile patients (over 60 years old) underwent 224 organ-sparing resection surgeries (63%) and 132 organ-resecting interventions (37%). In the resection surgical intervention group, 89.3% of patients did not experience postoperative complications. In the organ-resecting intervention group, this indicator was 81% (χ=4.7; p=0.031). In the course of multivariate analysis of identification of predictors of negative immediate treatment results in young and mature patients, it was found that two parameters statistically significantly increase the likelihood of grade III–V complications: multivisceral resection in tumor invasion into adjacent anatomical structures and male gender. Minimally invasive surgery statistically significantly reduces the likelihood of postoperative complications. Other three parameters that demonstrated significance only in univariate models were: comorbidity index of more than 6 points at Charlson-Deyo scale, more than 180-minute duration of surgery, and complications of the tumor process before surgery.

Conclusion: Thus, the obtained data demonstrate the advantage of organ-sparing resection interventions for elderly and senile patients for gastric cancer over organ-resecting interventions. The advantage was demonstrated as a statistically significant decrease in the total number of postoperative complications, as well as «severe» complications (grades III–V according to the Clavien-Dindo classification). In young and mature patients suffering from gastric cancer, the scope of surgical intervention does not affect the incidence of postoperative complications. In order to improve the immediate results of the surgical treatment, surgical intervention should be performed laparoscopically.

Background: The potential for diagnosing lung carcinoids using cytological methods has been underexplored, with limited publications available to support evidence-based conclusions.

Aim: This study aims to evaluate the of cytological diagnostic capabilities for differentiating typical and atypical lung carcinoids.

Materials and Methods: The study included cytological examination results from 18 patients diagnosed with carcinoid tumor at the cytological laboratory of the Altai Regional Oncology Dispensary (Barnaul). The cell material of carcinoid tumors was obtained during diagnostic video bronchoscopy and stained using the Pappenheim method. In all observations, the final diagnosis was the result of histological examination of tumors with immunohistochemical reactions. The obtained results were evaluated using Microsoft Office Excel 2010 and Statistica 10.0. Significant cellular signs (using multivariate analysis) were determined which were assessed to solve diagnostic problems when establishing a cytological diagnosis. Differences between carcinoids were assessed using discriminant analysis with Fisher’s F-test.

Results: Carcinoid tumors accounted for 2.72% of the number of neuroendocrine lung neoplasms. Typical carcinoid was diagnosed in 13 patients, atypical carcinoid was observed in 5 cases. The average age at onset of typical carcinoid was 58.46±19.04 years, of atypical carcinoid — 63.2±4.66 years. Cellular features of typical and atypical carcinoids were assessed, which formed the basis for the statistical analysis. To identify the most informative combinations of cellular features, a multivariate analysis was used that determined the main cytological features for carcinoids characterization, using only light microscopy. The values of the first, second, and third factors were determined; the factor value of the cellular feature variants was 96.02% of the sample (variance). In the discriminant analysis, 14 initial tumor cell parameters (discriminant indices) were used to classify patients into one of two groups (typical and atypical carcinoids), on the basis of which the results of the carcinoid study were classified. Step-by-step assessment using Fisher’s F-test revealed differences that amounted to 37.97% only, suggesting that the cellular features are statistically insignificant.

Conclusion: The data obtained demonstrate the possibilities of cytological diagnosis of lung carcinoids using only light microscopy at the first stage of patient examination. Cellular features enable to diagnose the carcinoid tumor with an accuracy of more than 96%. However, it is possible to differentiate between typical and atypical carcinoids in less than 40% of cases due to the large number of similar features.

The first part of our research focused on studying the prevalence of major solid and life-threatening malignant neoplasms. In the second part, we examine the patterns of effectiveness of anti-cancer measures in Russia, calculating the observed and relative one-year survival rates. This became possible due to the formation of the population cancer registry at the federal district level. Notably, the standardized incidence and mortality rates for malignant neoplasms are similar across Russia, including the Northwestern Federal District, and therefore our materials reflect the overall state of cancer care on in the country, excluding national districts. The population covered by the population-based cancer registry of the Northwestern Federal District of Russia is approximately 14 million people (which is more than the population of Belarus, Latvia and Estonia combined), with over 1.5 million records in the database. Using this registry, we calculated the rates of observed and relative one-year survival for the most common and life-threatening solid malignant neoplasms. We also used data from the International Agency for Cancer Research and the directory of the N. N. Petrov Research Institute of Oncology (St. Petersburg). Data was processed using licensed programs MS Excel 2013–2016 and STATISTICA 6.1. The survival rates were calculated using the modified Eurocare program, along with mathematical, bibliographic, and statistical methods.

For the first time in Russia, the age-related patterns of one-year survival in patients with the most common and life-threatening solid malignant neoplasms. The first population-based study of one-year survival rate dynamics in patients with major solid and life-threatening localizations of malignant neoplasms conducted in Russia at the federal district level revealed an increase in these rates, except for the results for elderly and long-lived groups.

Extensive literature data demonstrate the safety and effectiveness of colon stenting in surgical treatment of tumor colonic obstruction, as well as potential prospects and successful implementation of the Accelerated Recovery Program in the elective colorectal surgery. Based on this, the authors of this review attempted to substantiate the possibility and feasibility of including the stenting technique in the Accelerated Recovery Program as a component of its implementation in the surgical treatment of colon cancer complicated by intestinal obstruction. Due to the reduction of intermediate stages of traditional multi-step surgical treatment and the absence of colostomy and the associated need for further reintervention to eliminate the colostomy and restore colon continuity, stenting contributes to a significant reduction in the overall period of hospitalization and rehabilitation of patients, as well as a decrease in the financial and economic costs of treatment. The disadvantages, advantages, and complications of colon stenting in patients with colon cancer complicated by obstructive intestinal obstruction are described, taking into account surgical and oncological results according to the literature. It was shown that a two-step surgical treatment strategy (with preliminary colon stenting at the first stage and performing one-step radical interventions with primary restoration of colon continuity at the second step) enables to achieve better immediate and remote results and improve the quality of life of patients. At late stages of the tumor process and the presence of unresectable cancer, colon stenting can serve as a definitive palliative treatment method in inoperable patients. Within the context of oncological aspects of the problem, it is declared that colon stenting carries a risk of severe complications associated with tumor trauma, contributing to the generalization of the malignant process due to an increase in the level of carcinoembryonic antigen and an increase in the number of circulating tumor cells in the peripheral blood, significantly reducing cancer survival in potentially operable patients with a resectable cancer. It is shown that further prospective randomized studies and multivariate analysis of the results are needed to determine the location of colon stenting within the framework of the implementation of the Accelerated Recovery Program in the surgical treatment of colon cancer complicated by obstructive intestinal obstruction.

Among breast cancer cases, approximately 10% are associated with mutations in the BRCA1/2 genes, and about 50% of these cases present with a luminal HER2-negative phenotype. The standard first-line therapy for this subtype is sequential lines of hormone therapy, including combinations with various targeted drugs (CZK4/6 inhibitors, PI3K inhibitors, mTOR). PARP inhibitors are also a possible option for the treatment of metastatic BRCA-associated HER2-negative breast cancer.

We present a clinical case of successful use of olaparib as a third-line therapy for metastatic luminal HER2-negative breast cancer. Through this case, we discuss the role of various treatment strategies in managing metastatic BRCA-associated luminal HER2-negative breast cancer.