[Application of nephrometry for choice of the treatment tactics in patients, suffering nephrocellular cancer].

Most significant nephrometric parameters, impacting the operative procedure choice, basing on analysis of examination and treatment of 903 patients, suffering localized nephrocellular cancer (NCC), were determined a residual volume of kidney parenchyma, maximal size and localization of tumor. The authors elaborated the estimation system for tumor affection of kidney (NCIU-nephrometry), what give possibility to determine the tactics of operative treatment of NCC. While localization of tumor in the kidney pole or its lateral segment a threshold value of the functioning parenchyma volume, in which the conduction of resection of kidney (RK) is indicated, must be over 55%. While localization of tumor in the kidney medial segment the indication for RK is a maximal size of tumor up to 4 cm. Introduction of the elaborated system into clinical practice would permit to make objective indications for RK and nephrectomy conduction.

[PECULIARITIES OF METHOD AND RESULTS OF PLASTY, USING INTESTINAL SEGMENT, FOR IATROGENIC INJURY OF URETER].

Basing on analysis of the examination and treatment results in 53 patients, suffering iatrogenic injury of ureter (IIU), the indications for ureteric reconstruction using intestinal segment were the ureter long irreversible changes, while renal function preserved. A segmental ureteric plasty was done in 8 (15.1%) patients, a subtotal one--in 16 (30.2%), total--in 14 (26.4%), and bilateral--in 15 (28.3%). With the objective to prevent the bladder-intestinal reflux occurrence a distal part of the intestinal transplant was modeled. In 35 (66%) patients 2 - 3 cm of distal part of intestinal mucosa were turned out with the wrap formation. In 18 (34%) patients the creation of antireflux wrap was added by its modeling in a kind of intraileal plasty with formation of two separate channels in the intestinal-bladder anastomosis region. While performance of intraileal plasty of the bladder-intestinal reflux have occurred in 2 (11.1%) patients, and after procedure with the wrap formation--in 13 (37.1%).

[NEOADJUVANT TARGET THERAPY IN A RENAL-CELL CANCER].

There were observed 30 patients (32 tumors), to whom preoperatively for renal-cell cancer (ROC) a neoadjuvant target therapy (NATTH) was conducted. In 19 (66.7%) of them a pazopanib (800 mg per os once a day through 2 mo) was applied, and in 10 (33.3%)--sunitinib (50 mg per os once a day through 28 days, the gap--14 days, repeated course--28 days). The indications for the NATTH conduction were: in 7 (21.9%) patients--a locally--spread RCC with the objective to localize a tumor and to search a further possibility of radical surgical intervention performance, and in 25 (78.1%)--the tumor reduction and searching possibility of the organpreserving treatment conduction. The NATTH conduction in the patients, suffering RCC, have guaranteed a primary pathological focus reduction in 90% of observations, and a partial regression in accordance to the RECIST criteria--in 28.1%. A tumor reduction by (22.9 ± 17.8)% at average have permitted to perform a renal resection in 75% of observations, concerning localized RCC, when indication of preservation of enough functioning renal parenchyma was secured.

[TACTICS OF TREATMENT OF PATIENTS FOR ONCOLOGICAL DISEASES IN IATROGENIC INJURY OF UPPER URINARY WAYS].

Results of examination and treatment of 119 patients for oncological diseases were analyzed, in whom iatrogenic injury of ureter (IIU) have occurred. Remission of oncological diseases plastic operations were performed in 48 (40.3%) patients, reconstructive - in 23 (19.3%), restoration - in 3 (2.5%); while a progress - palliative nephrostomy in 41 (34.5%) patients. In 4 (3.4%) patients dynamical observation was conducted. The method of operative treatment was selected, taking into account efficacy of treatment of oncological diseases; mechanism of IIU; level of obstruction and irreversibility of changes in wall of ureter; character of injury (one-sided, bilateral, injury of ureter of a single kidney); anatomo-functional changes of upper and lower urinary ways; the patient state severity.

[CRITERIA OF ESTIMATION AND RESULTS OF TREATMENT OF IATROGENIC INJURIES OF URETERS IN ONCOLOGICAL PATIENTS].

Clinical analysis was conducted in 74 oncological patients, in whom 103 iatrogenic injuries of ureter (IIU) were revealed and for which they were treated in Scientific-nvestigative Department of Plastic and Reconstructive Oncourology. Restoration of renal and ureteric function were noted in terms up to 6 mo, in these terms were revealed all complications, caused by recurrence of obstruction. Late follow-up results of III were positive in 95.2% patients, unsatisfactory result was revealed in 3 (4.8%) patients, what have demanded conduction of surgical secondary correction of urodynamics. Quality of life after restoration operative treatment have improved in 31.70%patients in comparison of such before the operation.

POLYAMINES AS NEW POTENTIAL BIOMARKERS FOR DIFFERENTIAL DIAGNOSIS OF PROSTATE CANCER AND ESTIMATION OF ITS AGGRESSIVENESS.

BACKGROUND: Prostate cancer (PCa) is one of the most common malignancies in older men. The study of tissue markers of PCa can provide information about the state of proliferation and apoptosis in tumors, the susceptibility of tumor cells to metastasis and the mechanisms of resistance to therapy, which, in turn, can help predict the course of the disease and develop personalized treatment. Polyamines (PAs) spermine, spermidine, putrescine are of particular interest in terms of PCa tissue markers. AIM: To investigate the levels of basic and acetylated forms of PAs in the postoperative samples of malignant and benign tumors of the human prostate and evaluate the possibility of their use for differential diagnosis and assessment of the PCa aggressiveness. OBJECT AND METHODS: 57 postoperative tumor samples from patients with prostate adenocarcinoma of different Gleason score (GS) and clinical stage (T1-T4) and 20 samples of tumors from patients with benign prostate hyperplasia (BPH) were studied. The content of PAs was determined by high performance liquid chromatography. RESULTS: Among the studied PAs, the most significant difference between PCa and BPH was observed for spermine (Spm). The level of Spm in PCa samples was 16 times lower than in BPH samples (p < 0.01). We did not find a significant dependence of PAs levels, including Spm, on the clinical stage. The association between the Spm level and the GS was established. The indolent (GS6) tumors were characterized by the highest Spm level while in the most aggressive (GS9 and GS10) tumors Spm content was the lowest. CONCLUSIONS: A sharp decrease in Spm levels is probably a characteristic feature of prostate malignant tumors. The obtained results indicate an association of Spm levels in tumors with the GS. This may indicate Spm involvement in the formation of the aggressiveness of PCa. The results of the study can be further used for differential diagnosis of prostate tumors and for assessing the aggressiveness of PCa.

Evaluation of response to tyrosine kinase inhibitors in renal cell carcinoma patients based on expression of miR-99b, -144, -210, -222, -302а and -377 in tumor tissue.

BACKGROUND: Renal cell carcinoma (RCC) is one of the most common solid tumors in adults highly resistant to conventional therapies. The expression profile of a number of miRNAs correlates with RCC response to chemotherapeutic agents. AIM: To identify the association of tumor miRNAs expression with neoadjuvant treatment response in patients with RCC. MATERIALS AND METHODS: We analyzed the expression levels of tumor miR-99b, -144, -155, -210, -222, -302а, -377 in 93 RCC patients who received pazopanib or sunitinib in neoadjuvant regimen using RT-PCR. RNU48 was used as a reference miRNA. RESULTS: The levels of expression of miR-99b and -377 are associated with the RCC response to pazopanib, and microRNA-210 and -377 to sunitinib. The characteristic expression profile of miR-99b, -144, -222, -377, and miR-302a determined in 90% of cases was delineated in pazopanib responders as opposed to nonresponders. Similarly, the characteristic expression profile of miR-210, -222, -302a and -377 was suggested for sunitinib responders. CONCLUSIONS: Levels of miR-99b, -210 and -377 expression in RCC tumor tissue might be used as a basis for future predictive panel intended for the assessment of the sensitivity to the regimens of neoadjuvant RCC treatment.

NANOG as prognostic factor of prostate cancer course.

The variability of the clinical course of prostate cancer (PC) indicates the need to find factors that could predict the aggressive potential of neoplasms accounting the biological characteristics of tumor cells. In this context, the role of NANOG, a transcription factor involved in maintaining pluripotency and one of the markers of cancer stem cells (CSCs), is being actively studied today. AIM: To investigate the level of NANOG mRNA in tumor tissue of patients with PC and to analyze the possibility of its use as a marker of the disease course. MATERIALS AND METHODS: The study involved 85 patients with PC of stages II-IV. Morphological and immunohistochemical studies were performed on serial paraffin sections of resected PC using monoclonal antibodies to Ki-67 and androgen receptor. NANOG and miR-214 mRNA expression in tumor cells was analyzed by real-time reverse transcription polymerase chain reaction. The identification of CSCs was performed by double-labeled immunohistochemical method using primary antibodies to CD24 and CD44. RESULTS: We have revealed notable variability of NANOG mRNA levels in tumor tissue of patients with PC (mean 4.18 ± 0.65 a.u. with individual deviations from 0.11 ± 0.03 a.u. to 15.24 ± 0.36 a.u.). According to NANOG mRNA levels, two groups of the PC patients were delineated: group 1 and group 2, with the average NANOG mRNA levels of 2.12 ± 0.16 a.u., and 8.68 ± 1.24 a.u., respectively. The NANOG mRNA levels in tumor tissue of PC patients of groups 1 and 2 correlated with preoperative serum prostate-specific antigen level (r = 0.58; p < 0.05 and r = 0.64; p < 0.05, respectively), tumor volume (r = 0.42; p < 0.05 and r = 0.72; p < 0.05, respectively), regional lymph node metastases (r = 0.70; p < 0.05 and r = 0.75; p < 0.05, respectively). High NANOG mRNA levels in tumor cells were associated with such molecular and biological features of PC as androgen receptor expression (r = 0.52; p < 0.05), high proliferative activity (r = 0.60; p < 0.05) and the presence of CSC markers (r = 0.75; p < 0.05). CONCLUSIONS: The findings indicate that NANOG is involved in the formation of the PC malignancy and should be further studied as a potential marker for the prediction of the disease course.