EFFECT OF SELECTED PROGNOSTIC AND RISK FACTORS ON SURVIVAL OF WOMEN WITH BREAST CANCER IN GEORGIA.

According to the population-based cancer registry data in Georgia, the incidence rate of breast cancer per 100000 women was 90.6 in 2016. The aim of this study is to explore the effects of risk and prognosis factors on survival of female invasive breast cancer patients in Georgia. Cancer survival analysis was conducted, it is based on retrospective study of Georgian cancer registry data. Almost all breast cancer cases who were diagnosed and histologically confirmed during the period of 2006-2015 and are recorded in the cancer registry system, were included in the study. From factors, associated with prognosis of disease and are considered as risk and prognosis factors, demographic (age at diagnosis, place of residence) and histopathology factors (stage at diagnosis and tumor cell differentiation grade) were included in the study. Survival status (alive, dead or censored) was used as the dependent (response) variable. As the starting point of time for estimating survival of patients was defined the date of diagnosis. Patients' observation period included the time from the date of diagnosis to the last follow-up (31ST December 2016) for those who was alive by the end of the study, and the date of death (end-point) for those who died during the study period. Any cause of death of cancer patients was considered as the end point. That means the overall (and not breast cancer specific) survival rate response to predictor factors was estimated in the study. Cox proportional hazard regression model was constructed to analyze the effect of all risk and prognosis factors and calculate the hazard ratio (HR) for mortality and 95% Confidence Interval (95% CI). A p value < 0.05 was considered as statistically significant. Total number of breast cancer cases enrolled in the study is 3852, age range from 21 to 80 years. We have found that cancer diagnosed between 41-59 years of age had a lower death hazard (HR=1.45, p=0.04) compared to cancer detected over 60 years of age (HR=2.40, p<0.01). There were significant differences (p<0.01) in terms of survival between patients, detected at different stages: the hazard ratio of death for cancer patients diagnosed at the second, third and fourth stages was 2.25, 4.04, and 10.43 accordingly. The study results showed that the moderately differentiated tumor had better survival chance (HR=1.35, p=0.44), than those with poorly differentiated (HR=2.37, p=0.03), and undifferentiated cancers (HR=5.19, p=0.01). Patients living in regions of Imereti (HR=1.40, p=0.02), Adjara (HR=1.37, p=0.07), and Guria (HR=1.30, p=31), had higher risk of mortality than residents of Tbilisi, while living in Shida Kartli (HR=0.59, p=0.01) region had statistically significant effect on better survival. Breast cancer survival dissimilarities among the regions of Georgia could be explained by detection of cancer at different stages and non-standard approaches to cancer management. Some risk and prognosis factors, such as the demographic (age and place of residence) and histopathology (stage at diagnosis and tumor cell differentiation grade) factors have impact on survival of the female invasive breast cancer patients, moreover, this effect mainly is statistically significant.

EFFECT OF AGE AT DIAGNOSIS ON THE PROGNOSES IN FEMALE BREAST CANCER PATIENTS IN GEORGIA.

The aim of the study was to describe prognostic factors of Breast Cancer (BC) survival in relation to patient's age at diagnosis. Cox proportional hazard regression model was constructed. All women aged ≤80 years, diagnosed from 2006 to 2015 with invasive breast cancer, and included in the national cancer registry database, were eligible for inclusion in the analysis. We estimated hazard (mortality) ratio (HR) and 95% of confidence interval (95%CI). The patients under 41 years were selected as a reference group. High risk of death was defined as a mortality of BC patients within 5 years after diagnosis. Total number of BC cases enrolled in the study is 3852, about 10% of patients was under 41 years (a young group), 50% - 41-59 years (a middle age group), and 40% - 60 years and over (an elderly group). There were some age-specific differences in almost all the variables of interest: for example, 53.3% of patients aged under 41 years were detected at early stages (the first and second) compared with 46% in patients aged 41-59 years, and 45% in patients aged ≥60 years old. Younger women were more likely to have histologically poorly differentiated tumor; it was 42%, 35%, and 31% in young, middle, and elderly age group of patients accordingly. Utilization of radio and chemotherapy decreased with age. Application of radio and chemotherapy among young group of patients in comparison with older counterparts were about twice and 1.2 times higher accordingly. The HR for cancer cases detected at any stage, except of the first stage, was increasing with age and it was the highest and statistically significant for older patients, diagnosed at the second (HR=2.84; 95%CI=1.02-7.95) and fourth stages (HR=2.71; 95%CI=1.64-4.49). Poorly differentiated cancer has the worst outcome among elderly - aged ≥60 years old (HR=2.78; 95%CI=1.61-4.80), while moderately differentiated cancer survival is not related with patients' age during detection of cancer. In addition, absence of a radio or chemotherapy treatment is associated with increased hazard of mortality. In conclusion, the relatively low risk of mortality among young women diagnosed with BC in Georgia can be explained by the higher proportion of cases in the early stages and the high level of use of chemotherapy and radiotherapy.

Cancer screening program in Georgia (results of 2011).

This paper reviews and summarizes the results and epidemiological data of 2011 Cancer Screening Program in Georgia. The first paragraph of paper underlines main results of capacity building of the program and its implementation. The second paragraph is focused on activities conducted within the program on population behaviour change and communication campaign and the final paragraph analyses the data of epidemiological results collected during year 2011 of breast, cervical, prostate and colorectal cancer screening, reviews and summarizes. Implementation of cancer screening programs is of great medical and social importance. Cancer screening, using simple tests that can cover the general population, and also promotes the early diagnosis of cancer and its treatment in a timely manner, increasing life expectancy and reduce mortality.

[Current methods of surgical rehabilitation of patients with pelvic exenteration]. / Sovremennye vozmozhnosti khirurgicheskoi reabilitatsii bol'nykh posle évistseratsii organov malogo taza.

An original procedure for supravesical urinary diversion to a small intestine pouch, intended to facilitate urination following pelvic exenteration, is suggested. Post-operative complications are minimized due to formation of a "dry" urinostomy, reduced pressure in the pouch and absence of reflux-pyelonephritis. If required, urine flow can be channeled to the pouch by connecting the sigmoid colon to the anal canal. Said procedure offers optimal advantage of rehabilitation as far as urine channeling is concerned.

[Features of the ultrastructure of endocrine and immunocompetent cells of the antral portion of the stomach in patients with grade II-III obesity]. / Osobennosti ul'trastruktury éndokrinnykh i immunokompetentnykh kletok antral'nogo otdela zheludka u bol'nykh s ozhireniem II-III stepeni.

All types of endocrine cells that occur in healthy persons were identified in the mucous membrane of gastric antrum of patients with obesity. Ultrastructural changes in endocrine cells in obese patients are suggestive of degenerative processes: in D-, D1- and G-cells these are fatty, P- and EC-cells albuminoid. Endocrine cells containing granules characteristic for cells of several types were found more frequently than in control patients. However such mixed types were observed in the two above groups of endocrine cells. Infiltration of mucous membrane of gastric antrum with lymphocytes and activation of intraepithelial lymphocytes and their interaction with endocrine cells were more pronounced in obese patients.

[Secretory and morphological state of the stomach in alimentary obesity patients kept on a low-calorie diet]. / Sekretorno-morfologicheskoe sostoianie zheludka u bol'nykh alimentarnym ozhireniem, nakhodiashchikhsia na nizkokaloriinoi diete.

The authors studied gastric secretion in 117 persons with alimentary obesity of degree II and III along with the morphological picture of the gastric mucosa. The secretion was investigated by the fractional method, pH-metry and without tubage. In the majority of patients with alimentary obesity gastric secretion proved to be normal. In these patients a greater appetite was not associated with an intensified secretion. In all of the cases under examination the morphological picture revealed the presence of chronic gastritis.