Introduction. Metastatic renal cell carcinoma (RCC) is the most difficult urological neoplasm form to treat. The last two decades have witnessed significant progress in the RCC treatment. A better understanding of oncogenesis has led to the development of several targeted therapies, including tyrosine kinase inhibitors (TKIs), vascular endothelial growth factor (VEGF) targeting agents, and mammalian target of rapamycin (mTOR) inhibitors. Despite the developed modern approaches to treatment and drugs with a new target action on tumor cells, the problem of treating metastatic RCC remains relevant in the world oncological science. Aim of study. Development of criteria for the selection of therapeutic effects in metastatic RCC, taking into account the factors of the tumor microenvironment. Materials and methods. The biological materials of the removed tumor tissue were studied in 110 patients with verified RCC, the first 2 groups with metastatic process, who after surgical treatment received immuno-targeted therapy in various modes, and the 3rd control group without metastases, for whom treatment was limited only to the surgical stage of treatment. Cytometry was used to identify key CD class proteins belonging to various types of immunocompetent cells.Immunohistochemical studies were performed to detect the activity of expression of tumor markers Bcl 2, Ki 67, p53 and VEGF. The histomorphological picture of extra tumor heterogeneity in RCC was studied using tumor tissue microscopy. Results. Differences in the composition of immunocompetent cells in groups with metastatic RCC and tumor tissue in patients without signs of metastatic spread indicated changes in the body's immunoreactivity at different stages, depending on the degree of tumor prevalence. The selection criteria allowing to prescribe a certain immuno/targeted therapy have been determined. Discussion. Based on the results of the analysis, we were able to establish a pathological phenotype based on the criteria of extra-tumor heterogeneity in metastatic RCC. Conclusions. Studies of the subpopulation spectrum of the tumor microenvironment have shown that differences in the quantitative and morphotypic composition of immunocompetent cells are the criterion for choosing the treatment and, together with the pathological characteristics of carcinogenesis, serve as a prognostic factor of the outcome of the disease.
In recent decades the detection of new cases of renal cell carcinoma (RCC) has remained unchanged. This tumor accounts for 2-3% of all cancer diagnoses in humans. Standard methods of surgical treatment are being improved towards less invasive resection methods; this let’s achieving the outcomes comparable to traditional nephrectomy in oncological practice. In some cases the risk factor of developing locoregionalrecurrence still remains after surgical treatment for renal cancer. The limited role of systemic therapy and radioresistance sets hopes on surgical removal of the recurrent tumor. Unfavorable prognostic factors such as the volum of recurrence, the presence of sarcomatoid histological elements, an increased level of serum alkaline phosphatase and lactate dehydrogenase were identified in the materials of several recent studies. The time of recurrence appearance and aforehandsurgeries hould be defined as one of the independent predictors as it reported by other several studies. The open laparotomic, laparoscopic and robotic methods of tumor removal, as well as the extents of renal segments of repeated resection are discussed depending on the size of the recurrent tumor and the extent of the previous opetations. At the present stage of the development of minimally invasive surgery, with its problem-solvingabilities which are very essential in treating the relapsed high-riskpatients.
The review article presents data on the modern possibilities of intensive care for patients with thoracic trauma in case of polytrauma. It should be noted that over the past 5 years, the number of patients with thoracic injuries in polytrauma who require intensive care in the intensive care unit has increased by 10 times. For their treatment, advanced intensive care methods are used, but, despite this, the mortality rate of this category of patients remains one of the highest, reaching 80%. Moreover, it is combined thoracic trauma that plays a leading role in thanatogenesis. Studying the clinical manifestations of thoracic trauma in patients with polytrauma will help to improve the quality of medical care and the results of treatment of such patients. One of the reasons for the high mortality and disability of patients with thoracic trauma during polytrauma is the lack of a single integrated pathogenetic approach to assessing the severity of the condition of patients and the tactics of intensive care. The values of direct damage to internal organs, the main vessels of the chest and mediastinum in the development of a number of formidable complications are not fully defined, and it is not clearly stated in which cases support for vital functions is needed or their replacement. In the practice of conducting intensive care with thoracic trauma on the background of software in different institutions, often opposite methods and approaches to tactics of conducting intensive care are used. This indicates that the problem of intensive care patients of this contingent is far from being solved and is of certain scientific and practical interest. The role of primary and secondary injuries in combined thoracic trauma has not been studied, the boundaries of compensatory and adaptive reactions have not been determined. Moreover, there is no single concept for intensive care patients with thoracic trauma during polytrauma. This type of damage is accompanied by deep disorders of homeostasis systems, which determine the severity of the clinical course and cause a high level of complications and disability. Unsatisfactory results of intensive care are often associated with insufficient ideas about the pathogenesis of the early post-traumatic period in patients with polytrauma, which leads to errors in determining the volume, timing, feasibility and sequence of intensive care. Conclusion. We believe that the improvement of treatment outcomes for this category of patients can be achieved only with a comprehensive, objectively substantiated approach to the choice of intensive care tactics, focused on the clinical features of thoracic trauma on the background of polytrauma
The high recurrence rate of muscle noninvasive bladder cancer (BC) dictates the search for new methods of surgical treatment. The problem of bladder cancer (BC) treatment is very urgent in urology, because of high morbidity, difficulties in determining the optimal treatment tactics, necessity of long-term follow-up examinations, high recurrence rate and progression. Risk and progression criteria have been developed to identify groups of patients in need of closer follow-up, which can be quantified using risk calculators for recurrence and tumour progression. Although there are clear guidelines for the treatment of patients with bladder cancer, it is also believed that the rate of recurrence depends on the quality of the primary surgical procedure performed [1,2].
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