To study the state of systemic immunity and local immunity before and during chemotherapy in patients with gastric adenocarcinoma. From 2017 to 2018 at the Tashkent city branch of the Republican specialized scientific and practical medical center of oncology and radiology 20 primary metastatic patients with gastric adenocarcinoma received chemotherapy. The sampling of biological material (peripheral blood, tumor tissue) was carried out twice (before treatment and during the first control examination, after 3 courses). The percentage of the degree of infiltration of tumor tissue by lymphocytes (CD45+CD14-TILs) was estimated by flow cytometry; T cells (CD3+CD19-TILs); B cells (CD3-CD19+TILs); NK cells (CD3-CD16+CD56+TILs); CD16 and CD8 effector cells and their cytotoxic potential (CTP) (CD16+Perforin+TILs; CD16CTPTILs), (CD8+Perforin+TILs; CD8CTPTILs); regulatory T cells - NKT cells (CD3+CD16+CD56+TILs), CD4 (CD4+CD25+CD127-TILs) and CD8 (CD8+CD11b-CD28-TILs) regulatory cells and these parameters of systemic results. The factor of a favorable prognosis for PFS in patients with metastatic gastric cancer in the peripheral blood was an increase in the number of CD8 + T-regulatory cells (5.1% - 12.1%, p = 0.019), and in tumor tissue - an increase in the perforin potential of effector CD16 cells (0.5% - 4.9%, p = 0.030) and their cytotoxic potential (13.2% - 55.7%, p = 0.011). When assessing the changes in the indices of local immunity during chemotherapy, it was noted a negative effect of an increase of T cells (22.0% - -9.7%, p = 0.012), NKT - cells (207.9% - -13.8%, p = 0.002) and CD4 + T-regulatory cells (190.7% - -25.2%, p = 0.002). In contrast, an increase in the level of effector CD16 cells during chemotherapy increases the likelihood of surviving PFS - 9 months (-69.5% - 9.1%, p = 0.013). Indicators of local and systemic immunity serve as additional prognostic factors for gastric cancer.
Lynch syndrome (LS) resulting from the abnormal repair of unpaired DNA bases is characterized by an increased risk of colorectal, endometrial, and urinary tract cancers. Regardless of the tumor type, immunotherapy with immune checkpoint inhibitors (ICIs) has been approved for the treatment of patients with unresectable or metastatic DNA mismatch repair‑ deficient (dMMR) tumors, which may present a treatment option for patients with LS. The article contains a case report of a female patient with a germline MLH1 mutation and multiple primary colonic malignancies treated with nivolumab for 26 months. This observation demonstrates the success of immunotherapy after 6 lines of chemotherapy, implying potential control of tumor growth in patients with LS.
Introduction. Arming gynecological oncology with modern chemotherapy schemes, elements of aggressive oncosurgery, it is possible to achieve an increase in the number of cured patients with locally advanced forms of cervical cancer (CC), providing an improvement in the immediate and long-term results of treatment. The proposed method of surgical treatment is the method of choice for the surgical treatment of patients with locally advanced forms of cervical cancer (stages IIA–IIIB).Purpose of the study. Introduction into clinical practice of the method of surgical treatment of IIA–IIIB stages of cervical cancer.Material and methods. Long-term results of treatment of 155 patients with morphologically verified stage IIA–IIIB cervical cancer were studied. The patients underwent neoadjuvant chemotherapy (NACT) (n = 110) and chemoradiotherapy (CRT) (n = 45). When resectability was achieved, the patients underwent surgical treatment using a new technique. Overall survival (OS) and progression-free survival (PFS) outcomes were assessed.Results. In the period from 2017 to 2020, 155 patients with stage IIA–IIIB cervical cancer after NACT (n = 110) and CRT (n = 45) underwent combinedextended extirpation of the uterus with appendages according to our patented method. The most frequent postoperative complications were urination disorders in 106 (67 [60.9%] and 19 [42.2%]) patients, lymphatic cysts in 30 (20 [18.2%] and 10 [22.2%]) patients and vesicovaginal fistula in 7 patients (5 [4.6%] and 2 [4.4%]), respectively. According to the results of a pathomorphological study, the most frequent tumor response to NACT was III degree of therapeutic pathomorphosis (TP) in 44 (40.0%) patients of group 1 and in 21 patients – IV-degree TP, amounting to 46.6%. The median follow-up was 28.7 (from 3.6 to 51.1) months. During this time, 30 patients died in both groups (17 [15.5%] and 13 [28.9%]) (p = 0.047). Disease progression occurred in 16 (10.3%) patients (6 [5.5%] and 10 [22.2%]) (p = 0.004), respectively. The 3-year OS was 83.8 ± 3.7 and 71.0 ± 6.8 (p = 0.131), PFS – 93.5 ± 2.6 and 77.7 ± 6.6 (p = 0.006).Conclusions. The proposed method of surgical treatment of IIA–IIIB stages of cervical cancer has a novelty and can be used in practical medicine for the surgical treatment of oncology diseases in cervical cancer
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