Aim: The aim of this study was to develop and implement the concept of fast-track surgery (FTS) for reconstructive breast surgery in patients with breast cancer (BC) to improve early and long-term results of treatment. Materials and methods: The study includes 749 patients with stage 1 to 3 BC. A total of 253 patients with BC got treatment according to FTS program and were included to the core group. Other 496 patients with BC (control group) were not included to the FTS program. Patients were treated from December 2010 to December 2014. All age groups were covered (18-70 years old). Results: There was a significant difference in the average length of hospital stay (LOS) which was 14.27 ± 7.00 days in the core group and 20.11 ± 7.70 days in the control group ( P < .001). In advanced BC cases in the core group, LOS was >8 days lower comparing with the control group on average. The LOS in patients who underwent adjuvant chemotherapy was 2.7 times lower in the FTS group comparing with the control group. Conclusions: The study results allow us to recommend the concept of FTS for implementation in broad medical practice for breast reconstructive surgery in patients with BC. The FTS program was shown to be effective in all types of breast surgery, including immediate oncoplastic and reconstructive surgeries. The gradual reduction of LOS increased the number of surgeries in our department by 75% from 2008 till 2018.
Recently, an increase in the incidence of multiple primary malignant neoplasms has been observed, specifically, when two or more unrelated tumors originate from different organs and appear in the body simultaneously or sequentially, one after another. During past few years, the interval between the first and second reproductive cancer diagnosis has decreased in 6 times – from 11 to just 2 years while probability of surviving the next 3 years after 8.5 years past initial diagnosis has decreased from 0.995 to 0.562. Using performed analysis, this paper provides details of survival modelling for women with breast cancer with the aim to find the most significant factors affecting the likelihood of survival not by chance alone. The data used for research were obtained from Ukrainian National Institute of Cancer covering 1981–2017 period. The modelling was performed using Cox regression with forward effect selection method and stay in p-value boundary equal to 0.15. The forward method firstly computes the adjusted chi-square statistics for each variable. Then, it examines the largest computed statistics and if particular one is significant, the corresponding variable is added to the model. Once the variable is entered, it is never removed from the model. 3 out of 4 factors that appeared to be significant according to forward selection method were confirmed as the significant ones by stepwise selection method. The results of modelling proved the possibility of prediction the survival using certain set of disease features and subjects’ characteristics. Testing of global hypothesis for Beta resulted in rejecting of null hypothesis (Beta = 0) in favor of the alternative one (Beta ≠ 0) thus it was confirmed that the models make sense and can be used to predict survival in women with breast cancer. According to obtained results, the most significant disease features and subjects characteristics appeared to be: type of multiple processes (synchronous or metachronous), presence of relapse and/or metastasis, type and combination of treatment, stage of disease. Cancer with synchronous processes is characterized by greater aggressiveness and it reduces survival by almost 13 times compared with cancer where metachronous processes take place. Even though chemotherapy significantly increases the survival rate of patients, it also impacts the probability of relapses and metastasis occurrence, which are 16 times more likely to occur if chemotherapy was a part of treatment. This gives grounds for assumption that it has an indirect effect on survival and hence needs to be analyzed considering its negative impact on the relapses and metastasis occurrence probability, which, in turn, reduces survival by 10 times. This fact, in our opinion, introduces the need for further in-depth analysis. The significant difference between survival rates in patients with the first and third stages of cancer has been proved – the chances to survive with the disease at the first stage are almost 12 times higher than with disease at the third stage. At the same time, the difference in the survival rates in women with the disease at the second and the third stages is not so big and it is only 1.6 times. The modern method of conducting surgery compared with the standard one appeared to be capable to reduce the risk of relapses and metastases by 2.6 times, while breast conservative surgery in multiple oncological processes – by 3 times compared with mastectomy, which allows to state that both factors have a positive effect on the survival probability and reduce the risk of mortality. Regarding subgroup models built for patients having synchronous process and patients with metachronous processes separately, an increase in the sample size is needed to assess assumed difference in factors affecting survival and to improve predictive abilities of models. This, in turn, requires additional studies during which the necessary amount of data can be collected.
Вступ. У жінок постменопаузального віку рівень циркулюючого естрогену у сироватці крові та тканині грудної залози знижений, але частота розвитку раку грудної залози (РГЗ) залишається високою, що вказує на наявність інших чинників, що зумовлюють його виникнення. До останніх можна віднести здатність естрогену та його метаболітів порушувати рівновагу в редокс-стані органів та крові шляхом посилення генерування супероксидних радикалів, які виявляють як сигнальні, так і пошкоджуючі ефекти. Накопичилися дані щодо того, що окиснювальний метаболізм естрогену з утвореннями катехол-естроген-3,4-хінонів має потенціал ініціювати РГЗ. Мета. Дослідити рівень церулоплазміну (ЦП), трансферину (ТФ), NO-гемоглобіну (NO-Hb), метгемоглобіну (MetHb), «вільного» заліза, супероксид-і NO-генеруючої активності нейтрофілів та матриксних металопротеїназ-2 і-9 у крові хворих на РГЗ ІІ-ІІІ стадії з різним гормонорецепторним статусом пухлин. Об'єкт і методи. Досліджено кров хворих на РГЗ у репродуктивному та постменопаузальному віці. Рівень ЦП, ТФ, «вільного» заліза, геміхромів, MetHb, NO-Hb та убісеміхінону досліджували методом електронного парамагнітного резонансу (ЕПР) у низькотемпературному режимі (77 К). Швидкість генерування супероксидних радикалів нейтрофілами визначали методом ЕПР при кімнатній температурі з використанням спінового уловлювача TEMPONE-H («Sigma»). NO-генеруючу активність нейтрофілів крові визначали методом ЕПР з використанням технології Spin Traps за температури 77 K (спіновий уловлювач-діетилдитіокарбамат). Рівень активних форм желатиназ у сироватці крові визначали методом зимографії у поліакриламідному гелі. Результати. У пацієнток репродуктивного та постменопаузального віку з естроген-рецептор (ER)(+)/прогестерон-рецептор (PR)(+) та ER(-)/PR(-)-статусом пухлин рівень ЦП перевищував значення, характерні для донорів, а рівень ТФ був достовірно нижчим. Вміст у крові NO-Hb був найвищим у хворих на РГЗ у постменопаузальному віці з ER(-)/PR(-)-статусом пухлин та прямо корелював з NO-генеруючою активністю нейтрофілів (r=0,56; р<0,05). Активність матриксної металопротеїнази-9 у сироватці крові хворих з ER(-)/PR(-)статусом пухлин у 3,3 раза достовірно перевищувала таку у хворих з ER(+)/PR(+). У крові 78% хворих на РГЗ постменопаузального віку з ER(-)/PR(-) виявлено підвищення вмісту метаболітів естрогенів-хінонів та убісеміхінонів, рівень останніх прямо корелював зі стадією пухлинного процесу (r=0,58; р<0,05). Встановлено, що нейтрофіли в крові хворих репродуктивного віку з ER(+)/PR(+) та ER(-)/PR(-) генерують супероксидні радикали зі швидкістю, яка є відповідно у 9 та 18 разів вищою порівняно з донорами, а NO-більше ніж у 12 разів незалежно від гормонорецепторного статусу пухлин. Висновок. Виявлено порушення редокс-стану крові у хворих на РГЗ, зміни якого залежать від гормонорецепторного статусу пухлин, зокрема ER(+)/PR(+) та ER(-)/PR(-). Характерний для хворих на РГЗ редокс-стан крові формується підвищенням супероксид-та NO-генеруючої активності нейтрофілів, появою значних рівнів NO-Hb, MetHb, геміхромів, убісеміхінонів і ...
This article investigates breast cancer incidence in Ukraine. The research is based on National cancer-registry data. It describes the problem of treatment choice complexity and ambiguity between surgical treatment and combined surgical treatment. The paper examines two types of combined surgical treatment: a combination of surgery with radiotherapy and a combination of surgery with radiotherapy and chemotherapy. In order to determine the positive and negative effects of each type of treatment, we conducted statistical analysis. The analysis was based on female patients’ data from the National Cancer Institute. Based on the results, the study proved the relevance of survival analysis from the perspective of overall survival and progression-free survival by treatment type. The article describes the analysis and its findings on 5-year survival rates. Specifics of research with censored data and methodology of evaluating factor weights in the Kaplan – Meier method are described. It also describes the distribution of patients treated in the National Cancer Institute, which made it possible to build a representative sample. The sample was used to conduct a comparative analysis of survival rates among breast cancer patients by treatment type. We built survival curves for comparative analysis by treatment type. This helped define relevant 5-year survival rates among patients. The study analyzed a number of factors that could be significant and could influence breast cancer patients’ survival. Furthermore, we applied stratified analysis by treatment type and checked the hypothesis that there is no difference between the population survival curves by using Log-rank and Wilcoxon tests. Based on the study results, new possibilities for further analysis were described. The results could be used for patients’ survival modeling and for determining the relationship between risk factors when they are influenced by another one. The results will be helpful in determining recommendations about treatment type.
Background. Breast reconstruction after mastectomy is an important factor affecting patient’s quality of life. Mechanical and biological features of acellular dermal matrix (ADM) allows simplifying the breast reconstruction and achieving better functional and aesthetic results, especially for women with medium and large breast size. Objective: to present the first experience of breast reconstruction with ADM in Ukraine with the analysis of the technical aspects of surgeries, early and delayed surgical, oncological and functional results. Materials and methods. This work is the retrospective analysis of implant-based breast reconstruction with ADM in the Breast Unit of LISOD Hospital of Israeli Oncology. Results. Thirty-five operations were performed for 27 patients, 34 of them were immediate and one — delayed reconstruction. The average age of women was 44 (30–71) years. Therapeutic procedures were performed in 25 (73.5 %) cases, prophylactic — in 4 (11.8 %), symmetrised — in 5 (14.7 %). Eighteen (52.9 %) mastectomies were nipple-sparing. The average time of follow-up was 46 (6–84) months. Early complications such as ischemia and skin necrosis, infection, hematoma were detected in 11 (31.4 %) cases. Late complications such as infections and late seromas were observed in 4 (11.4 %) cases. Five (14.3 %) revisions were performed, 3 (8.6 %) implants were lost. Grade 3 capsular contracture was found in 5 (14.3 %) reconstructed breasts. Systemic recurrence occurred in 6 patients, 5 of them died. We had performed a survey about aesthetic and functional results in 21 (77.8 %) patients: 19 (90.5 %) were very satisfied and 2 (9.5 %) — were rather satisfied. No patients were unsatisfied. Conclusions. Despite the certain complications rate, the mechanical and biological features of ADM allow us to make an effective breast reconstruction even in patients with medium and large breasts. It provides for the further lipografting, and promotes good aesthetic and functional results after breast reconstruction.
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