Onkourologiya最新文献

{"title":"Replacing prednisolone with dexamethasone to overcome the resistance to abiraterone in castration-resistant prostate cancer: a clinical case","authors":"A. Meshcheryakov, O. Gordeeva","doi":"10.17650/1726-9776-2020-16-2-162-168","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-2-162-168","url":null,"abstract":"Nowadays there are several effective drugs to treat castration-resistant prostate cancer. However, treatment options are still limited. In this regard, overcoming the resistance to the prescribed treatment remains extremely important. One possible way is to replace prednisone with dexamethasone when using abiraterone acetate. There are several studies, including randomized ones, which confirm the rationality of this method. We present a literature review and our own clinical observation, which demonstrates the possibility of repeated long-term (3 years) use of abiraterone acetate after replacing a steroid drug in an intensively pre-treated patient with castration-resistant prostate cancer.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67759365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacoeconomic aspects of using enzalutamide for treatment of patients with nonmetastatic castration-resistant prostate cancer","authors":"N. Avxentyev, M. Frolov, Y. Makarova","doi":"10.17650/1726-9776-2020-16-2-82-96","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-2-82-96","url":null,"abstract":"Background. Prostate cancer is one of the most common malignant diseases among men. Until recently, the most common treatment of nonmetastatic castration-resistant prostate cancer (nmCRPC) in Russia was to continue previously started hormonal therapy. Enzalutamide is a second-generation anti-androgen indicated for treatment of CRPC, regardless of a patient’s metastatic status, which significantly increases metastasis-free survival in nmCRPC compared with androgen deprivation therapy (ADT).Objective: to evaluate the incremental cost-effectiveness ratio (ICER) of enzalutamide use in patients with nmCRPC and the ICER of abiraterone as the first-line therapy for mCRPC from the Russian healthcare system perspective.Materials and methods. Standard ADT regimens for nmCRPC were used as a comparator as it was the only approved treatment for nmCRPC in Russia. We proposed a Markov model of CRPC progression on enzalutamide plus ADT (hereinafter enzalutamide) or ADT based on PROSPER trial data. Model was used to calculate progression-free life years and costs of nmCRPC and post-progression CRPC treatment. Simulation period was 5 years with one cycle of 1 month. In the “cost–effectiveness” analysis, we calculated enzalutamide ICER compared to ADT. In addition, we calculated ICER for abiraterone plus ADT and prednisolone (hereinafter abiraterone) vs ADT + prednisolone in the first-line therapy of metastatic CRPC (mCRPC) as a benchmark. In both cases, time to disease progression over a 5-year period was used as an efficacy criteria.Results. According to the Markov model, progression-free life-years gained for enzalutamide were 3.12 years compared to 1.79 for ADT within a 5-year period. The average enzalutamide therapy costs were 7,989,475.8 rubles/1 patient for 5 years, which were 5,716,983.5 rubles higher than when using ADT (2,272,492.3 rubles). ICER for enzalutamide (vs ADT) was 4,307,136.3 rubles per one progression-free life-year gained. ICER for abiraterone in the first line of mCRPC treatment (vs ADT + prednisolone) was 6,191,617.4 rubles per one progression-free life-year gained.Conclusion. In the Russian healthcare system, ICER for enzalutamide in nmCRPC was 4,307,136.3 rubles and the ICER for abiraterone in mCRPC was 6,191,617.4 rubles. ","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67760936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic thulium fiber laser partial nephrectomy without thermal ischemia","authors":"V. Dubrovin, A. Egoshin, A. Tabakov, R. Shakirov, O. V. Mihaylovskiy","doi":"10.17650/1726-9776-2020-16-2-46-51","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-2-46-51","url":null,"abstract":"Background. Laparoscopic partial nephrectomy (LPN) in the treatment of small kidney tumors is widespread, but the operation is associated with warm ischemia, which adversely affects the functional state of the kidney. Research is underway on methods of partial nephrectomy with a reduction of thermal ischemia or zero ischemia. The laser energy is one of the directions in the search for options for LPN. The aim of our work is to improve the LPN using a thulium laser. Materials and methods. From 2017 to 2019 a LPN was performed for 16 patients with small tumors, using the thulium laser with a wavelength of 1.94 ^m. There were men 7 (43.8 %), women — 9 (56.2 %), average age was 51 (39—68) years, average kidney tumor size was 24.9 (15—40) mm. The evaluation of laser resectability on the RENAL scale was carried out using 3D modeling. We used the laparoscopic laser aspirator-irrigator to reduce smoke generation during the procedures. Results. The average time of LPN using a fiber thulium laser was 97.5 (70—131) min. The time for kidney resection was 25.6 (10—40) min. 14 (87.5 %) procedures performed completely without warm ischemia. The average blood loss during surgery was 111.3 (50—250) ml. The duration of postoperative treatment was 7.1 (5—9) days. A positive surgical margin was not observed. Histological examination revealed renal cell carcinoma in 14 (87.5 %) patients, G2 — 10 (71.4 %), G2 — 4 (28.6 %). When examining glomerular filtratoin rare in the operated patients after procedures, no changes were observed. Conclusion. The use of the thulium laser for LPN allows perform the procedure without warm ischemia in selected patients with a predominantly extrarenal tumor location. The use of a laparoscopic instrument the laser aspirator-irrigator with a drip water supply and simultaneous aspiration reduced smoke generation during laser thulium resection, the operation performed under conditions of improved visualization, which prevents the danger of a positive surgical edge. Further monitoring of the results of applying the method of thulium laser LPN is required.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67760917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of PCA3, TMPRSS2:ERG and prostatic specific antigen derivatives in the detection of prostate cancer","authors":"A. Musaelyan, V. Nazarov, S. Lapin, A. G. Boriskin, S. Reva, D. G. Lebedev, V. Yakovlev, D. Viktorov, A. Toropovskiy, V. Emanuel, S. Al-Shukri, S. Petrov","doi":"10.17650/1726-9776-2020-16-2-65-73","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-2-65-73","url":null,"abstract":"Background . Prostate cancer (PCa) is one of the most common malignancy in men. A traditional marker in the laboratory diagnosis ofPCa is the prostatic specific antigen (PSA). However, the low specificity of this marker leads to a large number of unnecessary biopsies. The emergence of various modifications of PSA and tumor-specific genetic markers such as PCA3 and TMPRSS2ERG, have improved the diagnosis of PCa. Objective . Investigation of the diagnostic significance of molecular genetic markers, PCA3 and TMPRSS2:ERG, and their comparison with markers based on PSA isoforms: free/total PSA ratio (%fPSA) and prostate health index (PHI). Materials and methods. The study included 58 men with suspected PCa. All patients were defined PCA3 score and the presence of TMPRSS2:ERG fusion transcript in the urine sediment. Also, PHI and %fPSA were determined in 48 and 51 men, respectively. Results. The area under the ROC-curve regardless of the value of PSA was higher for PCA3 score (0.773, p 95 % PCA3 score had the highest specificity, positive and negative predictive values in men, regardless of the level of PSA: 65.22, 80.95, and 93.75 %, respectively. In men with PSA level of 2—10 ng/ml the area under the ROC-curve for PCA3, %fPSA and PHI was 0.776 (p = 0.001), 0.629 (p = 0.144) and 0.729 (p = 0.009), respectively. At high sensitivity (>95 %) characteristics of the diagnostic test PCA3 in men with a PSA level of 2—10 ng/ml also also exceeded those for PHIand %>fPSA. The negative predictive valuefor PCA3score in this group ofmen was 100 %. The sensitivity ofdetection ofthe TMPRSS2:ERG fusion transcript in urine was 37.14 %, specificity 86.96 %, and the positive predictive value was 81.25 %. Conclusion. The use ofthe PCA3 score in combination with the detection of TMPRSS2:ERG fusion will improve the assessment of PCa risk in men with PSA levels between 2 and 10ng/ml (the “grey zone”).","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67760929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New treatment options for advanced urothelial cancer: a combination of atesolizumab with chemotherapy","authors":"B. Alekseev, I. Shevchuk","doi":"10.17650/1726-9776-2020-16-2-104-117","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-2-104-117","url":null,"abstract":"Введение. Ингибитор PD-L1 атезолизумаб показал эффективность в лечении распространенных форм уротелиального рака как в 1-й линии при невозможности назначения цисплатина (при наличии экспрессии PD-L1 ≥5 % на иммунокомпетентных клетках) и любой платиносодержащей химиотерапии (независимо от экспрессии PD-L1), так и при прогрессировании заболевания на фоне химиотерапии, а также у пациентов с быстрым прогрессированием заболевания в течение 12 мес после неоадъювантной или адъювантной химиотерапии. В статье приведены результаты исследования III фазы IMvigor130, в котором сравнивали комбинацию атезолизумаба и химиотерапии на основе платины с химиотерапией и с монотерапией атезолизумабом в 1-й линии лечения больных распространенным уротелиальным раком. Материалы и методы. В рамках многоцентрового рандомизированного исследования III фазы, в котором принял участие 221 центр в 35 странах, ранее не леченным пациентам в возрасте 18 лет и старше с местно-распространенным или метастатическим уротелиальным раком были случайным образом назначены атезолизумаб + химиотерапия на основе платины (группа А), атезолизумаб в монотерапии (группа B), плацебо + химиотерапия на основе платины (группа C). Пациенты получали 21-дневные циклы гемцитабина (1000 мг / м2 площади поверхности тела, внутривенно в 1-й и 8-й дни каждого цикла) + либо карбоплатин (площадь под кривой 4,5 мг / мл / мин, внутривенно), либо цисплатин (70 мг / м2, внутривенно) в 1-й день каждого цикла с атезолизумабом (1200 мг, внутривенно, в 1-й день каждого цикла) или с плацебо. Пациенты группы В получали 1200 мг атезолизумаба, вводимого внутривенно в 1-й день каждого 21-дневного цикла. Первичными конечными точками эффективности лечения были оцененные непосредственно исследователями согласно критериям оценки ответа солидных опухолей версии 1.1 (RECIST 1.1) выживаемость без прогрессирования (ВБП) и общая выживаемость (ОВ) (группа A против группы C), а также ОВ (группа B против группы C) с необходимостью проверки в центральной лаборатории, если ОВ была выше в группе А, чем в группе С. Испытание зарегистрировано на ресурсе ClinicalTrials.gov – NCT02807636. Результаты. В период с 15 июля 2016 г. по 20 июля 2018 г. в исследование были включены 1213 пациентов. Случайным образом 451 (37 %) пациент распределен в группу A, 362 (30 %) – в группу B, 400 (33 %) – в группу C. Медиана наблюдения составила 11,8 мес (интерквартильный размах 6,1–17,2) для всех больных. Во время окончательного анализа ВБП и промежуточного анализа ОВ (31 мая 2019 г.) медиана ВБП в популяции больных, продолжающих лечение, составила 8,2 мес (95 % доверительный интервал (ДИ) 6,5–8,3) в группе А и 6,3 мес (95 % ДИ 6,2–7,0) в группе С (стратифицированное отношение рисков 0,82; 95 % ДИ 0,70–0,96; р = 0,007). Медиана ОВ составила 16,0 мес (95 % ДИ 13,9–18,9) в группе A и 13,4 мес (95 % ДИ 12,0–15,2) в группе C (0,03; 95 % ДИ 0,69–1,00; р = 0,027). Медиана ОВ составила 15,7 мес (95 % ДИ 13,1–17,8) в группе B и 13,1 мес (95 % ДИ 11,7–15,1) в группе C (","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67756554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative clinical and economic analysis of using cabozantinib as second-line therapy for adult patients with advanced renal cell carcinoma","authors":"I. Krysanov, V. Krysanova, B. Alekseev, V. Ermakova, E. Gameeva","doi":"10.17650/1726-9776-2020-16-2-52-64","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-2-52-64","url":null,"abstract":"Background. Currently there exists a wide range of advanced renal cell carcinoma (RCC) treatment schemes, among them cabozantinib, registered in Russia in 2019, was approved as a second-line therapy in both foreign and domestic guidelines. Objective: to conduct a comparative clinical and economic analysis of cabozantinib and alternative drugs in adult patients with advanced RCC after previous systemic therapy. Materials and methods. A literature review was conducted on clinical efficacy and safety of various second-line therapy drugs for advanced RCC in the available databases. The foreign partitioned survival model, reflecting the development of widespread RCC when using 4 different second-line therapy drugs (cabosantinib, nivolumab, axitinib and everolimus), was adapted considering 3 consecutive mutually exclusive conditions (before progression, after progression, death). Pharmacoeconomic analysis included “cost-effectiveness” and “cost-utility” analysis. We estimated direct medical costs for second- and third-line therapy and maintenance therapy (outpatient monitoring and palliative care). To estimate drug costs we used prices from the State Register of maximum selling prices, for cabozanthinib — price presented by the manufacturer. Costs of maintenance therapy were estimated based on the normal standardfor financial costs in accordance with the Program of state guarantees for 2020. Results. Efficacy analysis based on the partitioned survival model showed the highest rates of life-years gained (3.18 life-years-gained (LYG)) and quality adjusted life-years (1.87quality adjusted life-years (QALY)) for cabozanthinib compared with nivolumab (2.53 LYG and 1.6 QALY), axitinib and everolimus (2.21 LYG and 1.31 QALY). Total costs for advanced RCC patients when treated with cabozanthinib were 4.3 million rubles, which is 5 % less than when using nivolumab (4.5 million rubles). Total costs for axitinib were 2.1 million rubles, while its effectiveness was lower compared with the cabozanthinib one. Costs of 1 life-year saved for cabozantinib were 1.4 million rubles, which is 25 % less compared to those for nivolumab. Costs of 1 quality-life year saved when using cabozantinib amounted 2.3 million rubles, which is 19 % less than those for nivolumab. Conclusion. The study results showed that using cabozantinib to treat advanced RCC after previous systemic treatment is both clinically and cost-effective for adult patients with advanced RCC in the Russian Federation.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67760925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PI-RADS v2.1: moving towards clarity (comments on the updated version)","authors":"N. Rubtsova, A. Mishchenko, V. Danilov, G. A. Gulin, B. Alekseev, А. Kaprin","doi":"10.17650/1726-9776-2020-16-2-15-28","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-2-15-28","url":null,"abstract":"Previously presented Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) system was developed on the basis of consensus that was achieved by the results of published studies containing expert and analytical conclusions. Numerous studies on PI-RADS v2, not only confirmed the importance of a unified system in the diagnosis of prostate cancer, but also revealed a number of limitations. In order to eliminate flaws of PI-RADS v2, a number of potential solutions were proposed. The PI-RADS Steering Committee recommended changes in PI-RADS v2, with maintaining the structure of sequence scoring and using these scores to obtain the final category. The updated version was published as PI-RADS v2.1 at the beginning of 2019. It is expected that the use of PI-RADS v2.1 will optimize and simplify the evaluation magnetic resonance imaging of prostate and reduce the number of interpretation errors. At the same time, it is necessary to continue further studies on the assessment of the clinical significance of this system when choosing a treatment strategy and monitoring patients with a high potentialfor the development","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"16 1","pages":"15-28"},"PeriodicalIF":0.1,"publicationDate":"2020-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67758479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early complications of radical cystectomy with various types of urine diversion: prognostic factors analysis","authors":"T. Musayev","doi":"10.17650/1726-9776-2020-16-1-78-89","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-1-78-89","url":null,"abstract":"Objective: to analyze factors predicting complications in a series of radical cystectomies (RCs) performed for bladder cancer over a 10-year period at the National Center of Oncology (Baku).Materials and methods. From July 2008 to December 2017 we retrospectively selected 257 consecutive cases of RC with pelvic lymphadenectomy and various options of urine diversion for bladder malignant neoplasms. Information on preoperative prognostic factors, including demographic parameters, as well as general patient health parameters, tumor characteristics and factors concerning the operation was obtained from medical records. We analyzed perioperative factors using monovariant logistic regression, where the endpoints were development of any complication (I–V degrees according to Clavien–Dindo classification), as well as severe complication (III–V grades) within 30-days after RC were considered the endpoints. After the missing data on preoperative bacteriological urinalysis were multiply imputed, a multivariate logistic regression has been performed with odds ratio (OR) calculation.Results. During the 30-day period, complications were registered in 111 (43.2 %) patients, severe complications – in 48 (18.7 %). Multivariate analysis revealed the following independent predictors of any postoperative complications after RC: local cT4 tumor extension (OR 4.52; p = 0.002), age (OR 1.87; p = 0.017), positive bacteriological urine analysis (OR 2.16; p = 0.032) and number of performed RCs (OR 0.89; p = 0.038). Severe postoperative complications were associated with positive urine culture (OR 4.05; p = 0.002) and age (OR 2.44; p = 0.013).Conclusion. Our study revealed the following independent factors, which were significantly associated with the risk of any complication or severe complication after RC: local cT4 tumor extension, age, positive urine bacteriological analysis before the intervention and a small number of surgeries or positive urine culture and age, respectively.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67756154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological results of neoadjuvant chemohormonal therapy in patients with high and very high-risk prostate cancer","authors":"M. Berkut, A. S. Artemjeva, S. Reva, S. S. Tolmachev, S. Petrov, A. Nosov","doi":"10.17650/1726-9776-2020-16-1-54-63","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-1-54-63","url":null,"abstract":"TolsotogoSt., Saint Petersburg 197022, RussiaBackground.Prostate cancer (PCa) of a high and very high risk is a potentially fatal disease that requires an active multimodal approach, including the use of neoadjuvant drug treatment. As option for this treatment is neoadjuvant chemohormonal therapy (NCHT) followed by radical prostatectomy (RPE). However, data on the oncological results of treatment of such patients are still limited and the role of neoadjuvant therapy in the treatment of high and very high-risk PCa remains not fully understood.Objective:toassesstheoncologicalresultsoftreatmentpatientswithlocalizedandlocallyadvancedPCaofhighandveryhighriskafterNCHT.Materials and methods.This was a prospective randomized study: patients with PCa of high and very high-risk groups (prostate specific antigen levels (PSA) >20 ng/ml and/or Gleason score³8and/or clinical stage >T2c) were treated with RPE only (group RPE; n = 35) or NCHT followed by RPE (NCHT/RPE group; n = 36). The neoadjuvant course included the intravenous administration of docetaxel once every 21 days (75 mg/m2 up to 6 cycles) and the antagonist of the gonadotropin releasing hormone degarelix according to the standard scheme (6 subcutaneous injections every 28 days). After a follow-up examination evaluating the result of the neoadjuvant regimen, patients underwent RPE with extanded lymphadenectomy.Results.A mean follow-up was 37.08 ± 20.46 months. A statistically significant reduction of prostate specific antigen >50 % post-chemohormonal therapy was observed in all 36 cases. Lower postoperative stage was noticed in 38.5 % in NCHT/RPE group compared with 2.7 % in RPE group. Similarly, positive surgical margin rate was higher in group without neoadjuvant therapy – 40 and 25 % (RPE group). Cancerspecific survival was 97.2 % in NCHT/RPE group and 87.56 % in the RP group (p = 0.037), cancer specific survival rate – 91.4 % and97.2 % respectively (log-rank test p = 0.22). At the same time, no statistically significant differences were obtained in 3-year recurrence free survival between groups: 38.8 % in NCHT/RPE group versus 43.6 % in the RPE group (log-rank test p = 0.36).Conclusion.Conducting NCHT before RPE is a safe and effective strategy in patients with PCa of high and very high risk groups and could improve oncological results.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67756418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choice of urine derivation method after radical cystectomy in the high anesthesiological risk group","authors":"S. Shkodkin, Y. Idashkin","doi":"10.17650/1726-9776-2020-16-1-90-98","DOIUrl":"https://doi.org/10.17650/1726-9776-2020-16-1-90-98","url":null,"abstract":"Background. Radical cystectomy is the standard treatment for muscle-invasive bladder cancer. Muscle invasion can occur in 48 % of patients. Epidemiologically, the peak incidence of bladder cancer is observed in men at the seventh decade of life. At the time of diagnosis, many of these patients have serious comorbidity. The trauma of radical cystectomy in combination with comorbidity creates an insurmountable barrier to radical treatment in a large part of patients. Refusal to use intestinal segments for urine diversion dramatically reduces the invasiveness of the intervention. However, the implementation of bilateral ureterocutaneostomy is associated with a greater frequency of pyelonephritis due to the use of external stents and scarring of the ureterocutaneostomy. A transureteroureterostomy with a unilateral ureterocutaneostomy can be a definite alternative.Objective: to evaluate the effectiveness of cross ureteroureterostomy for urine derivation after radical cystectomy in patients with muscle-invasive bladder cancer and a high risk of perioperative complications.Materials and methods. The article analyzes 28 cystectomies for muscle-invasive bladder cancer in patients with severe concomitant pathology who underwent transureteroureterostomy with unilateral ureterocutaneostomy for urine derivation. Results. It was shown that this intervention does not have high morbidity, does not increase the incidence of early postoperative complications, and relieves patients from bilateral urostoma. Among late complications, inflammatory ones predominate due to obstruction of the external stent. The authors highlight the tactics and technical aspects of managing such patients with obstructive pyelonephritis and the experience of drainage-free management.Conclusion. Transureteroureterostomy with unilateral ureterocutaneostomy after cystectomy for muscle-invasive bladder cancer can be considered as the operation of choice in patients with a burdened comorbidity.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67756306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}