Современные подходы к диагностике и лечению первично-генерализованных форм почечно-клеточного рака

Аннотация

Subjects of research: 170 patients with renal-cellular cancer. Purpose of work: to improve methods of diagnosis, to reveal criteria of early generalization by identification of expression of tumor tissue genes and to improve results of the treatment in primary-generalized forms of renal-cellular cancer. Methods of research: the common clinical, roentgenological, ultrasonography, CT, MRI, cytogenic, immunological, immunohistochemical investigations. The results obtained and their novelty: Inclusion of ultrasonography, CT and MRI into the complex plan of investigation of the patients with renal-cellular cancer allows effective determination of the degree of the cancer invasion, to differ local cancer from primary-generalized form of tumor. Diagnostic accuracy of ultrasonography investigation was 97,1%, CT - 88,8% and MRI - 95,5%. In patients with primary-generalized forms of renal-cellular cancer there was observed moderate (in 56,6% patients) and marked (in 34% of patients) depression of antitumor immunity. Chromosome changes determined in the lymphocyte of peripheral blood by the cytogenetic method in the patients with disseminated form of renal-cellular cancer in comparison with local form were expressed by lower mitosis FGA (fitogcmaglutinin) stimulation, prevalence of meta-phase plates with multiple aberrations (23,9% and 5,3%; 57,1% and 8,3%, respectively). Determination of molecular-genetic predictive factors (p53 apoptosis inductor, Bel 2 apoptosis inhibitor and Ki-67 proliferation marker) by immunohistochemical investigation of tumor cells in the patients with primary-generalized forms of the renal-cellular cancer allows both evaluation of the tumor cell activity and prediction of patient’s life expectancy. Performance of palliative nephrectomy provided increase in survival of patients with primary-generalized forms of renal-cellular cancer and 4-fold increase in duration of life of the patients. Performance of the immunochemotherapy in the patients with generalized form of rcnal-cellular cancer was less effective. Practical value: The results of investigation allowed decrease the frequency of diagnostic mistakes at the stages of patient examination, improvement diagnosis, determination of the prognosis of disease progressing as well as contribute to development of the most rational strategy for treatment of patients with primary-generalized forms of renal-cellular cancer, that allow optimization of the methods of treatment, increase in survival time indicators, average life duration and improvement of the quality of life of the patients. Degree of embed and economic effectivity: Results of this research work has been introduced into the clinical practice of the urological department of the National Research Center of Oncology of MH of RUz, in the surgical department of Tashkent Province Oncological Dispensary, Department of Thoracoabdominal surgery of the Tashkent Oncological Dispensary. Field of application: oncourology.