BACKGROUND: In recent years, the incidence of thyroid cancer has been increasing, primarily due to the rising detection of papillary microcarcinomas (T1a). However, the mortality rates have not declined. This study is devoted to evaluate trends in thyroid cancer incidence in Altai Krai, with a particular focus on the T1a subcategory. AIM: The work aimed to study the trends of thyroid cancer incidence in Altai Krai in 2014–2023, with a focus on tumors at the papillary microcarcinoma stage (T1a), including their recurrence rates. METHODS: Data from the regional cancer registry were used. Incidence rates, stage distribution, histological structure, and recurrence rates were assesed. The data were than compared to those from across Russia, along with the international data on active observation. RESULTS: The incidence rate in the region was 3–4 times higher than the average rate in Russia. StageT1 accounted for 66.4% of cases, with T1a representing 36.1%. The recurrence rate of papillary microcarcinomas remained below 4%, with a declining trend reaching 0.35% in 2023. CONCLUSION: The high proportion of early-stage tumors and the low recurrence rate of papillary microcarcinomas highlight the potential for incorporating active surveillance strategies into Russian clinical practice.

The result of the treatment of tongue cancer, which includes surgical treatment at the first stage followed by radiation therapy, is presented. Carrying out radical combined treatment of tongue cancer in the future leads to the appearance of a post-radiation ulcer in the area of surgery, followed by the development of a recurrence of tongue cancer in it and metastasis to regional lymph nodes or submandibular salivary glands. All of the above requires oncologists to actively monitor this group of patients. With the development of a post-radiation chronic long-term non-healing ulcer in the area of surgery, surgical rehabilitation should be carried out. Surgical removal of such an ulcer prevents further development of cancer recurrence. Regular examination, neck ultrasound, cytological examination of suspicious areas of the tongue and regional lymph nodes allows timely detection of relapse and metastases and radical surgical treatment. Such an active tactic of managing this pathology affected the patient’s life expectancy — 17 years.

The term “microbiome” is defined as the community of all microorganisms and their metabolic byproducts within their environment. It also refers to the complete set of genetic material and the relationships between these microorganisms within a specific ecological setting throughout a certain period of time. The human microbiome profile develops from birth and remains relatively stable throughout adult life. The microbiota’s primary functions include involvement in the most essential processes of the body’s vital activity, such as the development of adaptive mechanisms, immune defense, physiological homeostasis, cognitive function, and regulation of energy resources within the body. Consequently, the microbiota plays a pivotal role in preserving equilibrium within the macroorganism itself and between the macroorganism and its environment. This article presents the findings of numerous scientific investigations that examine the impact of microbiota on the vital activity of tumors. These studies demonstrate that the microbiota can either accelerate or decelerate tumor growth, and in certain instances, the bacterial community does not contribute to the development of tumors. Tumors, characterized by the profound cellular changes resulting from the impairment of essential DNA mechanisms, create a specific environment that fosters bacterial colonization. In general, tumor tissue is known to have a higher bacterial load compared to normal tissue. Bacteria have been observed to produce certain metabolites that are subsequently used by tumor cells. Consequently, these bacteria and tumor cells compete directly for nutrients essential to their vital functions. The study examines the conditions underlying a particular scenario in which tumors and microbiota may interact. The review presents findings from studies that have sought to regulate intratumor microbes as a potential new target for anti-cancer therapy. This includes the use of bacterial platforms and fecal microbiota transplantation. Additionally, this study presents investigational findings concerning the use of microbiota in the treatment of acute respiratory viral infection, with a focus on chemotherapeutic and immunotherapeutic protocols. These findings corroborate the efficacy of microbiota-based interventions and concurrently highlight the potential for adverse complications.

Photodynamic therapy (PDT) is actively developing, becoming one of the important methods of non-invasive treatment of various oncological and infectious diseases. It is usually carried out using three main components: a photosensitizer, light, and oxygen. The key factors for the effective use of PDT are reactogenic oxygen species, which are produced during the oxidation of photosensitizers under the influence of light irradiation. To increase the production of reactogenic oxygen species, a technique was proposed for creating photosensitizers with aggregation-induced emission. At the present stage in oncology, the following PDT methods using photosensitizers with aggregation-induced emission are distinguished: PDT, absorbing near infrared radiation; enzyme- or glutathione-activated PDT; hypoxic PDT, and synergistic therapy. Compared to visible light, near infrared radiation (7001700 nm) has been shown to be more effective and safer due to reduced photodamage, less scattering, and deeper light penetration. The development of activated photosensitizers is an effective way to overcome the uncontrolled phototoxicity of photosensitizers during long-term PDT in vivo, providing controlled death of tumor cells. The oxygen concentration in tumor tissue varies depending on tumor progression, angiogenesis, metabolism, and metastasis. Therefore, the development of photosensitizers capable of effectively fluorescing under hypoxic conditions, including catalyzing intracellular substrates with the formation of oxygen and stimulating the production of reactogenic oxygen species through the type I mechanism, has become a potential solution to the problem of PDT of solid tumors. The therapeutic efficacy of a single PDT method, as well as most treatment methods in modern oncology, is limited. Therefore, a significant direction is the development of multifunctional treatment systems for synergistic therapy of tumors. Synergistic chemotherapy and PDT is an important area of treatment in oncology. The combination of PDT and immunotherapy is also a promising direction in the treatment of malignant neoplasms. There are obvious prospects for PDT in oncology not as a separate method of treatment, but as part of a complex multimodal treatment, including chemotherapy, radiation therapy, surgical treatment, and immunotherapy.

Pancreatic cancer is one of the most serious problems of modern oncology. In the Russian Federation, pancreatic cancer, along with a fairly small share in the structure of the incidence of malignant neoplasms 3%, ranks first in annual mortality (68.2%), and is also a nosology with the most unfavorable prognosis among tumors of the gastrointestinal tract. The current standard of first-line therapy is FOLFRINOX (FOLFIRINOX, a combination of 5-fluorouracil (5-FU), leucovorin, irinotecan, and oxaliplatin) or gemcitabine plus albumin-bound nab-paclitaxel. One of the main obstacles to the action of chemotherapeutic drugs is the microenvironment of fibro-solid stromal tumors, which include pancreatic cancer. In order to potentiate the action of chemotherapy and combat the tumor microenvironment, at the present stage, drugs are being considered for influencing the programmed death 1 (PD-1) gene and cytotoxic T-lymphocyte antigen 4 (CTLA-4). Approximately 1015% of malignant neoplasms of the pancreas are believed to be associated with hereditary mutations, while all neoplasms have somatic mutations in different combinations of driver genes. One of the most common mutations are BRCA1/BRCA2 gene mutations. Poly-ADP-ribose polymerase inhibitors, like cisplatin, have shown promise as a treatment for tumors with BRCA mutations. Another subtype of pancreatic cancer is characterized by microsatellite instability. Unlike the above mutations and phenotypes, which affect only a small proportion of patients with pancreatic cancer, mutations in KRAS (Kirsten homologous rat sarcoma viral oncogene) are found in 9095% of cases of pancreatic malignancy and may be a significant factor in pancreatic tumorigenesis. Another frequently mutating gene for a number of malignancies is ARID1A, which encodes a tumor suppressor protein, a subunit of the SWI/SNF chromatin remodeling complex. The future of conservative therapy for pancreatic cancer is a complex treatment that includes both chemotherapy and targeted therapy and immunotherapy, the implementation of which is impossible without a deeper study of genetic mutations, molecular mechanisms of invasion and development of pancreatic malignant neoplasms, as well as extensive testing for genetic mutations in the clinical practice of specialized institutions.

AIM: To evaluate the prognostic value of quantitative CD8+ T-lymphocyte counts in the peritumorotic zone of renal cell cancer. MATERIAL AND METHODS: The material of 74 patients after operative treatment for renal cell carcinoma with complete 5-year follow-up was retrospectively analyzed. Of the 74 patients, 56 were alive by the 5-year follow-up, and 18 had died of cancer. After immunohistochemical staining, CD8+ T-lymphocyte distribution density in the peritumorotic zone of carcinomas was determined in 3 representative fields of view at 400 magnification and correlated with the clinicopathological characteristics of neoplasms and overall 5-year patient survival rate. RESULTS: The high level of CD8+ T-lymphocyte infiltration in the peritumoral zone of carcinomas was seen in stages IIIIV of the disease (p=0.0000001), in tumors 7 cm (p=0.0000001), in Fuhrman grade IIIIV anaplasia (p=0.001), in metastases (p=0.0000001) and in the shorter total survival rate of patients (p=0.0003). High CD8+ T-lymphocyte count was also observed in men (p=0.001) and in cases of unclassified cancer. CONCLUSION: In the light of the need to search for new prognostic criteria in renal cancer, we conclude that a high level of peritumorous zone infiltration by CD8+ T-lymphocytes is an unfavorable prognostic factor. Assessment of peritumorous zone infiltration by CD8+ T-lymphocytes may serve as an additional prognostic factor in renal cell carcinoma.

BACKGROUND: The incidence of gastric cancer is still high and holds the leading place in the structure of oncological pathology in the world. Prognostic aspects in the treatment of generalized forms of gastric cancer are currently under revision. AIM: To study functional status of vascular endothelium in patients with gastric cancer in perioperative period and evaluate its influence on the outcomes of surgical treatment. MATERIALS AND METHODS: A prospective, randomized study was conducted from 2009 to 2019. Two populations were studied: healthy individuals (control group, n=40); patients diagnosed with gastric cancer (general group, n=122). Patients with gastric cancer underwent gastrectomy with lymphodissection. The functional state of the vascular endothelium was studied: the volume of circulating endotheliocytes (CCE); the level of von Willebrand factor (VF) and the degree of endothelium-dependent vasodilation (EDV). To study their prognostic significance we calculated a conventional cut-off point. RESULTS: The general group patients were divided into 2 subgroups: the main group the laparoscopic access (n=54) and the comparison group the laparotomy access (n=68). Endothelial dysfunction (EDF) correction with Glutargin 1.0 g per day in combination with Enalapril 2.5 mg per day was additionally used in the main subgroup. In the main group, the values of CCE and VF were lower (8.33.0 and 84.621.3, respectively) and the values of EDV were higher (13.73.9) in contrast to the comparison group (p 0.0001). Use of the EDF correction method in the main group resulted in a 4.4-fold and 5.1-fold decrease in CCE and VF concentrations, respectively, and a 4.3-fold normalization of EDV (p 0.0001). Increase of CCE concentration more than 7.0 per 103 platelets; PV more than 120 g/ml, as well as decrease of EDV below 14% in the study stages increased the risk of postoperative complications by 2.9; 1.7 and 1.8 times, respectively (p 0.0001). The incidence of surgical complications was 19.7% and non-surgical complications 31.1%. Hospital mortality was 3.3% and out-of-hospital mortality with up to three years follow-up was 13.1%. The number of purulent-septic complications in the main group was 2.9 times lower, and the rate of thrombotic complications was 4 times lower than in the comparison group (p 0.05). CONCLUSION: Combined use of laparoscopic technique by EDF medication correction reduces manifestations of stress reaction and decreases the potential risk of complications development in the postoperative period. Elevation of CCE, as well as EDV decrease beyond the relevant excision points in patients with gastric cancer in the perioperative period are prognostic predictors of the risk of purulent-septic and thrombotic complications development.

AIM: To quantitatively analyze the macrophage distribution density (MF) of the peritumoral zone (PZ) of clear cell renal cell carcinoma (CCRCC) and determine the relationship of MF distribution density in PZ with clinical and morphological prognostic variables and postoperative survival of patients. MATERIALS AND METHODS: The study included 52 patients with CCRCC, who had an average age of 56.70.8 years. Using monoclonal mouse antibodies for CD68 (clone PG-M1, DAKO), using an immunohistochemical method, macrophages were identified in the paraffin sections. The average amount of MF in the PZ was determined in three fields of view at 400 magnification. For the PZ, the tissue was taken directly adjacent to the tumor to the conditionally unchanged kidney tissue. RESULTS: The correlation analysis revealed that the density of the MF distribution in the CCRCC was interrelated with the stage of the disease (r=0.66; p=0.0001), size of the tumor node (r=0.52; p=0.0001), degree of anaplasia according to Fuhrman (r=0.80; p=0.0001), presence of metastases (r=0.62; 0.0001), and postoperative survival of patients (r=0.53; p=0.0001). However, there were no correlations with the gender (r=0.007; p=0.62) and age of the patients (r=0.03; p=0.83). With the number of MF in the PP 8.8, the cumulative proportion of survivors by the five-year term was 0.70 (70%). Moreover, when the number of MF in the PZ was 8.8, none of the patients lived to the five-year term, the cumulative proportion of survivors was 0 (log-rank-test, p=0.000001). CONCLUSION: The density of MF distribution in PZ is interrelated with significant clinical and morphological parameters of CCRCC and is a predictor of the prognosis of five-year postoperative survival of patients. Thus, quantitative estimation of the number of MF in the PZ can be used in predicting the course of CCRCC along with the traditional classical forecasting factors.

Алматинская региональная многопрофильная клиника, Алматы, Казахстан Цеймах А.Е. 1 , Олжаев С.Т. 2 , Лазарев А.Ф. 1 , Шойхет Я

Резюме Обоснование: анализируется комплексное лечение больных со злокачественными новообразованиями поджелудочной железы в двух нозологически сопоставимых группах больных

The purpose of the study was to analyze the cancer incidence in the males born from 1932 to 1949 and living in rural settlements of the municipal districts of the altai Krai affected by the traces from semipalatinsk first nuclear test on august 29, 1949. Material and methods. an epidemiological retrospective cohort study was based on the analysis of anonymized data on newly diagnosed and morphologically verified cases of cancer in a male cohort for the period from 2007 to 2016. the study included a cohort fixed by the date of the first nuclear test with a total of 6383 males. in total, 633 cases were identified in the cohort with newly diagnosed and morphologically verified cancer. at the beginning of the study, all males were alive and had no previous diagnosis of cancer. For a comparative analysis of the cancer incidence, the main (exposed) cohort comprised 2 291 men, and the control cohort included 4 092 men, who lived in rural settlements of municipal districts of the region and were not tracked during the first nuclear test conducted at the semipalatinsk test site. the person-time incidence rate (ptR), standard error (mptR) and confidence intervals (95 % ci) were calculated. the incidence and the relative risk of developing cancer were assessed. statistical analysis was carried out using microsoft office 2016. Results. the number of person-years in the main cohort was 1 6731 person-years, and in the control was 30 747. The incidence rate of person-time (ptR) in the main cohort was 2 032.22 × 105 person-years, with mptR equal to 110.21 and confidence intervals (95 % ci) – (1 811.80–2 252.64). in the control cohort, the corresponding values were: ptR – 952.94 × 105 person-years with mptR – 55,67 and 95 % ci (841.60–1 064.28). the most common cancer localizations in men of the main cohort were: digestive organs (c15-c26), respiratory and chest organs (c30-c39), skin (c43-c44), male genitals (c60-c63). in the control group, the most common localizations were respiratory and chest organs (c30-c39), digestive organs (c15-c26), male genital organs (c60-c63) and skin (c43-c44). Conclusion. an increased relative risk of developing malignant neoplasms in men born and living in the altai territory during the first nuclear test conducted at the semipalatinsk test site was revealed (RR=2.133; 95 % ci 1.824–2.493) with standard error of relative risk (s) equal to 0.0797. there were differences in cancer localization between the main and the control cohorts.

The paper analyses the tactics of managing patients with malignant neoplasms in the pancreatobiliary area complicated by obstructive jaundice in two nosologically and clinically comparable groups of patients. The aim of the research. To evaluate the effectiveness of complex palliative treatment with the use of photodynamic therapy in patients with malignant neoplasms in the pancreatobiliary area complicated by obstructive jaundice. Material and methods. In the main group, which consisted of 41 patients, palliative complex treatment was carried out using local and systemic photodynamic therapy of neoplasms in the pancreatobiliary area complicated by obstructive jaundice, purulent cholangitis. In the comparison group, which consisted of 165 patients, palliative complex treatment of complications was carried out without the use of photodynamic therapy. Complex palliative treatment in both groups included the following surgical interventions: percutaneous transhepatic mono- and bilobar drainage of the bile ducts, stenting of the bile ducts under ultrasound and X-ray control as well as bypass biliodigestive anastomoses. Symptomatic conservative treatment included infusion, detoxification, analgesic, hepatoprotective and antibacterial therapy. Results. Against the background of local and systemic photodynamic therapy in the main group, a decrease in the largest size of the neoplasm in patients with malignant neoplasms of the pancreas from 42.5 mm to 38 mm within a week after treatment was established according to the data of multispiral computed tomography of abdominal organs with intravenous bolus contrast. The largest neoplasm size decreased from 40.5 mm to 31 mm within a month after treatment according to the ultrasound examination of the abdominal cavities. Restoration of bile excretion into the intestine in 100% of patients with malignant neoplasms of the bile ducts and the head of the pancreas was registered, as well as an increase in life expectancy of patients by more than 1 year, a decrease in the risk of complications due to a slowdown in the growth of neoplasms associated with a decrease in the concentration of the cytokine TNF-α. Conclusion. Complex treatment with the use of photodynamic therapy of malignant neoplasms of the pancreatobiliary area allows reducing the largest size and rate of neoplasm invasion and to increase the survival rate of patients.

The aim of the study was to develop, implement and evaluate a method for predicting the aggressiveness of primary melanoma after surgical removal.It was established that the method for predicting tumor aggressiveness allows to determine the degree of aggressiveness, life expectancy, and to identify patients with poor prognosis in order to individualize treatment. The survival rate of patients was found to depend on the degree of aggressiveness of the tumor. A group of patients with stages 0-IIa (16,4 %) and tumor aggressiveness Grade II was identified as having a potentially high risk of progression, which can help individualize treatment for this category of patients. Using the method for predicting disease progression may potentially expand the scope of indications for further personalized treatment.

Олжаев С.Т. 1 , Лазарев А.Ф. 2,3, Шойхет Я

This work presents an analysis of x-ray, clinical, laboratory methods for the study of patients with pneumonia and central lung cancer, in order to study the main causes of diagnostic errors. It was established that the causes of diagnostic errors of patients with pneumonia and central lung cancer were the insufficient severity of the leading clinical signs of the course of the disease, the lack of an integrated approach in determining the volume and methods of examination, the inadequacy of accounting for the main radiological signs (localization, density, structure of formation, cavity of decay); lack of an algorithm in the stages of the diagnostic process and the late availability of specialized medical care.

There were analyzed the survival and mortality of 227 patients with malignant neoplasms of pancreatoduodenobiliary zone complicated by obstruction of bile duct syndrome for the period from 01.01.2014 to 01.05.2018 divided into 4 groups. The first group consisted of 20 patients who underwent radical operative treatment of malignant neoplasms of the pancreatoduodenobiliary zone without the use of minimally invasive biliary decompression as preoperative preparation; the second group included 34 patients who had minimally invasive biliary decompressionas preoperative preparationfor radical surgery; the third group included 121 patients who had palliative operative treatment of malignant neoplasms of the pancreatoduodenobiliary zone without the use of minimally invasive biliary decompression; the fourth group consisted of 54 patients who underwent palliative operations with the use of mini-invasive biliary decompression. After paired comparative analysis of postoperative survival and lethality, it was revealed a statistically significant increase in the average life expectancy and a decrease in postoperative mortality in patients who underwent radical surgery with the use of minimally invasive decompression technologies for bile ducts compared with all the other groups; a statistically significant increase in life expectancy and a reduction in postoperative mortality in patients who underwent palliative surgery with the use of mini-invasive biliary decompression compared to the group of patients who underwent open palliative surgeries. In patients who underwent radical surgical treatment without prior application of minimally invasive procedures for decompression of the biliary tree, there was no statistically significant increase in mean life expectancy and a decrease in postoperative mortality in comparison with the group of patients who underwent palliative operations with the use of mini-invasive bile decompressiontechnologies.

The paper presents the results of a complex palliative treatment using photodynamic therapy of patients with pancreatobiliary malignancies complicated by obstructive jaundice. In the main group, which included 22 patients, palliative comprehensive treatment was performed using local and systemic photodynamic therapy of pancreatobiliary neoplasms complicated by obstructive jaundice. In the comparison group, consisting of 165 patients, palliative complex treatment of complications was performed without the use of photodynamic therapy. The used photosensitizers were chlorin-based fotoditazin (21 patients) and radachlorin (1 patient). The first step was a systemic PDT. In the course of infusion through a peripheral access into the cubital vein, blood was irradiated externally by laser with monochromatic light with a wavelength of 662–665 nm and a light dose of 1200–1400 J/cm2 . As the second stage of the treatment, 3–5 hours after the end of the infusion, an intraductal PDT was carried out by irradiation with monochromatic light with a wavelength of 662 nm and a light dose of 220 J/cm2 . After the use of local and systemic photodynamic therapy, a statistically significant decrease in the size of the tumor focus in patients with pancreatic malignant neoplasms was established within a week after treatment in the main group according to the ultrasound examination of the abdominal cavity. Restoration of bile excretion into the intestine was noted in 100% of patients with malignant neoplasms of the bile duct and head of the pancreas. We also note an increase in median survival of patients in the main group to 5.9 months compared with 4.7 months in the comparison group.

This paper presents an algorithm for reducing the risk of errors in the diagnosis of diseases of the chest cavity within 14 days after treatment of patients. The developed algorithm, based on multivariate analysis of the integrated assessment of clinical and radiological descriptors (signs) of diseases, determination of the probability coefficient of errors, software for comparing individual integral data with established typical characteristics for differentiable pathological processes, improved diagnostics, aimed the doctor at an adequate examination, and reduced the risk of error by 20.1%.

Despite the development in oncological treatment, one of the unresolved problems is the treatment of stomach cancer with metastases to the liver. The standard treatment of colorectal cancer with metastases to the liver is surgery; however, the role of liver resection in the treatment of patients with non-colonial metastases in the liver remains uncertain. Herein, we present the treatment regimen of antral gastric cancer T3N1M1 with liver metastasis, which included extended combined subtotal–total gastric resection by Billroth II and lymphadenectomy on R-2 (by M.S. Segal), with resection of the left lobe of the liver (S2 and S3) and two incomplete courses of chemotherapy. This surgical intervention provided cure for a period of more than 31 years.