Objective of the study is to investigate the prevalence of PIK3CA mutations in breast cancer and gynecologic malignant neoplasms and to analyze the possibility of therapeutic effect on PIK3C –mutated gynecologic malignant neoplasms.
Materials and Methods. The evaluation of the prevalence of PIK3CA mutations was carried out using the data of Bi oPortal.
Results. PIK3CA mutations are common among gynecologic cancers and breast cancer: the incidence reaches 29,3 % among oncologic pathologies of this group. The prevalence of PIK3CA mutations in this group overtakes other nosologies. The presence of PIK3CA mutations is an indication for the prescription of PIK3CA- and AKT – inhibitors in hormone-de pendent breast cancer. In gynecologic tumors various clinical trials are carried out and preliminary results, indicating the effectiveness of the use of PIK3CA inhibitor alpelisib in endometrial, cervical and other reproductive cancers, have been obtained.
Conclusion. PIK3CA mutations are a promising target in gynecologic malignant neoplasms. Randomized trials may chan ge the current practice of treating gynecologic cancer patients with PIK3CA-mutated tumors.
Keywords: PIK3CA, malignant neoplasms of female reproductive system
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The article presents a comparative analysis of one-stage and two-stage reconstruction of the mammary gland after subcutaneous/skin-sparing mastectomy with an implant.
Breast cancer is steadily growing, which makes it a social problem. In Russia, as of 2021, the prevalence of breast cancer in women was 21.1 % [1].
Conducting one-stage reconstructive plastic surgeries allows achieving the best aesthetic, functional and psychoemotional results. Of course, the use of radiation therapy can complicate the postoperative course, but our own experience of one-stage reconstructions in combination with radiation therapy showed good aesthetic results with a low percentage of complications, which formed the basis of this study.
Objective of the study: to conduct a comparative characteristic of one-stage and two-stage reconstructions with endopros theses in breast cancer after subcutaneous/skin-sparing mastectomy in combination with radiation therapy in combination.
Materials and methods: 120 patients diagnosed with breast cancer were prospectively studied. The patients were divided into 2 groups: I (study) group (54 women), who underwent one stage - subcutaneous/skin-sparing mastectomy with breast reconstruction using an implant. II (control) group (66 patients) who underwent subcutaneous/skin-sparing mastectomy with breast reconstruction using an expander, followed by replacement of the expander with an implant. The results were assessed after radiation therapy.
Results and conclusions: The study did not show an increase in the incidence of postoperative complications and limitations in the use of concomitant treatment methods in the complex therapy of women with breast cancer after subcutaneous/skinsparing mastectomy with simultaneous breast reconstruction using an implant in combination with radiation therapy.
Keywords: breast cancer, subcutaneous/skin-sparing mastectomy, complications, radiation therapy
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Introduction. Breast cancer (BC) is the most common malignant tumor worldwide and it ranks first in the incidence among malignant neoplasms in women. Patients with luminal subtypes of breast cancer require hormone therapy. Tamoxifen and aromatase inhibitors are used as standard endocrine therapy. Fulvestrant is a representative of a new class of steroid antiestrogens that inhibit the proliferative effects of estrogens on sensitive tissues. The unique mechanism of action permits to use fulvestrant both alone and in combination with other antitumor agents. Currently, the drug is prescribed at a dose of 500 mg on day 1, 14, 28 and montly thereafter.
Objective of the study. The paper introduces a clinical observation that proves the high efficacy of fulvestrant in the treatment of patients with metastatic breast cancer with a favourable toxicity profile.
Conclusion. The clinical case demonstrates the effi cacy of the use of fulvestrant in cutaneous metastases of breast cancer, as well the change of receptor status in the metastatic tumor compared to the primary tumor.
Keywords: breast cancer, luminal subtype, cutaneous metastases, endocrine therapy, fulvestrant
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Objective of the study is to consider ESGO/ESHRE/ESGE 2023 principal guidelines on organ-preserving treatment of patients of reproductive age who have endometrial cancer and wish to preserve fertility, and to conduct a systematic analysis of the data available in current literature addressing these issues as well.
Materials and Methods. The review comprises the data of foreign and Russian academic articles found in PubMed on the subject and also clinical recommendations, elaborated by multidisciplinary group of experts of European Societies of Gynaecological Oncology (ESGO), of Human Reproduction and Embryology (ESHRE), of Gynaecological Endoscopy (ESGE) in 2023.
Results. The multidisciplinary team of experts developed guidelines, consisting of 48 provisions presented in four sections: patient selection, clinical and pathological features of the tumor, treatment and special issues.
Conclusion. The study of oncofertility should be continued. Specifi cally, it is necessary to conduct large-scale prospective research to confi rm the clinical signifi cance of molecular subtypes of endometrial cancer for patients of reproductive age who wish to preserve fertility.
Keywords: endometrial cancer, organ-preservation treatment, hormone therapy alone, recommendations
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Objective of the study is to search for the new ways to enhance diagnostics of serous endometrial cancer for improving results of the treatment.
Materials and Methods. Imaging methods of diagnostic radiology such as pelvis CT/MRI with contrast, that allow to determine a degree of tumor invasion, on the basis of which in conjunction with histological type of the tumor it is possible to differentiate tumor into prognostic risk groups, are a standard of preoperative scanning of patients with endometrial cancer. Rare endometrial tumors, such as serous cancer, require individualized treatment due to an extremely unfavorable prognosis. The value of the metabolic tumor volume and glycolytic index measured at the preoperative stage together with molecular genetic intricacies can serve an option in determining the treatment strategy for rare malignant tumors of the uterus. The search for the possibilities of PET-CT to solve this problem on the basis of a clinical case with a discrepancy in MRI and PET-CT data at the preoperative stage, was carried out.
Conclusion. Diagnosis and treatment of serous endometrial cancer require a comprehensive approach which encompasses a wide range of diagnostic methods, including, possibly, PET-CT. The combination of clinical and radiological methods with radionuclide diagnostics can allow to develop optimal treatment strategies, thus improving patient outcomes and reducing risk of recurrence.
Keywords: gynecologic oncology, serous endometrial carcinoma, diagnosis, staging, MRI, PET-CT
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Duplication of the uterus is one of the most common anomaly among congenital malformations of the female reproductive system. Endometrial cancer in such women is extremely rare, according to the world literature, only a few dozen cases have been reported over the past 30 years.
The article presents a clinical case of a 63-year-old patient with complete duplication of the uterus, Herlyn-Werner-Wunderlich syndrome and multiple primary synchronous cancer (endometriod adenocarci noma of the right uterine body with the presence of clear cell carcinoma foci, endometrioid adenocarcinoma of the left uterine body), as well as with leiomyoma of the cervix of the left uterus and steroid cell tumor of the right ovary. The patient underwent laparoscopic hysterectomies with bilateral salpingo-oophorectomy of the both uteri, she didn’t receive adjuvant therapy due to severe concomitant pathology. At the time of publication of the article according to the results of follow-up examination the patient has no symptoms of relapse of the disease 2 years after the dynamic follow up.
The authors of the article emphasize that clinicians should be aware of the possibility of tumor growth in the presence of anomalies of the development of the uterus. Medical imaging examinations in this case do not always allow to diagnose malignant process and that identifi es the importance of obtaining morphological material from both uteri.
Keywords: bicornuate uterus, endometrial cancer, Herlyn–Werner-Wunderlich syndrome
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Introduction. Based on the statistical data, a signifi cant number of ovarian cancer patients have recurrence of the disease after cytoreductive surgery. According to some authors, the reason for the high risk of recurrence is the insufficient informative value of the method of the study of histological specimens of regional lymph nodes after staining with hematoxylin and eosin and immunohistochemistry. At present, there is no clear understanding of how the presence of micrometastases in sentinel regional lymph nodes of the pelvic and abdominal cavities correlates with clinical, morphological and other characteristics of a patient, and their prognostic value.
Objective of the present study was to identify the intricacies of clinical morphological and clinical pathological parameters, the levels of CA125 tumor marker in patients with ovarian cancer and their correlation with the level of cytokeratin positive (+) cells in visually unchanged lymph nodes obtained during lymphadenectomy.
Materials and Methods. Material of the removed lymph node specimens of 21 patients with ovarian cancer was examined. The concentration of cells expressing cytokeratin was determined using flow cytometry. Results. The correlation analysis showed a close relationship between a high level of cytokeratin-positive (+) cells in a lymph node and the cancer spread (R = 0.5323, p < 0.05). The inter-group comparison testifies that a higher level of cytokeratin positive (+) cells in the lymph nodes was observed in patients with index N1 in comparison with a group N0: 7 (4–8) % and 1 (0–1,9) %, respectively. The cluster analysis allowed us to conclude that the presence of comorbidities such as diabetes mellitus, heterogeneous cancer and lipid metabolism disorders may be risk factors for tumor dissemination.
Conclusion. The results of the study indicate the high informative value of the level of cytokeratin-positive (+) cells in the distant lymph nodes, resected in lymph node dissection in patients with ovarian cancer, and can be used for the assessment of cancer spread and for the correction of the strategy of antitumor therapy. Keywords: ovarian cancer, cytokeratin, CA125, micrometastases, lymph node dissection, antitumor therapy, cancer spread
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Background. Cervical cancer (CC) continues to be a major health problem, ranking as the fourth most common cancer among women worldwide and the third leading cause of death. The risk of CC increases with age, but the majority of cases occur during the reproductive period. Experts predict an increase in incidence and mortality from CC in the future, especially among women over 65 years of age, and in areas with limited access to medical care. This emphasizes the need to improve methods for personalized diagnosis and prediction of the risk for developing cervical cancer.
Artificial intelligence, and in particular machine learning (ML), offers a promising approach for developing predictive models based on routine examination methods of laboratory blood parameters, which can help in the early diagnosis of cervical cancer.
Aim. Development of a medical decision support system – MDSS, to identify patients at high risk of developing cervical cancer.
Methods. A single-center cohort retrospective study of women over 18 years of age was conducted on data collected in 2000-2024 at the Moscow Research Institute named after P. A. Herzen. The study included 452 women aged 42.0 [median 33.75; 50.0] years. The following machine learning algorithms were used to build a model for predicting the presence of CC: MLR – Lasso, MLR – Ridge, Extra Tree (ET), k-Nearest Neighbors (kNN), Support Vector Machine (SVM), Naive Bayes (NB), Random Forest (RF), Gradient Boosting (XGB), Catboost (CB) and LightGBM (LGMB).
Results. The best predictive results were obtained when building a model based on the XGB MO algorithm, which on the test sample showed the following results: ROC-AUC = 98.2 % [95 % CI 96.0; 99.7], accuracy = 94.5 % [95 % CI 91.0; 97.2], sensitivity = 95.0 % [95 % CI 91.2; 98.3], specifi city = 91.7 % [95 % CI 81.0; 100.0]. The major predictive factors were platelet aggregation with ADP, ESR, D-dimer, transferrin and age.
Conclusions. This study introduces a new method for predicting the risk of CC based on routine laboratory hematological parameters. The constructed model can be used in a medical decision support system (MDSS) for the timely identifi cation of women with high risk of cervical cancer
Keywords: cervical cancer, diagnosis, machine learning, routine hematological parameters, prognostic model
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