No abstract

Ëüâ³âñüêèé îíêîëî´³÷íèé ðå´³îíàëüíèé ë³êóâàëüíî-ä³à´íîñòè÷íèé öåíòð (´åíåðàëüíèé äèðåêòîð-Êîâàëü÷óê ².Â.) 2 Ëüâ³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Äàíèëà Ãàëèöüêîãî Êàôåäðà îíêîëî´³¿ òà ðàä³îëî´³¿ ÔÏÄÎ (çàâ.-ïðîô. Ôåöè÷ Ò.Ã.) Ðåôåðàò Ìåòà. Ðîçãëÿíóòè ñó÷àñíèé ñòàí ïðîáëåìè ë³êóâàííÿ õâîðèõ ç àíàïëàñòè÷íèì ðàêîì ùèòîïîä³áíî¿ çàëîçè. Ìàòåð³àë ³ ìåòîäè. Ïðîàíàë³çîâàíî 21 âèïàäîê àíà-ïëàñòè÷íîãî ðàêó ùèòîïîä³áíî¿ çàëîçè ó õâîðèõ, ùî ïåðåáóâàëè ó Ëüâ³âñüê³é îáëàñí³é êë³í³÷í³é ë³êàðí³ (n=9) òà Ëüâ³âñüêîìó îíêîëî´³÷íîìó ë³êóâàëüíî-ä³à´-íîñòè÷íîìó öåíòð³ (n=12) ç 2004 ïî 2017 ðîêè. Âè-ñâ³òëåíî ï³äõîäè äî ë³êóâàííÿ àíàïëàñòè÷íîãî ðàêó ÙÇ íà îñíîâ³ ðåêîìåíäàö³é NCCN çà 2018ð. Ðåçóëüòàòè é îáãîâîðåííÿ. Àíàíàïëàñòè÷íèé ðàê ùèòîïîä³áíî¿ çàëîçè ÷àñò³øå çóñòð³÷àâñÿ ó ae³íîê-15 (71,4%) í³ae ó ìóae÷èí-6 (28,6%). ijà´íîç àíà-ïëàñòè÷íîãî ðàêó ùèòîïîä³áíî¿ çàëîçè âñòàíîâëåíî íà îñíîâ³ òðåïàí-á³îïñ³¿ ó 12 (57,1%) ïàö³ºíò³â, à â 9 (42,9%) õâîðèõ âåðèô³êàö³þ îòðèìàíî ï³ñëÿ õ³ðóð´³÷íîãî ë³êóâàííÿ. Ñåðåäí³é â³ê ïàö³ºíò³â íà ìîìåíò âñòàíîâëåííÿ ä³à´íîçó ñêëàâ 70,9±7,5 ðîê³â. Òèðåî¿-äåêòîì³ÿ áóëà ïðîâåäåíà ó 5 (23,8%) ïàö³ºíò³â. Ïà-ë³àòèâíà äèñòàíö³éíà ïðîìåíåâà òåðàï³ÿ çàñòîñîâóâàëàñÿ ó 3 (14,3%) õâîðèõ, ùå 4 ïàö³ºíòàì (19,0%) ïðîâåäåíî êîìá³íîâàíå ë³êóâàííÿ-òèðåî¿äåêòîì³ÿ òà ï³ñëÿîïåðàö³éíèé êóðñ äèñòàíö³éíî¿ ïðîìåíåâî¿ òå-ðàﳿ.  ³íøèõ 9 (42,9%) ïðîâîäèëàñÿ ñèìïòîìàòè÷íà òåðàï³ÿ, ç ÿêèõ ó 2 âèïàäêàõ íàêëàäåíî òðàõåîñòîìó â çâ'ÿçêó ç ñòèñíåííÿì ïóõëèíîþ âåðõí³õ äèõàëüíèõ øëÿõ³â. Çàãàëîì íå âñòàíîâëåíî âïëèâó õàðàêòåðó ïðîâåäåíîãî ë³êóâàííÿ íà çàãàëüíó òðèâàë³ñòü aeèòòÿ ïàö³ºíò³â (ð>0,05).  íàøîìó äîñë³äaeåíí³ ñåðåäíÿ òðèâàë³ñòü aeèòòÿ ñêëàëà 4,2±3,9 ì³ñ, à îäíîð³÷íà âèaeèâàí³ñòü ñòàíîâèëà 9,5 % (n=2). Âèñíîâîê. Ðåçóëüòàòè ë³êóâàííÿ õâîðèõ ç àíàïëàñ-òè÷íèì ðàêîì ùèòîïîä³áíî¿ çàëîçè çàëèøàþòüñÿ íå-çàäîâ³ëüíèìè-ìåä³àíà âèaeèâàíîñò³ ñòàíîâèòü ëèøå 3 ì³ñÿö³, ö³ äàí³ ñï³âïàäàþòü ç ïîêàçíèêàìè ñâ³òîâî¿ ë³òåðàòóðè. Ôàêòîðè, ÿê³ ïðîâîêóþòü öå çàõâîðþâàííÿ íå âèÿâëåí³, à ìåõàí³çìè, ùî ïðèçâîäÿòü äî òðàíñôîðìàö³¿ äèôåðåíö³éîâàíîãî ðàêó â àíàïëàñ-òè÷íèé íå âèçíà÷åí³. Âñ³ ö³ ôàêòè ïîòðåáóþòü ïîäàëüøîãî âèâ÷åííÿ òà ïðîâåäåííÿ â³äïîâ³äíèõ êë³í³÷íèõ äîñë³äaeåíü.

Aim. The research aims at analyzing the main changes in classification of medullary thyroid cancer and outlining the principles of staging according to modern studies. Material and Methods. Specific scientific articles for the period of 2009-2019 referring to the principles and rules of the TNM classification process, as well as recommendations of the TNM committees of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (IUAC) were selected for the analysis. The basic principles of classification and staging for 8th edition of TNM, as well as changes that have taken place in comparison with 7th edition of TNM It were defined. Results and Discussion. Medullary thyroid cancer accounts for 1-2 percent in the structure of cancers of the thyroid gland, however it is associated with a high mortality rate compared to highly differentiated forms of thyroid cancer. The main radical method of treatment is an adequate volume of surgical intervention, which is determined on the basis of proper staging, the use of visualization methods and the practical experience of doctors. The 7th edition of the TNM was introduced to the scientific society in 2009. It has been 10 years since a new version of the 8th edition based on the new data in evidence-based medicine appeared. It included numerous changes and additions, namely for medullary thyroid cancer. The following research suggests a detailed review and analysis of the basic principles of the staging and classification of medullary thyroid cancer for AJCC TNM-8 in order to improve the diagnosis and treatment of patients with the mentioned above disease. Conclusions. The use of modern principles of classification and staging of medullary thyroid cancer in clinical practice promotes choosing the adequate treatment method and estimating the patient's prognosis. In addition, further improvement of the staging system by TNM-committee and cancer registers depends on the presence of detailed information on additional "parameters for collection and further evaluation" in medical documentation.

Introduction. Medullary thyroid cancer (MTC) belongs to a class of rare neuroendocrine aggressive tumors and arises from parafollicular cells (C-cells). An important modern problem is the development of ways to predict the recurrence of this disease. The aim of the study is to determine the role of immunohistochemical tumor markers of medullary thyroid cancer in predicting recurrence or death. Materials and methods. The analysis of the prospective study included 22 patients with MTC, 5 of whom have developed a recurrence and 4 have died at the end of the 10-year (120 months) follow-up period. Immunohistochemical examinations were performed using monoclonal antibodies of tumor markers calcitonin, chromogranin A, vimentin and Ki-67. Results. The discrepancy between the data of histological and immunohistochemical examinations in MTC is 12.0%, which indicates the hyperdiagnosis of this nosology and argues the importance of performing immunohistochemical examinations to verify the diagnosis. Patients who had a recurrence of MTC had significantly (p <0.05) lower levels of calcitonin expression (5.00 [5.00; 5.00] points) compared with patients who did not relapse, where this figure was 6.00 [6.00; 7.00] points. In patients with MTC, an increase in calcitonin expression was significantly associated with an increase in chromogranin A expression (r = + 0.49, p = 0.02); a similar relationship was found for the proportions of immunopositive cells of these tumor markers: r = + 0.68, p = 0.001. At the same time, it was found that the increase in the level of calcitonin expression was apparently combined with the decrease in the level of Ki-67 expression (r = -0.52, p = 0.02). It was also found that the increase in the level of vimentin expression is combined with an increase in the expression (r = + 0.64, p = 0.001) and the proportion of immunopositive cells of chromogranin A (r = + 0.45, p = 0.038). Conclusions. Low levels of calcitonin expression are prognostically unfavorable markers for the recurrence of MTC. Specific tumor markers are important in the treatment process and for the dynamic monitoring of patients with MTC.