REVIEWS AND ANALYSIS
Introduction: In the Russian Federation and worldwide lung cancer (RL) is the leading malignancy. In order to improve the availability of modern diagnostic and treatment algorithms for a huge number of lung cancer patients, highly specialized audits of oncological care have been organized in many countries.
Purpose: Reviewing the basic principles for organizing specialized national lung cancer care audits based on the example from the Netherlands.
Materials and methods: The search for relevant articles was carried out in PubMed, as well as using the Google search engine. The search strings included keywords such as: «audit», «lung cancer», «Dutch», «the Netherlands» and many others.
Results: Nowadays, the specialized Dutch audit for lung cancer relies on the sub‑registers devoted to the following topics: 1) medical practice of oncologists‑pulmonologists; 2) the activities of surgeons; 3) the work of radiation oncologists. Wide coverage of different treatment areas and digital integration provide a comprehensive picture of cancer care throughout all aspects of routing patients with RL in the Netherlands Selective sub‑audits are of great scientific and practical importance. Feedback systems, the latest digital technologies and a sufficient level of transparency ensure effective quality control of diagnostics and treatment of patients with lung cancer in the studied countries.
Conclusion: Beneficial way to improve quality assurance is based on the use of complex, complementary principles of cognition, including holism, reductionism, induction methods, combinatorial analysis, etc. etc. Regardless of the implemented approaches to quality control, the cancer network should always remain focused on each single patient. The private interests of a particular patient, survival rate, quality of life with have determine the prioritized vector of innovative development of audits of oncological practice.
OWN RESEARCH
Introduction: The G8 Score is an important tool for geriatric assessment in current oncology practice. The G8 Score is applied as a prescreening method for selection of patients who need comprehensive geriatric assessment (CGA); however, this questionnaire has not been validated in Russia.
Study goal: To evaluate the reliability and predictive role of the Russian version of the G8 Score in evaluating the risk of complications of systemic antitumor therapy in elderly patients.
Materials and methods: The authors conducted a prospective non‑randomized study in elderly patients (≥ 65 years old) who received systemic antitumor therapy. All patients were screened using the Russian version of the G8 Score. Cases of adverse events during treatment (toxicity) and treatment discontinuation were analyzed. The area under the ROC curve (AUC) was used to evaluate the specificity and sensitivity of the Russian version of the G8 Score as a predictor of complications and complication‑associated events (treatment discontinuation) in cancer patients in Russia. The reliability of the Russian version of the G8 Score was also assessed using Cronbach»s alpha coefficient of internal consistency.
Results: The data of 133 cancer patients (57,1 % and 42,9 % of whom were female and male, respectively) with a mean age of 72,1 y. o. were analyzed using the Russian version of the G8 Score. The study demonstrated a satisfactory predictive ability of the tool in terms of prognosis of general toxicity, including hematologic and non‑hematologic toxicity, with the area under the curve (AUC) being 0,621 [95 % CI: 0,524–0,717]. The cut‑off value of the G8 Score was 13,5; sensitivity (Se) = 71 %, specificity (Sp) = 54 %. The characteristics of the positive and negative predictive values of the G8 Score were similar. The data on the predictive role of the Russian version of the G8 Score in terms of prognosis of toxicity‑related treatment discontinuation were not statistically significant (p > 0,05). The internal consistency of the Russian version of the G8 Score was demonstrated to be acceptable, with Cronbach»s alpha coefficient of 0,709 and split‑half values of α1 = 0,558 and α2 = 0,432. The results of the study indicated a satisfactory reliability of the Russian version of the G8 Score.
Conclusion: The Russian version of the G8 Score is a reliable tool that can be used as a possible predictor of toxicity of antitumor drug therapy and a useful tool for the selection of patients for comprehensive geriatric assessment.
Background: Recurrent ovarian cancer (OC) patients with platinum‑free interval (PFI) < 6 mo. are usually considered platinum‑resistant and treated with non‑platinum based chemotherapy. There is a lack of evidence to compare various non‑platinum therapeutic options in patients with platinum‑resistant ovarian cancer (PROC). We conducted meta‑analysis to assess efficacy of various therapeutic options in PROC patients. This article aimed to compare non‑platinum therapeutic regimens.
Methods: We queried the PubMed database for full‑text articles and abstracts on the treatment of PROC patients (01/01/2000–01/06/2019 timeframe). Inclusion criteria were: 1) epithelial ovarian cancer; 2) recurrent disease ≤ 6 mo. after platinum‑based chemotherapy; 3) standard therapy with platinum‑ or non‑platinum agents; 4) no targeted therapy, investigational agents or non‑platinum doublets; 5) reported response rate (RR) and assessment criteria. Proportion meta‑analysis (random‑effect model) and beta‑regression were conducted to assess efficacy of various options. Statistical analysis was dose with meta and betareg packages of R software.
Results: We identified 7156 articles and screened them for title and abstract, 157 studies were left for further analysis. Efficacy of non‑platinum‑ and platinum‑based therapy was assessed in 113 (n = 5272) and 44 (n = 1055) trials respectively, only the latter were included in this analysis. In meta‑proportion random‑ effect model RR among patients treated with taxanes, etoposide, doxorubicin/PLD, topotecan and gemcitabine were 27 % (95 % CI 0.21–0.34), 19 % (95 % ДИ 0.13–0.27), 15 % (95 % CI 0.11–0.19), 13 % (95 % CI 0.10–0.18) and 10 % (95 % CI 0.07–0.14), respectively. Multiple beta‑regression model accounting for response assessment method, number of prior therapy lines and other factors confirmed the results.
Conclusions: Taxanes monotherapy may be the most effective therapeutic option for patients who are not candidates for platinum‑based chemotherapy.
The purpose of this article is to evaluate the possibilities of cytology for lung neuroendocrine tumors (small‑cell lung carcinoma and carcinoids) diagnostics. Cytology specimens obtained by bronchoscopy (n = 112), biopsy of metastatic lymph nodes (n = 27) or from pleural effusion (n = 8) were collected within over 1 year from 147 patients and studied. Small-cell lung carcinoma was diagnosed in 143 patients, representing 23,9 % of all lung carcinomas. The proportion of carcinoid tumors was 2,7 % of all neuroendocrine tumors. Typical carcinoid was observed in three cases, and atypical carcinoid — in one case. Cytologic features most significant for cytological diagnosis of small‑cell lung carcinoma and carcinoids were identified (n = 11). Discriminant analysis demonstrated that the proportion of accurate cytological diagnosis of small‑cell lung carcinoma and carcinoids was 96,69 %. Cytology is a reliable method for neuroendocrine tumor diagnosis. Immunocytochemistry with neuroendocrine markers along with light microscopy should be used to differentiate small‑cell lung carcinoma metastases from other tumors and non‑malignant pathology in pleural effusion specimens.
Introduction: CA125 is an extracellular domain of MUC16 glycoprotein. The clinical significance of serum CA125 has been most extensively studied in ovarian cancer. The significance of serum CA125 in gastric cancer has not been fully elucidated. There is evidence that MUC16 overexpression is associated with poor survival in patients with metastatic gastric cancer. We have not found any research papers on the correlation between the levels of serum CA125 and MUC16 overexpression.
Objective: The objective of the study was to assess the effects of elevated CA125 levels in patients with metastatic cancer on the long‑term results (time to disease progression and overall survival).
Materials and methods: CA125 was determined in the serum before the start of first‑line chemotherapy in 75 patients (45 males and 30 females) with metastatic gastric cancer. The mean age of the patients was 61,3 (26,7–84,9) years. Synchronous metastases were observed in 85 % of patients: 57,3 % in the peritoneum, 37,3 % in the liver, 5,4 % at other sites. Palliative gastrectomy and metastasectomy were performed in 28 % and 20 % of patients, respectively. Monotherapy, doublet and triplet chemotherapy regimens were used in 6,7 %, 58,7 % and 36,0 % of patients, respectively.
Results: the analysis showed that elevated levels of CA125 (> 37 IU/mL) were associated with a significant reduction in median time to progression (3,5 months (CI 2,87–9,53) vs 6,2 months, р = 0.001 (CI 2,02–4,9)) and overall survival (5,1 months (CI 6,07–28,1) vs 17,1 months (CI 3,5–6,67), р = 0.001). One‑factor ANOVA showed that factors with the strongest effects on the survival rates included the location of metastases (peritoneum), tumor histology (adenocarcinoma/signet ring cell carcinoma), the use of palliative gastrectomy and metastasis resection. A multi‑factor ANOVA showed that the only favorable prognostic factors in terms of overall survival rates were normal CA125 levels (HR 0,39 (95 % CI 0,18–0,84), р = 0.001) and the use of palliative gastrectomy (HR 0,23 (95 % CI 0,1–0,58), р = 0.001). The use of triplet chemotherapy regimens allowed to slightly improve the overall survival rates in the group of patients with elevated CA125 levels; however, the differences were not statistically significant (6,7 months vs 4Ю0 months, p = 0.29).
Conclusion: Elevated levels of CA125, which reflect MUC16 overexpression to a certain extent, is a strong independent predictor of poor outcome in metastatic gastric cancer. Currently, a possible way to overcome this negative impact is to use more intensive chemotherapy regimens. However, further research should be aimed at finding adequate targets and ways of neutralizing the negative impact of MUC16 overexpression in patients with metastatic gastric cancer.
ISSN 2587-6813 (Online)