Method for predicting survival period in serous ovary carcinoma patients of reproductive age

FIELD: medicine.

SUBSTANCE: method involves calculating life duration in months from a formula being linear combination of several variables defined as morphological tumor parameters like carcinoma differentiation degree, tumor cell area, mean tumor cell nuclei ploidity level, p53 expression level, PCNA expression level and progesterone receptors expression level.

EFFECT: high accuracy of survival period prognosis.

 

The invention relates to the field of medicine and is used to assess the longevity of the treated patients with serous ovarian cancer, preserving reproductive function.

The closest method described in [1]. It lies in the fact that the forecast is on scoring some factors: age, method of treatment of a tumor, the degree of differentiation of the carcinoma, comorbidities. And then forecast based on the amount of points is divided into favorable, favorable, doubtful and negative.

The disadvantages of this method are the large number of parameters in the calculation of the forecast, as well as the subjectivity of the criteria used.

The essence of the invention lies in the fact that life expectancy in months is calculated by the formula representing a linear combination of several variables. Variables are the morphological characteristics of the tumor.

The technical result of the invention is to improve the accuracy of life expectancy, reducing the number of calculated variables and use it when planning tactics of treatment of patients, as well as in the choice of treatment method.

The method is implemented as follows: defined parameters such tumors as the degree of differentiation of the carcinoma, the area of the tumor cells, the average p is oidest nuclei of tumor cells, the expression level of p53, the expression level of PCNA, the level of expression of the progesterone receptor.

The degree of differentiation of the carcinoma is established in accordance with the criteria ..Broders and taken into account in the scoring: the low degree of differentiation 1 point; moderate - 2 points; high - 3 points.

The area of the cancer cell is measured by the eyepiece-micrometer or television image analyzer in μm2.

The average ploidy of the nuclei of tumor cells is measured by the photometer in units of the number of sets of chromosomes, C.

The magnitude of expression of p53 is expressed in points: the lack of p53 expression in tumor cells is scored 0; the expression of p53 detected in 1-10% of cells - 1 point; p53 is visualized in 11-50% of tumor cells - 2 points; p53 is defined in 51-100% of cancer cells is 3 points.

The magnitude of expression of PCNA (nuclear antigen of proliferating cells) is determined as a percentage of the number of PCNA - positive cells in the tumor.

The level of expression of the progesterone receptor was expressed in points: lack of expression of progesterone receptor in tumor cells is scored 0; the expression of the progesterone receptor identified in 1-10% of cells - 1 point; progesterone receptor visualized in 11-50% of tumor cells - 2 points; progesterone receptor is determined in 51-100% of cancer cells is 3 points.

Next, it calculates the life expectancy in months who Oh by the formula:

Y(months)=(-82,81)-4,39·X1+1,38·X2-4,04·X3+0,58·X4+0,70·X5+of 17.35·X6

where X1 is the degree of tumor differentiation (1 - low, 3 - high);

X2 is the square of the tumor cells, μm2;

X3 - the average ploidy of the nuclei of tumor cells, C;

X4 - the level of p53 expression (in points);

X5 - level expression of PCNA, %;

X6 - level expression of progesterone receptor (points);

The advantages of this method are the small number of morphological criteria, simplicity and low cost of the reagents to obtain the necessary parameters, the possibility of use in routine pathological practice and medical science.

Examples of use

1. Sick Hours, 42 years old, no history of the disease 1916, entered the Republican clinical Oncology dispensary horseboxes June 14, 1996, complaining of nagging abdominal pain, increasing abdominal weakness. Objectively: the patient's condition is moderate, the skin is pale pink, hemodynamic parameters in normal vesicular breathing in lungs. Palpation of the abdomen is enlarged, soft, painless, during deep palpation by Obraztsov was determined by the free liquid in the abdominal cavity. At vaginal examination revealed a tumorous formation in the pelvis up to size 15 see Abnormal vaginal discharge n is so Fertility saved. Cytological examination of ascitic fluid revealed atypical cells. Other changes in laboratory parameters are not set. At laparotomy diagnosed tumor of both ovarian cystic-solid character, metastatic peritoneal lesions. Produced hysterectomy with appendages and resection of the gland with subsequent 5 chemo - and hormonal therapy according to the standard scheme. Clinical diagnosis: Cancer in both ovaries, clinical stage III (FIGO), T3NxM0, carcinomatosis, ascites.

Histological examination was revealed serous histological type of carcinoma of the ovary high degree of differentiation (3 points). After conducting tsitomorfometricheskie study found that the average area of the tumor cells is equal to 59,77 μm2. The average ploidy of the nuclei of tumor cells was 3.16 C. the expression of the antigen p53 was not determined (0 points), the expression level of PCNA - 21%, and the reaction to the progesterone receptor is weak (1 point)

Thus, the calculated life expectancy:

Y(months)=(-82,81)-4,39·3+1,38·59,77-4,04·3,16+0,58·0+0,70·21+of 17.35·1=5.8 months.

According to clinical observation of the patient obtained from the Oncology center is established that the patient'clock lived 6 months since postanovka the diagnosis.

2. Patient P., 51 years, no history of the disease 3805, entered the Republican clinical Oncology dispensary horseboxes 27 November 2001 with complaints dragging pain in the abdomen, weakness, malaise, scant bloody discharge from the vagina. Objectively: the patient's condition moderate, skin physiological painting, hemodynamic parameters in normal vesicular breathing in lungs. Palpation of the abdomen is not enlarged, soft, moderately painful in the left and right iliac regions, where defined granulomas formation up to 5 cm in diameter. At vaginal examination are diagnosed lumpy tumor nodes in the pelvis size up to 5 cm Into the vagina scant spotting. Fertility saved. When the puncture Red space in the peritoneal fluid revealed atypical cells. Other changes in laboratory parameters are not set. At laparotomy diagnosed tumor of both ovaries solid character with metastatic peritoneal lesions. Produced hysterectomy with appendages and resection of the omentum with the following 4 courses of chemotherapy and hormonal therapy according to the standard scheme. Clinical diagnosis: Cancer in both ovaries, clinical stage III (FIGO), T3NxM0, carcinomatosis.

At histological research the Institute was revealed serous histological type of carcinoma of the ovary with a low degree of histological differentiation (1 point). After conducting tsitomorfometricheskie study found that the average area of the tumor cells is equal to 69,19 μm2. The average ploidy of the nuclei of tumor cells amounted to 8.34 C. the expression of the antigen p53 - moderate (2 points), the expression level of PCNA - 50%, and the reaction to the progesterone receptor negative (0 points).

Thus, the calculated life expectancy:

Y(months)=(-82,81)-4,39·1+1,38·69,19-4,04·a 8.34+0,58·2+0,70·50+of 17.35·0=10.7 months.

According to clinical observation of the patient obtained from the Oncology center is established that the patient P. lived for 11 months after diagnosis.

Sources of information

1. Bohman AV, Volkova A.T., Kolosov AU, Yudkivska I., Wisniewski A.S. uterine Fibroids in combination with endometriosis - factors high risk of development of malignant tumors // uterine Fibroids: Sat. scient. Tr. / Under the editorship of Prof. Linville. - M., 1979. p.47 - 50. the prototype.

A method for predicting life expectancy of patients with serous carcinoma of the ovary of childbearing age, which consists in the estimation of some parameters of the tumor and prognosis for him in life expectancy, characterized in that estimate only morphological characteristics of the tumor and the life expectancy (Y) in the months determined by the formula:

Y(months)=(-82,81)-4,39·X1+1,38·x2-4,04·X+0,58· X4+0,70·X5+of 17.35·X6,

where X1 is the degree of tumor differentiation (point) is set in accordance with the criteria ..Broders: low degree of differentiation 1 point; moderate - 2 points; high - 3 points (1 - low, 3 - high);

X2 is the square of the cancer cell (μm2), is measured by the eyepiece-micrometer or television image analyzer in μm2;

X3 - the average ploidy of the nuclei of tumor cells (C) is measured by the photometer in units of the number of sets of chromosomes (C);

X4 - intensity labeling of p53 (point), the lack of p53 expression in tumor cells is scored 0; the expression of p53 detected in 1-10% of cells - 1 point; oncogene suppressor p53 is visualized in 11-50% of tumor cells - 2 points; p53 is defined in 51-100% of cancer cells - 3 points;

X5 - the value of the expression of PCNA (nuclear antigen of proliferating cells) (%)is determined by the number of PCNA positive cells in the tumor;

X6 - intensity labeling of progesterone receptor (point), no expression of progesterone receptor in tumor cells is scored 0; the expression of the progesterone receptor identified in 1-10% of cells - 1 point; progesterone receptor visualized in 11-50% of tumor cells - 2 points; progesterone receptors are defined in 51-100% of cancer cells is 3 points.



 

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2 tbl

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EFFECT: higher accuracy of prediction.

2 ex, 3 tbl

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