Method for predicting serous ovarian carcinoma patients survival period in climacteric period and postmenopause

FIELD: medicine.

SUBSTANCE: method involves calculating survival period duration in months from a formula being linear combination of several variables like morphological tumor parameters, that is, tumor cell area, mean ploidity of tumor cell nuclei, p53 expression level and special area of spontaneous necroses.

EFFECT: high accuracy of prognosis.

 

The invention relates to the field of medicine and is used to assess the longevity of the treated patients with serous ovarian cancer in postmenopausal women and the menopausal period.

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 the 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: define such parameters as tumor size tumor cells, the average ploidy of nuclei tumors is of evich cells, the level of expression of PCNA, the level of expression of p53, surround the square of spontaneous necrosis.

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

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 volume fraction of spontaneous necrosis can be obtained by using a morphometric grid and expressed as a percentage of the area of the tumor site.

Next, it calculates the life expectancy in months according to the formula:

Mud (months)=(-67,94)+2,09*1-10,24*2+2,84*3-47,51*4-9,69*5,

where X1 is the area of the tumor cells, μm2;

X2 - the average ploidy of the nuclei of tumor cells, C;

X3 - the level of expression of PCNA, %;

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

X5 - dimensional area of spontaneous necrosis, %.

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

Examples of use

1. Patient A., 69 years old, no history of the disease 1035, retired, was admitted to the Republican clinical Oncology dispensary, Cheboksary 20 December 1997 with complaints of severe blunt abdominal pain with irradiation to the crotch and on the inner surface of the left thigh, severe weakness, weight loss. Heredity in oncopathology is not burdened, history 9 pregnancies. Objectively: the patient's condition moderate, pale skin turgor them reduced. AD - 160/100 mm Hg, pulse is 70/min, in the lungs weakened vesicular breathing. Palpation of the abdomen is not enlarged, soft, painful in the iliac regions, more to the left. During deep palpation is diagnosed dense mass education up to 20 see When vaginal examination is determined by the tumor site with a diameter of 20 cm, infiltrating the wall of the vault of the vagina, tight, nessesairy, sharply painful. Pathological vaginal discharge no. Diagnostic laparotomy diagnosed with bilateral tumor of ovarian cystic-solid character with invasion of the vagina. Cytology in flushing selected atypical cells. Produced palliative bilateral istovremene with the following 10 courses of chemotherapy and hormonal therapy according to the standard scheme. Clinical diagnosis: both ovarian Cancer with invasion of the vagina, clinical stage III (FIGO), T3NxM0, carcinomatosis, metastases in the omentum.

Histological study No. 2903 was revealed serous histological type of carcinoma of the ovary with a low degree of histological differentiation. After conducting tsitomorfometricheskie study found that the average area of the tumor cells is equal to 44,79 μm2. The average ploidy of the nuclei of tumor cells was 4,22 C. the expression of the antigen p53 was not determined (0 points), the expression level of PCNA - 90%, and the volumetric size of spontaneous necrosis amounted to 17.1%.

Thus, the calculated life expectancy (PJ):

PJ=(-67,94)+2,09*44,79-10,24*4,22+2,84*90-47,51*0-9,69*17,1=72.4 month.

According to clinical observation of the patient obtained from the oncological dispensary, it is established that a patient has lived for 72 months from the date of diagnosis.

2. Patient A., 59 years old, no history 2190, retired, was admitted to the Republican clinical Oncology dispensary, Cheboksary may 27, 2000, complaining of nagging abdominal pain, increasing abdominal expressed weakness, malaise. Heredity in oncopathology is not burdened, history 2 pregnancy. Objectively: the patient's condition moderate, skin pokr what you are pale pink, AD - 170/95 mm Hg, pulse is 68/min, in the lungs weakened vesicular breathing. Palpation of the abdomen is enlarged, soft, deep palpation by Obraztsov is determined by the free liquid in the abdominal cavity. At vaginal examination are diagnosed dense mass education in the pelvis up to 15 see If the puncture Red space in the peritoneal fluid revealed atypical cells. Other changes in laboratory parameters are not set. Produced diagnostic cystadenoma with subsequent 1 course of chemotherapy and hormonal therapy according to the standard scheme. Clinical diagnosis: ovarian Cancer, clinical stage III (FIGO), T3NxM0. Ascites, peritoneal carcinomatosis.

Histological study No. 8583 was revealed serous histological type of carcinoma of the ovary a high degree of histological differentiation. After conducting tsitomorfometricheskie study found that the average area of the tumor cells is equal to 62,47 μm2. The average ploidy of the nuclei of tumor cells was 9,03 C. the expression of the antigen p53 was not detected (0 points), the expression level of PCNA - 15%, the volume fraction of spontaneous necrosis was 1.2%.

Thus, the calculated life expectancy:

PJ=(-67,94)+2,09*62,47-10,24*9,03+2,84*15-47,51*0-9,69*1,2=1,1 months.

According to clinical nab is Eugenia for the patient, obtained from the cancer center found that patient A. he lived for 1 month from the moment of diagnosis.

Literature

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 in menopause and postmenopause, 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 lifespan (PI) in the months determined by the formula

Mud(months)=(-67,94)+2,09·x1-10,24·x2+2,84·X3-47,51·x4-RS 9.69·X5

where x1 is the area of the cancer cell (μm2), is measured by the eyepiece-micrometer or television image analyzer in μm2;

x2 - 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);

X3 - the value of the expression of PCNA (nuclear antigen of proliferating cells) (%)is determined by the number of PCNA - positive cells in the tumor;

x4 - intensity labeling of p53 (point), the absence of the expression of p53 protein in tumor cells 0 points; 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 - dimensional area of spontaneous necrosis in cancer site (%)can be obtained by using a morphometric grid and expressed as a percentage of the area of the tumor site, %.



 

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