COMPLEX ASSESSMENT OF PROGNOSTIC FACTORS IN CHOOSING METHOD OF TREATMENT OF PATIENTS WITH SUPEFICIAL AND LOCALLY- SPREAD CARCINOMA OF THE UROTHELIUM

THE AIM of the investigation was to develop recommendations fo r choice of the method of treatment of patients with carcinomas of the urothelium. PATIENTS AND METHODS. A retrospective investigation of findings of primary examination and 5 year dispensary follow-up was carried on after radical surgical treatment of 452 patients with superficial and locally-spread carcinoma of the urothelium (urinary bladder - in 344 (76.1%), urinary bladder and urethra - 33 (7.3%), renal pelvis - 37 (8.2%), ureter - 23 (5.1%), renal pelvis and ureter - 15 (3.3%) patients respectively). The ratio of men and women was 3.2:1, mean age - 62.4±13.2 years. All patients underwent radical operative treatment. In addition to standard histological investigation of TNMG categories in tumor tissue the stroma effectors were calculated, an analysis of the parameters of distribution of nucleolus organizers and Ki-67 index was made. Survival of the patients with carcinoma of urothelium of the upper and lower urinary tracts after the first, third and fifth years of postoperative follow-up was 72%, 29%, 19%, and 91.7%, 77.8%, 68.6% respectively. Recurrences were found in the urinary bladder in 69% of the patients, the term of the appearance of recurrences was from 0.5 through 62 months and was at an average 11.9±1.8 months. RESULTS. High proliferative activity, invasive growth, low degree of differentiation, weakly pronounced stromal component and high degree of its infiltration by effectors, squamous cell cancer and adenocarcinoma in combination with the infiltrative character of growth, plurality and big sizes of tumors in patients older than 60 years, with impaired urodynamics and infected urinary tracts point to the highest risk of postoperative progressing and recurrences of carcinomas of the urothelium. Recommendations for choice of the method of treatment of such patients were developed depending on the significance of the risk factors. CONCLUSION. A complex approach in detection of prognostically unfavorable factors determining the risk of aggressive biological behavior of cancer after radical surgical interventions allows possible decision on the correct medical strategy in patients with carcinomas of the urothelium.

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