Vol 22, No 1 (2017)

There was executed the analysis of thematic literature during from 1956 to 2015 devoted to receptors to fetal proteins, including to alpha-fetoprotein (AFP) known in medicine as oncomarker and used by malignant cells for the organization of tumoral homeostasis. As protein carrier, AFP similar to albumin takes of vitally important molecules in a space «hydrophobic pocket» and moves inside a cell, but as the cancer-embryonal antigen (CEA) - determines the existence of a malignant tumor, but not the type of a neoplasm. On the bounding of AFP with teratogen and their internalization and delivery in an embryo there is based the development of ways of «address» delivery of substances into a cell. This is realized by means of receptor mediated endocytosis via specific membranous receptors to AFP (ReCAF) with high selectivity concerning malignant cells of various genesis. Up to 90% of all malignant cells of the human and tumor models for human and mammalians express AFP receptors, including rather recently opened stem tumor cells - the most probable source of metastasing. AFP production and expression of receptors is selectively raised in malignant tumors of patients and human tumor models. The hyperproduction of AFP and hyperexpression of ReCAF are related to the histologic type of tumor model and are characteristic for embrional cell tumors and hepatoblastomas with initially low drug sensitivity or with the resistance. When choosing the model it is necessary to consider that in different types of tumor cells ReCAF have specific features in cultivation which are not pronounced in conditions of an animal organism. More differentiated tumors are characterized by the larger level of the AFP production and a hyperexpression of ReCAF. The use of subcutaneous tumor xenografts signal for AFP localizations with the hyperexpression of receptors, allows to reveal mostly evidentially the effectiveness of the therapeutic system at the preclinical level. Address delivery of therapeutic systems created on the basis of AFP or its fragments is capable of causing the change of their pharmacological properties. The therapeutic prize is possible due to the induction of process of apoptosis via the mitochondrial pathway, but at the same time the fall in the cytotoxic capacity of system is possible.

In the work there was investigated the prognostic value of the counting of intratumoral stromal mast cells (MC) in renal cell carcinoma. Tissue samples were obtained intraoperatively from 63 patients with renal cell carcinoma. The average age of patients accounted for 58.2 ± 12 years. There were observed 34 (54%) men and 29 (46%) women. There were revealed correlation relationships between the density of distribution of mast cells in tumor and the clinical stage of the disease (r = 0.69; p = 0.0001), tumor nodule size (r = 0.58; p = 0.0001), the presence of regional and distant metastases (r = 0.48; p = 0.0001), tumor grade according to the criteria of Fuhrman (r = 0.89; p = 0.001), and postoperative survival of patients (r = 0.40; p = 0.001). There was found no interrelationship between the number of MC in tumor with the gender (r = -0.03; p = 0.8), age (r = -0.15; p= 0.25), and the histological type of tumor (r = 0.16; p = 0.19). The gain in the number of intratumoral stromal MC in carcinoma can be considered as a predictor of the possible appearance of metastases. The high amount of MC in tumor has been shown to correlate with a poor prognosis of the patients with renal cell carcinoma.

The significance of the study is associated with the high level of the morbidity rate of colorectal cancer, generous amount of patients with the 4th stage and the necessity of the research of palliative surgical treatment. A retrospective analysis of 364 cases with metastatic colorectal cancer included 58 patients with palliative colon resection and 306 patients with bypass anastomosis and unloading stoma. Evaluated parameters are the frequency of postoperative complications, postoperative mortality rate, median survival and one-year survival. In the group of palliative resections the frequency of postoperative complications and postoperative mortality rate were 32.7% and 20.6%, in the group of symptomatic operations the same results were 12.1% and 8.8%. Median survival, one-year survival in the group of palliative resections are longer than in the group of symptomatic operations - 10.0 and 5.1 months, 37.0% and 18.3%, respectively (p < 0.05). However, after stratification of studied subgroups according to the sign of the presence or absence of post-operative chemotherapy the survival were shown to be higher in patients with chemotherapy and hardly depended on fact of the removal of the primary tumor. To our opinion the high rate of postoperative complications and the postoperative mortality rate after palliative resections of the colon can be corrected by more precise determination of indications to their performance in emergency surgery. The improvement in survival indices is associated with the execution of postoperative adjuvant chemotherapy.

The poor performance of rural health in remote from the center territories of the Tomsk region, determined the need for the optimization of cancer control measures. In 2013-2015 in the oncology service of the Tomsk region there were occurred structural and qualitative changes: there was formed a three-level system of the provision of specialized health care. For workers of the first level of health care system - feldsher obstetric units (FOUs) there were approved methodical approaches to the organization and implementation of screening for external location cancer, the formation of cancer risk groups for further examination; routing and observation of cases with risk factors, precancerous and background processes; documenting of the execution of the examination for cancer; routing and tactics for the observation of cancer patients. There are introduced motivational measures for the improvement of the quality of the work of medical staff. There are actively practiced mobile forms of the activity, with taking into account seasonality, the state of the transport accessibility (the use of mobile mammographs based on KAMAZ chassis, the regional project «The floating clinic», curation of districts by oncologists). There was introduced the mechanism of «individual road map», including telemedical technologies for distance observation of patient documents (the number of unnecessary visits of rural residents decreased by 30%). There were founded primary oncological units (POU), their base is enhanced by the diagnostic equipment, which reduced the number of underexamined patients by 47.5%. There was created the network of primary cytological laboratories completed with microscopes with digital processing and transmission of images over the Internet, there were performed more than 20,000 telemedical consultations, resulting in 70 diagnosed cases of cervical cancer for 2 years. The execution of POU-based courses of drug antitumor therapy increased the number of patients received the treatment at site of residing by 2.2 times. There was organized beneficiary drug coverage, including drugs for the treatment of chronic pain. Thanks to the work of POUs in the new status there were increased both the coverage of the population by cancer preventive examinations and indices of detection rates of precancerous diseases and chronic external localization diseases as in men as well in women.