[Factors affecting survival of radically operated nonsmall cell lung cancer patients of 70 years and older].

It is performed univariate and multivariate analysis of factors affecting the overall cancer survival of 613 patients of 70 years or older radically operated for non-small cell lung cancer. It is found that the main independent predictors of survival are T and N categories. These variables retain their importance in the overall multivariate model both types of survival, and the variable T - in separate multivariate models for samples stratified by category N. The presence of diabetes dramatically reduced both types of survival. Among patients without regional metastases women had a higher survival rate. The age of the operated patients older than 70 years had no significant independent effect on survival.

[Long-term results of isolated chemoperfusion of the lung with melphalan and cisplatin in combination with metastasectomy in treatment for resectable metastatic lung lesion].

For treatment of metastatic lung lesions there was used the method isolated chemoperfusion of the lung in combination with metastasectomy. The study includes 74 patients with metastases in the lungs who underwent 101 normothermal isolated chemoperfusion of the lung: of these 38 (37,6%) with melphalan and 63 (62,4%) with cisplatin without lethality. In the early postoperative period 1 (1,4%) patient died due to postperfusion lung edema. The period of observation of patients ranged from 2 to 99 months (median 29.3 months). Of 74 patients 53 (71,6%) patients are alive, 2 (2,7%) patients died from causes unrelated to the underlying disease. 43 (58,1%) patients showed progression of disease, what in 18 (41,9%) of them was the cause of death. Repeated appearance of metastases in perfused lung was detected in 30 (40,5%) patients. A 5-year disease-free (in the lungs) and observed survival of patients after isolated chemoperfusion of the lung with metastasectomy was 45% (median 46 months) and 59% (median not reached) respectively. There were established predictors of effectiveness of isolated chemoperfusion of the lung with metastasectomy: DFI> 13 months, ≤5 metastatic nodes in the lungs, the size of the largest metastasis in the lungs ≤20 mm, intralobular location of metastases in the lungs as well as the time of doubling the volume of metastases >64 days for chest computed tomography.

[New method of plastic in surgery for skin melanoma localized near body's midline].

With a wide excision of skin melanoma localized in areas of the sternum, the sacrum or on the back near body's midline there is often occurred a problem of closing appeared defect. Local tissues are insufficient and performing of free plastic is undesirable because of the unfavorable conditions of the free flap engraftment due to the peculiarities of transplant bed and difficulties of immobilization and fixation of the flap. For exactly such surgical situations we have developed a method of reliable replacement of appeared defects by two adjacent symmetrical rotary flaps.

[Analysis of one-year mortality of radically operated patients over 70 years with nonsmall cell lung cancer].

One-year lethality was studied in 613 patients older than 70 years who underwent surgery for lung cancer for the period of 1970-2002. During the first year after surgery 166 patients died (27.1%) and besides from the generalization of the disease - 92.2%, from other causes - 7.8%. The highest rate of one-year lethality was observed after pneumonectomy (39.4%), the lowest one - after lung margins resection (16.5%). It was found that the most important factor in one-year lethality rate was N2 lymph node status. Risk of dying from the generalization of the disease during the first year sharply increased in group of patients underwent extended and combined pneumonectomy (one-year lethality of 52.6% and 57.1%, respectively), pneumonectomy with N2 (56,0%), lobectomy in peripheral cancer with metastases of N2 level (63,6%), especially when the amount of the tumor was more than 5 cm (83.3%).

[Clinical course of cutaneous melanoma of the head and neck, and the factors affecting patient survival].

It was found that melanomas of the skin of the head and neck, compared to the trunk and limbs, were characterized by a greater proportion of men, an older average age of the patients, high frequency spindle cell tumors, more frequent synchronous distant metastasis and worse survival. Melanomas, which are localized on the skin of the neck and scalp, have similar aggressive clinical course and are characterized by worse overall and disease-free survival than skin melanomas on the trunk and limbs. However, melanomas of the skin on the ear and face proceed more favorably as compared to skin melanomas of the scalp and neck. Multivariate regression analysis using Cox models showed that the melanoma of the head and neck Breslow tumor thickness was the strongest predictor of overall survival. For skin melanomas of the neck and scalp Breslow tumor thickness was the only significant independent factor for overall survival. In melanoma, skin and ear predictors of survival are: sex, age and tumor thickness. In skin melanomas of the face and ear predictors of survival were sex, age and tumor thickness.

[The factors of disease-free survival in patients with nodal metastases of cutaneous melanoma]. / Faktory, vliiaiushchie na sroki poiavleniia metastazov v regionarnykh limfaticheskikh uzlakh u bol'nykh melanomoi kozhi.

The time between primary lesion excision to lymphadenectomy for cutaneous melanoma was determined in 550 patients. Maximum relapse-free interval was 17.8 years, mean--16.4 months, with median time of 6.2 months. We used retrospective multivariate analysis of the time for metastases to the regional lymph nodes with such variables as sex, age at tumor presentation, site, volume of tumor or largest nodular metastasis, number of involved nodes, satellites, Breslow thickness, ulceration, epithelioid-cell presence, pigmentation, mitotic index, spontaneous tumor regression, invasive growth (Clark), and lymphoid infiltration. A retrospective univariate analysis involved such significant predictors as spontaneous tumor regression (p(0.00001), logarithm of primary tumor volume (p=0.0005), sex (p=0.0007), tumor site (p=0.008), satellites (p=0.011), and Clark's index (p=0.025). Cox's multivariate analysis established a relationship between relapse-free time and such variablesas spontaneous tumor regression (p(0.00001), logarithm of primary tumor volume (p=0.0006), tumor site (p=0.016), logarithm of volume of largest nodular metastasis (p=0.019), and sex (p=0.032).

[Influence of growth rates of local recurrences and in-transit metastases on survival of patients with cutaneous melanoma]. / Vliianie kineticheskikh kharakteristik mestnykh retsidivov i tranzitnykh metastazov na vyzhivaemost' bol'nykh melanomoi kozhi.

The growth rates of local recurrences and in-transit metastases of skin melanoma were assessed in 271 patients. Median growth rate in the course of chemotherapy was 0.02 a day--1 which corresponded to a doubling time of 34.7 days. Median survival time for patients with local recurrences and in-transit metastases was 22.6 months, 12-month survival--70.1%, 5-year--19.6% and 10-year--9.9%. Growth rate appeared to be the most significant prognostic factor; similarly important were tumor volume, relapse-free interval, tumor mitotic rate, site and number of recurrences. The following additional characteristics of tumor growth rate have been suggested: maximum growth rate and doubling time limit, to assess the rates of secondary tumor focus development.

[Quantitative growth characteristics of pulmonary metastases in cutaneous melanoma]. / Kolichestvennye kharakteristiki rosta legochnykh metastazov melanomy kozhi.

The dynamics of growth of skin melanoma metastases to the lung versus chemoimmunotherapy regime has been assessed quantitatively. Natural course of such pathology at advanced stages was found to correspond to the exponent. An analytical procedure for plotting graphs was suggested, which will allow to estimate the kinetic characteristics of tumor growth. This in turn can be used as an indicator of therapy efficacy.

[The surgical correction of pressure in the lesser circulation after extensive lung resections for cancer]. / Khirurgicheskaia korrektsiia davleniia v malom kruge krovoobrashcheniia posle obshirnykh rezektsii legkogo po povodu raka.

The surgical bypass of v. azygos and v. pulmonalis sup. dext. to decompress the lesser circulation after extensive resections of the lung is elaborated. The operation was performed on 21 patients for cancer of the right lung, and in one patient with bilateral disease. The shunting followed pneumonectomy in 11 cases, the lower bilobectomy in 7, the upper lobectomy in 2. In 1 patient the operation was performed after successive left-sided lower lobectomy and right-sided upper lobectomy. The shunting reduced the middle pressure in the lung artery by 13,9-21,0% of the postresection level. The bypass did not cause statistically significant decrease of the oxygenation in the arterialized capillary blood.