Log-rank Criteria Research Articles

Controversies in minimally invasive surgery for invasive cervical cancer

Background. Determination of the feasibility of performing minimally invasive surgery for invasive cervical cancer and identification of criteria for optimal surgical access that ensures safety, effectiveness, and satisfactory immediate and long-term results remain challenging in gynecological oncology. The aim of the study was to evaluate the immediate and long-term treatment outcomes in patients with invasive cervical cancer who underwent radical hysterectomy via laparotomy compared to those who underwent minimally invasive surgery. Material and methods. Treatment outcomes of 91 patients with invasive carvical cancer were analyzed. The assessment of the objective tumor response to neoadjuvant chemotherapy using the RECIST scale (Response Evaluation Criteria in Solid Tumors) was confirmed by clinical, ultrasound and CT/ MRI findings. The Kaplan-Maier curves and the log-rank criterion were used to compare the time of relapse-free and overall survivals. Statistical analysis and visualization of the analysis results were performed using prism 9.5.1 (GraphPad, USA). Results. The presence of parametrial lymphovascular space invasion and the frequency of lymphadenopathy were comparable for both groups of patients. there were no statistically significant differences in the number of the resected lymph nodes, but there was a statistically significant difference in volume of blood loss and the duration of surgery between the groups (p=0.0001). Every third patient was diagnosed with stage IIIC after surgery (pelvic lymph node lesion). Intraoperative complications were significantly lower in the laparoscopy group than in the laparotomy group (6.7 % vs 13 %). No significant differences in the proportion of relapses of the disease between the groups were found (9.6 % in the laparotomy group vs 11.7 % in the laparoscopy group). There were no significant differences in overall and relapse-free survival between the groups. Conclusion. Minimally invasive surgery is a promising and adequate surgical technique for the treatment of cervical cancer. However, additional studies are needed to determine the indications for these surgeries.

Sepsis Course and Outcome Depends on the Genetic Variant in the 3`-Region of Aquaporin 4 Gene <i>AQP4</i> and Comorbidities

Aquaporins 4 and 5 are proteins that form water channels in the cell membrane, participate in the transfer and migration of immune cells, being expressed on many cell types including CNS astrocytes, kidney cells, lungs, and the immune system. We have previously shown that AQP5 genetic polymorphism is associated with different outcomes of abdominal sepsis. Since another common aquaporin protein, AQP4, is also expressed on the surface of immunocompetent cells, determining cell motility, it was suggested that AQP4 may also be important in the pathogenesis of sepsis, and that AQP4 polymorphism may predetermine sepsis severity and outcome. AQP4 rs1058427 genetic polymorphism has not been studied earlier. The aim of the study was to determine the effects of region 3` polymorphism in the AQP4 gene on the clinical course and outcome of sepsis.Materials and methods. The prospective study included 290 ICU patients from three clinical hospitals in Moscow aged 18–75 years with clinical signs of sepsis (SEPSIS-3, 2016).Results. It was found that the minor T allele of the AQP4 rs1058427 gene provides strong protection against septic shock, as among GG genotype carriers septic shock developed in 66%, but in presence of the minor T allele dropped to half of cases (P=0.009, Fisher’s exact test, OR=1.99, 95% CI: 1.12–3.55, N=290). There was a significant association between AQP4 rs1058427 genetic polymorphism and 30-day hospital mortality in a subgroup of patients with more severe organ dysfunction and higher comorbidity burden (cardiovascular diseases, type II diabetes mellitus) requiring extracorporeal treatment modalities and ventilator support for 5 or more days (N=66). Carriers of the minor T allele showed better survival rates as compared AQP4 rs1058427 GG genotype carriers (5 deaths out of 10 and 47 deaths out of 56, respectively, P=0.003, Fisher’s exact test, N=66, OR=5.22, 95% CI: 1.25–21.82, P=0.009, log-rank criterion).Conclusion. The minor AQP4 rs1058427 T allele is associated with protection against septic shock and better survival in sepsis in a group of ICU patients with high comorbidity burden requiring extracorporeal life support interventions.

Clinical and morphological features in patients with advanced endometrial cancer treated with immunotargeting therapy

Background. Endometrial cancer (EC) is one of the most significant oncogynecological problems. The main mortality cause in this disease, as in the case of other malignant neoplasms, is the tumor progression. The presence of mutations associated with mismatch repair-deficient is of great prognostic importance. Immunotargeting therapy (ITT), lenvatinib in combination with pembrolizumab, seems to be the most effective solution in the second line treatment of advanced EC without microsatellite instability. At the same time, the group of such patients is heterogeneous in terms of progression-free survival (PFS) on ITT. So that it determines the continuing need to search for reliable parameters steadily associated with the PFS duration in this type of treatment.Aim. To analyze the clinical and morphological features in patients with advanced EC depending on the PFS duration on ITT. Materials and methods. The study included data on patients (n = 36) with advanced EC who received ITT in oncological dispensaries in Siberia and the Russian Far East. The overall patients’ group was analyzed using the Kaplan-Meier method. PFS was defined as the time from the ITT initiation until progression or death against the background of treatment. The influence of the selected factors (clinical and morphological parameters, treatment features, and adverse events) on PFS was assessed using a log-rank criterion. The study participants were then divided into 2 subgroups (15 women and 9 women) according to median PFS. Mann–Whitney tests for independent samples (quantitative measures), and Fisher’s tests (qualitative measures) were used to identify significant differences in comparison subgroups for the selected factors. Differences were considered statistically significant when the significance level was reached (p <0.05); data at the statistical trend level (p <0.10) were also discussed.Results. In the study group, median PFS on ITT was 9.7 months (cut-off point), which was accepted as a response criterion. Among the 74 parameters reflecting clinical and morphological features in patients with advanced EC, metastatic lesions of pelvic lymph nodes (p = 0.028), para-aortic lymph nodes (p = 0.014), bone metastases (p = 0.080), and degree of estrogen receptor expression in tumor cells (p = 0.071) were associated with PFS. Partial regression as the maximal response to ITT (62.5 % vs 7.14 %, p = 0.011), as well as longer duration of response (median PFS 15.11 ± 1.10 months vs 4.47 ± 0.57 months, p = 0.00007), and the absence of foci in the pelvic/para-aortic lymph nodes (89 % vs 50 %, p = 0.069, and 89 % vs 47 %, p = 0.048, respectively), were more frequently observed in patients with a duration of median PFS ≥9.7 months compared to those with progression before 9.7 months. Stabilization as the maximum response to ITT (78.6 % vs 37.5 %, p = 0.072) was more frequently registered in the subgroup of patients with progression up to 9.7 months.Conclusion. ITT can be considered as a potentially promising therapeutic option in advanced EC. Further research in this direction should be aimed at finding criteria to identify patients with EC who would have most benefit from this type of therapy more accurately.

#6715 COGNITIVE IMPAIRMENT IS ASSOCIATED WITH INCREASED MORTALITY IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Patients on dialysis are at substantially higher risk for developing cognitive impairment compared with the general population. At the same time cognitive impairment is a strong and independent risk factor for all-cause mortality. Given that the approaches used to access the prevalence of cognitive disfunction widely vary in different patient populations, their true burden in hemodialysis patients remains poorly understood. The aim of our study was to determine the association between cognitive impairment and overall survival and mortality in patients undergoing hemodialysis treatment. Method A total of 69 chronic hemodialysis patients (47 men and 22 women) were included. The median age of patients was 61 [47-69] years. The median duration of hemodialysis treatment was 32 [21-72] months. The study of cognitive status was conducted using the Montreal Cognitive Assessment (MoCA) questionnaire. The test results are between 0 and 30 points. A score of 26 points or more is considered the norm, less than 26 indicates the presence of cognitive impairment. The end point was a fatal outcome from acute pathology or progression of a chronic disease. The analysis of survival and mortality was evaluated using survival tables, the construction of Kaplan-Mayer curves with the Mantel-Cox log–rank criterion. The risks of the influence of cognitive impairment on mortality were assessed using Cox regression. Results During the 24-month follow-up period, 23 patients died. Structure of mortality over the observation period: acute coronary syndrome – 6 (26 %), COVID-19 – 6 (26 %), acute cerebrovascular accident – 2 (9%), thromboembolic complications – 3 (13%), another causes – 6 (26 %). In patients with cognitive impairment on hemodialysis, the average survival value was 16.33 months ± 1.70 months [CI 95% 12.99-19.66] and 20.48 months±1.32 months [CI 95% 17.88-23.07] in patients without cognitive impairment. According to the Mantel-Cox log-rank criterion, there was a statistically significant decrease in overall survival in patients with cognitive impairment, P = .02. The mortality rate of dialysis patients with cognitive impairment was 51%, without cognitive impairment – 19%. Relative risk of death in the group of patients with cognitive impairment using Cox regression: Hazard ratio (HR) :2.90 [95% CI 1.11-7.37, P = .03]. Conclusion Our results support the notion that cognitive impairment may be an independent predictor of all-cause mortality in hemodialysis patients. There are limitations on the sample size of patients in our study. Further larger-scale observations a large cohort of patients are required.

Results of dose-dense neoadjuvant chemotherapy in the treatment of stages IB2—IIB cervical cancer

Background. Applied standard methods of cervical cancer (CC) treatment have several disadvantages in terms of local and systemic toxicity and the risks of local recurrence. Our study proposed the use of neoadjuvant chemotherapy (NACT) in a dose-dense mode, followed by radical hysterectomy, in order to improve the results of treatment of locally advanced CC (IB2-IIB stages) (FIGO)/T1b2-2bN0M0 (TNM).Aim. Improvement of immediate and long-term results in treatment of locally advanced CC IB2-IIB stages (FIGO), determining the immediate effectiveness of dose-dense NACT, based on magnetic resonance imaging (MRI) data, and the identification of prognostic factors for tumor response to chemotherapy.Materials and methods. Between April 2016 to November 2019 120 women with IB2-IIB stages (FIGO) were included in this study. Of these, 58 patients underwent 3 cycles of intensified NACT according to the AP scheme (cisplatin 75 mg/m2, doxorubicin 35 mg/m2) and 62 patients underwent NACT according to the TR scheme (cisplatin 60 mg/m2, paclitaxel 60 mg/m2). The assessment of the effect of intensified NACT was performed according to the RECIST 1.1 criteria according to MRI data. Also 2 retrospective groups of patients were recruited: group I - surgical treatment without preoperative chemotherapy (25 patients with IB2-IB3 stages (FIGO) from November 2009 to August 2019), group II - concurrent chemoradiotherapy (44 patients with stage IIB cervical cancer (FIGO) from January 2013 to June 2018).Results. Complete clinical response was detected in 12 (10.0 %) patients, partial response - in 69 (57.5 %) patients, stable disease - in 35 (29.2 %) patients, progression was observed in 4 cases (3.3 %). After NACT in a dose dense mode, due to an objective clinical response (complete response, partial response and stable disease for stage IIA according to RECIST 1.1 criteria), 99 (82.5 %) patients underwent surgical treatment. For 21 (17.5 %) patients due to the absence achievement of objective clinical response (stable disease for stage IIB according to RECIST 1.1 criteria or progression), performed concurrent chemoradiotherapy. During the observation period, 113 (94.2 %) patients remained alive. Mortality for the first year was 1.7 % (2 cases). There was a coincidence of the results of a complete response according to MRI in 11 (91.7 %) cases out of 12 cases with the pathology data. According to multivariate analysis, it was revealed that parametrial invasion, according to the histological examination of the surgical material, is an independent prognostic factor for recurrence. According to comparative evaluation of disease-free survival curves between groups of IB2-IIB stages (FIGO) patients who received and did not receive dose-dense chemotherapy, it was found that disease- free survival in the group with NACT was higher compared to the group without NACT (p = 0.03, the log-rank criterion).Conclusions. The use of dose-dense NACT is an effective treatment mode for patients with IB2-IIB CC (FIGO), which in most cases allows achieving a tumor response with subsequent improvement in immediate and long-term results and can be considered as an alternative to standard treatment for locally advanced CC.

Comparative evaluation of bone defect substitution in revision knee arthroplasty

Objective: to evaluate the immediate and long-term outcomes of revision knee replacement using porous metaphysical sleeves and cones. Material and methods. The research involved 134 patients who underwent revision arthroplasty of their knee joints. The patients were divided into two groups according to the type of metaphyseal fixator: sleeves (Group 1) — 97 patients, and cones (Group 2) — 37 patients. The evaluation of the surgical outcomes was carried out at discharge from the hospital (in 7-12 days) as well as 6, 12, and 24 months after their surgeries. The survival rate of the implants was analyzed by the Kaplan — Meyer method. A revision with total replacement of the implant or its components was considered to be a critical event. Results. The analysis of the survival rate of the implants using various metaphysical fixators showed that the groups with metaphyseal sleeves and cones do not differ statistically (Log Rank criterion (Mantel — Cox) p=0.108). Conclusion. The medium term follow-up revealed no difference in clinical, functional or radiological outcomes of revision knee arthroplasty using porous cones or metaphyseal sleeves in 2A, 2B, and 3 (by Anderson Orthopaedic Research Institute classification) bone loss replacements.

Predictors of clinical outcomes for the treatment of complex intracranial aneurysms in the anterior circulation: a prospective randomised study; SCAT

Background. Large and giant aneurysms (> 10 mm and >25 mm, respectively), wide-necked (dome / neck ratio > 1.5) and fusiform examples are challenging for both endovascular and microsurgical intervention. Currently, there is a lack of a universal approach in treating complex anterior circulatory aneurysms. Due to high morbidity and mortality rates and the absence of a common strategy, predictor analysis may have diagnostic relevance.Aim. We sought to identify predictors of unfavourable neurological outcomes for the treatment of complex intracranial aneurysms.Methods. The investigation of complex intracranial aneurysms (SCAT, NCT03269942) is a prospective randomised multicentre study. Unifactorial and multifactorial analyses of clinical outcomes were performed to identify predictors. According to our study protocol, we included 110 patients admitted to Meshalkin National Medical Research Center and the Federal Neurosurgical Center (Novosibirsk, Russian Federation) from March 2015 to June 2018, who met eligibility criteria (age > 75 years, neck size > 4 mm and dome/neck ratio <1.5). Depending on the procedure, patients were divided into two groups using sealed envelope randomisation: 1) endovascular flow diversion (55 patients) and 2) microsurgical revascularisation (55 patients). Unfavourable outcomes were thought to be neurological deterioration with two or more mRS (modified Rankin scale) scores or ≥ mRS 4 decline.Results. Data analysis revealed significatly favourable outcomes in 94.5 % of the endovascular group, and 76.4 % of the microsurgical group at 12 months follow-up (p = 0.001). Morbidity and mortality rates were 5.5 and 1.8 % for the endovascular group, and 25.4 and 3.6 % for the microsurgical group, respectively. Log-rank criteria did not reveal any differences in mortality (p = 0.32). The overall complication rates were 29.1 % for the endovascular group, and 5.4 % for the microsurgical group (p = 0.001). We identified a significant difference in the frequency of ischaemic complications (p = 0.004), but haemorrhagic complication rates were similar (p = 0.297). Unifactorial analysis revealed predictors of unfavourable clinical outcomes: gender (male, ОR = 2.475, 95% CI: 1.005–6.094, p = 0.049), microsurgical intervention (OR = 5.618, 95% CI: 1.635–19.302, p = 0.006), giant aneurysm size (OR = 3.1, 95% CI: 1.22–7.88, p = 0,017), and temporary occlusion for > 40 min (OR = 3.016, 95% CI: 1.13–8.04, p = 0.028). Giant aneurysm size is 6.1 times more increase the probability of unfavorable outcomes according multifactorial analysis.Conclusion. In spite of a high complete occlusion rate after microsurgical treatment with revascularisation, endovascular flow diversion demonstrated better clinical outcomes at short-term follow-up (12 months). Giant aneurysm size was a predictor of both ischaemic and haemorrhagic complications, with an approximate six-fold rise in unfavourable clinical outcomes. Other predictors included the microsurgical intervention itself, especially with increased temporary occlusion for > 40 min, and the male gender. Received 12 May 2020. Revised 11 November 2020. Accepted 12 November 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: K.Yu. Orlov, A.V. DubovoyData collection and analysis: R.S. KiselevStatistical analysis: R.S. KiselevDrafting the article: R.S. KiselevCritical revision of the article: D.S. Kislitsin, A.V. Gorbatykh, A.V. Dubovoy, K.Yu. Orlov, V.V. Berestov, K.S. OvsyannikovFinal approval of the version to be published: R.S. Kiselev, A.V. Dubovoy, D.S. Kislitsin, A.V. Gorbatykh, K.S. Ovsyannikov, V.V. Berestov, K.Yu. Orlov

Association between a Deficit Accumulation Frailty Index and Mobility Outcomes in Older Adults: Secondary Analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study.

Frailty is a geriatric syndrome represented by susceptibility to precipitating health events and reduced functional reserve. Frailty can be difficult to measure in clinical practice and research. One approach to approximate frailty is based on a deficit accumulation approach, which assesses a larger number of less specific measures such as the presence of comorbidities, physical or cognitive assessments, and lab tests, and summarizes these as a frailty index. The objective of this study was to develop such an index using the Lifestyle Interventions and Independence for Elders (LIFE) Study and evaluate the validity of the frailty measure derived based on baseline information via its association with the primary outcomes of the trial, namely major mobility disability (MMD) and persistent MMD (pMMD). Further, this study aimed to evaluate the effectiveness of the physical activity intervention among participants based on their baseline frailty score. Subjects in the LIFE Study were evaluated at baseline for demographics, clinical history, and a battery of physical and cognitive functioning assessments. In total, 75 possible deficits were scored either as present (yes/no) or based on each score’s quintiles for score-based assessments. The frailty index was measured as the total sum of deficits divided by the total number of possible deficits on a continuous scale between 0 and 100 (i.e., percent of deficits present). The frailty index was further divided into quintiles for comparison. A proportional hazards model was estimated for the MMD outcome controlling for other baseline information. A data driven approach was also used to determine relevant cut-offs in the frailty index where the trial intervention appeared to be modified. Among 1635 trial participants, the mean frailty index was 30.4 ± 6.6 and normally distributed. Over 2.5 years of average follow-up, 14.6%, 16.5%, 18.6%, 22.6%, and 27.6% of participants experienced MMD in quintiles 1–5, respectively. Each 1-unit increase in the frailty index increased the hazard of MMD by 4% (2–5%), and there was a nearly 2-fold increase in MMD between the highest and lowest frailty quintiles. Using log-rank criteria, a cut-point at the median was identified. Further, iterations tested for a frailty cut-off and indicated a subgroup beyond the 85th percentile wherein the physical activity intervention appeared to be no longer be effective. This internally derived deficit accumulation frailty index was uniquely able to identify individuals at higher risk of MMD and pMMD and showed that along the spectrum of frailty, the physical activity intervention remained effective for the majority of participants.

Thrombotic and hemorrhagic complications in atrial fibrillation patients, undergoing elective percutaneous coronary intervention

To evaluate efficacy and safety of reduced dose of direct oral anticoagulants (DOACs) as part of triple antithrombotic therapy in AF patients, undergoing elective percutaneous coronary intervention (PCI), and to identify factors, associated with this strategy. The study is a cohort analysis of AF patients with AF, who successfully underwent elective PCI and assigned DOACs as part of triple antithrombotic therapy (TAT).Influence of a reduced DOACs dose as a part of TAT on the frequency of thecomposite efficacy endpoint (acute coronary syndrome, ischemic stroke, venous thromboembolic events, cardiovascular death and angina pectoris aggravation/need for unplanned PCI) and safety endpoint (hemorrhagic complications BARC types 2-5) were assessed using the Log-Rank criterion. The study included 124 pts (69.4% women, mean aged 69±8.2 years). Themedian total score CHA2DS2-VASc was 5, the median of the Charlson index composed 7. Half (52%) of AF patients with high risk of thrombotic events after elective PCI received reduced-DOACs dose. Median follow up period was 11.0 month. 17 adverse thrombotic events were recorded during this period, BARC 2-5 bleedings occurred in 27 patients. Reduced DOACs doses in AF patients undergoing PCI were associated with significant increase of thrombotic events during follow up period compared to patients received full DOACs doses (0.79 vs 0.93, Log-Rank p=0.0292). Patients, who received full and reduced DOAC doses, were comparable in the frequency of BARC 2-5 bleedings (0.78 vs 0.75, Log-Rank p=0.06742). The administration of a reduced DOACs dose as a part of TAT in patients with AF, who underwent PCI, was associated with significant increase in the incidence of all thrombotic events, compared to patients, who received full dose of anticoagulants. The number of hemorrhagic complications was comparable.

PROGNOSTIC VALUE OF COGNITIVE TESTS AND THEIR COMBINATION IN PATIENTS WITH CHRONIC HEART FAILURE AND REDUCED LEFT VENTRICULAR EJECTION FRACTION

Impaired cognitive function (CF) is common among patients with CHF and is an additional factor impairing the quality of life, adherence to treatment, and hence the clinical prognosis in this category of patients. The aim of this work was to study the prognostic significance of individual cognitive tests, as well as their combination in patients with CHF with a reduced left ventricular ejection fraction (LV EF). Materials and methods. The study was conducted in the Department of Heart Failure of National Scientific Center "M.D. Strazhesko Institute of Cardiology" National Academy of Medical Sciences of Ukraine, in the period from 01/01/2016 to 04/27/2018. A total of 124 patients with CHF between the ages of 18 and 75 years, II-IV functional classes by NYHA were examined. The cognitive function was assessed using the Schulte test, Mini-Mental State Examination scale (MMSE); HADS scale. Cognitive dysfunction (CD) was considered as MMSE ≤26 points. To construct the survival curves and the onset of the combined critical event (death or hospitalization), the Kaplan – Meier method was used, the significance of the differences between the curves was determined using the log-rank criterion. Differences were considered statistically significant at p <0.05. Results. The MMSE scale was highly informative regarding the prediction of survival and the onset of a combined critical event (death or hospitalization) in patients with CHF and reduced LVEF even after correction of the compared groups by age and functional class according to NYHA (p=0.025 and p=0.049, respectively). Using the same sample, Schulte showed low prognostic significance regarding survival and reliable informativeness regarding the onset of the combined critical event, which, however, was leveled after correcting the compared samples by age and functional class NYHA (p=0.798 and p=0.240, respectively). The inclusion in the prognostic algorithm of estimating the sum of points on the HADS depression scale allowed increasing the degree of reliability of differences between the compared groups of patients with CD and without CD in terms of both long-term survival and the onset of a combined critical event (death or hospitalization) (p=0.006 and p=0.001 respectively). Conclusions. The MMSE scale is informative regarding the prediction of survival and the onset of a combined critical event in patients with CHF and reduced LVEF. Schulte's test does not have the prognostic information indicated above, however, the inclusion in the algorithm of the sum of points on the HADS depression scale allows to increase the degree of statistical confidence in the compared groups.

Proton pump inhibitors receiving and prognosis of patients after scheduled percutaneous coronary interventions.

The urgency of the study is determined by the lack of data necessary in order to assess the safety of prolonged use of proton pump inhibitors (PPI) in patients with IHD combined with anti-aggregant therapy. The aim of the study was to study the relationship between the use of PPI and the risk of thrombotic complications in patients undergoing planned procedures of percutaneous coronary interventions (PCI) and receiving dual antiplatelet therapy. The study is a prospective register of patients who successfully underwent planned percutaneous coronary intervention (PCI). The effect of PPI (omeprazole and pantoprazole) on the frequency of the combined end point cardiovascular death, ACS, AI, TIA, peripheral arterial thrombosis and PE was assessed using the Log-Rank criterion, as well as in a multivariate analysis (Cox proportional risk regression model). A total of 391 patients were included in the study (23.1% women, mean age 61.2 years ± 10.4 years). The median duration of follow-up was 18 months. During this period of time, 34 adverse events were recorded. Log-Rank analysis showed that the proportion of patients without adverse events in the omeprazole group was significantly lower in comparison with patients who did not receive PPI (0.56 vs. 0.84, Log-Rank p=0.003), and for pantoprazole no such pattern was found (0.89 against 0.84, Log-Rank p=0.21). The average level of residual platelet reactivity (ORT), as well as the number of patients with high ORT (> 208 PRU), did not differ significantly between the groups of omeprazole, pantoprazole and the group of patients not receiving PPI. According to multivariate analysis, omeprazole was an independent predictor of thrombotic complications after a planned PCI (OR 3.75, 95% confidence interval 1.72-8.17, p=----0.0009). Long-term use of omeprazole (at least 30 days) is an independent predictor of thrombotic complications in patients who underwent planned PCI.

EXPRESSION OF CANCER-TESTIS GENES PRAME, NY-ESO1, GAGE1, MAGE A3, MAGE A6, MAGE A12, SSX1, SLLP1, PASD1 IN PATIENTS WITH MULTIPLE MYELOMA, THEIR INFLUENCE ON OVERALL SURVIVAL AND RELAPSE RATE

Objective:to study the prognostic significance of the expression of cancer-testis (CT) genes PRAME, NY-ESO1, GAGE1, MAGE A3, MAGE A6, MAGE A12, SSX1, SLLP1, PASD1 in patients with multiple myeloma (MM) and their influence on overall survival and relapse rate. To determine their effect on suсh clinical parameters as levels of lactate dehydrogenase, leucocytes, hemoglobin, calcium, albumen, creatinine, beta-2-microglobulin.Materials and methods.Real-time polymerase chain reaction was performed on complementary DNA obtained from bone marrow of 77 patients with MM. The statistical analysis was performed using the Statistica 10.0 software package. To estimate prognostic values of the CT gene expression data were analyzed by the Kaplan – Meier method.Results.The study was conducted to determine the level of expression of CT genes PRAME, NY-ESO1, GAGE1, MAGE A3, MAGE A6, MAGE A12, SSX1, SLLP1, PASD1 in a group of patients with MM. The group included primary and receiving cancer treatment in MM patients. According to the log-rank criterion expression of any of the CT genes PRAME, NY-ESO1, GAGE1, MAGE A3, MAGE A6, MAGE A12, SSX1, SLLP1, PASD1 exerts a significant influence on overall survival and progression-free survival/relapse. It was also determined that providing expression of some CT genes, the levels of creatinine, calcium, beta-2-microglobulin were much higher to compare with patients without expression.