ÍÀÖIÎÍÀËÜÍÎÃÎ IÍÑÒÈÒÓÒÓ ÎÍÊÎËÎÃI¯ ÑØÀ Ç ÌÅÒÎÞ IÍÒÅÃÐÀËÜÍί ÎÖIÍÊÈ ÐÅÇÓËÜÒÀÒIÂ

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ÍÀÖIÎÍÀËÜÍÎÃÎ IÍÑÒÈÒÓÒÓ ÎÍÊÎËÎÃI¯ ÑØÀ Ç ÌÅÒÎÞ IÍÒÅÃÐÀËÜÍί ÎÖIÍÊÈ ÐÅÇÓËÜÒÀÒIÂ

ÌÎÄÈÔIÊÎÂÀÍί ÅÍÄÎÑÊÎÏI×Íί

ÐÀÄÈÊÀËÜÍί ÏÐÎÑÒÀÒÅÊÒÎÌI¯ Ó ÕÂÎÐÈÕ

ÍÀ ËÎÊÀËIÇÎÂÀÍÈÉ ÐÀÊ ÏÅÐÅÄÌIÕÓÐÎÂί ÇÀËÎÇÈ Â ÓÌÎÂÀÕ ÄÅÐÆÀÂÍί ÓÑÒÀÍÎÂÈ

«IÍÑÒÈÒÓÒ ÓÐÎËÎÃI¯ ÍÀÌÍ ÓÊÐÀ¯ÍÈ»

Ñ. Î. Âîç³àíîâ, Ñ. Ì. Øàìðàºâ, À. Ì. Ëåîíåíêî ÄÓ «Iíñòèòóò óðîëî㳿 ÍÀÌÍ Óêðà¿íè»

Âñòóï. Àêòóàëüí³ñòü ðîçðîáêè íîâèõ òà ïî- äàëüøîãî âäîñêîíàëåííÿ âæå ³ñíóþ÷èõ ïðèí- öèï³â îö³íêè ðåçóëüòàò³â ðàäèêàëüíî¿ ïðîñòàò- åêòî쳿 (ÐÏ) íå âèêëèêຠæîäíèõ ñóìí³â³â.

Òàêà ñèòóàö³ÿ çóìîâëåíà íåîáõ³äí³ñòþ âðàõóâàí- íÿ íå ëèøå äîñÿãíåííÿ àáî íåäîñÿãíåííÿ ðàäè- êàëüíîñò³ â³äíîñíî ë³êâ³äàö³¿ îñåðåäêó íåîïëàñ- òè÷íîãî ïðîöåñó (ùî ó êàòåãî𳿠õâîðèõ íà ëî- êàë³çîâàíèé ðàê ïåðåäì³õóðîâî¿ çàëîçè [ÐÏÇ]

áóëî ³ çàëèøàºòüñÿ ïåðøî÷åðãîâèì çàâäàííÿì õ³ðóðã³÷íîãî ë³êóâàííÿ), à é çáåðåæåííÿ åðåê- òèëüíî¿ ôóíêö³¿ òà ñòàòóñó êîíòèíåíòíîñò³. Çà- ãàëüíîâ³äîìèì º òå, ùî ñàìå äâ³ îñòàíí³ ñêëà- äîâ³ çíà÷èìî âïëèâàþòü íà ÿê³ñòü æèòòÿ ïðî- îïåðîâàíèõ ïàö³ºíò³â, ïðè öüîìó íàÿâí³ñòü âè- ðàæåíîãî íåòðèìàííÿ ñå÷³ (ÍÑ) ôàêòè÷íî ³íâà- ë³äèçóº õâîðîãî. Âàð³àíòíà æ ñóêóïí³ñòü ð³çíèõ êîìá³íàö³é îíêîëîã³÷íèõ òà ôóíêö³îíàëüíèõ ðå- çóëüòàò³â ÐÏ ïîòðåáóº çðîçóì³ëîãî, ëàêîí³÷íî- ãî òà óí³ô³êîâàíîãî ñâîãî ïðåäñòàâëåííÿ.

Ó ðîë³ îäíîãî ³ç íàéá³ëüø ïåðñïåêòèâ- íèõ ñïîñîá³â âèð³øåííÿ ö³º¿ ïðîáëåìè ìè âáà÷àºìî ñàìå ³íòåãðàëüíèé ï³äõ³ä äî îö³íêè ðåçóëüòàò³â ÐÏ.

Çà ôîíäàö³¿ òà ãðàíäîâî¿ ï³äòðèìêè Íà- ö³îíàëüíîãî ³íñòèòóòó îíêîëî㳿 ÑØÀ êîëåê- òèâîì àâòîð³â ï³ä êåð³âíèöòâîì J. W. Saranchuk áóëî ðîçðîáëåíî îðèã³íàëüíó êîíöåïö³þ ñòàí³â õâîðîãî ï³ñëÿ ÐÏ [1], ÿêà áàçóºòüñÿ íà ðåêóð- ñèâíîìó çàñòîñóâàíí³ îäíîì³ñÿ÷íèõ öèêë³â Ìàð- êîâà (Markov cycles) [2]. Ðàí³øå ìè ïðîâîäèëè îö³íêó ðåçóëüòàò³â ìîäèô³êîâàíî¿ ÐÏ ³ç çàñòî- ñóâàííÿì òàêèõ ³íòåãðàëüíèõ êîìá³íàö³é åôåê- òèâíîñò³ (²ÊÅ) ÿê òðèôåêòà, ïåíòàôåêòà ³ êëà- ñèô³êàö³ÿ âèæèâàííÿ, óòðèìàííÿ ñå÷³ òà ïîòåíö³¿

(Survival, Continence and Potency ñlassification [SCP]) çà V. Ficarra et al. [3, 4].

Ìåòà äîñë³äæåííÿ: îö³íêà åôåêòèâíîñò³ åíäîñêîï³÷íî¿ ÐÏ ç âèêîíàííÿì ðîçðîáëåíîãî òà àïðîáîâàíîãî â óìîâàõ ÄÓ «²íñòèòóò óðîëî㳿

ÍÀÌÍ Óêðà¿íè» ñïîñîáó ôîðìóâàííÿ âåçèêî- óðåòðàëüíîãî àíàñòîìîçó (ÂÓÀ) øëÿõîì çàñòî- ñóâàííÿ ñàìå êîíöåïö³¿ ñòàí³â Íàö³îíàëüíîãî

³íñòèòóòó îíêîëî㳿 ÑØÀ.

Ìàòåð³àëè òà ìåòîäè äîñë³äæåííÿ. Îö³- íþâàíà êîãîðòà âêëþ÷àëà 34 ïàö³ºíò³â, ÿê³ ïå- ðåíåñëè óäîñêîíàëåíó îðèã³íàëüíèì ñïîñîáîì ôîðìóâàííÿ ÂÓÀ [5] åíäîñêîï³÷íó (ëàïàðîñêî- ï³÷íó àáî åíäîâ³äåîñêîï³÷íó åêñòðàïåðèòîíåàëü- íó) ÐÏ â óìîâàõ ÄÓ ²íñòèòóò óðîëî㳿 ÍÀÌÍ Óêðà¿íè ïðîòÿãîì 2015–2017 ðð. Ìåä³àíà ÷àñó ñïîñòåðåæåííÿ çà õâîðèìè ñêëàëà 45,5 (Q₁=41;

Q₃=52) ì³ñÿö³â ïðè 95% IJ â³ä 43 äî 51 ì³ñÿöÿ, ùî äîçâîëèëî óïåâíåíî çàñòîñîâóâàòè êîíöåï- ö³þ ñòàí³â Íàö³îíàëüíîãî ³íñòèòóòó îíêîëî㳿

ÑØÀ (ÊÑͲΠÑØÀ). Êëþ÷îâèìè òî÷êàìè îö³- íþâàííÿ, ÿê ³ ó ïåðâèíí³é ðîáîò³ J. W. Saranchuk et al., ìè âñòàíîâèëè òåðì³í ó 12, 24 òà 36 ì³ñ. ç ìîìåíòó âèêîíàííÿ åíäîñêîï³÷íî¿ ÐÏ êîæíîìó

³ç õâîðèõ. Çàãàëîì â ðàìêàõ ÊÑͲΠÑØÀ ïå- ðåäáà÷åíî òðè âàð³àíòè ðåçóëüòàò³â ÐÏ, ñåðåä íèõ:

– îïòèìàëüíèé ñòàí, ùî âêëþ÷ຠóòðè- ìàííÿ ñå÷³, çáåðåæåííÿ åðåêòèëüíî¿ ôóíêö³¿ òà â³äñóòí³ñòü á³îõ³ì³÷íîãî ðåöèäèâó ó ïðîîïåðî- âàíîãî õâîðîãî;

– ñóáîïòèìàëüíèé ñòàí, ÿêèé õàðàêòåðè- çóºòüñÿ ïðèñóòí³ñòþ íåòðèìàííÿ ñå÷³ òà/àáî ïîñòïðîñòàòåêòîì³÷íî¿ åðåêòèëüíî¿ äèñôóíêö³¿

çà óìîâè äîñÿãíåííÿ ðàäèêàëüíîñò³ âòðó÷àííÿ;

– ³ â òðåòþ êîãîðòó âèä³ëÿþòü âñ³õ õâîðèõ

³ç á³îõ³ì³÷íèì ðåöèäèâîì (íå çàëåæíî â³ä ñó- ïóòíüîãî ôóíêö³îíàëüíîãî ðåçóëüòàòó).

ßê ³ ó ïîïåðåäí³õ íàøèõ ðîáîòàõ, óòðèìàí- íÿ ñå÷³ âèçíà÷àëè ñóá’ºêòèâíèì, íåñòðîãèì ñïî- DOI: 10.26641/2307-5279.24.3.2020.213466

ñîáîì (äîïóñêàëîñü âèêîðèñòàííÿ ïàö³ºíòîì îäí³º¿ ñòðàõîâî¿ ïðîêëàäêè ïðîòÿãîì äîáè), à çáåðåæåííÿ åðåêòèëüíî¿ ôóíêö³¿ çà óìîâè äî- ñÿãíåííÿ õâîðèì åðåêö³¿ äîñòàòíüî¿ äëÿ ïðîâå- äåííÿ ñòàòåâîãî àêòó ó á³ëüøå í³æ ïîëîâèí³ âèïàäê³â ÿê ç, òàê ³ áåç ïðèéîìó ³íã³á³òîð³â 5 ôîñôîä³åñòåðàçè [3, 4]. Äî ìîìåíòó âèêîíàííÿ ÐÏ âñ³ ïàö³ºíòè óòðèìóâàëè ñå÷ó. Á³îõ³ì³÷íèé ðåöèäèâ âèçíà÷àëè çã³äíî ç ðåêîìåíäàö³ÿìè ªâðîïåéñüêî¿ àñîö³àö³¿ óðîëîã³â çà óìîâè ïåðå- âèùåííÿ ïðîñòàò ñïåöèô³÷íèì àíòèãåíîì çíà-

÷åííÿ ó 0,2 íã/ìë [6].

Îñîáëèâ³ñòþ ðåàë³çîâàíîãî íàìè ìåòîäî- ëîã³÷íîãî ï³äõîäó ñòàëî òå, ùî âñ³ ïàö³ºíòè äîñ- ë³äæóâàíî¿ ãðóïè ïåðåíåñëè íåíåðâîâîçáåð³ãà- þ÷ó åíäîñêîï³÷íó ÐÏ, çà âèêëþ÷åííÿì îäíîãî âèïàäêó, â ðàìêàõ ÿêîãî çàñòîñîâàíî óí³ëàòåðàëüíå íåðâîâå çáåðåæåííÿ. Òàêèé ï³äõ³ä óçãîäæóºòüñÿ

³ç ïîïåðåäí³ì äîñë³äæåííÿì, äå âèâ÷åíî ³íø³ ²ÊÅ (òðèôåêòó, ïåíòàôåêòó ³ êëàñèô³êàö³þ SCP) [7]

òà ïðîäèêòîâàíèé çáåðåæåííÿì ö³ë³ñíîñò³ äî- ñë³äæóâàíî¿ ãðóïè õâîðèõ ç ìåòîþ çàáåçïå÷åííÿ ç³ñòàâíîñò³ ³íòåãðàëüíèõ îö³íîê ðåçóëüòàòèâíîñò³ ÐÏ ³ç çàñòîñóâàííÿì ð³çíèõ ²ÊÅ íàäàë³. Òàê, ³ç ïåðâèííî¿ êîãîðòè â 34 õâîðèõ, ùî ïåðåíåñëè åíäîñêîï³÷íó ÐÏ ³ç íîâèì ñïîñîáîì ôîðìóâàí- íÿ ÂÓÀ âèêëþ÷åíî ÷îòèðüîõ, ÿê³ ìàëè âèðàæå- íó äîîïåðàö³éíó åðåêòèëüíó äèñôóíêö³þ îðãà- í³÷íîãî μåíåçó, äëÿ íèõ ðåçóëüòàò çà ÊÑͲΠÑØÀ ðîçðàõóâàòè òåõí³÷íî íåìîæëèâî (÷åðåç ñòðîãèé ë³ì³òóþ÷èé åôåêò ôàêòîðà), ÿê ³ òðè- ôåêòó ç ïåíòàôåêòîþ ÐÏ, ùî çíàéøëî ñâîº â³äîáðàæåííÿ ³ ó âèùåçãàäàí³é ðîáîò³ [7, ñ. 14].

Ñóáîïòèìàëüíèé ñòàí êîíñòàòóâàëè ó êîæ- íîãî ïàö³ºíòà îäðàçó ï³ñëÿ ÐÏ, à ùîì³ñÿöÿ õâîð³ ìîãëè ïåðåõîäèòè äî îïòèìàëüíîãî ñòàíó, çàëè- øàòèñü ó ñóáîïòèìàëüíîìó, àáî æ âèÿâëÿëè á³î- õ³ì³÷íèé ðåöèäèâ. Ïðè öüîìó, îñòàííÿ êàòåãîð³ÿ ïàö³ºíò³â âæå íå ìîãëà ïîâåðíóòèñü äî ñóáîï- òèìàëüíîãî ³ òèì á³ëüøå îïòèìàëüíîãî ñòàíó

÷åðåç íåäîñÿãíåííÿ ðàäèêàëüíîñò³ îïåðàö³¿ – òîáòî îñíîâíî¿ ¿¿ ìåòè.

Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ.  ðàìêàõ 12-ì³ñÿ÷íî¿ êîíòðîëüíî¿ òî÷êè ñïîñòåðåæåííÿ áóëè âèÿâëåí³ íàñòóïí³ îñîáëèâîñò³ ì³ãðàö³¿

ñòàí³â. ²ç ñóáîïòèìàëüíîãî ñòàíó â îïòèìàëü- íèé ïåðåéøëè 19 (63,3%) ïàö³ºíò³â (òîáòî â íèõ êîíñòàòîâàíî â³äì³ííèé ôóíêö³îíàëüíèé ðå- çóëüòàò). Çàëèøèëèñü ó ñóáîïòèìàëüíîìó ñòàí³ äåâ’ÿòü (30%) õâîðèõ, ïðè öüîìó, á³îõ³ì³÷íèé ðå- öèäèâ âèíèê ó îäíîãî (3,3%) ïàö³ºíòà ³ç ñóïóò- íüîþ ï³ñëÿîïåðàö³éíîþ åðåêòèëüíîþ äèñôóíê- ö³ºþ ³ ùå ó îäíîãî (3,3%) õâîðîãî ³ç äîáðèì ôóíêö³îíàëüíèì ðåçóëüòàòîì (ïðàêòè÷íî ïîâí³ñòþ â³äíîâèëèñü óòðèìàííÿ ñå÷³ òà åðåêö³ÿ).

Ïî äîñÿãíåííþ 24-ì³ñÿ÷íî¿ êîíòðîëüíî¿

òî÷êè ñïîñòåðåæåííÿ ³ç ñóáîïòèìàëüíîãî ñòàíó äî îïòèìàëüíîãî ïåðåéøëè ùå äâîº (6,7%) õâî- ðèõ (â íèõ â³äíîâèëàñü åðåêòèëüíà ôóíêö³ÿ), â ñóáîïòèìàëüíîìó ñòàí³ çàëèøàëîñü ñ³ì (23,3%) ïàö³ºíò³â ³ â îäíîìó (3,3%) êë³í³÷íîìó âèïàä- êó õâîðèé ç îïòèìàëüíîãî ñòàíó ïåðåéøîâ äî êîãîðòè á³îõ³ì³÷íîãî ðåöèäèâó. Òàêèì ÷èíîì,

÷åðåç äâà ðîêè ï³ñëÿ îïåðàö³¿ 20 (66,7%) ïàö³ºíò³â äîñë³äæóâàíî¿ êîãîðòè ïåðåáóâàëè â îïòèìàëüíîìó ñòàí³, à ó òðüîõ (10%) âèïàäêàõ âèíèê á³îõ³ì³÷íèé ðåöèäèâ.

Íà ìîìåíò êîíòðîëüíî¿ òî÷êè ñïîñòåðå- æåííÿ ó 36 ì³ñÿö³â ³ùå äâîº (6,7%) õâîðèõ ïå- ðåñòàëè ïåðåáóâàòè â ðàìêàõ ñóáîïòèìàëüíîãî ðåçóëüòàòó ³ ïåðåéøëè äî êîãîðòè îïòèìàëüíî- ãî ñòàíó, ÷èñåëüí³ñòü ÿêî¿ ñêëàëà 22 (73,3%) ïàö³ºíòè, à ùå ó îäíîãî (3,3%) õâîðîãî ³ç ñóá- îïòèìàëüíèì ðåçóëüòàòîì âèÿâëåíî á³îõ³ì³÷- íèé ðåöèäèâ. ×åòâåðî (13,3%) õâîðèõ çàëèøè- ëèñü ó ñóáîïòèìàëüíîìó ñòàí³: òðîº (10%) ³ç ÿêèõ ìàëè ò³ëüêè âèðàæåíó åðåêòèëüíó äèñôóíê- ö³þ ³ â îäíîìó (3,3%) âèïàäêó òàêà ïîºäíó- âàëàñü ³ç êë³í³÷íî òà ñîö³àëüíî çíà÷óùîþ ³íêîí- òèíåíö³ºþ (ç ïðèâîäó ÷îãî ïàö³ºíòó ïðîâåäåíî îïåðàòèâíó êîðåêö³þ íåòðèìàííÿ ñå÷³, ùî çà- áåçïå÷èëî éîãî çàäîâ³ëüíó ñîö³àëüíó ðåàäàïòà- ö³þ íàäàë³).

Âèùåíàâåäåí³ ðåçóëüòàòè ï³äñóìîâàíî â òàáë. 1.

Òàêèì ÷èíîì, ÿê âèäíî ³ç òàáë. 1, 22 (73,3%) õâîðèõ äîñÿãëè îïòèìàëüíîãî ñòàíó, à ó

÷îòèðüîõ (13,3%) êîíñòàòîâàíî ñóáîïòèìàëüíèé ôóíêö³îíàëüíèé ðåçóëüòàò çà óìîâè äîñÿãíåí- íÿ ðàäèêàëüíîñò³ ÐÏ. Ïðè öüîìó òðèð³÷íà áåç- ðåöèäèâíà âèæèâàí³ñòü ïàö³ºíò³â ó äîñë³äæó- âàí³é êîãîðò³ ñòàíîâèëà 86,7%. Çàçíà÷èìî, ùî òàêèé ðåçóëüòàò º ñï³âñòàâíèì ³ç äàíèìè ³íøèõ ñó÷àñíèõ ë³òåðàòóðíèõ äæåðåë ñòîñîâíî åôåêòèâ- íîñò³ ðàäèêàëüíîãî õ³ðóðã³÷íîãî ë³êóâàííÿ ëî- êàë³çîâàíîãî ÐÏÇ [8, 9]. Òàê, T. Van den Broeck et al. (2019) ó ñâîºìó ñèñòåìàòè÷íîìó îãëÿä³, ùî ïðèñâÿ÷åíèé âèâ÷åííþ ïðîãíîñòè÷íî¿ ö³ííîñò³ á³îõ³ì³÷íîãî ðåöèäèâó ÐÏÇ âêàçóþòü, ùî îñ- òàíí³é ìîæå âèíèêàòè ó ïðèáëèçíî 35% ïðî- ë³êîâàíèõ õâîðèõ íà ëîêàë³çîâàíèé ðàê ïåðåä- ì³õóðîâî¿ çàëîçè [8, ñ. 968]. Çàðàçîì, R. Tourinho- Barbosa et al. (2018) ó ñâî¿é ðîáîò³ îãëÿäîâî àíà- ë³òè÷íî¿ íàïðàâëåíîñò³ ïîäàþòü äàí³ ïðî 20–

40% á³îõ³ì³÷íîãî ðåöèäèâó ó õâîðèõ íà êë³í³÷íî ëîêàë³çîâàíèé ÐÏÇ ï³ñëÿ ðàäèêàëüíîãî õ³ðóðã³÷- íîãî ë³êóâàííÿ [9, ñ. 14]. Òàêèì ÷èíîì, ³íôîð- ìàö³ÿ, îòðèìàíà ³ç âèùåíàâåäåíèõ àâòîðèòåòíèõ äæåðåë, äîçâîëÿº ðîçö³íþâàòè îòðèìàíèé íàìè îíêîëîã³÷íèé ðåçóëüòàò ÿê ö³ëêîì ïðèéíÿòíèé.

Âèñíîâêè

Íà â³ò÷èçíÿí³é ñóáïîïóëÿö³¿ õâîðèõ íàìè âïåðøå àïðîáîâàíî ³ùå îäíó âàë³äèçîâàíó ³íòåã- ðàëüíó êîìá³íàö³þ åôåêòèâíîñò³, ÿêà äîçâîëÿº ëàêîí³÷íî òà ³íòó¿òèâíî çðîçóì³ëî ïðåäñòàâèòè ñóêóïí³ñòü ð³çíîïëàíîâèõ äèñêðåòíèõ ðåçóëüòàò³â ðàäèêàëüíî¿ ïðîñòàòåêòî쳿, çà ðàõóíîê ÷îãî, ç

÷àñîì, öÿ ñèñòåìà ìîæå ïðåòåíäóâàòè íà ðîëü óí³ô³êîâàíîãî îö³íî÷íîãî ³íñòðóìåíòó ïîðÿä ³ç á³ëüø â³äîìèìè òðèôåêòîþ ³ ïåíòàôåêòîþ.

Ó õîä³ òðèð³÷íîãî ñïîñòåðåæåííÿ îïòè- ìàëüíîãî ñòàíó çà êîíöåïö³ºþ ñòàí³â Íàö³îíàëü- íîãî ³íñòèòóòó îíêîëî㳿 ÑØÀ äîñÿãëè 73,3%

õâîðèõ äîñë³äæóâàíî¿ êîãîðòè, à îñíîâíîþ ïðè-

÷èíîþ êîíñòàòàö³¿ ñóáîïòèìàëüíîãî ôóíêö³î- íàëüíîãî ðåçóëüòàòó ñòàëà ï³ñëÿîïåðàö³éíà åðåê- òèëüíà äèñôóíêö³ÿ.

Óäîñêîíàëåíà åíäîñêîï³÷íà ðàäèêàëüíà ïðîñòàòåêòîì³ÿ äåìîíñòðóº ç³ñòàâíèé ³ç äàíèìè ñó÷àñíèõ ³íîçåìíèõ äæåðåë ïîêàçíèê òðèð³÷íî¿

áåçðåöèäèâíî¿ âèæèâàíîñò³ õâîðèõ íà ëîêàë³çî- âàíèé ðàê ïåðåäì³õóðîâî¿ çàëîçè. Òàêèì ÷èíîì, ðîçðîáëåíà â óìîâàõ äåðæàâíî¿ óñòàíîâè «²íñòè- òóò óðîëî㳿 ÍÀÌÍ Óêðà¿íè», òåõí³÷íà ìîäèô³- êàö³ÿ ìîæå ³ íàäàë³ øèðîêî çàñòîñîâóâàòèñü ó êë³í³÷í³é ïðàêòèö³.

Òàáëèöÿ 1 ̳ãðàö³ÿ ñòàíó ïðîîïåðîâàíèõ õâîðèõ (n=30)

Ñòàí õâîðîãî çà ÊÑͲΠÑØÀ, n (%)

×àñ, Îïòèìàëüíèé Ñóáîïòè-

Á³îõ³ì³÷íèé ðåöèäèâ

ì³ñ. ìàëüíèé *

Ñóá→→→→→Îïò Îïò↔↔↔↔↔Îïò Çàãàëîì Ñóá↔↔↔↔↔Ñóá Ñóá→→→→→ÁÐ Îïò→→→→→ÁÐ Çàãàëîì 12 19 (63,3 %) – 19(63,3 %) 9 (30 %) 1 (3,3 %) 1 (3,3 %) 2 (6,7 %) 24 2 (6,7 %) 18 (60 %) 20(66,7 %) 7 (23,3 %) 0 1 (3,3 %) 3(10 %) 36 2 (6,7 %) 20 (66,7 %) 22(73,3 %) 4(13,3 %) 1 (3,3%) 0 4(13,3 %) Ïðèì³òêè: ÊÑͲΠÑØÀ – êîíöåïö³ÿ ñòàí³â Íàö³îíàëüíîãî ³íñòèòóòó îíêîëî㳿 ÑØÀ;

Ñóá – ñóáîïòèìàëüíèé ñòàí; Îïò – îïòèìàëüíèé ñòàí; ÁÐ – á³îõ³ì³÷íèé ðåöèäèâ; ì³ñ. – ì³ñÿö³;

→

→→

→→ – ïåðåõ³ä ì³æ ñòàíàìè; ↔↔↔↔↔ – ïàö³ºíò çàëèøàºòüñÿ â ðàìêàõ ïîïåðåäíüîãî ñòàíó;

* – îêðåìèì ñòîâï÷èêîì ÷èñëî õâîðèõ íå ïðåäñòàâëÿëè ÷åðåç íåïåðåäáà÷åíó â ðàìêàõ ñèñòåìè ÊÑͲΠÑØÀ ìîæëèâ³ñòü äàóíãðåéäó õâîðîãî ³ç ñóáîïòèìàëüíîãî ñòàíó, çà âèíÿòêîì êîíñòàòàö³¿

á³îõ³ì³÷íîãî ðåöèäèâó

Ñïèñîê ë³òåðàòóðè

1. Saranchuk J. W., Kattan M. W., Elkin E. et al. Achieving optimal outcomes after radical prostatectomy.

Journal of Clinical Oncology. 2005. Vol. 23, No. 18. P. 4146–4151.

2. Sonnenberg F.A., Beck J.R. Markov models in medical decision making: a practical guide. Medical Decision Making. 1993. Vol. 13, No. 4. P. 322–338.

3. Âîç³àíîâ Ñ.Î., Øàìðàºâ Ñ.Ì., Ëåîíåíêî À.Ì. Àíàë³ç âèêîðèñòàííÿ ³íòåãðàëüíèõ êîìá³- íàö³é åôåêòèâíîñò³ ðàäèêàëüíî¿ ïðîñòàòåêòî쳿 òà îö³íþâàííÿ íîâîãî ñïîñîáó ôîðìóâàííÿ âåçè- êîóðåòðàëüíîãî àíàñòîìîçó ïðè åíäîñêîï³÷í³é ðàäèêàëüí³é ïðîñòàòåêòî쳿 ó õâîðèõ íà êë³í³÷íî ëîêàë³çîâàíèé ðàê ïåðåäì³õóðîâî¿ çàëîçè. Çäîðîâüå ìóæ÷èíû. 2017. ¹ 4. C. 16–29.

4. Âîçèàíîâ Ñ. À., Øàìðàåâ Ñ. Í., Øóëÿê À. Â., Áîéêî À. È., Ëåîíåíêî À. Í. è äð. Èíòåãðàëüíàÿ îöåíêà ðåçóëüòàòîâ ýíäîñêîïè÷åñêîé ðàäèêàëüíîé ïðîñòàòýêòîìèè ñ íîâûì ñïîñîáîì ôîðìèðîâà- íèÿ âåçèêîóðåòðàëüíîãî àíàñòîìîçà ó áîëüíûõ ëîêàëèçîâàííûì ðàêîì ïðåäñòàòåëüíîé æåëåçû:

òðèôåêòà, ïåíòàôåêòà, êëàññèôèêàöèÿ SCP. Ìåäèöèíñêèé æóðíàë Óçáåêèñòàíà. 2017. ¹ 6. Ñ. 47–53.

5. Âîç³àíîâ Ñ.Î., Øàìðàºâ Ñ.Ì., Ëåîíåíêî À.Ì. Ìîäèô³êàö³ÿ ëàïàðîñêîï³÷íî¿ òà åíäîâ³äåî- ñêîï³÷íî¿ åêñòðàïåðèòîíåàëüíî¿ ðàäèêàëüíî¿ ïðîñòàòåêòî쳿. Óðîëîã³ÿ. 2017. Ò. 21, ¹ 4. C. 37–50.

6. Heidenreich A., Bastian P.J., Bellmunt J. et al. EAU guidelines on prostate cancer. Part II:

treatment of advanced, relapsing, and castration-resistant prostate cancer. European Urology. 2014. Vol. 65, No. 2. P. 467–479.

7. Ëåîíåíêî À. Ì. Ìîäèô³êàö³ÿ åíäîñêîï³÷íî¿ ðàäèêàëüíî¿ ïðîñòàòåêòî쳿 ó õâîðèõ íà ëîêàë³çîâà- íèé ðàê ïåðåäì³õóðîâî¿ çàëîçè [àâòîðåôåðàò]. Êè¿â: ÄÓ «²íñòèòóò óðîëî㳿 ÍÀÌÍ Óêðà¿íè», 2018. 23 ñ.

8. Van den Broeck T., van den Bergh R.C.N., Arfi N. et al. Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer: a systematic review. European Urology. 2019.

Vol. 75, No. 6. P. 967–987.

9. Tourinho-Barbosa R., Srougi V., Nunes-Silva I. et al. Biochemical recurrence after radical prostatectomy: what does it mean? International braz j urol. 2018. Vol. 44, No. 1. P. 14–21.

References

1. Saranchuk, J. W., Kattan, M. W., Elkin, E., Touijer, A. K., Scardino, P. T., & Eastham, J. A. (2005).

Achieving optimal outcomes after radical prostatectomy. Journal of Clinical Oncology, 23(18), 4146–4151.

Doi: 10.1200/JCO.2005.12.922.

2. Sonnenberg, F. A., & Beck, J. R. (1993). Markov models in medical decision making: a practical guide. Medical Decision Making, 13(4), 322–338. Doi: 10.1177/0272989X9301300409.

3. Heidenreich, A., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T., ... & Mottet, N.

(2014). EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration- resistant prostate cancer. European urology, 65(2), 467–479. Doi: 10.1016/j.eururo.2013.11.002.

4. Van den Broeck, T., van den Bergh, R.C.N., Arfi, N., Gross, T., Moris, L., Briers, E., Cumberbatch, M., De Santis, M., Tilki, D., Fanti, S., Fossati, N., Gillessen, S., Grummet, J. P., Henry, A. M., Lardas, M., Liew, M., Rouvière, O., Pecanka, J., Mason, M.D., … Mottet, N. (2019). Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer: a systematic review. European Urology, 75(6), 967–987. Doi: 10.1016/j.eururo.2018.10.011.

5. Tourinho-Barbosa, R., Srougi, V., Nunes-Silva, I., Baghdadi, M., Rembeyo, G., Eiffel, S. S., Barret, E., Rozet, F., Galiano, M., Cathelineau, X., & Sanchez-Salas, R. (2018). Biochemical recurrence after radical prostatectomy: what does it mean? International Braz j Urol, 44(1), 14–21. Doi: 10.1590/s1677 5538.ibju.2016.0656.

Ðåôåðàò

Ï Ð È Ì Å Í Å Í È Å Ê Î Í Ö Å Ï Ö È È Ñ Î Ñ Ò Î ß Í È É Í À Ö È Î Í À Ë Ü Í Î Ã Î ÈÍÑÒÈÒÓÒÀ ÎÍÊÎËÎÃÈÈ ÑØÀ Ñ ÖÅËÜÞ ÈÍÒÅÃÐÀËÜÍÎÉ ÎÖÅÍÊÈ ÐÅÇÓËÜÒÀÒÎÂ Ì Î Ä È Ô È Ö È Ð Î Â À Í Í Î É ÝÍÄÎÑÊÎÏÈ×ÅÑÊÎÉ ÐÀÄÈÊÀËÜÍÎÉ Ï Ð Î Ñ Ò À Ò Ý Ê Ò Î Ì È È Ó Á Î Ë Ü Í Û Õ Ë Î Ê À Ë È Ç Î Â À Í Í Û Ì Ð À Ê Î Ì ÏÐÅÄÑÒÀÒÅËÜÍÎÉ ÆÅËÅÇÛ Â ÓÑËÎÂÈßÕ Ã Î Ñ Ó Ä À Ð Ñ Ò Â Å Í Í Î Ã Î Ó × Ð Å Æ Ä Å Í È ß

«ÈÍÑÒÈÒÓÒ ÓÐÎËÎÃÈÈ ÍÀÌÍ ÓÊÐÀÈÍÛ»

Ñ. À. Âîçèàíîâ, Ñ. Í. Øàìðàåâ, À. Í. Ëåîíåíêî

Öåëü. Ïðîâåñòè èíòåãðàëüíûé àíàëèç ýô- ôåêòèâíîñòè óñîâåðøåíñòâîâàííîé ýíäîñêîïè-

÷åñêîé ðàäèêàëüíîé ïðîñòàòýêòîìèè ïóòåì ïðè- ìåíåíèÿ êîíöåïöèè ñîñòîÿíèé Íàöèîíàëüíîãî èíñòèòóòà îíêîëîãèè ÑØÀ (ÊÑÍÈÎ ÑØÀ).

Ìàòåðèàë è ìåòîäû.  îáùåé ñëîæíîñòè 34 ïàöèåíòà ïåðåíåñëè ýíäîñêîïè÷åñêóþ ðàäè- êàëüíóþ ïðîñòàòýêòîìèþ ñ íîâûì ñïîñîáîì ôîðìèðîâàíèÿ âåçèêîóðåòðàëüíîãî àíàñòîìîçà â òå÷åíèå 2015–2017 ãã. Ìåäèàíà âðåìåíè íà- áëþäåíèÿ çà áîëüíûìè ñîñòàâèëà 45,5 ìåñÿöåâ (95% ÄÈ 43–51). Ðåçóëüòàòû îöåíèâàëè ñ ïî- ìîùüþ ÊÑÍÈÎ ÑØÀ ÷åðåç 12, 24 è 36 ìåñ. ñ ìîìåíòà îïåðàöèè. Èç-çà íàëè÷èÿ âûðàæåííîé ýðåêòèëüíîé äèñôóíêöèè äî îïåðàöèè ÷åòâåðî

Summary

IMPLEMENTATION OF THE CONCEPT O F C O N D I T I O N S O F T H E N A T I O N A L CANCER INSTITUTE OF USA FOR INTEGRAL A S S E S S M E N T O F R E S U L T S O F T H E M O D I F I E D E N D O S C O P I C R A D I C A L PROSTATECTOMY IN PATIENTS WITH LOCALIZED PROSTATE CANCER IN THE S T A T E I N S T I T U T I O N « I N S T I T U T E O F UROLOGY OF NAMS UKRAINE»

S. O. Vozianov, S. M. Shamrayev, A. M. Leonenko

The Objective of study is to investigate an integral analysis of the effectiveness of modified endoscopic radical prostatectomy by applying the concept of conditions of the National Cancer Institute of USA (CCNCI USA).

Material and methods. A total of 34 patients who had undergone endoscopic radical prostatectomy with a new method of forming a vesico-urethral anastomosis during 2015–2017. The median of follow-up time was 45.5 months (95% CI 43–51).

The results were evaluated using the CCNCI USA after 12, 24 and 36 months from the moment of operation. Due to the presence of severe erectile dysfunction before surgery, four patients were excluded from the analysis. According to the CCNCI USA, the following variants of results of radical prostatectomy are provided: optimal condition

áîëüíûõ áûëè èñêëþ÷åíû èç àíàëèçà. Ñîãëàñíî ÊÑÍÈÎ ÑØÀ ïðåäóñìîòðåíî òàêèå âàðèàíòû ðåçóëüòàòîâ ðàäèêàëüíîé ïðîñòàòýêòîìèè: îï- òèìàëüíîå ñîñòîÿíèå (óäåðæàíèå ìî÷è, ñîõðàíå- íèå ýðåêòèëüíîé ôóíêöèè è îòñóòñòâèå áèîõè- ìè÷åñêîãî ðåöèäèâà); ñóáîïòèìàëüíîå ñîñòîÿ- íèå (íåäåðæàíèå ìî÷è è/èëè ýðåêòèëüíàÿ äèñ- ôóíêöèÿ ïðè îòñóòñòâèè áèîõèìè÷åñêîãî ðåöè- äèâà); áèîõèìè÷åñêèé ðåöèäèâ.

Ðåçóëüòàòû. ×åðåç 12 ìåñÿöåâ 19 (63,3%) áîëüíûõ óæå áûëè â îïòèìàëüíîì ñîñòîÿíèè, ñóáîïòèìàëüíîì ñîñòîÿíèè îñòàâàëîñü 9 (30%) ïàöèåíòîâ, à ó 2 (6,7%) âîçíèê áèîõèìè÷åñêèé ðåöèäèâ. ×åðåç 24 ìåñÿöà 3 (10%) áîëüíûõ èìå- ëè áèîõèìè÷åñêèé ðåöèäèâ, à 20 (66,7%) è 7 (23,3%) íàõîäèëèñü â îïòèìàëüíîì è ñóáîïòè- ìàëüíîì ñîñòîÿíèÿõ ñîîòâåòñòâåííî. ×åðåç 36 ìåñÿöåâ ïîñëå ðàäèêàëüíîé ïðîñòàòýêòîìèè 22 (73,3%) áîëüíûõ áûëè â îïòèìàëüíîì ñî- ñòîÿíèè, 4 (13,3%) îñòàâàëèñü â ñóáîïòèìàëü- íîì, à òðåõëåòíÿÿ áåçðåöèäèâíàÿ âûæèâàåìîñòü ñîñòàâèëà 86,7%.

Âûâîäû.  õîäå òðåõëåòíåãî íàáëþäåíèÿ îïòèìàëüíîãî ñîñòîÿíèÿ ñîãëàñíî ÊÑÍÈÎ ÑØÀ äîñòèãëè 73,3% áîëüíûõ èññëåäóåìîé ãðóïïû, à îñíîâíîé ïðè÷èíîé êîíñòàòàöèè ñóáîïòèìàëü- íîãî ôóíêöèîíàëüíîãî ðåçóëüòàòà ñòàëà ïîñëå- îïåðàöèîííàÿ ýðåêòèëüíàÿ äèñôóíêöèÿ. Óñîâåð- øåíñòâîâàííàÿ ýíäîñêîïè÷åñêàÿ ðàäèêàëüíàÿ ïðîñòàòýêòîìèÿ äåìîíñòðèðóåò ñîïîñòàâèìûé ñ äàííûìè ñîâðåìåííûõ èíîñòðàííûõ èñòî÷íèêîâ ïîêàçàòåëü òðåõëåòíåé áåçðåöèäèâíîé âûæèâà- åìîñòè áîëüíûõ ëîêàëèçîâàííûì ðàêîì ïðåä- ñòàòåëüíîé æåëåçû, çà ñ÷åò ÷åãî äàííàÿ òåõíè-

÷åñêàÿ ìîäèôèêàöèÿ ìîæåò è â äàëüíåéøåì øèðîêî ïðèìåíÿòüñÿ â êëèíè÷åñêîé ïðàêòèêå.

Êëþ÷åâûå ñëîâà: ðàê ïðåäñòàòåëüíîé æå- ëåçû, ðàäèêàëüíàÿ ïðîñòàòýêòîìèÿ, âåçèêîóðåò- ðàëüíûé àíàñòîìîç, êîíöåïöèÿ ñîñòîÿíèé Íà- öèîíàëüíîãî èíñòèòóòà îíêîëîãèè ÑØÀ.

(continence, preservation of erectile function and biochemical recurrence free); suboptimal condition (urinary incontinence and/or erectile dysfunction with the absence of biochemical recurrence);

biochemical recurrence.

Results. There were 19 (63.3%) patients in optimal condition after 12 months, 9 (30%) patients remained in suboptimal condition, and 2 (6.7%) had biochemical recurrence. Only 3 (10%) patients had a biochemical recurrence after 24 months, and 20 (66.7%) and 7 (23.3%) were in optimal and suboptimal conditions, respectively. There were 22 (73.3%) patients in optimal condition after 36 months after radical prostatectomy, 4 (13.3%) remained in suboptimal condition, and three-year recurrence-free survival was 86.7%.

Conclusions. In sum, 73.3% of patients in the study group had been reached the optimal condition according to the CCNCI USA during the three- year follow up, and the main reason for constanting a suboptimal functional result had been postoperative erectile dysfunction. Modified endoscopic radical prostatectomy demonstrates a comparable indicator of modern foreign sources of three year recurrence- free survival of patients with localized prostate cancer, due to which this technical modification can continue to be widely used in clinical practice.

Keywords: localized prostate cancer, radical prostatectomy, vesico-urethral anastomosis, the concept of conditions of the National Cancer Institute of USA.

Àäðåñà äëÿ ëèñòóâàííÿ À.Ì. Ëåîíåíêî

E-mail: leonforworkandall@gmail.com

Íàä³éøëà 20.06.2020.

Àêöåïòîâàíà 02.09.2020.