Peculiarities of morphological changes in estimation of efficacyof neoadjuvant targeted therapy in patients, suffering localizedrenal–cell cancer
Objective. To determine the peculiarities ofmorphological changes under the influence of neoadjuvant targeted therapy (TTH) in patients, suffering localized renal-cell cancer (RCC).
Маterials and methods. The investigation was performed in 58 patients, suffering localized RCC, in whom two blocks of neoadjuvant TTH were conducted for determination of objective answer on treatment accomplished with further operative intervention and pathomorphological investigation.
Results. Median index of tumoral regression (М ± SD) after conduction of ТТH have constituted (20.5 ± 14.3)% (95% confidence interval - CІ 16 - 24.3). Estimation of tumoral regression in accordance to RECIST 1.1 have witnessed, that stabilization was registered in 44 (75.9%) patients, and partial regression - in 14 (24.1%). Сomplete regression or progression of the process was not observed in any patient. Median index of regression while presence of the Degree II process, in accordance to Furman method, have constituted (22.6 ± 14.4)% (95% CІ 18.3 - 26.9); Degree III in accordance to Furman method - (17.1 ± 11.7) (95% CІ 7.3 - 26.9); and the Degree IV in accordance to Furman method - (3.8 ± 2.9)% (95% CІ -1 - 8,5); estimation in accordance to ANOVA method: η2=0.13; power=0.72; p < 0.05. Median index of tumoral necrosis under the impact of ТТH is trustworthily higher in patients with partial regression. Correlation dependence of the vascular changes severity and viable part of tumoral tissue from degree of the RCC regression was not revealed.
Conclusion. Tumoral regression by (20.5 ± 14.3)% at average have occurred under the impact of neoadjuvant TTH in patients, suffering localized RCC. Low index of the RCC regression in patients, having histopathological nuclear Degree IV in accordance to Furman method have constituted (3.8 ± 2.9)%, what witnessed low TTH efficacy (estimation in accordance to ANOVA method: η2 = 0.13; power = 0.72; p < 0.05), and may be applied as a prognostic marker of answer.
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