Search

Izhodišča. Enega izmed največjih izzivov pri zdravljenju raka dojk v zgodnjem stadiju predstavlja izbor bolnic s predvidenim agresivnejšim potekom bolezni, ki potrebujejo dopolnilno sistemsko zdravljenje. O tem se odločamo na podlagi različnih napovednih dejavnikov, kot so status pazdušnih bezgavk, velikost tumorja, stopnja diferenciacije, limfovaskularna invazija, starost bolnic, status hormonskih receptorjev, status HER2, v zadnjem času pa v ta namen ponekod uporabljajo tudi urokinazni aktivator plazminogena (uPA) in inhibitor aktivatorja plazminogena 1 (PAI-1). Vloga novejših napovednih dejavnikov v primerjavi s tradicionalnimi še ni povsem razjasnjena. Namen raziskave je bil ugotoviti vpliv posameznih dejavnikov na preživetje bolnic z rakom dojk brez zasevkov v bezgavkah, zdravljenih v Univerzitetnem kliničnem centru (UKC) Maribor. Hkrati sem želela tudi primerjati preživetje bolnic, zdravljenih v UKC Maribor, s slovenskim povprečjem. Bolnice in metode. Opravila sem retrospektivno analizo bolnic z invazivnim rakom dojk brez zasevkov v bezgavkah, ki so bile primarno zdravljene v UKC Maribor v letih 2000–2009. Podatke sem pridobila iz medicinske dokumentacije in jih dopolnila s podatki iz Registra raka Republike Slovenije, od koder sem pridobila tudi podatke o vseh primerljivih slovenskih bolnicah, zdravljenih v istem obdobju. Analizirala sem korelacije med napovednimi dejavniki in s pomočjo Coxove regresije in Coxovega modela sorazmernih tveganj opravila univariatne in multivariatne analize preživetja brez bolezni, celokupnega in specifičnega preživetja. Rezultati. Študijsko skupino je sestavljalo 858 bolnic s srednjim časom sledenja 101 mesec. Med bolnicami, zdravljenimi v UKC Maribor, in vsemi slovenskimi bolnicami ni bilo razlik v celokupnem (HR 1,07 95 % CI 0,91–1,27 p = 0,413) in specifičnem preživetju (HR 0,85 95 % CI 0,66–1,11 p = 0,234). Preživetje brez bolezni (HR 0,67 95 % CI 0,50–0,91 p = 0,010) in specifično preživetje (HR 0,53 95 % CI 0,30–0,94 p = 0,031) je bilo statistično značilno boljše v obdobju 2005–2009 v primerjavi z 2000–2004, pri celokupnem preživetju pa se je kazal enako usmerjen statistično neznačilen trend (HR 0,73 95 % CI 0,51–1,05 p = 0,087). Med napovednimi dejavniki so bile prisotne številne korelacije. V multivariatnih analizah so na preživetje brez bolezni najbolj vplivali starost ob diagnozi, vrednost uPA/PAI-1 in status estrogenskih receptorjev, na celokupno preživetje starost, stopnja diferenciacije in vrednost uPA/PAI-1, na specifično preživetje pa stopnja diferenciacije. Zaključki. Preživetje bolnic z rakom dojk brez zasevkov v bezgavkah, primarno zdravljenih v UKC Maribor v letih 2000–2009, je zelo visoko in enakovredno preživetju vseh primerljivih bolnic na ravni Slovenije. Kot najpomembnejša napovedna dejavnika sta se pri tej skupini bolnic izkazala vrednost uPA/PAI-1 in stopnja diferenciacije, ki sta klinično pomembno vplivala na preživetje brez bolezni, celokupno in specifično preživetje. Introduction. The choice of patients with an expected aggressive course of the disease who need adjuvant systemic treatment represents one of the main challenges of early stage breast cancer treatment. Prognostic factors, such as lymph node status, tumour size, grade, lymphovascular invasion, patient age, hormone receptor status, HER2 status, and more recently urokinase plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1), can be used to guide this decision. The significance of some novel prognostic factors in comparison with traditional factors is not yet completely understood. The purpose of this study was to determine the effect of different prognostic factors on survival in node-negative breast cancer patients treated in University Medical Centre Maribor. In addition, I wished to compare the survival of patients treated in Maribor with that of all Slovenian patients. Patients and methods. A retrospective analysis of lymph node-negative invasive breast cancer patients treated in University Medical Centre Maribor in the years 2000–2009 was performed. Data were obtained from patient medical records and from the Cancer Registry of Republic of Slovenia whence I also obtained information on all comparable Slovenian patients diagnosed in the same period. Correlations between different prognostic factors were analysed. Univariate and multivariate analyses of disease-free (DFS), overall (OS), and breast cancer specific survival (BCSS) were performed using the Cox regression and the Cox proportional hazards model. Results. The study group consisted of 858 patients with a median follow-up of 101 months. No differences were observed between the Maribor and Slovenian patients in terms of OS (HR 1.07 95% CI, 0.91–1.27 p=0.413) and BCSS (HR 0.85 95% CI, 0.66–1.11 p=0.234). DFS (HR 0.67 95% CI, 0.50–0.91 p=0.010) and BCSS (HR 0.53 95% CI, 0.30–0.94 p=0.031) were significantly better for patients diagnosed in the period 2005–2009 compared to 2000–2004 and a similar though unsignificant trend was observed for OS as well (HR 0.73 95% CI, 0.51–1.05 p=0.087). Many correlations existed between different prognostic factors. In multivariate analyses, DFS was particularly influenced by patient age at diagnosis, uPA/PAI-1 level and oestrogen receptor status, OS by age, grade and uPA/PAI-1 level, and BCSS by tumour grade. Conclusions. Survival of node-negative breast cancer patients treated in University Medical Centre Maribor in the period 2000–2009 was very good and not inferior to the survival of comparable patients at the national level. The most important prognostic factors in node-negative patients were uPA/PAI-1 level and tumour grade because they had a clinically important influence on DFS, OS and BCSS.

Background: The revised FIGO staging system for carcinoma of the vulva, cervix uteri, and endometrium, which had been previously revised in 1988, 1994, and 1988, respectively, was approved by the International Federation of Gynecology and Obstetrics (FIGO) in September 2008. In addition to the revisions of previously existing staging systems, a new staging system for uterine sarcomas was introduced at the same time. Conclusions: The changes mostly addressed the prognostic disproportions between certain (sub) stages that had been shown in numerous statistical analyses. Vulvar cancer staging has undergone the greatest changes. Izhodišča: Mednarodno združenje ginekologov in porodničarjev (FIGO) je septembra 2008 sprejelo novo klasifikacijo raka zunanjega spolovila (zadnja predhodna revizija 1988), raka materničnega vratu (zadnja predhodna revizija 1994), raka endometrija (zadnja predhodna revizija 1988) in materničnih sarkomov, za katere posebna klasifikacija prej ni obstajala. Zaključki: Spremembe klasifikacij so nastale predvsem na podlagi rezultatov statističnih analiz, ki so ugotavljale neprimerna razmerja v napovedih izida bolezni med nekaterimi stadiji oz. podstadiji. Najbolj se je spremenila klasifikacija raka zunanjega spolovila.

Background: The paper describes the role of urokinase-type plasminogen activator (uPA) and its inhibitor, PAI-1, in breast cancer invasion and metastasis. These two parts of fibrinolytic system were the first novel tumor biological factors to be validated at the highest level of evidence (LOE I) regarding their clinical utility in breast cancer. Conclusions: Numerous independent studies have demonstrated that breast cancer patients with low levels of uPA and PAI-1 in their primary tumor tissue have a significantly better survival than patients with high levels of either factor. uPA and PAI-1are recognized as level 1 tumor prognostic markers in early breast cancer. The methodology of determination is standardized and validated. The involvement of uPA and PAI-1 in cancer progression identifies its components as suitable targets for anti-cancer therapy. Several therapeutic approaches have been shown to be active in vitro, and are being currently tested in phase II clinical trials. The infotmation provided in this brief review aims to inform the professional public of the latest knowledge and to promote greater interest in the role of the plasminogen activator system in breast cancer. Izhodišča: Prispevek opisuje vlogo urokinaznega aktivatorja plazminogena (uPA) pri invaziji in zasevanju raka dojk. Ta dva dela fibrinolitičnega sistema sta prva novejša biološka dejavnika, katerih klinična vloga pri raku dojk je bila zanesljivo preverjena (raven dokazov I). Zaključki: Številne neodvisne raziskave so dokazale, da je pri bolnicah z rakom dojk z nizkimi vrednostmi uPA-1 v tkivu primarnega tumorja preživetje značilno daljše od preživetja bolnic s povišanimi vrednostmi enega od obeh dejavnikov. Dejavnika uPA in PAI-1 sta prepoznana kot tumorska označevalca stopnje 1 pri zgodnjem raku dojke. Metodologija določanja uPA in PAI-1 je standardizirana in validirana. Določanje uPA in PAI-1 pri ugotavljanju napredovanja raka omogoča prepoznavanje nujnih sestavin kot primernih ciljev za protitumorsko zdravljenje. In vitro so se izkazali učinkoviti različni terapevtski načini, potekajo pa že tudi klinične raziskave faze II. S tem kratkim pregledom želimo seznaniti strokovno javnost z najnovejšimi spoznanji in vzbuditi večje zanimanje o vlogi sistema aktivatorja plazminogena pri raku dojk.

Urinary incontinence is a common side effect of treatment of gybecological cancers and has an important negative effect on the patients' quality of life. It can be caused by all of the three main treatment methods in gynecological oncology, namely by surgical procedures, radiation and chemotherapy. Urinary incontinence can result from the treatment of all kinds of gynecological cancers; its incidence primarily depends on the form of treatment. The basic principle of treatment of urinary incontinence is removal of its causes, which can be done by several conservative or operative methods. After treatment of gynecological cancers, doctors should be aware of the possibility of urinary inconntinence and should actively ask the patients about this kind of symptoms. Early diagnosis and correct treatment of urinary incontinence can significantly improve the quality of life in gynecological oncological patients. Uhajanje seča je pogost neželeni učinek zdravljenja ginekoloških rakov, ki ima pomemben negativen vpliv na kakovost življenja bolnic. Povzročijo ga lahko vsi trije osnovni načini zdravljenja v ginekološki onkologiji (kirurški posegi, obsevanje in zdravljenje s citostatiki). Do uhajanja seča lahko pride po zdravljenju vseh ginekoloških rakov, pogostnost pojavljanja te težave pa je odvisna predvsem od oblike zdravljenja. Po zdravljenju ginekoloških rakov moramo bolnice ciljano vprašati po uhajanju seča. Pri zdravljenju uhajanja seča skušamo odpraviti vzroke zanj, pri čemer so nam na voljo številne konzervativne in operativne metode. S pravočasnim odkrivanjem in ustreznim zdravljenjem uhajanja seča lahko bistveno izboljšamo kakovost življenja ginekoloških onkoloških bolnic.

Background. Adolescence is a critical time for bone mineral acquisition and isas such the crucial period for the prevention of osteoporosis. The purpose of the study was to find whether adolescents' calcium intake in Celje region is high enough to attain peak bone mass. Methods. 2Z 7 pupils attending primary school and 434 students attending secondary school participated in an anonymous survey regarding their calcium intake. The acquired data were statistically analysed. Results. Only 77 (11.8%) among 651 teenagers had an optimal daily intake of calcium (>= 1300 mg). The average calcium intake was 828.9 mg per day. The average daily calcium intake for girls was 777.6 mg and for boys 910.0 mg. Calcium intake decreased with the age of the adolescents. The lowest calcium intake was found in those adolescents who were concerned that drinking milk would make them fat. Conclusions. Because of adolescents' sub-optimal intake of calcium there is a probability that osteoporosis will break out in the future. To avoid that, it would be necessary to start inexpensive education programs aimed at teenagers about the importance of the prevention of osteoporosis in adolescence. Izhodišča. Za preprečevanje osteoporoze je ključnega pomena obdobje do 20. leta, ko se v kostnino vgradi največji del kalcijevih soli. V raziskavi smo želeli ugotoviti, ali je dnevni vnos kalcija med mladimi na Celjskem zadosten za doseganje največje kostne mase. Metode. Med 217 osnovnošolci in 434 srednješolci smo izvedli anonimno anketo, v kateri smo spraševali po vnosu kalcija. Pridob jene podatke smo statistično analizirali. Rezultati. Med 651 anketiranci jih je samo 77 (11,8%) dnevno užilo dovolj kalcija (več kot 1300 mg). Povprečni dnevni vnos kalcija je bil 828,9 mg nižji pri dekletih (777,6 mg) kot pri fantih (910,0 mg), in je s starostjo padal. Najnižji vnos kalcija so imeli tisti najstniki, ki so bili prepričani, da mlečni izdelki redijo. Zaključki. Več kot 88% mladostnikov je imelo prenizek dnevni vnos kalcija, zato obstaja velika verjetnost, da se bo pri njih v prihodnosti pojavila osteoporoza. To bi lahko z nizkimi stroški preprečili s pravočasnim izobraževanjem mladih o ključnem pomenu preprečevanja osteoporoze v najstniških letih.