Yakovlev P. Peculiarities of diagnostics and surgical treatment of patients with urothelial cartinoma of upper urinary tract

The dissertation is devoted to the study of peculiarities of clinical course, diagnostic work up and surgical treatment of patients with urothelial carcinoma of upper urinary tract, in particular, the effect of different surgical approaches on cancer specific survival and recurrence free survival, development of factors of negative prognosis, development of the method of the marker diagnostics of micrometastases of urothelial carcinoma to the regional lymph nodes. The work is based on the analysis of the treatment results of 124 patients with renal pelvis and ureteral cancer.It was established that clinical course of ureteral carcinoma is worse than course of renal pelvis cancer in terms of recurrence-free and cancer specific survival. It was determined that radical nephruretherectomy with bladder cuff resection or segmental resection of the ureter contribute the most to the best results of recurrence-free survival in comparison to nephrectomy alone or resection of synchronous tumors of the urinary bladder in case of non-manifestant tumors in the upper urinary tract.). Individual negative prognosis factors for patients with renal pelvis carcinoma and ureteral carcinoma have been determined, and correlation coefficients for time-to-survival have been calculated. It was proven that serum oncomarker CA-125 is a valuable tool for preoperative determination of the risk of regional metastases of urothelial carcinoma, which could be helpful in planning neoadjuvant chemotherapy. Reference level of CA-125, sensitivity, specificity and predictive value of this marker test have been calculated.