OVARIAN CANCER TREATMENT OPTIMIZATION: THE COMPLEX ANALYSIS OF THE RESULTS OF CYTOREDUCTIVE SURGERY, MICROSCOPIC MALIGNANCY AND T-LYMPHOCYTIC INFILTRATION OF THE TUMOR

The paper discusses 64 cases of ovarian cancer (observed in 2016-2019). Patients underwent cytoreductive surgery. Both Shimizu/Silverberg system and the "Two-tier" system were used to grade the tumor differentiation of serous carcinomas. The grade of the differentiation was specified by expression of oncoprotein p53. The tumor infiltrating lymphocytes (TILs) labeled with immunohistochemical markers - CD2, CD3, CD4, CD8 - were evaluated for the intensity of expression in both - the ovarian tumor parenchyma and stroma. Quantitative assessment of expression was performed by a computer program ImageJ. The survival of patients with ovarian cancer was examined by using the Kaplan-Meier curves and calculations of Cox Hazard Ratio (HR). Multiple regression analyses of factors influencing surgical intervention was performed by a logarithmic regression method. According to the obtained data, the carcinogenesis of high-grade and low-grade serous ovarian carcinoma is different: low-grade forms are always preceded by serous cystadenoma and/or serous cystadenofibroma, which progresses to borderline serous carcinomas and then to low-grade invasive carcinoma; high-grade serous carcinomas are not developed from the progression of low-grade invasive carcinomas and are the product of the de novo formation. p53 may be used as an additional molecular-biological feature for specifying the grade of microscopic malignancy of the tumor in the cases, when the moderate differentiation is established by Shimizu/Silverberg system. The antineoplastic and/or prognostic role of the tumor-infiltrating T lymphocytes is not fully evident and needs further investigation. High-grade (G3) of ovarian carcinoma and the neoadjuvant chemotherapy are the factors having a significant impact in defining the effectiveness of the surgical treatment of ovarian cancer.