Aim of this work is to review the current literature on the study and evaluation of surgical complications after reconstructive plastic surgery in patients with breast cancer.

   The search for relevant sources was carried out in PubMed, Cochrane Library, E-library systems, publications from 2013 to 2022 were studied, 38 of which were used to write this review. There is no doubt that the development of complications during reconstructive plastic surgery can affect the quality of life of patients, despite attempts to eliminate them. Therefore, a more detailed study of the nature, causes, and ways to eliminate complications will allow oncologists and plastic surgeons to correctly assess the disadvantages and advantages of various methods of surgical treatment of breast cancer, and, accordingly, to conduct a personalized approach when choosing the volume of surgical treatment. Based on the analyzed world and domestic literature, it was found that the choice of breast reconstruction technique should be determined separately for each clinical case. The risks, advantages and disadvantages of each technique must be taken into account and considered for each individual clinical situation.

   The generally accepted standard in early breast cancer surgery today is breast-conserving surgery with external beam radiation therapy, which is comparable in results to previously widely performed radical mastectomy and even has an advantage in terms of overall survival and control. Until now, there are areas of discussion and a number of questions remain related to the methodology of irradiation of patients with breast cancer, namely: is it advisable to irradiate the axillary zone after radical resection for early breast cancer? Does irradiation of axillary lymph nodes provide regional control comparable to lymphadenectomy, and whether it can be an alternative to lymph node dissection? Whether provides an irradiation of axillary lymph nodes comparable with regional lymph node dissection the control over patients with a positive sentry lymph node? A lot of studies have been published so far, answers to questions derived from what we present in this work.

   Many patients with various localizations of malignant neoplasms require therapy aimed at preventing or reducing the manifestations of nausea and vomiting induced by anticancer pharmacotherapy. New drugs to prevent the development of complications of chemotherapy are critical to improve the quality of life of patients and their adherence to therapy. Palonosetron, a new generation 5-HT3 receptor antagonist, has a long half-life (up to 40 hours) and a 30-fold higher affinity for 5-HT3 receptors compared to previous generations of 5-HT3 receptor antagonists. Clinical studies have shown the ability of palonosetron in combination with dexamethasone and, if indicated, neurokinin antagonists to effectively prevent the development of nausea and vomiting during single- and multi-day cycles of chemotherapy for both solid tumors and hematological diseases, including high-dose chemotherapy, in preparation for transplantation of auto- and allogeneic stem cells. The innovative oral drug Akynzeo is currently available for use in clinical practice, which includes 2 highly selective NK1 and 5-HT3 receptor antagonists in fixed doses. The drug prevents induced nausea and vomiting during moderate and highly emetogenic chemotherapy in more than 90 % of cases, both in the acute and delayed phases.

   Background. Breast cancer (BC) is the leading cancer in the world and in Russia. Epidemiological factors predicting breast cancer survival in Russia have not been studied enough.

   Aim. To evaluate the factors predicting survival in BC by the data of the Arkhangelsk Regional Cancer Registry in 2000–2020 and the survival during the COVID-19 pandemic

   Materials and methods. Data on all cases of Вс for 2000–2020 retrieved from the Arkhangelsk Regional Cancer Registry database. Cancer-specific survival was estimated using the Kaplan–Meier and the life tables method. The prognostic value of variables available in Arkhangelsk Regional Cancer Registry was assessed in Cox regression.

   Results. The final analysis included 9,089 cases of breast cancer. During the observation period, 2723 deaths from breast cancer were registered. The one-, five- and ten-year survival rates in the entire population were 91.6 %, 73.0 % and 64.0 %, respectively. In a multivariate analysis, the risk of death from BC increased by 2.9, 8.2, 21.3 and 6.8 at 2, 3, 4 and unknown stages; 2.1 times with the localization of the tumor in the area of the nipple and areola; by 33 % in ductal cancer compared with lobular cancer, by 1.8 and 2.6 times in those who received palliative treatment and did not receive treatment; by 33 % in women aged 80 years and older; by 22 % for those living in rural areas. In the period 2013–2019, the 5-year cancer-specific survival reached 79.1 %, which is 14 % and 6 % higher than in the periods 2000–2006 and 2007–2012. Survival rates have not declined during the COVID-19 pandemic.

   Conclusion. The risk of death from BC is increased in advanced stages, ductal morphology, localization in the nipple-areolar region, age over 80 years, and living in rural areas. During the COVID-19 pandemic BC survival did not worsen, but this requires further study.

   Background. BRCA-associated triple negative breast cancer (TNBC) is considered one of the most aggressive subtypes of breast cancer with high sensitivity to chemotherapy, which leads to increased interest in finding new treatment options for patients with this subtype of breast cancer.

   Aim. To determine the role of adding a platinum drug to standard systemic neoadjuvant therapy (NAC) for patients with primary BRCA-associated TNBC with clinical stage T1–3N0–3M0, and to evaluate the effect of platinum-based drugs on recurrence-free survival in patients of this category.

   Materials and methods. The study included 75 patients diagnosed with primary BRCA-associated TNBC. They were divided into 2 groups depending on the NAC provided, and then they were subdivided depending on the completion of the course of ongoing NAC, the final pathomorphological result and the presence of recurrence.

   Results. Group I included 48 (64 %) patients who received the AC–T regimen; in group II (n = 27 (36 %)) patients received NAC according to the AC–TCarb regimen. Patients of group II showed a higher frequency of achieving pathological complete response (pCR) compared with patients of group I (73.7 % versus 41.2 %, respectively, p = 0.0433). Taking into account the NAC regimens being carried out, patients of group I had a slightly higher risk of recurrence compared to patients of group II (p = 0.099).

   Conclusion. In patients with primary BRCA-associated TNBC, the addition of platinum compounds to the systemic NAC resulted in achieving of pCR in 73.7 % cases compared with 41.2 % pCR after the standard anthracycline-taxane NAC, which entails a reduced risk recurrence in this category of patients. Performing a full course of planned NAC has a positive trend in achieving pCR in patients of this category.

   Aim. To increase the efficacy of systemic breast cancer therapy and reduce inappropriate prescriptions using individual immunohistochemical tumor characteristics, as well as to develop prognostic scales to ensure a tailored approach to adjuvant systemic treatment in breast cancer patients.

   Materials and methods. We conducted a comprehensive study that included collection of literature data on clinical, pathomorphological, prognostic, and predictive factors of breast cancer, as well as a retrospective cohort study using the data from the cancer registry. We also performed histological and immunohistochemical examination of tumor tissue samples from breast cancer patients (for the retrospective cohort study) and statistical data analysis. A total of 1,216 patients with T1–2N0M0 breast cancer were included in this study. Histological and immunohistochemical examinations of tissue samples (paraffin blocks) were conducted in the laboratory of N. N. Petrov National Medical Research Center of Oncology. We stained slides for both routinely used markers (including estrogen receptors, progesterone receptors, HER2, and Ki-67) and other markers (CK14, FOXA1, FOXP3, PD-L1, P53, SMA, androgen receptors, E-cadherin, CD4, CD8, CK5 / 6, EGFR).
We analyzed risk factors for lethal outcomes in patients from this group to develop prognostic scales and compared their results.

   Results. We evaluated the most clinically and statistically significant factors affecting mortality. Using logistic regression, we chose 10 factors that had the greatest impact on the outcomes and then produced several scales, including
a 10-point regression scale (based on 10 most significant factors identified). Survival analysis in high-risk and low-risk patients using the regression scale demonstrated significant differences between these groups (р <0.00001). The assessment of adjuvant chemotherapy efficacy in the combined group of intermediate- and high-risk patients (as estimated by the regression model) showed that intermediate- and high-risk patients receiving adjuvant chemotherapy had significant differences in their survival (р = 0.0057). The regression scale for 10-year prognosis demonstrated sufficient sensitivity (58.05 %), specificity (69.47 %) and ef fectiveness (63.76 %).

   Conclusion. Our regression prognostic scale includes markers with a high prognostic value. The multifactorial approach used in the developed regression scale for breast cancer 10-year prognosis increases its accuracy and reliability.

   Background. Breast cancer is one of the most common female malignancies. Molecular diagnostic methods of tumor profiling allow us to analyze individual tumor characteristics, identify new prognostic and predictive markers.

   Aim. To increase the efficacy of systemic therapy for breast cancer and reduce inappropriate prescriptions using the data on individual molecular tumor characteristics; to develop a polygenic panel to ensure a tailored approach to systemic therapy for breast cancer.

   Materials and methods. We analyzed 84 tumor tissue samples from pre- and postmenopausal women with metastatic breast cancer who were treated and followed-up in 6 healthcare institutions. We assessed expression of genes involved in breast cancer. In a pilot study, we analyzed archived paraffin-embedded tumor specimens form 12 out of 1,216 patients with T1–2N0M0 breast cancer included into retrospective analysis. Gene expression was assessed using the nCounter technology based on direct digital detection of targets using fluorescent barcodes (nCounter Analysis System; NanoString Technologies, USA). Tumor tissue (biopsy and surgical specimens) was analyzed. The choice of genes was based on the literature data and experience in the development of other polygenic panels, as well as clinical significance of markers of prognostic scales. Gene mutations were confirmed by next generation sequencing and reverse transcription-polymerase chain reaction.

   Results. We analyzed the expression of 28 genes with a high predictive value that have been substantially studied (including ESR1, PGR, PIK3CA, BCAR4, BCAS2, CCND1, CCND2, CCND3, FOXA1, Erb2, EGFR, CDH3, FOXC1, KRT14, KRT5, CD274, CDK4, CDK6, P53, PTEN, BRCA1, BRCA2, CHEK2, CLDN3, CLDN7, AR, TOP2a, TUBBIII). We identified 29 cases of discrepancy (29 / 84; 34.5 %) in tumor subtype, including 11 cases of luminal A and B breast cancer, which might potentially affect the choice of the treatment regimen. In 18 cases, there were some principal discrepancies in the tumor subtype that implied totally different treatment regimens. The proposed polygenic signature allows accurate identification of the tumor subtype in patients with metastatic breast cancer and choice of an optimal treatment strategy.

   Conclusion. We have developed a 100-gene signature including molecular subtypes of breast cancer (luminal A, luminal B, basal, claudin-like) and treatment-oriented clusters. Molecular tumor profiling using this polygenic signature is an accurate method for determining tumor subtype in patients with breast cancer, which enables a tailored approach to therapy.

   Aim. To conduct an analysis of the incidence of breast cancer in the Krasnoyarsk Territory for 2012–2021 and calculate the medium-term forecast of indicators until 2030.

   Materials and methods. An analysis of the incidence of breast cancer in the Krasnoyarsk Territory was performed using the Microsoft Office Excel 2021 program. A calculation was made of “rough” indicators of oncological incidence of breast cancer, calculated per 100,000 population of the corresponding sex and age. Forecasting the incidence of breast cancer was carried out among the population of residents of Krasnoyarsk and the Krasnoyarsk Territory (excluding the city of Krasnoyarsk), of the following type: y = b + ax, where y is the predicted incidence of lung cancer; х is the serial number of the year of observation, starting from the initial reference point (2012); b is a constant; a is a coefficient reflecting the average change in y with an increase in x by one unit; and the approximation coefficients R2 were also determined.

   Results and conclusion. The incidence of breast cancer during the study period increased both in the regions of the Krasnoyarsk Territory and in the city of Krasnoyarsk by 21.36 % and 19.05 %, respectively. Age-specific analysis of the incidence of breast cancer in the female population showed that the incidence in Krasnoyarsk in the age group of 20–24 years showed the maximum increase, the maximum decrease in incidence was observed in the age group of 25–29 years. In the regions of the Krasnoyarsk Territory, the maximum increase in this indicator is observed in the age group of 40–44 years, and the maximum decrease in the age group of 30–34 years. The share of early detection among the working-age population is higher in the regions of the Krasnoyarsk Territory and amounts to 4.7 % over a 10-year period. The share of early detection among the working-age population is higher in the regions of the Krasnoyarsk Territory and amounts to 4.7 % over a 10-year period. The proportion of early detection among women of the disabled population is higher in Krasnoyarsk, but there is a decrease of 0.97 %. According to prognostic estimates, by 2030 the incidence of breast cancer will increase by 1.2 times in the regions of the Krasnoyarsk Territory and in the city of Krasnoyarsk. The largest increase in the incidence is predicted in the female population of the city of Krasnoyarsk – by 1.24 times compared to 2021 and by 47.8 % compared to 2012. To overcome the growth, it is necessary to introduce new technologies and methods for early diagnosis and monitoring the effectiveness of anticancer therapy.

   Many patients with different malignancies require analgesic therapy not only at advanced stages of the disease, but also during their diagnosis and treatment, as well as after treatment completion to ensure pain relief. New highly effective painkillers with a lower adverse event burden are critical to improve the quality of life of cancer patients with chronic pain syndrome. Tafalgin (tyrosyl-arginyl-phenylalanyl-glycinamide) is a highly specific μ1-opioid receptor agonist. It is an innovative Russian drug for subcutaneous administration, which has no analogues abroad. This article discusses the results of phase I–III clinical trials assessing tafalgin efficacy, safety, and potential to improve patients’ quality of life.

   Background. More than 80 % of cases ovarian cancer are detected at stage III–IV. One of the most important predictive factors is the cytoreductive surgery without residual tumor.

   Aim. To determine the selection criteria for cytoreductive surgery in the advanced ovarian cancer patients.

   Materials and methods. The study included 190 primary IIB–IV stage ovarian cancer patients who underwent surgical treatment in the oncogynecological department of the N. N. Petrov NMRC on Oncology in the period from August 2017 to August 2020. All patients underwent pelvic magnetic resonance imaging, chest and abdominal computed tomography, and diagnostic laparoscopy. Assessment of the peritoneal carcinomatosis index (PCI) was performed according to P. Sugarbaker. The outcome of cytoreductive surgery was determined by the size of the residual tumor: complete – without a macroscopically detectable tumor, optimal – residual tumor ≤1 cm, suboptimal – residual tumor ≥1 cm.

   Results. The complete or optimal cytoreduction achieved in 72.6 % of cases (48.9 % (93 / 190) and 23.7 % (45 / 190), respectively), suboptimal in 22 % (42 / 190) of cases, 5 % (10 / 190) only a diagnostic laparoscopy due to the initial underestimation of the tumor dissemination. In the entire sample PCI value ranged from 0 to 35 points, the median was 4 points (2; 11). In the group of optimal cytoreductions PCI ranged from 0 to 19 points, median – 3 points (2; 6), in the group of suboptimal from 5 to 35 points, median – 19.5 points (15; 23) (p < 0.0001, Mann–Whitney test). No optimal cytoreduction was performed in PCI >20 points. The optimal cut-off PCI point was 9.5 points (sensitivity 92.1 %, specificity 86.2 %, overall accuracy 87.4 %), if PCI ≤ 9 points – the operation will be hypothetically optimal, if PCI ≥ 10 then hypothetically suboptimal. The main cause of non-optimal interventions (n = 52) were: diffuse carcinomatosis of the small bowel and its mesentery – 73 % (38 / 52), carcinomatosis of the hepatoduodenal zone – 9 % (5 / 52) and a total of 16 % (9 / 52) were other non-resectable tumors (paraaortal, intrathoracic lymph nodes, invasion of the pancreas or pleura, lung metastases). Radiation diagnostic and intraoperative revision were comparable in 60.5 % (115 / 190) of cases. The sensitivity of radiological diagnostic methods in detecting of the small intestine lesions was 23.7 %, the specificity was 90 %, while for laparoscopic diagnostics, the sensitivity in detecting of the small intestine lesions was 93.3 %, and the specificity was 100 %. In assessing of carcinomatosis of the hepatoduodenal zone, the advantage belongs to radiation diagnostic methods: the sensitivity of computed tomography was 66.7 %, the specificity was 97 %, while the sensitivity of diagnostic laparoscopy was 0 %.

   Conclusions. Determination of a high score in assessing the index of peritoneal carcinomatosis, detection of damage to the hepatoduodenal zone, diagnosed mainly by radiation imaging methods, detection of diffuse lesions of the small intestine, determined mainly by laparoscopic diagnosis reduces the frequency of suboptimal cytoreductive operations from 67 % to 13 %.

   Background. Information on the incidence of cervical intraepithelial neoplasia (CIN) is relevant for planning and evaluating the effectiveness of medical care at the stage of secondary prevention of cervical cancer.

   Aim. To analyze the incidence of CIN and benign diseases of the cervix: erosion and ectropion, leukoplakia, polyp, according to medical organizations in Yekaterinburg in 2013–2019.

   Materials and methods. A descriptive epidemiological study of the incidence of cervical pathology in the population of women in Yekaterinburg in 2013–2019 was conducted. The forms of Federal Statistical Observation No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”, in terms of erosion and ectropion, and data from the city’s women’s consultations on the number of cases of CIN, leukoplakia and cervical polyp were examined. Information on the number of female population of the city from Sverdlovskstat was used.

   Results. The primary incidence of CIN increased throughout the follow-up period. The indicator increased by 1.7 times compared to 2013 (p < 0.001) in 2016, it had a maximum value in 2019 – 215.5 per 100 thousand women and was 3.2 times more than in 2013 (p < 0.001). The dynamics of the primary incidence of other types of cervical pathology: ectropion, leukoplakia and cervical polyp, was characterized by the absence of significant changes (p > 0.05) in 2013–2019. The increase in the overall incidence of CIN was registered from 2014 to 2019 in comparison with 2013 (p < 0.001). The indicator of the overall incidence of CIN in 2019 was 2.1 times higher than in 2013 (p < 0.001).

   Conclusions. The growth of primary and total incidence of CIN in the population of Yekaterinburg women noted since the beginning of the XXI century continued in 2013–2019. The primary incidence rate of CIN had the maximum value in 2019. The increase in the incidence of CIN is associated with the natural spread of the disease, accessibility and improvement in the quality of medical care.

   Background. The age-standardized cervical cancer incidence rate in the Tomsk region in 2021 was consistently higher than the average for the Russian Federation (21.2 / 100,000 versus 13.6 / 100,000 women). Primary prevention of cervical cancer is best achieved by human papillomavirus (HPV) vaccination of girls.

   Aim. To evaluate HPV vaccine efficacy for the prevention of cervical cancer in the Tomsk region within the framework of implementation of two regional programs: “Prevention of gynecological cancer and rehabilitation of women diagnosed with gynecological cancer in 2008–2010” and “Urgent measures to improve cancer care for the population of the Tomsk region in 2011–2013”.

   Material and methods. We studied the tolerability and efficacy of HPV vaccination for the prevention of HPV-associated cervical cancer in 439 vaccinated girls aged 9–26 years during a follow-up time of 14-years.

   Results. The assessment of a 14-year follow-up study of the impact of HPV vaccination on HPV-associated cervical lesions has shown that HPV vaccine is safe and 100 % effective.

   Conclusion. Further prospects for primary prevention of cervical cancer before the introduction of vaccines against HPV infection in the national immunization schedule indicates the feasibility and real clinical effectiveness of the introduction of regional and regional programs with the development of a mathematical model for optimizing financial costs for primary prevention of cervical cancer, taking into account demographic parameters and socio-economic damage from cervical cancer in the study area.

   Background. Infection caused by human immunodeficiency virus (HIV) is a slowly developing anthroponosis with a long course and a variety of clinical manifestations, which finally results in acquired immunodeficiency syndrome (AIDS). Over the past 4 decades, the HIV / AIDS pandemic has been considered as one of the world’s most serious public health problems. Globally, there were approximately 38 million people living with HIV in 2022; 53 % of them were women. The number of HIV-infected patients living in Russia reaches 1,168,000. The incidence and prevalence of HIV infection
varies across different regions of Russia. High prevalence of cervical cancer usually correlates with HIV prevalence, which is associated with the long-term and aggressive persistence of human papillomavirus (HPV) in HIV patients. HIV co-infection is believed to be the main risk factor for HPV-related precancerous lesions to the cervical epithelium and their rapid progression to invasive cancer.

   Aim. To analyze risk factors for poor prognosis in HIV-infected patients with HPV.

   Materials and methods. This study included 15 HIV-infected patients with cervical cancer treated in Novosibirsk Regional Clinical Oncology Dispensary or Federal Research and Clinical Center for Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of Russia between 2016 and 2021.

   Results. Median age of the patients was 38 years; all of them were HPV-positive. Their viral load was >400 copies / mL and baseline CD4+ cell count ≥350 cells / mL. All patients were diagnosed with AIDS, given the presence of HPV infection. During the therapy for cervical cancer, patients also received combination antiretroviral treatment, including Lamivudine Advanced at a dose of 300 mg / day. Ten patients received comprehensive treatment, while 8 patients received chemoradiotherapy.

   Conclusion. Given the more aggressive course of cervical cancer in HIV-infected patients, their treatment plan should be developed by a multidisciplinary team, including an infectious disease specialist, clinical pharmacologist, radiotherapist, and gynecological oncologist. Such patients should receive maximal antitumor treatment, as well as intensive antiretroviral therapy. HIV-positive women with cervical cancer require special attention to ensure treatment completion and to optimize long-term outcomes.

   Malignant neoplasms of the pelvic organs and abdominal cavity are often associated with peritoneal gliomatosis (PG). Detection of PG and its differentiation from carcinomatosis and other changes in the tissue using ultrasound, magnetic resonance imaging, computed tomography is extremely limited. Questions of the pathogenesis of PG, its influence on the course of the main tumor process, as well as the relationship with indicators of overall and relapse-free survival remain debatable. We believe that the description of the PG encountered in practice is extremely relevant in the aspect of considering the possibility of the presence of such a pathology in the tumor process and the inclusion of PG in the differential diagnostic series in the diagnosis of changes in the omentum and peritoneum of the small pelvis and abdominal cavity using various methods (ultrasound, magnetic resonance imaging, intraoperative urgent histological examination).

   We report a case of mucinous breast cancer with metastases in the skull in a patient with endometr ial cancer in anamnesis. We decided to demonstrate this clinical case because of the complexity of the differential diagnosis between mucinous breast cancer and benign breast tumor.