Number№82 (4) 2020

SYSTEMIC CONNECTIVE TISSUE DISEASES AS A MANIFESTATIONS OF PARANEOPLASTIC SYNDROME IN PATIENTS WITH LUNG CANCER

Synyachenko O.V., Yermolaieva M.V., Stepko P.A., Verzilov S.M., Liventsova K.V.

Summary. Relevance. The risk of developing malignant neoplasms increases in the presence of inflammatory autoimmune rheumatic diseases. Comorbid diseases such as manifestations of paraneoplastic syndrome (PNPS) affect the course of lung cancer (LС) and reduce the survival rates of patients. The purpose and objectives of the research: to determine the frequency, clinical signs and risk factors of rheumatological PNPS in LC, to establish the nature of the interaction of both pathological processes. Material and methods. 1669 LC patients aged 24 to 87 years (average 59 years) were under observation, among which the small-cell histological variant of the disease was diagnosed in 18% of cases, and non-small-cell — in 82%. The ratio of IB, IIA, IIB, IIIA, IIIB, IV stages of the disease was 1:2:6:58:43:57. The average integral staging of the tumor process was 6 r.u., and its severity — 3 r.u. The incidence of comorbid rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, Sjögren’s disease, dermatopolymiositis and immunoglobulin-G4-associated disease (as manifestations of PNPS) correlated with 8:7:4:3:2:1. Results. The relationships between the development of LC and comorbid systemic autoimmune diseases of the connective tissue were proved, the frequency of occurrence of such PNPS, the clinical signs of its course (skin-joint-muscle manifestations, visceritis) and the relationship with the background tumor process (seve­rity of neoplasm, the nature of germination in neighboring organs and metastasis, apical localization, small-cell and non-small-cell histological variants) were determined, the differences of clinical and laboratory signs of «tumor» variants of rheumatic disease and «primary» (idiopathic), the negative impact of PNPS on the survival of patients with RL, the dependence of the occurrence of PNPS on the chemotherapy drugs usage (antimetabolites, periwinkle’s alkaloids, anthracyclines) and the deve­lopment of complications of therapeutic measures (pulmonary hypertension, cerebrovascular accident, radiation pneumofibrosis, jaundice, thrombophlebitis). Conclusion. Further study of rheumatologic PNPS in LC will improve the quality of early diagnosis of both groups of diseases, develop prognostic criteria and increase the effectiveness of individual combined medical technology for treating patients.

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