Комбінована низькодозова естроген-антиандрогенна терапія прогресуючого раку передміхурової залози: Автореф. дис… канд. мед. наук / Т.Ю. Арістова, АМ

AEAAeAIIss IAAeE*IEO IAOE OE?A?IE

?INOEOOO O?IEIAI? OA IAO?IEIAI?

A?INOIAA Oaoyia TH?i?aia

OAeE 616.36-004-06-089

EIIAIIIAAIA IECUeEIAeICIAA ANO?IAAI-AIOEAIAe?IAAIIA OA?AIIss
I?IA?ANOTH*IAI ?AEO IA?AAeIIOO?IAI? CAEICE

14.01.06 — o?ieiaiy

Aaoi?aoa?ao aeena?oaoei?

ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

EE?A — 1998

Aeena?oaoei?th ? ?oeiien.

?iaioa aeeiiaia a Iinoeoooi o?ieiai? oa iao?ieiai? AII Oe?a?ie (i.
Ee?a).

Iaoeiai ea?iaieee aeieoi? iaaee/ieo iaoe, i?ioani?

Eeeiaiei Iaai Ieaenaiae?iae/

caaiaeoaa/ aiaeaeieo iieio?ieiai?

Iinoeoooo o?ieiai? oa iao?ieiai? AII Oe?a?ie

/eai-ei?aniiiaeaio IAI i AII Oe?a?ie,

aeieoi? iaaee/ieo iaoe, i?ioani?

?aciieia Ieaenaiae? A?eai?iae/

caaiaeoaa/ a?aeae?eo aiaeie?eiieia?? ?ai?iaeoeoe?? ?

aaeaioaoe?? Iinoeoooo aiaeie?eiieiai? oa iaiiio

?a/iaei ii. aeaae.A.I.Eiiina?aiea AII Oe?a?ie

Ioioeieii iiiiaioe aeieoi? iaaee/ieo iaoe, i?ioani?

Aecth?ae Aaea??e Naiaiiae/

caaiaeoaa/ eaoaae?e o?ieia??

Ee?anueei? iaaee/ii? aeaaeaii? iineyaeeieiiii?

inaioe ?i. I.E. Ooieea IIC Oe?a?ie

aeieoi? iaaee/ieo iaoe

Eo/eoeueeee ?aaai Aaneeueiae/

caaiaeoaa/ a?aeae?eo ee?i?/ii? aiae?ieia??

Iinoeoooo aiaeie?eiieiai? oa iaiiio ?a/iaei

ii. aeaae. A.I. Eiiina?aiea AII Oe?a?ie

I?iaiaeia onoaiiaa Iaeanueeee aea?aeaaiee iaaee/iee oiiaa?neoao

?i. I.?. Ie?iaiaa IIC Oe?a?ie,

eaoaae?a o?ieiai?

Caoeno aiaeaoaeaoueny “ 16 “ ethoiai 1999 ?. i 13 aiaeeii ia caniaeaiii
niaoeiaeiciaaii? a/aii? ?aaee Ae 26.615.01 Iinoeoooo o?ieiai? oa
iao?ieiai? AII Oe?a?ie (254053, i. Ee?a, aoe. TH. Eioethaeinueeiai, 9a).

C aeena?oaoei?th iiaeia iciaeiieoeny o aiaeiioaoei Iinoeoooo o?ieiai?
oa iao?ieiai? AII Oe?a?ie (254053, i. Ee?a, aoe. TH. Eioethaeinueeiai,
9a).

Aaoi?aoa?ao ?icineaiee “ 15 “ c?/iy 1999 ?.

A/aiee nae?aoa?

niaoeiaeiciaaii? a/aii? ?aaee

aeieoi? iaaee/ieo iaoe AIEEI I.?.

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeueiinoue oaie. ?ae ia?aaeiioo?iai? caeice (?IC) ? iaeaieueo
iioe?aiei caoai?thaaiiyi /ieiaieia iioeeiai oa noa?a/iai aieo, a
i?ioyaii inoaiiueiai aeanyoe?i//y i?iyaey? noieeo oaiaeaioeith aei
caieueoaiiy caoai?thaaiinoi. O aieueoinoi e?a?i naioo oa a Oe?a?ii ?IC
iaieia? ae?oaa iinoea na?aae iieio?ieiai/ieo caoai?thaaiue. O ca’yceo ic
c?inoaiiyi caoai?thaaiinoi ?IC ? aieiaiith i?e/eiith nia?oi /ieiaieia
iioeeiai aieo (I.O. Aiciaiia, 1993, 1994, 1996; E.I. Iaaeiaa, I.I.
Naeaeaeiaa, 1995; I.E. Oiainueeee, 1997; H.B. Carter, D.?. Coffey,
1990).

O ca’yceo c aacneiioiiiei eeiii/iei ia?aaiaii ?IC o ii/aoeiaeo
noaaeiyo, 70-80% oai?eo caa?oathoueny ca iaaee/iith aeiiiiiaith o III-IV
noaaei? caoai?thaaiiy, eiee ?acoeueoaoe eieoaaiiy oa i?iaiic cia/ii
ai?oi. ?aaeeeaeueia oi?o?ai/ia ao?o/aiiy iiaea aooe aeeiiaia eeoa o 10%
oai?eo. Iiiaae 80% oai?eo ? ai?iiicaeaaeieie oa iiceoeaii ?aaaothoue ia
eieoaaiiy ano?iaaiieie i?aia?aoaie i/aai eano?aoeith. Nooo?aei
iaaeieieii iiiiano?iaaioa?aii? ? iaiaoiaeiinoue i?ecia/aiiy aenieeo aeic
i?aia?aoia, ui ni?e/eiy? aeieeiaiiy oyaeeeo ea?aeii-aaneoey?ieo oa
aaiaoioiene/ieo oneeaaeiaiue. Aeeiiaiiy i?oiaeoiii? iaiaaeaia /a?ac
iaaaoeaia noaaeaiiy aieueoinoi iaoei?ioia aei oei?? iia?aoei?.
I’yoe?i/ia aeaeeaaiiy i?e ?iciianthaeaeaiiio i?ioeani neeaaea? aiae 30
aei 45% (I.I. O?aiacieeia, 1990). Oaeei /eiii, ?acoeueoaoe eieoaaiiy
oai?eo ia ?IC caeeoathoueny iacaaeiaieueieie, a iiaeaeueoee iiooe
iaoiaeia i noai eieoaaiiy o?eaa?.

O oaia?ioiie /an iniaeeaiai cia/aiiy i?e eieoaaiii i?ia?anoth/iai ?IC
iaaea?oueny eiioeaioei? iiaii? aiae?iaaiii? aeieaaee. Iaeiei c iai?yieia
caeieniaiiy oei?? eiioeaioei? ? iiooe aoaeoeaieo aioeaiae?iaaiieo
i?aia?aoia c iiiiiaeueiith iiai/iith aei?th. Oea ni?eyei noai?aiith
iiaiai eeano niieo/aiue — ianoa?i?aeieo aioeaiae?iaaiia, aei yeeo
iaeaaeeoue ia?oee i ?aeeiee aio/eciyiee i?aia?ao — iiooieiae.

Aeaii aenia?eiaioaeueieo aeineiaeaeaiue iiaeoaa?aeeee aenieo
aioeaiae?iaaiio aeoeaiinoue oeueiai i?aia?aoo oa iieacaee, ui
oa?iaeieiai/iee aoaeo iiooieiaeo iiaea iineethaaoenue ia oiii
canoinoaaiiy iiiiiaeueieo aeic ano?iaaiia (I.A.Neieoeui oa niiaaao.,
1988). Iio?aao? anaai/iiai aea/aiiy eeiii/ia aoaeoeaiinoue iiaiai
i?aia?aoo o ii?iaiyiii c aiaeiieie o?aaeeoeieieie eiea?nueeeie caniaaie.
Nueiaiaeii ua ia ii?aoeueiaaiee iaoiae niieo/aiiai eieoaaiiy oai?eo ia
?IC ianoa?i?aeiei aioeaiae?iaaiii oa iaeeie aeicaie ano?iaaiia.
Iaiaoiaeii aeineiaeaeaiiy ai?iiiaeueiiai noaoono i?e aeei?enoaiii ?icieo
noai ai?iiiioa?aii?.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeena?oaoeieia
?iaioa aeeiiaia a ?aieao aaeocaai? iaoeiai? i?ia?aie AII Oe?a?ie i ?,
cie?aia, o?aaiaioii aeaio IAe? “?ic?iaea iiaeo iaoiaeia eieoaaiiy ?IC,
caniiaaieo ia ii?aeiaiii oi?o?ai/iiai ao?o/aiiy c
ai?iiiaeueii-aioeai?iiiaeueiith oa?aii?th” (? aea?ae?a?no?aoei? UA
0100449(?) oa “Ii?iaiyeueia ioeiiea aoaeoiaiinoi oa eieoaaiiy
i?ia?anoth/iai ?aeo ia?aaeiioo?iai? caeice ca aeiiiiiaith
aioeaiae?iaaiia, ano?iaaiia oa ?o ii?aeiaiiy o noaoa?aiaaoe/ieo aeicao”
(? aea?ae?a?no?aoei? 0195U008311).

Iaoa i caaea/i aeineiaeaeaiiy. Iaoith ?iaioe ? iie?auaiiy ?acoeueoaoia
eiina?aaoeaiiai eieoaaiiy oai?eo ia i?ia?anoth/ee ?IC oeyoii ?ic?iaee oa
ai?iaaaeaeaiiy o eeiii/io i?aeoeeo iaoiaaiaoe/ii ia??oioiaaiiai iiaiai
iaoiaeo iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii?, ui aaco?oueny
ia i?eioeeii iiaii? aiae?iaaiii? aeieaaee. Aieiaii caaaeaiiy
aeineiaeaeaiiy:

1.Ii?aoethaaoe oa aea/eoe eeiii/io aoaeoeaiinoue iaoiaeo ii?aeiaiiai
eieoaaiiy oai?eo ia ?IC ianoa?i?aeiei aioeaiae?iaaiii iiooieiaeii oa
iecueeeie aeicaie ano?iaaiia.

2.Aea/eoe eeiii/io aoaeoeaiinoue ia?oiai aio/eciyiiai ianoa?iiaeiiai
aioeaiae?iaaio — iiooieiaeo i?e eieoaaiii oai?eo ia ?IC.

3.Aeineiaeeoe ai?iiiaeueiee aaeain o oai?eo ia ?IC aei oa iiney
eieoaaiiy aiae?ieo?ii, iiooieiaeii, neiano?ieii oa eiiaiiiaaii?
iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii?.

4.Aecia/eoe eeiiiei-eaai?aoi?ii e?eoa?i? ioeiiee aoaeoeaiinoi
?ic?iaeaiiai iaoiaeo ai?iiiaeueii? oa?aii? oai?eo ia ?IC.

5.Aea/eoe aiaeaeaeaii ?acoeueoaoe eieoaaiiy oai?eo ia ?IC ca
?ic?iaeaiei iaoiaeii oa i?iaanoe ioeiieo eiai aoaeoeaiinoi o ii?iaiyiii
c o?aaeeoeieieie caniaaie eieoaaiiy.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoaoia. Aia?oa ?ic?iaeaia iiaa noaia
eieoaaiiy oai?eo ia ?IC — iecueeiaeiciaa ano?iaai-aioeaiae?iaaiia
oa?aiiy, caniiaaia ia canoinoaaiii ianoa?i?aeiiai aioeaiae?iaaia o
ii?aeiaiii c iaeeie aeicaie ano?iaaiia, /ei, caaaeyee ia?eoa?e/iie aei?
aioeaiae?iaaiia oa oeaio?aeueiie — ano?iaaiia, caaacia/o?oueny
aeinyaiaiiy i?aeoe/ii iiaii? aiae?iaaiii? aeieaaee oa i?aeoe/ii iiaiiai
oieeiaiiy oyaeeeo ea?aeiiaaneoey?ieo oa aaiaoioiene/ieo oneeaaeiaiue.
Io?eiaii iiai aeaii i?i aieea ?icieo aeaeia ai?iiiaeueieo oa
aioeai?iiiaeueieo i?aia?aoia oa ?o eiiaiiaoeie ia ai?iiiaeueiee noaoon
oai?eo ia ?IC. Aia?oa iaea?aeaii eieueeinii iieacieee, ui
oa?aeoa?ecothoue ai?iiiaeueiee aoaeo niieo/aiiai canoinoaaiiy iecueeeo
aeic ano?iaaiia oa ianoa?i?aeiiai aioeaiae?iaaio iiooieiaeo.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoaoia. Aea/aia eeiii/ia
aoaeoeaiinoue ai?iiiaeueii? iiiioa?aii? oai?eo ia ?IC aiae?ieo?ii,
iiooieiaeii, neiano?ieii oa eiiaiiiaaii? aiae?iaaiii? aeieaaee.
?ic?iaeaiee oa ai?iaaaeaeaiee o eeiii/io i?aeoeeo iiaee iaoiae eieoaaiiy
oai?eo ia ?IC, caniiaaiee ia ii?aeiaiii iecueeeo aeic ano?iaaiia oa
aioeaiae?iaaiia. Caaaeyee canoinoaaiith iecueeeo aeic ano?iaaiia
aaeaeiny i?aeoe/ii oieeiooe iaaaoeaiiai iiai/iiai aieeao inoaiiio ia
na?oeaai-noaeeiio nenoaio oa ia/iieo. Aianeiaeie aeeth/aiiy o noaio
eieoaaiiy ianoa?i?aeiiai aioeaiae?iaaio, iiaia aiae?iaaiia aeieaaea
iiaea aooe aeinyaiooa aac canoinoaaiiy i?oiaeoiii?. I?iaaaeaia ioeiiea
aiaeaeaeaiieo ?acoeueoaoia ai?iiiaeueii? oa?aii? oai?eo ia ?IC ?icieie
i?aia?aoaie a caeaaeiinoi aiae noaaei? iooeeiiiai i?ioeano. Aea/aiiy
ai?iiiaeueiiai noaoono aei i iiae /an i?iaaaeaiiy ai?iiiioa?aii?
aeicaieeei aeeo/eoe iieacieee, yei iiaeooue aooe aeei?enoaii ye e?eoa?i?
ioeiiee aoaeoeaiinoi eieoaaiiy. Aia?oa a i?aeoeeo eieoaaeueieo caeeaaeia
e?a?ie ai?iaaaeaeaii aoaeoeaiee aio/eciyiee i?aia?ao — ianoa?i?aeiee
“/enoee” aioeaiae?iaai iiooieiae — aieueo aeaoaaee oa aeinooiiee
ii?iaiyii c eiai iiii?oieie aiaeiaaie.

Iaea?aeaii i?e aeeiiaiii aeena?oaoeieii? ?iaioe ?acoeueoaoe
ai?iaaaeaeaii a Iinoeoooi o?ieiai? oa iao?ieiai? AII Oe?a?ie oa
Ee?anueeiio iinueeiio iieieiai/iiio oeaio?i. Aieiaii iaoeiai iieiaeaiiy
?iaioe aeei?enoiaothoueny o i?ia?aii iaa/aiiy o?ieiaia ia eo?nao
noaaeoaaiiy oa iioi?iaoei? o eeiiioei iieio?ieiai? Iinoeoooo o?ieiai? oa
iao?ieiai? AII Oe?a?ie, a oaeiae a Iinoeoooi aiaeie?eiieiai? oa iaiiio
?a/iaei ii. aeaae. A.I. Eiiina?aiea AII Oe?a?ie.

Iniaenoee aianie caeiaoaa/a. Iaeay aeena?oaoeieiie ?iaioe oa ??
iaoiaeieiai/ii iniiae cai?iiiiiaaii iaoeiaeie ea?iaieeaie, caaaeaiiy,
aaeaeaaoii iaoi, aecia/aii caeiaoaa/ai. Aiaeai?, ianoaaeaiiy oa
eieoaaiiy oai?eo ia ?IC aeeiiaii aeena?oaioii iniaenoi. Ai?iiiaeueii
aeineiaeaeaiiy o oai?eo ia ?IC i?iaaaeaii ?acii ?c niia?iaioieeaie
a?aeae?eo ?ai?iaeoeoe?? oa aaeaioaoe?? Iinoeoooo aiaeie?eiieiai? oa
iaiiio ?a/iaei ii. aeaae. A.I. Eiiina?aiea AII Oe?a?ie. Aeena?oaioii
ia??oioiaaia aeioeieueiinoue canoinoaaiiy iiaiai iaoiaeo eiiaiiiaaii?
iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii?, a oaeiae aea/aia eiai
eeiii/ia aoaeoeaiinoue o oai?eo ia ?IC. Aaoi?ii iniaenoi aoee
i?iaiaeiciaaii aaciina?aaeii oa aiaeaeaeaii ?acoeueoaoe canoinoaaiiy
?icieo ai?iiiaeueieo i?aia?aoia o oai?eo ia ?IC, aeeiiaiee noaoenoe/iee
aiaeic oa ocaaaeueiaiiy iaea?aeaieo aeaieo ia ia?niiaeueiiio eiii’thoa?i
c aeei?enoaiiyi i?eeeaaeieo i?ia?ai.

Ai?iaaoeiy ?acoeueoaoia aeena?oaoei?. Iniiaii iieiaeaiiy aeena?oaoei?
aoee aenaioeaii ia caniaeaiii iaoeiaiai oiaa?enoaa o?ieiaia i. Ee?aa oa
iaeanoi (1993), VII ieaioii o?ieiaia Oe?a?ie (Ee?a, 1993),
iaoeiai-i?aeoe/ieo eiioa?aioeiyo a Iinoeoooi o?ieiai? oa iao?ieiai? AII
Oe?a?ie (1993, 1994, 1995), iaoeiai-i?aeoe/ieo eiioa?aioeiyo iieieiaia
Oe?a?ie (AEeoiii?, 1993; Ea?/, 1993; *a?eane, 1994; Iieoaaa, 1995), I
c’?caei iieieiaia e?a?i NIAe (Iineaa, 1996), 2-e ?inienueeie iaoeiaie
eiioa?aioei? ca o/anoth e?a?i NIAe (Iaieinuee, 1997).

Ioaeieaoei?. Ca oaiith aeena?oaoei? iioaeieiaaii 11 iaoeiaeo ?iaio, a
oiio /enei 3 aeo?iaeueii noaooi o i?iaiaeieo oaoiaeo aeaeaiiyo (c ieo 1
— iaeiiiniaia) oa iiniaiee aeey eiea?ia. Iaea?aeaii iaoaio Oe?a?ie
“Niinia eieoaaiiy ?aeo ia?aaeiioo?iai? caeice”.

No?oeoo?a aeena?oaoei?. Aeena?oaoeiy neeaaea?oueny c anooio, 5
?icaeieia, na?aae yeeo iaeyae eioa?aoo?e, iien iaoa?iaeia oa iaoiaeia
aeineiaeaeaiue, aeaa ?icaeiee aeanieo aeineiaeaeaiue, aiaeic oa
ocaaaeueiaiiy io?eiaieo ?acoeueoaoia, aeniiaeia, i?aeoe/ieo
?aeiiaiaeaoeie oa nieneo aeei?enoaii? eioa?aoo?e, ui iinoeoue 170
aeaea?ae aio/eciyieo oa ca?oaiaeieo aaoi?ia. Aeena?oaoeieia ?iaioa
aeeeaaeaia ia 140 noi?iieao iaoeiiieno, i?iiethno?iaaia oaaeeoeyie,
a?aoieaie oa aeoyaaie c inoi?ie oai?ia.

INIIAIEE CIINO ?IAIOE

Iaoa?iaee oa iaoiaee aeineiaeaeaiue

A ?aaioi aeei?enoaii aiaeic ?acoeueoaoia ianoaaeaiiy oa eieoaaiiy 200
oai?eo ia ?IC aieii aiae 40 aei 85 ?ieia, yei ciaoiaeeeeny a eeiiioei
iieio?ieiai? Iinoeoooo o?ieiai? oa iao?ieiai? AII Oe?a?ie ia aaci
o?ieiai/iiai aiaeaeieaiiy Ee?anueeiai iinueeiai iieieiai/iiai oeaio?o.
Aeey caeieniaiiy ii?iaiyeueii? ioeiiee ?acoeueoaoia eieoaaiiy ca
?ic?iaeaiith oa o?aaeeoeieieie iaoiaeeeaie, ani oai?i aoee ?iciiaeieaii
ia aeai a?oie — iniiaio oa a?oio ii?iaiyiiy. A iniiaio a?oio oaieoee 54,
a a?oio ii?iaiyiiy — 146 oai?eo. ?iciiaeie oai?eo ca a?eii iaaaaeaii a
oaaeeoei 1.

Oaaeeoey 1

?iciiaeie oai?eo ia ?IC a a?oiao ca aieii

Aie Iniiaia A?oie ii?iaiyiiy Anueiai

(?ieia) a?oia

I II III aan. %

40-49 — 3 3 2 8 4

50-59 13 15 19 6 53 26,5

60-69 24 16 22 14 76 38

70-79 14 5 22 14 59 27,5

Iiiaae 80 3 1 2 2 8 4

Anueiai 54 40 68 38 200 100

Ani oai?i, ui niinoa?iaaeeny, iaea?aeoaaee ai?iiiaeueio oa?aiith, ye
aoiiiaoiaaiaoe/iee cania eieoaaiiy. Oai?i iniiaii? a?oie iaea?aeoaaee
ianoa?i?aeiee aioeaiae?iaai iiooieiae oa ano?iaaie o iecueeeo aeicao
(neiano?ie aai, a ?aci iayaiinoi iaoanoacia, — oiiaai aai oinoano?ie).

Oai?i a?oie ii?iaiyiiy aoee ?iciiaeieaii ia 3 iiaea?oie a caeaaeiinoi
aiae i?aia?aoa, yeei i?iaiaeeee eieoaaiiy. Oai?i I iiaea?oie
iaea?aeoaaee noa?i?aeiee aioeaiae?iaai aiae?ieo?, II — ianoa?i?aeiee
aioeaiae?iaai iiooieiae, III — ano?iaai o o?aaeeoeieii aenieeo aeicao.

A i?ioeani ianoaaeaiiy aoee aeei?enoaii no/anii iaoiaee aeiaaiinoeee,
yei aeicaieeee anoaiiaeoe aeiaaiic oa aecia/eoe noai i?aaiia i nenoai o
oeeo oai?eo. Anii oai?ei aoei aeeiiaii caaaeueiieeiii/ia oa eaai?aoi?ia
ianoaaeaiiy, iaeueoeaaa ?aeoaeueia aeineiaeaeaiiy, o?ain?aeoaeueio
ioieoeieio aiiinith IC c iiaeaeueoei ainoieiai/iei aeineiaeaeaiiyi aai
anii?aoeieio ioieoeith IC aeey oeeoieiai/iiai aeineiaeaeaiiy,
o?ioeioiao?iy, oeueo?acaoeiaa oa ?aioaai?aaeiieiai/ia aeineiaeaeaiiy
(iaci?ia oa aene?aoi?ia o?ia?aoiy, oeenoia?aoiy, aeineiaeaeaiiy einoie
neaeaoo oa inoainoeeioia?aoiy).

*anoi iieeeee ia na/iaeioneaiiy aiaeii/aee 101 (50,5%) oai?eo, ?ici i?e
na/iaeioneaiii — 72 (28,5%), iioiioaiiy oa iineaaeaiiy no?oieie na/i —
57 (28,5%), iai?oaeaiiy i?e na/iaeioneaiii — 32 (16%), aieue o
i?iiaaeeii — 9 (4,5%), aieue o einoeao neaeaoo — 24 (12%). Iieoo?iy
aeyaeaia o 88 (44%) oai?eo, iae?iaaiaoo?iy — o 14 (7%), iiaeaeuaiiy
oaiia?aoo?e oiea aei noaoaa?eeueieo oeeo? — o 3 (1,5%). Eiioinoac
ieaeiio eiioeiaie aianeiaeie iaoanoacoaaiiy a caeooaeiii eiioiaocee
niinoa?iaaany o 4 (2%) aeiaaeeao.

A caaaeueiiio aiaeici na/i a?eo?ioeeoo?iy aeyaeaia o 30 (15%) oai?eo,
eaeeioeeoo?iy — o 45 (22,5%). Aiaiiy a caaaeueiiio aiaeici e?iai (Hb
<110a/e) aiaeii/aeanue o 23 (11,5%) oai?eo, eaeeioeeoic >9o109/e — o 24
(12%), caieueoaiiy OIA >10ii/aiae — o 22 (11%).

Ia/ioeinoue eiioo?a IC i?e iaeueoeaaiio ?aeoaeueiiio aeineiaeaeaiii
aoea aeyaeaia o 56 (28%) oai?eo, ai?aenoinoue iiaa?oii — o 66 (33%).

Iiae /an oeueo?acaoeiaiai neaioaaiiy ie?ie ?icoe?aiiy
/aoa/ei-ieni/eiai? nenoaie c iaio aieia aecia/aeinue o 8 (4%) oai?eo,
ni?aaa — o 4 (2%),ceiaa — o 7 (3,5%). I?e oeueo?acaoeiaiio
aeineiaeaeaiii IC aaoa?iaaiiinoue oeaieie niinoa?iaaee o 126 (63%)
oai?eo, iooeeiiee aocie o eiaie /anooei — o 50 (25%) oai?eo, o i?aaie —
o 32 (16%), a na?aaeiie o 2 (1%). Iioieueo?aoeiy ia?ai?inoaoe/ii?
eeioeiaeie aoea aeyaeaia o 12 (6%) oai?eo.

?aioaaiieiai/ia aeineiaeaeaiiy aeeiiaia o 44 (22%) oai?eo. Ia
iaeyaeiaie o?ia?aii oiii eiie?aiaioia o i?iaeoei? ie?ie aecia/aeenue o 7
(3,5%) oai?eo, o i?iaeoei? na/iaiai iioo?a — o 5 (2,5%). Ia aene?aoi?ieo
o?ia?aiao oiiaieueiaiiy aeaeieueii? ooieoei? ie?ie c iaio aieia ciaeoee
o 8 (4%) oai?eo, c iaeiiai aieo — o 11 oai?eo: ni?aaa — o 4 (2%), ceiaa
o 7 (3,5%). Ia ienoiaeiie oeenoia?aii aeaoaeo iaiiaiaiiy na/iaiai iioo?a
aianeiaeie iiaaci? iooeeie IC o na/iaee iioo? aoa aeyaeaiee o 4 (2%)
oai?eo.

I?e ?aioaaiia?aoi? neaeaoo iaoanoace o einoee oaca oa o?aaoa aeyaeaii o
28 (14%) aeiaaeeao. ?aaeiiicioiiia ?aiia?aoiy aiio?aiii 131I aeeiiaia o
30 (15%) oai?eo. Oiiaieueiaiiy aene?aoi?ii? ooieoei? ie?ie aeyaeaia o 24
(12%).

C iaoith aeineiaeaeaiiy ai?iiiaeueiiai noaoono aea/aee aiino o e?iai
aiiethoa?iicoth/iai ai?iiio (EA), oanoinoa?iio (O),
aeeaiae?ioanoinoa?iio (AeAO), ano?aaeiieo (A),
oanoinoa?ii-ano?aaeiieca’ycoth/iai aeiaoeiio (OACA), iiaeaen aieueiiai
oanoinoa?iio (IAO).

Iieacieee ai?iiiaeueiiai noaoono — aecia/aee aei eieoaaiiy, a i?ioeani
ai?iiiaeueii? oa?aii? (/a?ac 3 iinyoei) oa iiney eieoaaiiy. Iaoa?iaee
i?iaaaeaieo ai?iiiaeueieo aeineiaeaeaiue aoee ii?aoeueiaaii ia
ia?niiaeueiiio eiii’thoa?i o aeaeyaei oeeo?iaeo aeaieo.

I?e ainoieiai/iiio aeineiaeaeaiii aiiinieiiai iaoa?iaeo aeyaeaii
aaeaiiea?oeeiiio IC o 96 (48%) oai?eo, ooaoeiaeueaaiey?iue ?ae — o 23
(11,5%), aaeaiiio c iaeiaiicaoei?th — o 22 (11%), iaaeeoa?aioeieiaaiee
?ae — o 18 (9%), nei?iciee ?ae — o 17 (8,5%), e?ea?iciee ?ae — o 13
(6,5%), nieiaeiio?aaaeoey?iee ?ae — o 9 (4,5%), ?ae in situ — o 2 (1%).
Ia iiaenoaai aeeiiaiiai eiiieaeniiai ianoaaeaiiy anoaiiaeaii caeeth/iee
aeiaaiic ?IC.

?iciiaeie oai?eo a a?oiao ca noaaeiyie, caiaeii c Iiaeia?iaeiith
eeaneoieaoei?th ca nenoaiith TNM (1997), i?aaenoaaeaiee a oaaeeoei 2.

Oaaeeoey 2

?iciiaeie oai?eo ia ?IC a a?oiao ca noaaeiyie caoai?thaaiiy

Noaaeiy

caoai?thaaiiy Iniiaia

a?oia A?oia ii?iaiyiiy

Iiaea?oie

I II III

T1N0M0 0 7 2 6

T2N0M0 32 19 25 12

T3N0M0 11 12 23 20

T4N0-1M0-1 11 2 18 0

Anueiai 54 40 68 38

Aeey eieoaaiiy oai?eo aeei?enoiaoaaee iiiioa?aiith noa?i?aeieie i
ianoa?i?aeieie aioeaiae?iaaiaie oa ano?iaaiaie aai eiiaiiiaaio
aiae?iaaiio aeieaaeo.

I?aaenoaaieeii noa?iiaeieo aioeaiae?iaaiia, yeee canoiniaoaaee o aeaiie
?iaioi ? aiae?ieo? (Shering, I?ia//eia), aeith/ith ?a/iaeiith yeiai ?
oeei?ioa?iia aoeaoao, iioiaeia aiae i?iaanoeiia, eiea?nueea oi?ia —
oaaeaoee aeey aioo?ioiueiai i?eeiio ii 50 ia. Aiae?ieo? i?ecia/aee ii
100 ia aeai/i ia aeiao i?ioyaii 6 iinyoeia 40 oai?ei I iiaea?oie
ii?iaiyiiy.

Aeey i?iaaaeaiiy iiiioa?aii? ianoa?iiaeiei aioeaiae?iaaiii aeei?enoaii
iiooieiae (oiii/ii-caiiuaiee ea?aienaiieiae, eiea?nueea oi?ia — oaaeaoee
aeey aioo?ioiueiai i?eeiio). I?aia?ao i?ecia/aee ii 250 ia 3 ?ace ia
aeiao i?ioyaii 6 iinyoeia 68 oai?ei II a?oie ii?iaiyiiy.

A III iiaea?oii ii?iaiyiiy 38 oai?eo iaea?aeoaaee iiiioa?aiith
ano?iaaiaie — neiano?ieii, o aeaeyaei 2% ieieiiai ?ic/eio ii 3 ie ia
aeiao i?ioyaii 3 iinyoeia.

A iniiaiie a?oii 54 oai?eo iaea?aeoaaee eiiaiiiaaio iecueeiaeiciao
ano?iaai-aioeaiae?iaaiio oa?aiith. Ianoa?i?aeiee aioeaiae?iaai iiooieiae
i?ecia/aee aioo?ioiuei ii 250 ia 3 ?ace ia aeiao o niieo/aiii c
aaaaeaiiyi 5 ia neiano?ieo (2% ieieiiai ?ic/eio 0,25ie), aeiaiaa aeica
yeiai aoea a 12 ?acia iaioa ca o?aaeeoeieio (47 oai?eo), aai
aioo?ioiueiaaiiei aaaaeaiiyi oiiaaio (oinoano?ieo) 250-300 ia ia aeiao
(7 oai?eo). I?ioyaii ia?oeo 3 iinyoeia neiano?ie aaiaeeee
aioo?ioiueii’ycaai, o ianooiii 3 iinyoei eiai i?ecia/aee noaeiiaaaeueii
o oaaeaoiaaiie oi?ii a aeaiaaeaioiie aeici. Neiano?ie i?ecia/aee oai?ei
a noaaeiyo caoai?thaaiiy O1-3N0M0, oiiaai (oinoano?ie) — oai?ei c
einoeiaeie iaoanoacaie a noaaei? O4N0-1M1.

Ioeiieo ?acoeueoaoia i aoaeoeaiinoi eieoaaiiy oa yeinoi aeeooy a aaeao
caeienithaaee o aiaeiiaiaeiinoi c oeaeith AIIC. Iiaia ?aiiniy — i?e
iaeueoeaaiio ?aeoaeueiiio /e oeueo?acaoeiaiio aeineiaeaeaiii iooeeia ia
aecia/a?oueny, ca aeaieie o?ioeioiao?i? oa noa’?eoeaieie ioeiieaie
iie?aueeiny na/iaeioneaiiy, ciaioeeenue aeico?e/ii yaeua; /anoeiaa
?aiiniy — ciaioaiiy ?icii?ia iooeeie ia 50% oa aieueoa; noaaieicaoeiy —
aeeiaiiea ?icii?ia iooeeie a iaaeao 25%; i?ia?anoaaiiy — caieueoaiiy
?icii?ia iooeeie ia 25% oa aieueoa. Ioeiiea yeinoi aeeooy: 0 aaeia —
iiaia aeoeaiinoue, iiaeeeainoue ianeoaiaoaaoe naaa oa aeeiioaaoe ?iaioo
aac iaiaaeaiue; 1 aae — iaiaaeaiiy oece/ii? aeoeaiinoi, iiaeeeainoue
aeeiioaaoe eaaeo aai neaey/o ?iaioo; 2 aaee — aiaoeaoi?iee oai?ee,
iiaeeeainoue ianeoaiaoaaoe naaa, aea iaiiaeeeainoue aeeiioaaoe ?iaioo; 3
aaee — iaiiaeeeainoue ianeoaiaoaaoe naaa, iio?aao? aeiaeyaeo, a ?aci
iaiaoiaeiinoi — ainiioaeicaoei?, iiaeeeainoue aeeiioaaoe aeiiaoith
?iaioo iaio, iiae ia 50%; 4 aaee — iaiiaeeeainoue ianeoaiaoaaoe naaa oa
aeeiioaaoe aoaeue-yeo ?iaioo.

Iniiaii ?acoeueoaoe aeineiaeaeaiue

O oai?eo I iiaea?oie ii?iaiyiiy, eieiaaieo aiae?ieo?ii, /anoeiaa
?aiiniy aeinyaiooa o 17 (42,5%) /ieiaieia, noaaieicaoeiy i?ioeano — o 19
(47,5%), i?ia?anoaaiiy caoai?thaaiiy — o 4 (10%). sseinoue aeeooy oai?eo
oei?i a?oie aoea ioeiiaia oaeei /eiii: 1 aaeo aiaeiiaiaeaa noai 16
oai?eo (40%), 2 aaeai — 20 (50%), 3 aaeai — 4 (10%). Na?aae iiai/ieo
?aaeoe?e o iaeiiai oai?iai aiaeii/aany iiii?iee aieue a aiiaano?aeueiie
aeieyioei, yeee naiinoieii ciee iiney 3-aeaiii? ia?a?ae o i?eeiii
i?aia?aoo. Cieaeaiiy iioaioei? aiaeii/aee 2 (5%) oai?eo, iiaeaeuaio
/ooeeainoue o aeieyioei nineia — 15 (37,5%). O 2 iaoei?ioia aiaeii/aii
iiii?ia iiaeaeuaiiy a?oa?iaeueiiai oeneo, eoiiaaia aiaoeaoi?iei
i?ecia/aiiyi aiiioaiceaieo caniaia. Aaaeeeo oneeaaeiaiue c aieo
na?oeaai-noaeeiii? nenoaie ia aoei a aeiaeiiio aeiaaeeo.

Aeineiaeaeaiiy ?iaiy ai?iiiia iieacaei, ui iiae /an eieoaaiiy
aiae?ieo?ii aiino O oa AeAO nooo?ai ciaioo?oueny i?ioyaii anueiai
ia?iiaeo niinoa?aaeaiiy — ?iaaiue O cieaeoaaany o 2, oa AeAO — o 2,3
?ace o ii?iaiyiii c aacaeueiei ?iaiai. Na?aaeiie aiino EA oa IAO a
oeieiio ii a?oii iaa eeoa oaiaeaioeith aei cieaeaiiy. Oei ciiie
aeinyaaee ?iaiy ai?iaiaeiinoi eeoa c o?aooaaiiyi iiaeeaiaeoaeueieo
eieeaaiue ?iaiy ai?iiio. ?iaaiue EA cieaeoaaany iiney 3 iinyoeia
eieoaaiiy oa aiaeiiaethaaany aei aeoiaeieo cia/aiue iiney 6 iinyoeia
i?eeiio aiae?ieo?o. IAO aoa cieaeaiee ia i?ioyci anueiai ia?iiaeo
niino?aaeaiiy. I?ecia/aiiy aiae?ieo?o ia aieeaaei ia ?iaaiue OACA o
ieacii oai?eo.

I?ioyaii 3 ?ieia niinoa?aaeaiiy a oeie a?oii iiia?ee 5 oai?eo: 4 — aiae
aaia?aeicaoei? i?ioeano, 1 — aiae ?aeo oeoiea.

A II a?oii ii?iaiyiiy, aea eieoaaiiy i?iaiaeeeinue iiooieiaeii,
?acoeueoaoe aoee ioeiiaii ye /anoeiaa ?aiiniy o 7 (10,3%) oai?eo, ye
noaaieicaoeiy — o 38 (55,9%) oa ye iiai?oaiiy — o 23 (33,8%).

I?e aiaeici aeaieo ai?iiiaeueieo aeineiaeaeaiue aeyaeeinue, ui iiae
aei?th iiooieiaeo iiaeaeuaiiy ?iaiy EA a ieacii oai?eo niinoa?iaaeinue
ye /a?ac 3, oae i /a?ac 6 iinyoeia, ii?iaiyii c ii/aoeiaei iieacieeii.
Aiino O iiaeaeuoaaany /a?ac 3 iinyoe? oa cieaeoaaany aei aacaeueiiai
?iaiy /a?ac 6 iinyoeia. E?ii oiai, c o?aooaaiiyi iiaeeaiaeoaeueii?
?aaeoei? iaoei?ioia ia 6-iiny/ia canoinoaaiiy iiooieiaeo, aoei
aiaeii/aii cieaeaiiy ?iaiy IAO. Oea ? iiceoeaiei iiiaioii, oiio ui aiii
iia’ycaia ic ciaioaiiyi o?aeoei? aieueiiai O, aeinooiiiai aeey oeaiei.
Aiino OACA ia ciaiooaaany i?ioyaii anueiai ia?iiaeo niinoa?aaeaiiy.

Aiaeii/aiee ia i?ioyci ia?oeo 3 iinyoeia ae?aaeaiee iiceoeaiee
eeiii/iee aoaeo eieoaaiiy iiooieiaeii iiynith?oueny aeieoaaiiyi
?aoeaioi?ia aiae?iaaiia a eeioeiao-iioaiyo. I?ioa, iiaeaeuaiiy ?iaiy O a
iiaeaeueoiio (aianeiaeie eiai iaeiie/aiiy) ? aeinoaoiii aeey noeioeyoei?
?inoo iooeeie. I?e oeueiio neiae caa?iooe iniaeeao oaaao ia oa, ui
i?ia?anoaaiiy caoai?thaaiiy aiaeii/aeinue cae/aeii o oai?eo c IV
noaaei?th i?ioeano.

Ioeiithth/e yeinoue aeeooy iaoe??io?a, ie iaea?aeaee ianooiii
?acoeueoaoe: 1 aaeo aiaeiiaiaeaa noai 20 (29,4%) oai?eo, 2 aaeai — 30
(44,1%) oai?eo, 3 aaeai — 13 (19,1%) oai?eo, 4 aaeai — 5 (7,4%) oai?eo.
O oeie a?oii ia i?ioyci 3 ?ieia iiia?ei 20 oai?eo. C ieo 15 (9 — ic
aiaeaeaeaieie iaoanoacaie, aeyaeaieie aei ii/aoeo eieoaaiiy oa 6 — ic
II-III noaaeiyie caoai?thaaiiy) iiia?ee aiae i?ia?anoaaiiy,
aaia?aeicaoei? i?ioeano oa iioieneeaoei?, 5 — aiae noiooiuei? iaoieiai?
(na?oeaai-noaeeiia oa aeeoaeueia iaaeinoaoiinoue).

Aiaeic ?acoeueoaoia eieoaaiiy a III iiaea?oii ii?iaiyiiy iieacaa, ui
/anoeiaa ?aiiniy aoea aeinyaiooa o 16 (42,1%) oai?eo, noaaieicaoeiy
noaio — o 22 (57,9%), i?ia?anoaaiiy i?ioeano ia aoei aiaeii/aia a
aeiaeiiio aeiaaeeo. A oeie a?oii niinoa?iaaeeny ianooiii oneeaaeiaiiy:
o?iiaioeaaio ieaeiio eiioeiaie — o 4 (10,5%) /ieiaieia, iioa?eo
iiiea?aeo — o 2 (5,3%), a?oa?iaeueia aiia?oaiciy o 16 (42,1%), aino?a
ii?ooaiiy iiceiaiai e?iaiiaiao o 2 (5,3%).

sse i a iiia?aaeiio a?oiao, aoea i?iaaaeaia ioeiiea yeinoi aeeooy: 1
aae aecia/aii o 6 (15,8%), 2 aaee — o 8 (21,1%), 3 aaee — o 16 (42,1%),
4 aaee — o 8 (21,1%) oai?eo.

?iaaiue EA, O, IAO ?icei ciaiooaaany ii?iaiyii c aacaeueiei /a?ac 1,5
iinyoei oa caeeoaany oaeei ia i?ioyci anueiai ia?iiaeo i?eeiio
i?aia?aoo. Aiino EA ciaiooaaany a 5 ?acia, O- a 2,3 ?ace, IAO — a 4,4
?ace. Ciaioaiiy IAO aiaeaoaaeinue aianeiaeie nooo?aiai cieaeaiiy O oa
iiaeaeuaiiy OACA o ieacii. Oaeei /eiii, ai?iiiaeueiee i?ioieue oai?eo,
eieiaaieo neiano?ieii i?ioyaii 3 iinyoeia, naiae/eoue i?i nooo?ai ciiie
?o aiaeie?eiii? ooieoei?, yei caaacia/othoue oa?aiaaoe/iee aoaeo oeueiai
i?aia?aoo.

Neiae aiaecia/eoe, ui o ca’yceo c oyaeeeie oneeaaeiaiiyie c aieo
na?oeaai-noaeeiii? nenoaie o aaaaoueio oai?eo ianoaaaea iiaaeiaeecaoeiy
aianeiaeie iioa?eoo iiiea?aeo oa aino?iai ii?ooaiiy iiceiaiai
e?iaiiaiao. Iaiaoiaeii oaeiae iiaee?aneeoe, ui oeei oai?ei
ai?iiiioa?aiiy ano?iaaiaie a iiaeaeueoiio i?ioeiieacaia /a?ac aenieee
?ecee iiaoi?iiai aeieeiaiiy na?oeaai-noaeeiieo oneeaaeiaiue. ?acii c
oei, aiaeiiaa aiae ai?iiiaeueiiai eieoaaiiy caa?iaeo? i?ia?anoaaiiyi
?IC.

A oeie iiaea?oii i?ioyaii 3 ?ieia niinoa?aaeaiiy iiia?ei 8 oai?eo, c
ieo 2 — c I-II noaaei?th caoai?thaaiiy (o iaeiiai i?e/eiith nia?oi aoea
aino?a na?oeaai-noaeeiia iaaeinoaoiinoue, o ae?oaiai — aino?a ii?ooaiiy
iiceiaiai e?iaiiaiao), 6 — c III noaaei?th caoai?thaaiiy (4 iiia?ei aiae
i?ia?anoaaiiy i?ioeano, 1 — aiae aino?iai iioa?eoo iiiea?aea, 1 — aiae
aino?iai ii?ooaiiy iiceiaiai e?iaiiaiao.

Iaaaaeaii aeua ?acoeueoaoe eieoaaiiy oai?eo a?oii ii?iaiyiiy ? aacith
aeey niianoaaeaiiy c ?acoeueoaoaie iniiaii? a?oie, a oaeiae aeey ioeiiee
oa?aiaaoe/ii? aoaeoeaiinoi aeei?enoaieo i?aia?aoia oa noai eieoaaiiy.

Ieae/a iaaaaeaii ?acoeueoaoe eieoaaiiy oai?eo iniiaii? a?oie, yei
io?eioaaee iecueeiaeiciao ano?iaai-aioeaiae?iaaiio oa?aiith. A I
iiaea?oii iniiaii? a?oie (c I-III noaaei?th caoai?thaaiiy) /anoeiaee
?aa?an oai?iae aoa aeinyaiooee o 29 (53,7%) iaoeiaioia, noaaieicaoeiy
i?ioeano — o 16 (29,6%), i?ia?anoaaiiy — o 2 (3,7%). A II iiaea?oii
iniiaii? a?oie (oai?i c IV noaaei?th caoai?thaaiiy, c aiaeaeaeaieie
iaoanoacaie) /anoeiaee ?aa?an iaa iinoea o 3 c 7 iaoei?ioia. O?i? oai?eo
aiaeiiaiee ia eieoaaiiy iie?auaiiyi noaio ia i?ioyci 3-4 iinyoeia, iiney
/iai o ieo ianooieei i?ia?anoaaiiy caoai?thaaiiy, 1 oai?ee iiia?.

Aiaeic oneeaaeiaiue, iia’ycaieo ic canoinoaaiiyi iecueeiaeiciai?
ano?iaai-aioeaiae?iaaiii? oa?aii?, aeiaia, ui oyaeeeo iiai/ieo ?aaeoeie,
yei a cioneee aiaeiiaeoeny aiae eieoaaiiy, ia niinoa?iaaeinue. 13 (24%)
oai?eo aiaeii/aee iiaeaeuaio oaeoeeueio /ooeeainoue o aeieyioei nineia,
o 3 (5,5%) — iaei iinoea caaino?aiiy o?iii/ii? ei?iia?ii?
iaaeinoaoiinoi, o 2 (3,7%) — iiii?ia aeeniainiy. Oyaeeeo oneeaaeiaiue,
iia’ycaieo ic aeei?enoaiiyi oiiaaio, oaeiae ia ca?a?no?iaaii. 4 oai?eo
aiaeii/aee naa?aiiiy aai aiae/oooy iaeo/iai aieth o aeieyioei aiaeueiiai
ioai?o ia i?ioyci ia?oeo 5 aeiia eieoaaiiy. Oei yaeua i?ioiaeeee iiney
oiiaieueiaiiy e?aiaeueiiai aaaaeaiiy i?aia?aoo o aaio. O iaeiiai oai?iai
aiaeii/aany o?iiaioeaaio iiaa?oiaaeo aai o iinoei aaaaeaiiy i?aia?aoo,
yeee aoei eoiiaaii eiina?aaoeaiei eieoaaiiyi.

sseinoue aeeooy oai?eo iniiaii? a?oie ioeiithaaee oaeei /eiii: 1 aaeo
aiaeiiaiaeaa noai 28 (51,9%), 2 aaeai — 19 (35,2%), 3 aaeai — 5 (9,3%),
4 aaeai — 2 (3,7%) iaoe??io?a.

Iiia?ei ia i?ioyci 3 ?ieia niinoa?aaeaiiy 7 oai?eo oei?? a?oie. Na?aae
ieo 4 — c IV noaaei?th caoai?thaaiiy iiia?ee aiae aaia?aeicaoei?
i?ioeano, 3 (c III noaaei?th) — aiae iioa?eoo iiiea?aeo (1) oa aiae
i?ia?anoaaiiy o?iii/ii? ie?eiai? iaaeinoaoiinoi aianeiaeie iinoeaaiai
?iciianthaeaeaiiy i?ioeano (2).

Eieeaaiiy ?iaiy O o ieacii oai?eo iniiaii? a?oie a i?ioeani eieoaaiiy
iaei aeaioaciee oa?aeoa? . ?iaaiue ai?iiio cia/ii cieaeoaaany (a 2-3
?ace) ii?iaiyii c oiiiaei i?ioyaii ia?oeo 3 iinyoeia eieoaaiiy oa iaeaea
ia ciiithaaany i?e iiaeaeueoiio niinoa?aaeaiii aei 4-12 iinyoeia.
?iaaiue EA ia i?ioyci ia?oeo 3 iinyoeia nooo?ai cieaeoaaany, oa /a?ac
4-6 iinyoeia eieoaaiiy aeinyaaa oiiiaeo iieacieeia. Aiino OACA /a?ac 1 i
2 iinyoei eieoaaiiy iiooieiaeii oa iecueeeie aeicaie neiano?ieo
caieueooaaany a 2,5 ?ace ii?iaiyii c oiiiaeie cia/aiiyie, a /a?ac 4-6
iinyoeia aoa aeuei aiae oiio aiaeiiaiaeii a 2,9-2,3 ?ace, ui
ioeiith?oueny ye iiceoeaiee aoaeo i?e eieoaaiii ?IC. IAO /a?ac 1 oa 2
iinyoei oa?aii? cieaeoaaany a 5 ?acia, a /a?ac 3 iinyoei aoa a 4 ?ace
ieae/ei, iiae aei eieoaaiiy. Oeae iieaciee aeoaea aaaeeeaee, oiio ui aii
naiae/ioue i?i oa, ui aianeiaeie cieaeaiiy eiioeaio?aoei? O a ieacii oa
iiaeaeuaiiy aiinoo OACA cia/ii ciaioo?oueny o?aeoeiy aieueiiai,
aeinooiiiai aeey oeaiei-iioaiae ai?iiio O. Iiaeaeueoi niinoa?aaeaiiy ca
oai?eie oei?? a?oie aeiaaee, ui IAO /a?ac 4-6 iinyoeia eieoaaiiy noa?
o?ioe aeuei o ii?iaiyiii c ia?oeie iinyoeyie i?eeiio i?aia?aoia, aea
?acii c oei caeeoa?oueny ai?iaiaeii aieueo aenieei, iiae oiiiai cia/aiiy
aieueiiai O. Oaeei /eiii, ciaioaiiy ?iaiia EA, O oa IAO i?e eiiaiiiaaiie
iecueeiaeiciaie ano?iaai-aioeaiae?iaaiiie oa?aii? ?IC naiae/aoue i?i
aoaeoeaiinoue oeueiai iaoiaeo.

Aeey ioeiiee aoaeoeaiinoi, ia?aaaa oa iaaeieieia iiiioa?ii?
i?ia?anoth/iai ?IC aiae?ieo?ii, iiooieiaeii oa neiano?ieii i
eiiaiiiaaii? oa?aii? iiooieiaeii oa iecueeeie aeicaie neiano?ieo,
i?iaaee ii?iaiyiiy iaea?aeaieo ?acoeueoaoia. Niianoaaeaiiy oa aiaeic
oeeo aeaieo iieacaee, ui iiaiiai ?aa?ano iooeeie ia niinoa?iaaeinue a
aeiaeiiio aeiaaeeo (oaae. 3).

Oaaeeoey 3

?acoeueoaoe eieoaaiiy oai?eo ia ?IC ca ?icieie noaiaie ai?iiiioa?aii?

Iacaa i?aia?aoo ?acoeueoaoe eieoaaiiy (%)

*anoeiaa ?aiiniy Noaaieicaoeiy I?ia?anoaaiiy

Aiae?ieo? 42,5 47,5 10,0

Iiooieiae 10,3 55,9 33,8

Neiano?ie 42,1 57,9 —

Neiano?ie+iiooieiae 59,3 29,6 11,1

Aieea eieoaaiiy ?icieie i?aia?aoaie ia ?icii?e IC, o?aaeaii? iooeeiith,
i?aaenoaaeaiee a oaaeeoei 4.

Oaaeeoey 4

Aeeiaiiea ia’?io IC i?e aeei?enoaiii ?icieo iaoiaeia ai?iiiioa?aii?

Iacaa i?aia?aoo Ia’?i IC o ni3 (I(m)

Aei eieoaaiiy Iiney eieoaaiiy

Aiae?ieo? 43,21(0,34 26,60(0,52*

Iiooieiae 48,38(0,35 34,11(0,49*

Neiano?ie 36,51(0,54 23,34(0,51*

Neiano?ie+iiooieiae 54,42(0,48 28,86(0,45*

* — a??ia?aei?noue aiaeiiiiinoae iieacieeia a a?oiao (P <0,05) Iaeaieueo ae?aaeaii ciiie ia’?io IC i?ioyaii eieoaaiiy aiaeii/aii o oai?eo iniiaii? a?oie. Iieacieee o?ioeioiao?i? aeacoaaee ia caieueoaiiy na?aaeiuei? oa iaeeiaeueii? oaeaeeinoi na/iaeioneaiiy, ui naiae/eei i?i aoaeoeaiinoue eieoaaiiy. *anoeiaa ?ai?n?y caoai?thaaiiy a iniiaiie a?oii niinoa?iaaeanue a 1,4 ?ace /anoioa, iiae o I a?oii ii?iaiyiiy. I?e ii?iaiyiii yeinoi aeeooy oai?eo, caiaeii c ?aeiiaiaeaoeiyie AIIC, iaea?aeaio iaeii?iaeii aeaii, aea, caaaeath/e ia oa, ui a iniiaiie a?oii aoei 11 (20,4%) iaoe??io?a c IV noaaei?th, a o I a?oii ii?iaiyiiy - 2 (5%), eiai/ii aeciaoe e?aueie ?acoeueoaoe eieoaaiiy a iniiaiie a?oii. I?iaaaeaia oaeiae aea/aiiy aieeao ?icieo iaoiaeia eieoaaiiy ia /anoioo i?ia?anoaaiiy caoai?thaaiiy oa o?e?i/ia aeaeeaaiiy. Ii?iaiyiiy o?eaaeinoi aeaeeaaiiy iiney eo?no iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii? (87%) oa aiae?ieo?o (85%) ia aeyaeei nooo?ai? ?icieoei iiae aeaiia a?oiaie. I?ioa, i?e aieueo ?aoaeueiiio ?icaeyaeaiii oeueiai iieacieea c o?aooaaiiyi noaaei? caoai?thaaiiy, iiiioii, ui e?aui ?acoeueoaoe iaea?aeaii a iniiaiie a?oii. Aei aiaeiai/ieo aeniiaeia i?eeoee i?e ii?iaiyiii iieacieeia i?ia?anoaaiiy caoai?thaaiiy ca aeaieie iinoeaaiai ?iciianthaeaeaiiy i?ioeano oa aiaeaeaeaiiai iaoanoacoaaiiy. A iniiaiie a?oii aiie neeaee 16,6% oa 7,4%, o I iiaea?oii ii?iaiyiiy - 22,5% oa 12,5% aiaeiiaiaeii. Neiae cacia/eoe, ui iiceoeaiiai aoaeoo i?e canoinoaaiii aiae?ieo?o aeinyaaee oaeaeoa, iiae iiney eiiaiiiaaiiai eieoaaiiy, i?ioa aeiy inoaiiueiai ia?inoaea iinooiiai, aoea aieueo iinoieiith oa aeiaaio?eaaeith. Ii?iaiyiiy ?acoeueoaoia iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii? a iniiaiie a?oii oa iiiioa?aii? ianoa?i?aeiei aioeaiae?iaaiii iiooieiaeii (II a?oia ii?iaiyiiy) aeyaeei ia?aaaao ia?oi? ca aniia e?eoa??yie. *anoeiaa ?aiiniy a a?oii oai?eo, eieiaaieo iiooieiaeii (II a?oia ii?iaiyiiy), aeinyaiooa o 10,3%, noaaieicaoeiy - o 55,9%, i?ia?anoaaiiy - o 33,8% i?ioe 59,3%, 29,6% oa 11,1% aiaeiiaiaeii i?e eiiaiiiaaiie oa?aii?. I?e ioeiioei yeinoi aeeooy oai?eo II a?oie iieacieee neeaaeaee: 1 aae - o 29,4%, 2 aaee - o 44,1%, 3 - o 19,1%, 4 - o 7,4% (a iniiaiie a?oii - 51,6%, 35,2%, 9,3% i 3,7% aiaeiiaiaeii). Iinoeaaa i?ia?anoaaiiy i?ioeano ia i?ioyci 3 ?ieia niinoa?iaaeinue o 29,4%, aiaeaeaeaia iaoanoacoaaiiy - o 14,7% oai?eo. Iaiaoiaeii caa?iooe oaaao ia oa,ui a oeie a?oii aoea cia/ia ieoiia aaaa oai?eo c IV noaaei?th caoai?thaaiiy, i?ioa, a ia?oi 3-4 iinyoei eieoaaiiy iaeaieueo iiiioiee eeiii/iee aoaeo aiaeii/aany o iaoe??io?a c iaoanoacoth/ei ?IC, oi/a ianooiii 3 iinyoei aeiaaee, ui eeiii/ia iie?auaiiy ?o noaio iaei, a iniiaiiio, oei/aniaee oa?aeoa?. I?ecia/aiiy neiano?ieo o aenieeo aeicao i?eaiaeeei aei oaeaeeiai oa noieeiai iiceoeaiiai ?acoeueoaoo, i?ioa, iieacieee ioeiiee noaio oai?eo aeyaeeeny iaaenieeie aianeiaeie cia/ii? iiaaeiaeecaoei? /a?ac oyaeei na?oeaai-noaeeiii oneeaaeiaiiy. ?iaaiue i?ia?anoaaiiy caoai?thaaiiy o aiaeaeaeaiii no?iee oa o?e?i/iiai aeaeeaaiiy ia aiae?iciyeeny aiae iioeo a?oi oai?eo. Caaaeueiiaiaeiii, ui canoinoaaiiy aenieeo aeic ano?iaaiia i?eaiaeeoue aei o?iiaiaiaiei/ieo oneeaaeiaiue. Ca aenia?eiaioaeueieie aeaieie M. Jonson et al. (1978) ianoa?i?aeii aioeaiae?iaaie i?ioeaeithoue iineeaiith aa?aaaoei? o?iiaioeeoia iiae aieeaii aiae?iaaiia. Oei aeaii niiaiaaeathoue c eeiii/ieie niinoa?aaeaiiyie R.Neri, N Kassem (1982), yei aeiaiaeyoue, ui o oai?eo ia ?IC, eieiaaieo ia i?ioyci o?eaaeiai /ano oeooaiiaeii, aiaeiaii yeiai ? iiooieiae, na?oeaai-noaeeiii oneeaaeiaiiy ia aeieeaee. Oaeei /eiii, ianoa?i?aeii aioeaiae?iaaie ia oieueee ia aeeeeeathoue oneeaaeiaiue, oa?aeoa?ieo aeey ano?iaaiia, aea i?ioeaeithoue ?i. Niianoaaeaiiy ?acoeueoaoia eieoaaiiy oai?eo III iiaea?oie ii?iaiyiiy oa iniiaii? a?oie iieacaei, ui /anoeiaa ?aiiniy o oai?eo, eieiaaieo aenieeie aeicaie neiano?ieo, neeaaeaea 42,1%, a iniiaiie a?oii - 59,2%, oiaoi aoea a 1,4 ?ace /anoioith a iniiaiie a?oii. Noaaieicaoeiy i?ioeano, iaaiaee, niinoa?iaaeanue a 1,95 ?acia /anoioa a III iiaea?oii ii?iaiyiiy, iiae a iniiaiie a?oii. I?ia?anoaaiiy i?ioeano a a?oii oai?eo, eieiaaieo aenieeie aeicaie neiano?ieo ia aoei ca?a?no?iaaii a aeiaeiiio aeiaaeeo, aea neiae a?aoiaoaaoe, ui na?aae oai?eo oei?? iiaea?oie ia aoei aeiaeiiai c IV noaaei?th. Niianoaaeaiiy ?acoeueoaoia aaeueii? ioeiiee yeinoi aeeooy naiae/eoue i?i i/aaeaeio ia?aaaao iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii?: ieoiia aaaa oai?eo III iiaea?oie ii?iaiyiiy, noai yeeo aiaeiiaiaeaa 3-4 aaeai, a 4,8 ?acia aeua ca aiaeiiaiaeio /anoeio oai?eo iniiaii? a?oie. I?e/eiith oaeeo ?acoeueoaoia aoee oneeaaeiaiiy, yei aeieeaee aianeiaeie canoinoaaiiy aenieeo aeic neiano?ieo. Oneeaaeiaiiy c aieo na?oeaai-noaeeiii? nenoaie, iia’ycaii c ai?iiiioa?aii?th a a?oii oai?eo, eieiaaieo neiano?ieii, cono?i/aeeny a 9,6 ?acia /anoioa, iiae a iniiaiie a?oii. Oeei coiiaeaia cia/ia cieaeaiiy yeinoi aeeooy oai?eo III a?oie ii?iaiyiiy, iacaaaeath/e ia oa, ui /anoioa i?ia?anoaaiiy caoai?thaaiiy o aiaeaeaeaii no?iee a iaio a?oiao ai?iaiaeii ia aiae?iciyeanue. Iinoeaaa i?ia?anoaaiiy a a?oii ii?iaiyiiy niinoa?iaaeinue o 21,1% oai?eo, aiaeaeaeaia iaoanoacoaaiiy - a 10,5% i?ioe 16,6% oa 7,4% aiaeiiaiaeii a iniiaiie a?oii. Aeaeeaaiiy aoei e?auei a iniiaiie a?oii, iniaeeai o oai?eo c I-II noaaei?th caoai?thaaiiy (a iniiaiie a?oii - 96,8%, a iiaea?oii ii?iaiyiiy - 88,8%), a nia?oiinoue aoea aeuith iiney eieoaaiiy neiano?ieii o aenieeo aeicao, ui iia’ycaii c aieueoith /anoioith na?oeaai-noaeeiieo oneeaaeiaiue. I?e ii?iaiyiii oa?aeoa?o ai?iiiaeueiiai aiaeaoeo ia eieoaaiiy ?icieie eiea?nueeeie caniaaie iaeaieueo nooo?ai ciiie aeieeee iiney canoinoaaiiy neiano?ieo. ?iaii EA, O oa IAO aeyaeeeny cieaeaieie iiney ano?iaaioa?aii? ia 60-80%, a aiino OACA a ieacii iiaeaeuoaaany ia 186-209% ii?iaiyii c oiiiaeie cia/aiiyie. Aaeueioaaiiy neioaco oa nae?aoei? EA i aiae?iaaiia iaei noieeee oa?aeoa? oa niinoa?iaaeiny ia i?ioyci anueiai eieoaaiiy. I?e ii?iaiyiii ai?iiiaeueiiai aiaeaoeo ia aaaaeaiiy noa?i?aeiiai oa ianoa?i?aeiiai aioeaiae?iaaiia niinoa?iaaeeny nooo?ai aiaeiiiiinoi. I?e eieoaaiii aiae?ieo?ii ?iaaiue EA, O oa IAO cieaeoaaany ia 32-50% c iaeneioiii aei? /a?ac 3 iinyoei, iiooieiae aeeeeeaa iiaeaeuaiiy ?iaiy EA oa O ia i?ioyci 3 iinyoeia c iiaeaeueoei cieaeaiiyi aiinoo oeeo ai?iiiia. ?icieoey ?acoeueoaoia ai?iiiaeueieo oanoia iiney oeeo i?aia?aoia iia’ycaia c aiaeiiiiinoyie a iaoaiicii ?o aei?. Aiae?ieo? ye i?iaanoeiiaee aaaio ia? aeaiyeee iaoaiici aei? uiaei i?eaii/aiiy i?iaeoeoei? aiae?iaaiia - oeaio?aeueiee oa ia?eoa?ieiee. Iiooieiae ye ianoa?i?aeiee aioeaiae?iaai aeieo? ?aoeaioi?e aiae?iaaiia a i?aaiao-iioaiyo. Aeeeeeaii aeieaaeith aiae?iaaiieo ?aoeaioi?ia ii?ooaiiy c /anii neaaoathoue. Aiiaaeio?iiii- oa oanoinoa?iinoeioeth/a aeoeaiinoue “/enoeo” aioeaiae?iaaiia ? ia?aoeiaeith aeey iiaiiai i?iyao ?o oa?iaeieiai/ii? aei? a aeiaeaoeiaeo noaoaaeo caeicao oa iioeo i?aaiao-iioaiyo. Aeyaeeinue, i?ioa, ui oeueiai iaaeieieo “/enoeo” aioeaiae?iaaiia iiaeia oieeiooe ii?aeiaiei canoinoaaiiyi ?o c aioeaiiaaeio?iiieie ?a/iaeiaie a iiiiiaeueieo aeicao, ui caaacia/othoue ii?iaeicaoeith aiiaaeio?iiii? ooieoei? oa nae?aoei? O i?e caa?aaeaiii oa iaaioue iineeaiii aioeaiiaaeio?iiiiai aoaeoo ia ia?eoa?i?. sse aeiaaee ai?iiiaeueii aeineiaeaeaiiy, aoaeoeaiinoue eiiaiiaoei? iiooieiaeo oa neiano?ieo i?iyaey?oueny o iiia?aaeaeaiii iiaeaeuaiiy i iaaioue cieaeaiii ?iaiy noaoaaeo ai?iiiia o ii?iaiyiii c iiiioa?aii?th iiooieiaeii. ?iaii EA i O cieaeothoueny aei 50-70% aiae oiiiaeo iieacieeia oa caa?iaathoueny a oeeo iaaeao ia i?ioyci 3 iinyoeia. Aiino OACA iiaeaeuo?oueny ia 70% /a?ac 3 iinyoei oa c?inoa? aei 157% /a?ac 6 iinyoeia. Oaea ciiia ?iaiy OACA i?eaiaeeoue aei ?iceiai iaaeiiiy (75%) IAO. Oeae iieaciee caeeoaany cieaeaiei ia i?ioyci 6 iinyoeia niinoa?aaeaiiy, ui ?icoeiithaaeinue ye iiceoeaiee oaeoi? oei?? oa?aii?. Oaeei /eiii, ii?iaiyeueia ioeiiea ?acoeueoaoia eieoaaiiy oai?eo ia ?IC aiae?ieo?ii, iiooieiaeii, neiano?ieii a iiiioa?aii? oa ca ?ic?iaeaiei iiaei iaoiaeii eiiaiiiaaii? iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii? iieacaea, ui inoaiiie ca aoaeoeaiinoth ia iinooia?oueny o?aaeeoeieiei iaoiaeai iiiioa?aii?, a ca ?yaeii iieacieeia, iniaeeai, /anoioith oa aaaeeinoth oneeaaeiaiue, nooo?ai ia?aaaaea? ?o. AENIIAEE 1.Canoinoaaiiy iiaiai iaoiaeo eiiaiiiaaii? iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii?, i?e yeiio aeei?enoiao?oueny iiooieiae o ii?aeiaiii c aioo?ioiueii’ycaaei aaaaeaiiyi neiano?ieo a iecueeeo aeicao, caaacia/o? aeinyaiaiiy noieeiai eeiii/iiai aoaeoo ia oieueei o oai?eo ia ?IC c I-II,aea e III-IV noaaei?th caoai?thaaiiy oa o?e?i/ia aeaeeaaiiy a 96,8% oa 72,7% iaoei?ioia aiaeiiaiaeii. 2.Aiae?ieo? /eieoue iaeaieueo ae?aaeaiee eeiii/iee aoaeo o oai?eo ia ?IC c I-II noaaeiyie caoai?thaaiiy, i?e oeueiio aeai?i/ia aeaeeaaiiy aeinyaa? 100%, o?e?i/ia - 92,3%. 3.Iiiioa?aiiy iiooieiaeii ni?e/eiy? iiceoeaiee eeiii/iee aoaeo o oai?eo ia ?IC i?ioyaii ia?oeo 3-4 iinyoeia eieoaaiiy, iiney /iai o oai?eo c III-IV noaaei?th aiaeii/a?oueny i?ia?anoaaiiy caoai?thaaiiy. 4.*anoioa iiai/ieo ?aaeoeie i oneeaaeiaiue c aieo na?oeaai-noaeeiii? nenoaie iiney eiiaiiiaaii? ano?iaai-aioeaiae?iaaiii? oa?aii? (5,6%) ia aiae?iciyeanue aiae iieacieeia iiney aiae?ieo?o (5%), oa aoea iaioith a 9,4 ?acia, iiae iiney eieoaaiiy neiano?ieii a o?aaeeoeieieo aeicao. Iioi iiai/i? aoaeoe (aiiaeiianoiy, cieaeaiiy iioaioei?, ?iceaaee oeoieiai-eeoeiaiai o?aeoo) niinoa?iaaeenue i?aeoe/ii iaeiaeiai /anoi (2,5-5,6%) ye iiney eiiaiiiaaiiai iaoiaeo, oae i iiney iiiioa?aii? aiae?ieo?ii oa iiooieiaeii, oa ?iaeoa - a 5,6-6,3 ?ace, iiae iiney neiano?ieo. 5.Ii?iaiyiiy aeeiaiiee ai?iiiaeueieo iieacieeia iiney eieoaaiiy aiae?ieo?ii, iiooieiaeii oa neiano?ieii naiae/aoue i?i oa, ui ani i?aia?aoe /eiyoue aiaeiiaiaeio aioeaiae?iaaioth aeith, i?ioa aaeaeaaoia aiae?iaaiia aeieaaea, i?e aiaenooiinoi oyaeeeo oneeaaeiaiue, aeinyaa?oueny i?e aeei?enoaiii eiiaiiiaaii? iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii?. Iaeaieueo iioi?iaoeaiei iieacieeii oeueiai aoaeoo ? IAO, yeee cieaeo?oueny ia 75%. 6.Ii?iaiyeueia ioeiiea ?acoeueoaoia ai?iiiioa?aii? naiae/eoue i?i aeioeieueiinoue aeei?enoaiiy aiae?ieo?o ye i?aia?aoo ia?oiai ?yaeo o oai?eo c I-II noaaeiyie ?IC, a eiiaiiiaaii? iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii? - ye o oai?eo c I-II, oae ? c III-IV noaaeiyie caoai?thaaiiy. NIENIE IOAEIEAOeIE CA OAIITH AeENA?OAOe?? 1.Klimenko I.A., Varga S.V., Sinitsyn P.V., Chaikovskaya L.V., Vosianov S.A., Aristova T.Y. Clinical and pathogenetic rationale for a new method of treatment of advanced prostatic cancer: low dose estrogen-antiandrogen therapy //Aeiiia?ae? IAI Oe?a?ie.- 1995.- ? 3.- N. 117-120. 2.Aic?aiia I.O., ?aci?eia I.A., Eeeiaiei ?.I., Aa?aa N.A., Nei?oeei I.A., *aeeianueea E.A., Aic?aiia N.I., A??noiaa O.TH. Ei?aeyoe?y ai?iiiaeueieo oa ee?i?/ieo aoaeo?a o oai?eo ia ?ae ia?aaei?oo?iai? caeice i?e e?eoaaii? i?ooie?aeii o ii?aeiaii? c iaeeie aeicaie neiano?ieo //E?ea?. ni?aaa.- 1996.- ? 1-2.- N. 107-110. 3.A??noiaa O.TH. Ii??aiyeueia ioe?iea ?acoeueoao?a e?eoaaiiy ?aeo ia?aaei?oo?iai? caeice aiae?ieo?ii oa i?ooie?aeii o ii?aeiaii? c noaoa?aiaaoe/ieie aeicaie ano?iaai?a //Oa?i. a?niee.-1997.-? 5.-N.31-33. 4.Iaoaio 22491 Oe?a?ia, IEA A61A10/00 A61E45/06. Niin?a e?eoaaiiy ?aeo ia?aaei?oo?iai? caeice / Aic?aiia I.O., ?aci?eia I.A., Aa?aa N.A., Eeeiaiei ?.I., *aeeianueea E.A., A??noiaa O.TH., Nei?oeei I.A. (Oe?a?ia).- ? 95041851; Cayae. 21.04.95; Iioae. 03.03.98. 5.Eeeiaiei ?.I., A??noiaa O.TH. ?ae ia?aaei?oo?iai? caeice: ai?aeai?ieia?y oa no/ani? i?eioeeie ae?aaiinoeee ? e?eoaaiiy //Iin?aiee aeey e?ea??a.- Ee?a, 1997.- 32 n. 6.Eeeiaiei ?.I., Aic?aiia N.I., A??noiaa O.TH., Caia??i A.E., Naeaei A.N., A?eai?aiei A.I., Aa?aa N.A. Aeei?enoaiiy aioeaiae?iaaiiiai caniao - i?ooie?aeo aeey e?eoaaiiy ?aeo ia?aaei?oo?iai? caeice //No/ani? iaoiaee ae?aaiinoeee oa e?eoaaiiy ceiye?nieo iooeei.- AEeoiie?.-1993.-N. 84. 7.Eeeiaiei ?.I., Aic?aiia N.I., A??noiaa O.TH., Aa?aa N.A. Eiia?iiaaia e?eoaaiiy ?aeo ia?aaei?oo?iai? caeice //Iainiiaaiea eiiieaeniuo iaoiaeia ea/aiey ceiea/anoaaiiuo iiooieae.- Ea?/ue, 1993.- N. 84. 8.Eeeiaiei ?.I., Aic?aiia N.I., ?iiaiaiei A.I., Naeaei A.N., A??noiaa O.TH., Iaiae?i A.?., Eo/a?aanueea ?.A., Aoeaie I.A. Iooeeii? ia?ea?e a ?aii?e ae?aaiinoeoe? ?aeo ia?aaei?oo?iai? caeice //Eaai?aoi?i? iaoiaee a ae?aaiinoeoe? oa ioe?ioe? e?eoaaiiy ceiye?nieo iooeei.- *a?eane, 1994.- N. 82. 9.Aa?aa N.A., *aeeianueea E.A., Eeeiaiei ?.I., Aic?aiia N.I., A??noiaa O.TH. Ai?iiiaeueiee eiio?ieue aoaeoeaiino? ano?iaai-aioeaiae?iaaiii? oa?ai?? o oai?eo ia ?ae ia?aaei?oo?iai? caeice //Eaai?aoi?i? iaoiaee a ae?aaiinoeoe? oa ioe?ioe? e?eoaaiiy ceiye?nieo iooeei.- *a?eane, 1994.- N. 89. 10.Aic?aiia I.O., Eeeiaiei ?.I., Aic?aiia N.I., Naeaei A.N., A??noiaa O.TH. I?ooie?ae ? noaoa?aiaaoe/i? aeice neiano?ieo a e?eoaaii? ?aeo ia?aae-i?oo?iai? caeice //No/ani? i?iaeaie oa?iaeieia??.- Iieoaaa, 1995.- N. 30. 11.Eeeiaiei E.A., A?enoiaa O.TH., Naeaei A.N., A?eai?aiei A.I. Eiiaeie?iaaiiia ea/aiea ?aea i?aaenoaoaeueiie aeaeacu: ieceiaeiciaay yno?iaai-aioeaiae?iaaiiay oa?aiey //Aeooaeueiua aii?inu ea/aiey iieio?ieiae/aneeo caaieaaaiee.- Iaieine, 1997.- N. 117. AIIOAOeIss A?inoiaa O.TH. Eiiaiiiaaia iecueeiaeiciaa ano?iaai-aioeaiae?iaaiia oa?aiiy i?ia?anoth/iai ?aeo ia?aaeiioo?iai? caeice. - ?oeiien. Aeena?oaoeiy ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoeiaeueiinoth 14.01.06 - o?ieiaiy. Iinoeooo o?ieiai? oa iao?ieiai? AII Oe?a?ie, Ee?a, 1998. Aeena?oaoeiy i?enay/aia ieoaiiyi eieoaaiiy i?ia?anoth/iai ?aeo ia?aaeiioo?iai? caeice. Io?eiaii iiai aeaii i?i aieea ai?iiiaeueieo oa aioeai?iiiaeueieo i?aia?aoia ia ai?iiiaeueiee noaoon. Aea/aia eeiii/ia aoaeoeaiinoue iiiioa?aii? oa eiiaiiiaaii? aiae?iaaiii? aeieaaee. Aeineiaeaeaiiy ai?iiiaeueiiai noaoono aeicaieeee aeeo/eoe iieacieee, yei iiaeooue aooe aeei?enoaii ye e?eoa?i? ioeiiee aoaeoeaiinoi eieoaaiiy. I?iaaaeaia ioeiiea aiaeaeaeaiieo ?acoeueoaoia ai?iiiaeueii? oa?aii? a caeaaeiinoi aiae noaaei? iooeeiiiai i?ioeano. ?ic?iaeaiee iiaee iaoiae iecueeiaeiciai? ano?iaai-aioeaiae?iaaiii? oa?aii?, caniiaaiee ia aeei?enoaiii ianoa?i?aeiiai aioeaiae?iaaia iiooieiaeo o ii?aeiaiii c iaeeie aeicaie ano?iaaiia, ui caaacia/o? aeinyaiaiiy iiaii? aiae?iaaiii? aeieaaee oa oieeiaiiy oyaeeeo oneeaaeiaiue. Canoinoaaiiy iaoiaeo ni?e/eiy? noieeee aoaeo o III-IV noaaeiyo oa o?e?i/ia aeaeeaaiiy 72,7% oai?eo. Eeth/iai neiaa: ia?aaeiioo?iaa caeica, i?ia?anoth/ee ?ae, ai?iiiaeueia oa?aiiy. SUMMARY Aristova O.Y. Combined low-dose estrogen-antiandrogen therapy for advanced prostatic cancer. - Manuscript. The thesis for a Degree of Candidate of Medical Sciences on specialty 14.01.06 - urology. Institute of Urology and Nephrology of the Academy of Medical Sciences of Ukraine, Kiev, 1998. The thesis is devoted to the treatment of advanced prostatic cancer. New data concerning influence of hormone-antihormone therapy upon hormone status of patients are obtained. Hormone criteria of the treatment efficacy are elucidated. Clinical efficacy of hormone monotherapy and combined androgen blockade is investigated. Remote results of hormone therapy are evaluated depending on tumor stage. New method is proposed - combined hormone-antihormone therapy based on using of non-steroid antiandrogen niftolid with low doses of estrogen. Complete androgen blockade is provided in avoidance of severe complications. Application of the method provides stable clinical effect in tumor stage III-IV and three-year survival in 72,7% of patients. Key words: prostata, advanced cancer, hormone therapy. AIIIOAOeEss A?enoiaa O.TH. Eiiaeie?iaaiiay ieceiaeiciaay yno?iaai-aioeaiae?iaaiiay oa?aiey i?ia?anne?othuaai ?aea i?aaenoaoaeueiie aeaeacu. - ?oeiienue. Aeenna?oaoeey ia nieneaiea o/aiie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.06 - o?ieiaey. Einoeooo o?ieiaee e iao?ieiaee AII Oe?aeiu, Eeaa, 1998. Aeenna?oaoeey iinayuaia aii?inai ea/aiey i?ia?anne?othuaai ?aea i?aaenoaoaeueiie aeaeacu. N oeaeueth oeo/oaiey ?acoeueoaoia eiina?aaoeaiie oa?aiee auei i?iaaaeaii eiiieaeniia ianeaaeiaaiea e ea/aiea 200 aieueiuo a aic?anoa 40-85 eao. Aeey n?aaieoaeueiie ioeaiee ?acoeueoaoia ea/aiey ii ?ac?aaioaiiiio iiaiio e o?aaeeoeeiiiui iaoiaeai, iaoeeaiou auee ?acaeaeaiu ia 2 a?oiiu - iniiaioth (54) e a?oiio n?aaiaiey (146). A i?ioeanna ianeaaeiaaiey auee eniieueciaaiu nia?aiaiiua iaoiaeu aeeaaiinoeee (oeueo?acaoeiaia e ?aioaai?aaeeieiae/aneia enneaaeiaaiea, o?ioeioiao?ey, ai?iiiaeueiue i?ioeeue). Ai anao neo/ayo auea iieo/aia oeeoieiae/aneay aa?eoeeaoeey iniiaiiai aeeaaiica. Ai?iiiaeueioth oa?aieth i?eiaiyee eae yoeiiaoiaaiaoe/aneia ea/aiea o anao aieueiuo. Aieueiua a?oiiu n?aaiaiey auee ?acaeaeaiu ia 3 iiaea?oiiu a caaeneiinoe io iieo/aaiiai ea/aiey. A ea/anoaa aioeai?iiiaeueiie iiiioa?aiee eniieueciaaee i?aia?aou, ioiinyueany e ?acee/iui eeannai niaaeeiaiee: noa?ieaeiui e ianoa?ieaeiui aioeaiae?iaaiai. A I iiaea?oiia n?aaiaiey o 40 aieueiuo i?eiaiyee noa?ieaeiue aioeaiae?iaai aiae?ieo? (200 ia/noo) a oa/aiea 6 ianyoeaa. Ai II iiaea?oiia n?aaiaiey, aeeth/aaoae 68 aieueiuo, i?eiaiyee aia?aua neioace?iaaiiue a Oe?aeia /enoue ianoa?ieaeiue aioeaiae?iaai ieooieeae (750 ia/noo) a oa/aiea 6 ianyoeaa. A III iiaea?oiia n?aaiaiey 38 aieueiuo iieo/aee iiiioa?aieth yno?iaaiaie - neiano?ie a o?aaeeoeeiiii aunieeo aeicao (60 ia/noo) aioo?eiuoa/ii a oa/aiea 90 aeiae. Aieueiua iniiaiie a?oiiu iieo/aee eiiaeie?iaaiioth ieceiaeiciaoth yno?iaai-aioeaiae?iaaiioth oa?aieth: ianoa?ieaeiue aioeaiae?iaai ieooieeae aioo?ue (750 ia/noo) a ni/aoaiee n neiano?ieii (5 ia/noo), o.a. a aeica, iaiueoae o?aaeeoeeiiiie a 12 ?ac. A oa/aiea ia?auo 3 ianyoeaa neiano?ie iacia/aee aioo?eiuoa/ii, a iineaaeothuea 3 ianyoea - noaeeiaaaeueii a yeaeaaeaioiie aeica. Neiano?ie i?eiaiyee o aieueiuo ni noaaeeyie caaieaaaiey T1-3N0M0. O aieueiuo n einoiuie iaoanoacaie a noaaeeyo T1-4N0-1M1 iacia/aee oiiaai (oinoyno?ie) ii 250-300 ia/noo. Ioeaieo ?acoeueoaoia ea/aiey e ea/anoaa aeecie iaoeeaioia inouanoaeyee a niioaaonoaee ni oeaeie AIC. A I iiaea?oiia n?aaiaiey /anoe/iay ?aienney eiinoaoe?iaaia o 42,5%, noaaeeecaoeey - o 47,5%, i?ia?anne?iaaiea - o 10% aieueiuo. Ea/anoai aeecie iaoeeaioia ioeaieee neaaeothuei ia?acii: 1 aaee - 40%, 2 aaeea - 50%, 3 aaeea - 10%. A oa/aiea 3 eao iaaethaeaiey oia?ee 5 aieueiuo. Ai II iiaea?oiia n?aaiaiey ?acoeueoaou auee ?anoeaiaiu eae /anoe/iay ?aienney o 10,3%, noaaeeecaoeey - o 55,9% e i?ia?anne?iaaiea - o 33,8% aieueiuo. Ea/anoai aeecie niioaaonoaiaaei 1 aaeeo o 29,4%, 2 aaeeai - o 44,1%, 3 aaeeai - o 19,1%, 4 aaeeai - o 7,4% iaoeeaioia. A oa/aiea 3 eao oia?ee 20 aieueiuo. A III iiaea?oiia n?aaiaiey /anoe/iay ?aienney aeinoeaiooa o 42,1%, noaaeeecaoeey - o 57,9% aieueiuo, i?ia?anne?iaaiey i?ioeanna ia auei ioia/aii. A yoie a?oiia o 20 (52,6%) iaoeeaioia iaaethaeaeenue ineiaeiaiey ni noi?iiu na?aea/ii-ninoaeenoie nenoaiu, a o./.: eioa?eo ieiea?aea, a?oa?eaeueiay aeia?oaicey, ino?ia ia?ooaiea iicaiaiai e?iaiia?auaiey. Ea/anoai aeecie niioaaonoaiaaei 1 aaeeo o 15,8%, 2 aaeeai - o 21,1%, 3 aaeeai - o 42,1%, 4 aaeeai - o 21,1% aieueiuo. Oia?ee a oa/aiea 3 eao 8 aieueiuo. A iniiaiie a?oiia /anoe/iay ?aienney aeinoeaiooa o 59,3%, noaaeeecaoeey - o 29,6%, i?ia?anne?iaaiea - o 11,1% aieueiuo. A yoie a?oiia ionoonoaiaaee oyaeaeua ea?aeeiaaneoey?iua e aaiaoioiene/aneea ineiaeiaiey. Ea/anoai aeecie aieueiuo ioeaieee a 1 aaee o 42,6%, 2 aaeea - o 25,9%, 3 aaeea - o 9,3%, 4 aaeea - o 3,7%. Oia?ee a oa/aiea 3 eao 7 aieueiuo. Enneaaeiaaiea iieacaoaeae ai?iiiaeueiiai noaoona o aieueiuo iniiaiie a?oiiu ia i?ioyaeaiee 6 ianyoeaa auyaeei noieeia nieaeaiea ia 50-70% o?iaiae aeiethoaeiece?othuaai ai?iiia e oanoinoa?iia, iiauoaiea niaea?aeaiey oanoinoa?ii-yno?aaeeienaycuaathuaai aeiaoeeia aei 157% e ?aceia iaaeaiea aei 75% eiaeaena naiaiaeiiai oanoinoa?iia, /oi naeaeaoaeuenoaoao i aeinoeaeaiee iieiie aiae?iaaiiie aeieaaeu. Eniieueciaaiea iiaiai iaoiaea ieceiaeiciaie yno?iaai-aioeaiae?iaaiiie oa?aiee iaania/eaaao aeinoeaeaiea noieeiai eeeie/aneiai yooaeoa a III-IV noaaeeyo caaieaaaiey e o?aoeaoithth auaeeaaaiinoue 72,7% iaoeeaioia n i?ia?anne?othuei ?aeii i?aaenoaoaeueiie aeaeacu. Eeth/aaua neiaa: i?aaenoaoaeueiay aeaeaca, i?ia?anne?othuee ?ae, ai?iiiaeueiay oa?aiey. PAGE PAGE 2

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