Механизмы полового диморфизма в патогенезе сарком

Саркомы органов, не относящихся к половой сфере, поражают женщин в 1,5–3 раза реже, чем мужчин. Механизм подобного диморфизма изучается на различных уровнях, главным образом в области влияния на патогенез половых гормонов и их рецепторов, эффект которых значительно связан с гистогенезом опухоли, ее локализацией, процессом злокачественного превращения и стадией прогрессии. Рецепторы половых гормонов чаще обнаруживаются на ранних этапах развития новообразования и утрачиваются в ходе его прогрессии. При этом экспрессия одних и тех же рецепторов в разных по гистогенезу опухолях может коррелировать с противоположным прогнозом течения заболевания и чувствительностью к гормональной терапии. В лейомиосаркомах матки экспрессия эстрогенового и андрогенового рецепторов ассоциирована с лучшим прогнозом и большей эффективностью терапии, а в остеои фибросаркомах – наоборот. Эстрогены стимулируют пролиферацию клеток остеосаркомы, а андрогены – рабдомиосаркомы и мелкокруглоклеточной опухоли, рост которой ингибируют препараты, применяемые при раке простаты. В связи с этим при попытке включения гормонального компонента в терапевтический комплекс необходимо индивидуальное исследование гормональной чувствительности опухоли. Одним из методических подходов является тестирование культуры опухолевых клеток из биопсийного или операционного материала на чувствительность к агонистам/антагонистам гормональных рецепторов по отдельности и в сочетании с химиотерапевтическими препаратами.

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