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Doctoral Thesis
DOI
10.11606/T.5.2011.tde-05052011-141501
Document
Author
Full name
Iberê Cauduro Soares
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2011
Supervisor
Committee
Alves, Venancio Avancini Ferreira (President)
Bernardi, Fabiola Del Carlo
Kassab, Paulo
Mello, Evandro Sobroza de
Stávale, João Norberto
Title in Portuguese
Avaliação de fatores de estadiamento em carcinoma epidermoide do esôfago e de fatores imuno-histoquímicos relacionados a apoptose e p53
Keywords in Portuguese
Apoptose
Carcinoma de células escamosas
Esôfago
Estadiamento de neoplasias
Imunoistoquímica
Proteína supressora de tumor p53
Abstract in Portuguese
O carcinoma epidermoide do esôfago continua sendo a principal neoplasia maligna esofágica na população brasileira. Os objetivos desta investigação foram: avaliar a imuno-expressão de um grupo de proteínas relacionadas à via intrínseca da apoptose (bax, APAF-1 e citocromo c) e da proteína p53 em um grupo de carcinomas epidermoides do esôfago; confrontar estes resultados com a atividade proliferativa medida pela imuno-expressão do antígeno Ki67 e com a atividade apoptótica medida pela imuno-expressão da caspase 3 clivada; e confrontá-los com parâmetros implicados no estadiamento do carcinoma epidermoide do esôfago (invasão local ou pT, estado dos linfonodos regionais ou pN, grau de diferenciação do tumor primário e local do tumor primário no esôfago) e com o tamanho do tumor primário. De um grupo inicial de 91 carcinomas esofágicos consecutivos, 66 carcinomas epidermoides do esôfago foram revistos, alocados em micromatrizes teciduais e submetidos à técnica de imuno-peroxidase com anticorpos primários anti: bax, APAF-1, citocromo c, p53, Ki67 e caspase 3 clivada. Suas imuno-expressões foram semiquantificada de 0 a 5+, exceto caspase 3 clivada que foi contada em 1000 células. Apresentaram amostras válidas um conjunto de 63 carcinomas epidermoides do esôfago. A mediana de imuno-expressão destas 6 proteínas foi: 2+, 5+, 5+, 5+, 3+ e 26, respectivamente. Houve correlação positiva entre a imunoexpressão do antígeno Ki67 e a de caspase 3 clivada (coeficiente rho de Spearman =0,373, p=0,003). Houve associação entre a imunoexpressão de APAF-1 e o grau de diferenciação, com valores maiores de APAF-1 para os carcinomas epidermoides do esôfago bem diferenciados (mediana de 5+ para tumores bem diferenciados, contra mediana de 2+ para tumores pouco diferenciados, p<0,001, teste de Kruskal-Wallis). Houve associação entre o tamanho do tumor primário e o nível de invasão local do tumor primário, com tamanhos maiores quanto maior o nível de invasão local dos carcinomas epidermoides do esôfago (mediana de 32,5 mm para os tumores pT1 e mediana de 50,0 mm para os tumores pT3 ou pT4, p=0,027, teste de Kruskal-Wallis). Não houve associação entre as demais variáveis. Embora atividade proliferativa e atividade apoptótica caminhem juntas nos carcinomas epidermoides do esôfago, no estágio invasivo do principal tipo histológico de carcinoma esofágico da população brasileira, não são mais os fatores ligados à via intrínseca da apoptose que influenciam a sua progressão. Além disso, se a imunoexpressão aumentada da proteína APAF-1 estimula a diferenciação nos carcinomas epidermoides esofágicos, não o faz através de estímulo da atividade apoptótica pura e simplesmente
Title in English
Assessment of staging factors in squamous cell carcinoma of the esophagus, and of immunohistochemical factors related to apoptosis and p53
Keywords in English
Apoptosis
Esophagus
Immunohistochemistry
Neoplasm staging
Squamous cell carcinoma
Tumor suppressor protein p53
Abstract in English
Squamous cell carcinoma of the esophagus remains as the major malignant esophageal neoplasm in the Brazilian population. The objectives of this study were: to assess the immunoexpression of a group of proteins related to the intrinsic pathway of apoptosis (bax, APAF-1 and cytochrome c) and to p53 protein in squamous cell carcinoma of the esophagus; to confront these results with proliferative activity measured by the immunoexpression of Ki67 and with apoptotic activity measured by the immunoexpression of cleaved caspase 3; and to confront them with parameters involved in the staging of squamous cell carcinoma of the esophagus(local invasion or pT, lymph node status or pN, grade of differentiation of primary tumor and site of primary tumor in the esophagus) and with size of primary tumor. From a starting group of 91 consecutive carcinomas of the esophagus, 66 squamous cell carcinomas of the esophagus were selected, revised, placed in tissue microarrays blocks, and submitted to immunoperoxidase technique with primary antibodies to: bax, APAF-1, cytochrome c, p53, Ki67 and cleaved caspase 3. The immunoexpression was semiquantified in a scale from 0 to 5+, except for cleaved caspase 3, whicht was counted in 1000 cells. Sixty three squamous cell carcinomas of the esophagus displayed valid cores for analysis. The median immunoexpression of these 6 proteins were: 2+, 5+, 5+, 5+, 3+ and 26, respectively. A positive correlation was found between Ki67 antigen and cleaved caspase 3 immunoexpression (Spearmans rho coefficient =0.373, p=0.003). There was association between the immunoexpression of APAF-1 and the grade of differentiation, with higher values of APAF-1 for well differentiated squamous cell carcinomas of the esophagus (median of 5+ for well differentiated tumors and median of 2+ for poorly differentiated tumors, p<0.001, Kruskal-Wallis test). The size of primary tumor was statistically associated to the degree of local invasion of primary tumor, with higher size associated to deeper local invasion (median of 32.5 mm for pT1 tumors and median of 50.0 mm for pT3 or pT4 tumors, p=0.027, Kruskal-Wallis test). There was no association among the other variables. Although proliferative activity and apoptotic activity go together in squamous cell carcinomas of the esophagus, the factors involved in the intrinsic pathway of apoptosis does not differ significantly according to the histological parameters in the invasive phase of the development of squamous cell carcinoma of esophagus. Moreover, , if increased immunoexpression of APAF-1 stimulates differentiation of squamous cell carcinomas of the esophagus, it does not work through direct higher apoptotic activity
 
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Publishing Date
2011-05-06
 
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