Contexte  Le cancer colorectal, deuxième par ordre de fréquence chez les femmes françaises, se développe principalement à partir de lésions précancéreuses, des adénomes. Les facteurs associés à l’obésité sont multiples, incluant des événements de début de vie, le niveau socio-économique et le comportement alimentaire ; l’obésité a aussi été associée de façon assez constante au risque de cancer colorectal. Cependant les associations entre des facteurs anthropométriques spécifiques ou au cours de la vie et le risque de tumeurs colorectales selon la filiation adénome-cancer ou selon le site sont moins claires. La ménopause est un événement de vie majeur et est associée à des modifications anthropométriques, tandis que le traitement hormonal de la ménopause (THM) est susceptible d’interagir avec les aspects anthropométriques mais aussi directement avec le risque de tumeur. De plus, la prescription du THM dépend de plusieurs paramètres, dont l’importance du suivi médical. Enfin, si le dépistage des tumeurs colorectales est conseillé à partir de 50 ans (soit aux environs de la ménopause) les attitudes vis-à-vis du dépistage varient selon de nombreux paramètres incluant les antécédents familiaux de cancer, le niveau socio-économique et les comportements de santé. Objectif  Le risque de tumeurs colorectales dépend ainsi de nombreux facteurs étroitement liés, parmi lesquels nous avons choisi d’étudier les relations complexes entre facteurs anthropométriques au cours de la vie, utilisation de THM et antécédents personnels de coloscopie, et le risque d’adénomes et de cancers colorectaux. Population  Les analyses ont été effectuées sur les données de la cohorte de femmes françaises E3N, comportant environ 1400 cas d’adénomes diagnostiqués parmi 17000 femmes ayant passé une coloscopie au cours du suivi (1993-2002) et 690 cas de cancers diagnostiqués parmi 92000 femmes au cours du suivi (1990-2008). Résultats  Notre étude a mis en évidence plusieurs aspects originaux. Tout d’abord, nous avons mis en évidence que les trois facteurs d’exposition principaux étudiés étaient associés au risque de tumeurs colorectales de façon significativement hétérogène en fonction du site, renforçant l’hypothèse selon laquelle il existe trois entités bien distinctes le long du cadre colorectal. Les caractéristiques anthropométriques typiquement occidentales (IMC et tour de taille élevés) étaient associées à un risque accru de tumeurs du côlon gauche, tandis que les associations originales que nous avons décrites entre taille assise et risque d’adénomes du côlon droit, et entre corpulence dans l’enfance et plus faible risque d’adénomes du rectum suggèrent de nouvelles pistes de recherche pour ces sites à l’étiologie mal connue. La mise en évidence d’une association positive entre prise de THM de type estrogènes seul (habituellement prescrit aux femmes hystérectomisées) et risque d’adénomes, en particulier du côlon gauche, et d’une association inverse entre le même type de THM et le risque de cancer, en particulier du côlon gauche, n’étant pas cohérentes avec les associations décrites dans la littérature, nous a conduit a explorer un éventuel biais de dépistage. La pratique de coloscopie était effectivement plus fréquente chez les femmes utilisant des estrogènes seuls (et donc aux antécédents d’hystérectomie), tandis que les antécédents de fibrome utérin étaient associés à un risque accru d’adénomes. De leur côté, les antécédents personnels de coloscopie étaient associés à une diminution de risque de cancer, surtout du côlon gauche, tandis que la réduction de risque des cancers du rectum devenait semblable à celle observée pour le côlon gauche dans la période la plus récente. Conclusion  En conclusion, nos résultats suggèrent qu’il existe des moyens efficaces de prévention des tumeurs distales, mais que la prévention des tumeurs du côlon droit demande des études spécifiques et peut-être de nouveaux paradigmes. / Background  Colorectal cancer, the second most common cancer in French women, mostly develops from precancerous lesions, the adenomas. Factors associated with adult obesity are multiple, including early life events, the socio-economic level, and eating habits; obesity has also been, in turn, quite consistently associated with colorectal cancer risk. However, associations between specific anthropometric components or lifetime anthropometry and colorectal tumours according to the adenoma-carcinoma sequence or to tumour site are less clear. Menopause is a major event in women, and is associated with changes in anthropometric features, while menopausal hormone therapy (MHT) may interact with post-menopausal anthropometry but also with tumour risk per se. In addition, prescription of this MHT depends on various parameters including quality of medical follow-up. Finally, while screening for colorectal tumours is advocated after the age of 50 (thus around menopausal age), attitudes towards colorectal screening differ according to many factors including family history of cancer, the socio-economic level, and attitudes towards a healthy behaviour. Objective  Thus colorectal tumour risk depends on many interrelated factors, among which we chose to investigate the complex relationship between lifetime anthropometric features, MHT use and personal history of colonoscopy, and colorectal adenoma and cancer risk. Population  This study was based on data from the French E3N cohort, including approximately 1400 adenoma cases diagnosed among 17000 women who underwent a colonoscopy during follow-up (1993-2002), and 690 cancer cases diagnosed among 92000 women (1990-2008).Results  Our study brought out several original findings. First our findings regarding all three major studied exposures displayed significant heterogeneity between sites, thus enforcing the hypothesis of separate entities according to site along the large bowel. Typical Western anthropometric features (high BMI and high waist circumference) were associated with left colon tumours, while the original findings of sitting height associated with risk of right colon tumours and of a large silhouette in childhood inversely associated with rectal tumours may bring out new hypotheses regarding these less understood sites. The findings of a positive association between estrogens only MHT use (usually prescribed in hysterectomised women) and adenoma risk, especially left colon adenomas, and an inverse association between the same MHT and cancer risk, especially left colon cancer, which are not consistent with associations generally described in the literature, led us to explore potential screening biases. Indeed, colonoscopy screening was more common in women who used estrogens alone (so with a history of hysterectomy), while colorectal adenomas were more common in women with uterine leiomyoma. Colonoscopy screening in turn was associated with a reduced risk of colorectal cancer, especially left colon cancer, while the risk reduction for rectal cancers became similar to that of left colon cancer in the most recent years. Conclusion  Altogether, our findings suggest efficient ways to prevent distal tumours, while prevention of right colon tumours requires further specific investigations and new paradigms.

Le métabolisme des lipides joue un rôle prépondérant dans le cancer. Ce métabolisme a pour effet, particulièrement grâce à la production de phospholipides (PLs), de supporter le niveau accru de prolifération mais aussi de réguler finement des mécanismes intra-cellulaires et extra-cellulaires qui promeuvent le maintien et la progression des cellules cancéreuses. Parmi tous ces acteurs, les gouttelettes lipidiques (GLs), connues pour leur fonction de réservoir, commencent à dévoiler leurs côtés sombres. Notre premier projet nous a permis de mettre en avant l’accumulation de GLs par des cellules de cancer colorectal (CCR) chimiorésistantes. La formation de GLs est régie par l’expression de l’enzyme lysophosphatidylcholine acyltransférase 2 (LPCAT2), permettant la production de phosphatidylcholine. Elle a pour effet de protéger le réticulum endoplasmique (RE) de l’induction d’un stress prévenant l’activation d’une mort cellulaire immunogène. Ces modulations lipidiques peuvent également se retrouver dans le plasma, où elles font l’objet de l’identification de biomarqueurs. Dans ce contexte, nous avons montré dans un second projet, que certains PLs pouvaient diagnostiquer la présence d’un carcinome hépatocellulaire (CHC) sur un foie cirrhotique. Ces deux aspects soulignent l’importance du métabolisme des PLs dans les cancers digestifs. / Among all altered cancer metabolic pathways, lipid metabolism has a preponderant role in cancer development. This metabolism, especially through the production of phospholipids, supports high level of proliferation and carefully regulates intra-cellular and extra-cellular mechanisms promoting maintenance and progression of cancer cells. Among all metabolic players, lipid droplets (LD), known for their storage function, begin to reveal dark sides. Our first project led us to highlight LD involvement in the chemoresistance of colorectal cancer (CRC) cells. This resistance carries out thanks to LD accumulation during chemotherapy treatment. Their accumulation is regulated by the expression of lysophosphatidylcholine acyltransferase 2 (LPCAT2), leading to the production of phosphatidylcholine. It causes the protection of the endoplasmic reticulum (ER) stress induction preventing the activation of immunogenic cell death. These lipid modulations can also be found in plasma where they can be identified as biomarkers. In this context, we have shown that some phospholipids could prognosticate hepatocellular carcinoma (HCC) upon cirrhotic liver. These two aspects highlight the significance of phospholipid metabolism in digestive cancers.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O câncer colo-retal (CCR) representa o quarto tipo de câncer mais freqüente no Brasil entre homens e mulheres e a sobrevida para esse tipo de neoplasia é considerada boa, se a doença for diagnosticada em estádio inicial. Neste tipo de câncer a progressão do adenoma (tumor benigno) para o adenocarcinoma (tumor maligno) é dependente do acúmulo de mutações em diversos oncogenes e genes supressores de tumor. Estas mutações podem levar a alterações de importantes vias de sinalização que controlam estes eventos como, por exemplo, as vias Wnt e EGFR. No entanto, os mecanismos moleculares e celulares mediados por estas vias durante a progressão do CCR permanecem por serem definidos. Neste trabalho foi avaliada a participação da via Wnt e do EGFR durante a progressão do CCR usando células Caco-2, uma linhagem celular derivada de adenocarcinoma de cólon humano como modelo. As células foram tratadas com EGF, ativador da via EGFR, e cloreto de lítio (LiCl), um conhecido inibidor da enzima GSK-3β e conseqüentemente, ativador da via Wnt, ou alternativamente com a combinação de ambas drogas. Após os tratamentos, foi avaliada a morfologia celular, localização e expressão de proteínas juncionais, os padrões proliferativos e do ciclo celular e o potencial tumorigênico (migração e formação de colônias). Nossos resultados mostram que a localização subcelular das proteínas juncionais claudina-1 e β-catenina foi alterada após tratamento com EGF e LiCl, porém a expressão não foi afetada. A localização nuclear de β-catenina, um marcador da ativação da via Wnt, foi observada após tratamento com ambos os compostos, no entanto estes agentes modularam a enzima GSK-3β de forma diferencial. Além disso, tratamento com EGF aumentou a capacidade proliferativa e migratória da célula, mas não alterou a formação de colônias. LiCl, apesar de ser um conhecido ativador da via Wnt, inibiu o aumento da proliferação e migração causado pelo EGF, como visto pelo tratamento das células com EGF+LiCl, e reduziu a formação de colônias. Nossos resultados revelaram que LiCl possui uma atividade supressora de tumor o que pode representar um novo papel para este composto como um possível agente terapêutico para o tratamento do CCR. / Colorectal cancer (CCR) represents the fourth type of cancer most common in Brazil among men and women and the survival for this tumor type is considered good if the disease is diagnosed at early stage. The progression of an adenoma (benign tumor) to an adenocarcinoma (malign tumor) is dependent on the accumulation of mutations in a variety of oncogenes and tumors suppressors genes. These mutations can lead to alterations of important cell signaling pathways that control these events, such as Wnt e EGFR. However, the molecular and cellular mechanisms mediated by these pathways during CCR progression remain to be defined. In the present study we assesses the role that Wnt and EGFR pathway play during CCR progression using Caco-2 cells, a human cell line derived of colorectal cancer, as a model. Cells were treated with EGF, an EGFR pathway activator, and lithium chloride, (LiCl) a known inhibitor of the enzyme GSK-3β and, therefore a Wnt pathway activator or alternatively by using combination of both drugs. After treatments, we monitored cell morphology, localization and expression of junctional proteins, proliferative and cell cycle patterns, and the tumorigenic potential (cell migration and colony formation). We show that subcellular localization of the junctional proteins claudin-1 and β-catenin was altered after treatment with EGF and LiCl, however the expression were not affected. Nuclear localization of β-catenin, a marker of Wnt pathway activation, was observed after treatment with both compounds, however these agents modulated in a differential fashion the enzyme GSK-3β. Furthermore, EGF treatment increased the proliferative and migratory capacity of the cells, but did not alter colony formation potential. LiCl, despite being a known activator of the Wnt pathway, inhibited the increase of proliferation and migration caused by EGF, as demonstrated by the cell treatments with EGF+LiCl, and reduced the cell colony formation. Our results reveal that LiCl present a suppressor tumor activity, which may represent a new role for this compound as potential therapeutic agent in the CCR treatment.

Le cancer colorectal est un enjeu majeur de Santé publique. Près de la moitié des patients porteurs d’un cancer colorectal va développer des métastases hépatiques. La chirurgie est le seul traitement potentiellement curatif. Tout doit donc être mis en oeuvre pour que ces patients accèdent à un geste chirurgical. Le volume de foie restant après hépatectomie est un des principaux facteurs limitant en chirurgie hépatique. Des techniques innovantes ont été développées dans l’optique d’une épargne parenchymateuse : l’utilisation conjointe des techniques de destruction focalisée et la chirurgie hépatique en deux temps. La chirurgie hépatique en deux temps est efficace d’un point de vue carcinologique, mais reste une procédure complexe techniquement avec une morbidité non négligeable, notamment à cause des adhérences péri-hépatiques post-opératoires. Ces adhérences sont systématiques après chirurgie hépatique mais peuvent être prévenues par l’utilisation de membranes antiadhérences après la première hépatectomie. Dans cette indication, l’étude de phase II multicentrique, présentée dans ce travail, retrouvait une diminution de l’incidence et de la sévérité de ces adhérences après utilisation de seprafilm®, ce qui facilitait la seconde hépatectomie. Les techniques de destruction focalisée peuvent dans certains cas se substituer à la chirurgie en cas de métastases résécables. Elles permettent également d’augmenter le nombre de patients candidats à une prise en charge à visée curative, lorsqu’elles sont associées à la chirurgie, en cas de métastases non résécables. Ces techniques présentent néanmoins plusieurs inconvénients qui limitent leur utilisation. Les ultrasons focalisés de haute intensité (HIFU) sont une technique récente, non ionisante, de destruction focalisée dont les avantages théoriques sont particulièrement adaptés au traitement des tumeurs hépatiques. La technologie HIFU actuelle repose sur un dispositif de traitement extra-corporel, dont la limite principale est la faible taille des ablations, qui doivent être juxtaposées pour traiter des tumeurs de quelques centimètres, ce qui nécessite des temps de traitement de plusieurs dizaines de minutes. Le développement d’une sonde HIFU per-opératoire, à géométrie torique, a permis d’obtenir des ablations d’environ 7 cm3 en 40 secondes sur un modèle porcin. Nous avons pu montrer, lors de l’étude de phase I-IIa présentée dans ce travail, que ces résultats étaient reproduits chez l’homme sur foie sain destiné à être réséqué. Les résultats positifs de ces deux études prospectives nous ont permis d’envisager une étude de phase III sur la prévention des adhérences péri-hépatiques, la poursuite de l’étude HIFU en ciblant cette fois les métastases hépatiques, et la réalisation d’une étude de phase II sur la résection hépatique assistée par HIFU comme aide à l’hémostase / Colorectal cancer is a major health problem. Almost half of patients will develop liver metastasis. Surgery is the only potentially curative treatment. Everything possible must be done for these patients to perform liver surgery. Remnant liver volume after hepatectomy is the main limit of liver surgery. Innovative techniques have been developed to spare liver parenchyma: concomitant use of focal destruction and two-stage hepatectomy. Two-stage hepatectomy is oncologically effective but is a challenging procedure with high morbidity, in part because of peri-hepatic adhesions. These adhesions occur systematically after liver surgery but can be prevented by the use of anti-adhesion membranes at the end of the first hepatectomy. In this indication, the multicentre phase II study presented herein, showed a decrease in extent and severity of adhesions with use of seprafilm®. It facilitated the dissection and so the second hepatectomy. Techniques involving focal destruction can replace surgery in selected cases of resectable metastases. They also increase the number of patients candidates to curative liver-directed therapy in unresectable metastases. These techniques have however several disadvantages, which limit their use. High intensity focused ultrasound (HIFU) is a recent, non-ionizing, technology of focal destruction. Theoretical advantages make HIFU a promising technique for focal ablation of liver tumours. Current technology is based on extra-corporeal treatment. The main limit is that elementary ablations are small and must be juxtaposed to treat supra-centimetric tumours, resulting in long-time treatment. A new and powerful HIFU device enabling destruction of larger liver volumes (7 cm3 in 40 seconds) has been developed based on toroidal transducers. We showed, in a phase I-IIa study presented herein, that preclinical results could be reproduced on healthy liver of patients undergoing hepatectomy. Positive results of these two prospective studies have allowed to design a phase III trial on prevention of peri-hepatic adhesions, to continue the evaluation of HIFU by targeting liver metastases and by assisting liver resection, in a phase II study, as a sealing device

BDNF/TrkB são descritos em diversas neoplasias onde iniciam sinais mitogênicos, facilitam o crescimento tumoral, previnem apoptose e regulam angiogênese e metástase. Outros fatores de crescimento também são importantes para tumorigênese, como GRP/GRPR e EGF/EGFR. O objetivo geral deste trabalho foi investigar o papel de BDNF/TrkB em câncer colorretal avaliando possíveis interações com GRPR e EGFR. Verificamos que BDNF e seu receptor, TrkB, estão presentes em amostras de pacientes com câncer colorretal esporádico, e os níveis de BDNF encontram-se mais elevados no tecido neoplásico que no tecido adjacente ao tumor. O tratamento com RC- 3095, um antagonista de GRPR, na linhagem celular de câncer colorretal humana, HT-29, causa diminuição nos níveis de NGF secretados pelas células e aumento de BDNF em relação ao controle não tratado. RC-3095 inibe a proliferação e viabilidade celular das linhagens HT-29 (EGFR positiva) e SW-620 (EGFR negativa), embora apenas em HT-29 ocorra um aumento significativo na expressão de mRNA de BDNF. Por isso, um anticorpo monoclonal anti-EGFR, cetuximabe, foi combinado a RC-3095, nas células HT-29, sendo capaz de prevenir tal aumento, sugerindo que este efeito seja mediado por EGFR. Os tratamentos com um inibidor de Trks, K252a (1000 nM) ou com cetuximabe (10 nM) também inibem a proliferação celular. Entretanto, a combinação de BDNF a cetuximabe previne este efeito, enquanto que a combinação de doses não efetivas de K252a (10 nM) à cetuximabe (1 nM) inibe a proliferação celular de HT- 29. Além disso, cetuximabe também causa aumento na expressão de mRNA de TrkB e BDNF, após 600 minutos de tratamento. Nossos resultados sugerem que a inibição da proliferação celular in vitro ou do crescimento tumoral in vivo devem acontecer através do bloqueio combinado entre GRPR e TrkB em células de câncer colorretal EGFR positivas, e que BDNF também esteja envolvido em mecanismos de resistência a fármacos. Por isso, o bloqueio de BDNF / TrkB pode emergir como potencial alvo antitumoral. / BDNF / TrkB are described in various cancers where they participate in tumor growth, apoptosis, angiogenesis and metastasis. Furthermore, other growth factors are also important to tumorigenesis as GRP/GRPR and EGF/EGFR. Therefore, the aim of this study was to investigate the role of BDNF/TrkB in colorectal cancer evaluating the interactions with GRPR and EGFR. We found that BDNF and its receptor, TrkB, are present in samples from patients diagnosed with sporadic colorectal cancer, and BDNF levels were higher in tumor tissue compared to adjacent tumor tissue. Treatment with RC-3095, GRPR antagonist, in human colorectal cancer cell line, HT-29 caused a decrease in NGF levels secreted by cells, and generated increase of BDNF when compared to untreated control. RC-3095 inhibited the proliferation and cell viability in HT-29 (EGFR positive) and SW-620 (EGFR negative), but only HT-29 cells showed a significant increase in BDNF mRNA expression. Therefore, a monoclonal anti-EGFR antibody, cetuximab was combined with RC-3095 in HT-29 cells, and was able to prevent such an increase, suggesting that this effect is mediated by EGFR. The treatment with a Trk inhibitor, K252a (1000 nM) or cetuximab (10 nM), inhibited cell proliferation. However, the combination of BDNF with cetuximab prevented this effect, whereas the combination of ineffective doses of K252a (10 nM) with cetuximab (1 nM) still inhibited cell proliferation of HT-29. Furthermore, cetuximab also caused an increase in BDNF and TrkB mRNA expression, 600 minutes after treatment. In summary, our results suggest that inhibition of cell proliferation in vitro or tumor growth in vivo must occur between the combination of GRPR and TrkB in EGFR positive colorectal cancer cells, and that BDNF is also involved in drug resistance mechanisms. Therefore, blockage of BDNF / TrkB may emerge as potential antitumor target.

<p>Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.</p>

Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.

The detection and analysis of biomolecules, such as proteins, are of great interest since these molecules are fundamental for life and our health. Due to the complexity of biological processes, there is a great advantage of studying proteins in their natural context, for example by using bioimaging. The objective of this doctoral thesis has been to develop, implement and evaluate techniques for the use of proteinspecific affinity reagents in diverse bioimaging platforms for analysis of protein expression in situ in cells and tissues. To be able to visualize a desired protein in situ using affinity reagents, reporter labels are needed. A novel technique for labeling of antibodies on solid phase was developed. This method offers simultaneous purification, concentration and labeling of an antibody sample, giving highly predictable and reproducible results, in a miniaturized format. Another study demonstrates the use of an alternative affinity reagent, the Affibody molecule, in bioimaging as well as other immunoassays. As a relevant proof-of-principle, an Affibody molecule binding the HER2 receptor was site-specificly labeled and employed for analysis of HER2 protein expression in cells and tissue using immunofluorescence (IF), immunohistochemistry (IHC), immunoprecipitation and flow cytometry. Furthermore, it is shown how antibody-based bioimaging approaches can be applied for systematic analysis of protein expression in terms of subcellular localization and expression levels in cell lines. The systematic subcellular localization of nearly 500 proteins was performed using IF and confocal microscopy. Global analysis of expression levels of nearly 2000 proteins in a panel of cell lines using IHC and automated image analysis, revealed that most proteins are expressed in a cell size dependent manner. Two normalization approaches were evaluated and found to allow for protein profiling across the panel of morphologically diverse cells, revealing patterns of protein over- and underexpression, and proteins with stable as well as with lineage specific expression were identified. Finally, the value of antibody-based, bioimaging proteomics as a platform for biomarker discovery is demonstrated. The identification and in depth study of a candidate biomarker for colorectal cancer, SATB2, is described using both IHC and IF bioimaging. Results from extended analyses of tumor biopsies showed that detection of SATB2 protein using IHC provides a clinically relevant diagnostic tool with high specificity and sensitivity to aid in diagnosis of colorectal cancer. Furthermore, the study demonstrated a potential prognostic role of SATB2, as decreased expression was associated with a significantly shorter overall survival in patients with advanced colorectal cancer. / QC 20100824

Bakgrund: Tidigare studier har identifierat flera riskfaktorer, såsom kost, fysisk aktivitet och BMI, gällande kolorektal cancer. Att analysera kost utifrån kostmönster istället för enskilda livsmedel har visat sig vara effektivt för att undersöka risker för kolorektal cancer. Datamaterial samlades in med hjälp av en fall-kontroll studie med 257 fall och 805 kontroller. Syfte: Identifiera faktorer som ger en höjd eller sänkt risk för kolorektal cancer utifrån områdena kost, fysisk aktivitet och BMI. Metod: Faktoranalys användes för att upptäcka kostmönster. Logistisk regression användes för att skatta oddskvoter och 95 % konfidensintervall. Resultat: Tio stycken kostmönster erhölls från faktoranalysen. Kostmönstren ”Läsk, juice och mjölkprodukter” (OR=1,288; ORQ4=2,159), ”Te, men inte kaffe”(OR=1,228; ORQ3=1,891; ORQ4=1,668) och ”Fågel, rött kött och fisk”( ORQ4=1,724) gav alla en ökad risk. Däremot visade kostmönstret ”Mat från säd och ost”( ORQ2=0,546; ORQ4=0,592) en minskad risk. BMI för tio år sedan (OR=1,079; ORÖvervikt=1,491; ORFetma=2,260) identifierades som en riskfaktor. Att arbeta inom stillasittande (OR=0,975; OR&gt;15 år=0,517) och mellanaktiva (OR=0,977; OR6-10 år=0,497;OR&gt;15 år=0,565) yrken visade på en minskad risk. Slutsats: Flera kostmönster visade sig vara riskfaktorer, detta gäller även BMI för tio år sedan. Kostmönstret ”Mat från säd och ost” och att arbeta i fysiskt lätta till medeltunga yrken visade sig vara skyddande faktorer. / Background: Previous studies have shown several risk factors for developing colorectal cancer such as diet, physical activity and BMI. The method of analyzing diets based on dietary patterns, rather than individual food items, have been shown to be effective when investigating the colorectal cancer risk. The data was collected using a case-control study of 257 cases and 805 controls. Aim: Identify factors that cause increased or decreased risk in developing colorectal cancer based on diet, physical activity and BMI. Methods: Factor analysis was conducted to identify dietary patterns. Logistic regression was used to estimate odds ratio and 95 % confidence interval. Results: Factor analysis conducted ten dietary patterns, three of these patterns showed an increased risk “Soft drinks, juice and milk products” (OR=1,288; ORQ4=2,159), “Tea, but not coffee” (OR=1,228; ORQ3=1,891; ORQ4=1,668) and “Poultry, red meats and fish” (ORQ4=1,724).The dietary pattern “Food based on grain and cheese” (ORQ2=0,546; ORQ4=0,592) showed a decreased risk. BMI ten years ago (OR=1,079; OROverweight=1,491; ORObese=2,260) identified as a risk factor. To work in sedentary (OR=0,975; OR&gt;15 years=0,517) or physically medium heavy (OR=0,977; OR6-10 years=0,497; OR&gt;15 years=0,565) occupations indicated a decreased risk. Conclusions: Several dietary patterns has been identified as risk factors, this also includes BMI ten years ago. The dietary pattern “Food based on grain and cheese” and to work in sedentary or physically medium heavy occupations proved to be protective factors.

Ziel der vorliegenden Arbeit ist die retrospektive Beurteilung der Sicherheit und Effektivität der Leberteilresektion bei der Behandlung von Lebermetastasen des kolorektalen Karzinoms sowie der Re-Resektion bei Patienten mit Rezidivlebermetastasen. Weiterhin soll das operative Vorgehen bei synchronen Lebermetastasen hinsichtlich simultaner Resektionsverfahren und zweizeitigen Vorgehens untersucht werden. Insgesamt wurden die Ergebnisse von 660 Patienten ausgewertet, die zwischen 1988 und 2004 mit 685 Leberteilresektionen behandelt wurden. Unter diesen waren 75 Patienten, die eine Re-Resektion erhielten sowie 202 Patienten, bei denen die Lebermetastasen synchron auftraten. Neben der Analyse der postoperativen Letalität und postoperativen Komplikationen sollen prognostische Faktoren für das Langzeitüberleben und das Auftreten von Tumorrezidiven nach Leberteilresektion identifiziert werden. Da sich die Studienpopulation aus einem Zeitraum von über 15 Jahren rekrutiert, sollen außerdem verschiedene Zeitabschnitte vergleichend analysiert werden. Die Leberteilresektion ist derzeit die einzige potentiell kurative Therapie bei kolorektalen Lebermetastasen. Als prognostisch günstige Parameter in der multivariaten Analyse zeigten sich die Radikalität des Eingriffes, die Anzahl der Metastasen, vorhandene ligamentäre Lymph-knotenmetastasen sowie das Jahr der Resektion. Auch bei Rezidiven kolorektaler Lebermetastasen ist das chirurgische Vorgehen derzeit die einzige kurative Intervention. Re-Resektionen weisen ein vergleichbares operatives Risiko und vergleichbare Langzeitüberlebensraten auf wie Erstresektionen. Als einziger prognostischer Parameter für das Langzeitüberleben erwies sich in der multivariaten Analyse die Radikalität des Eingriffes. Bei synchronen Lebermetastasen sind die wichtigsten Kriterien, um eine simultane Resektion durchzuführen, die Berücksichtigung des Alters sowie des Resektionsausmaßes. Simultane Resektionen sind bei synchronen kolorektalen Lebermetastasen dann so sicher und effizient durchführbar wie Resektionen im zweizeitigen Vorgehen.