A avaliação sensitiva de pacientes tratados com oxaliplatina tem se tornado objeto de estudo, pelo fato deste medicamento causar como efeito colateral, uma neuropatia periférica com características sensitivas, imediatamente após início da infusão. Sintomas que causam restrições nas atividades de vida diárias e na qualidade de vida do paciente durante o tratamento. Para uma melhor compreensão do mecanismo das alterações sensitivas, atualmente tem se utilizado o teste quantitativo da sensibilidade (TQS), que através da mensuração quantitativa dos limiares de detecção aos estímulos quente, frio e de vibração, nos concede um perfil para melhor relacionar com as possibilidades de manejo ou tratamento. Neste estudo propomos uma análise da através do TQS e de instrumentos que quantificam e qualificam a neuropatia, a dor neuropática e suas características. Objetivos: Descrever de forma prospectiva as alterações de sensibilidade exteroceptiva somática causadas pelo uso da oxaliplatina em doentes com câncer colorretal. Métodos: Foram incluídos 110 doentes (média 55 anos) com câncer colorretal que realizaram tratamento antineoplásico com oxaliplatina por seis meses, e foram avaliados por mais seis após a quimioterapia. Os pacientes realizaram avaliação sensitiva com TQS e responderam questionário sócio demográfico e questionários específicos para dor e neuropatia na visita basal (VB), ao término da quimioterapia (VT) e novamente após 6 meses de seguimento (VS). Resultados: Os questionários de dor e neuropatia mostraram seu início e as suas características, na qual foi evidente a dor com características neuropáticas na visita término do tratamento em 21,7% dos participantes manifestada pela dormência, choque elétrico, alfinetadas e agulhadas e a sensibilidade ao frio. As principais alterações demonstradas pelo TQS foram: nos limiares de detecção mecânica; aumento dos limiares dolorosos térmicos; diminuição da hiperalgesia mecânica; diminuição do limiar de detecção vibratória na mão e aumento no pé. O TQS indicou alterações entre os participantes do estudo e o grupo de voluntários saudáveis em algum momento das avaliações. Conclusão: Os pacientes com câncer colorretal submetidos ao tratamento com oxaliplatina cursam com dor com características neuropáticas que interferem em suas atividades diárias. O TQS caracterizou as principais alterações relacionadas ao início do tratamento, término do tratamento e durante o seguimento. As comparações com voluntários saudáveis sugerem que a presença da neoplasia e outras comorbidades são capazes de causarem alterações no TQS / Sensory evaluation of patients treated with oxaliplatin has become an object of study, because this medication cause as a side effect, peripheral neuropathy with sensory characteristics, immediately after start of infusion. Symptoms that cause restrictions in daily activities and in the patient\'s quality of life during treatment. For a better understanding of the mechanism of sensory changes, currently it has used quantitative sensitivity testing (QST). That by the quantitative measurement of thresholds to warm stimuli, cold and vibration, gives us a profile to better relate to the possibilities of management or treatment. In this study we propose an analysis by QST and tools to quantify and qualify neuropathy, neuropathic pain and its features. Objectives: To describe prospectively the somatic exteroceptive sensitivity changes caused by the use of oxaliplatin in patients with colorectal cancer. Methods: We included 110 patients (mean 55 years) with colorectal cancer who underwent anticancer treatment with oxaliplatin for six months and were evaluated for six after chemotherapy. Patients underwent sensory evaluation with QST and answered sociodemographic questionnaire and specific questionnaires for pain and neuropathy at baseline, at the end of chemotherapy (visit six months) and again after 6 months of follow-up (visit twelve months). The instruments used were reduced McGill Pain Questionnaire (MPQ), Inventory symptoms of neuropathic pain (ISDN), Brief Pain Inventory (BPI-Brief Pain Inventory) Questionnaire neuropathic pain 4 (DN4), hospital scale of anxiety and depression (HADS). Results: The pain questionnaires and neuropathy showed its beginning and its characteristics, which was evident pain with neuropathic characteristics in the end visit of treatment in 21.7% of participants manifested by numbness, electric shock, pins and needles and sensitivity to cold. The main changes demonstrated by QST were in mechanical thresholds; painful increase in thermal thresholds; reduction in mechanical hyperalgesia; reduction of vibration detection limit for the hand and foot increases. The QST indicated changes between the study participants and the group of healthy volunteers at some point of the evaluations. Conclusion: Patients with colorectal cancer undergoing treatment with oxaliplatin occur with pain with neuropathic characteristics that interfere with their daily activities. QST characterized the major changes related to the start of treatment, end of treatment and during follow-up. Comparisons with healthy volunteers suggest that the presence of neoplasia and other comorbid conditions are capable of causing changes in the QST

Bai Hsing Chen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 89-94). / Abstracts in English and Chinese. / Acknowledgments --- p.ii / Publication --- p.iii / List of Abbreviations --- p.iv / List of Tables --- p.v / List of Figures --- p.vi / Abstract --- p.vii / 摘要 --- p.x / Table of Contents --- p.xii / Chapter Chapter 1 --- INTRODUCTION / Chapter 1.1 --- Molecular Biology in Cancer Development --- p.2 / Chapter 1.1.1 --- Cell Cycle and Cancer --- p.2 / Chapter 1.1.2 --- Oncogenes and Tumor Suppressor Genes --- p.4 / Chapter 1.1.3 --- Epigenetic Alteration in Tumor Cells --- p.6 / Chapter 1.2 --- Colorectal Cancer Development --- p.9 / Chapter 1.2.1 --- Epidemiology of Colorectal Cancer --- p.9 / Chapter 1.2.2 --- Adenoma-Carcinoma Sequence --- p.11 / Chapter 1.2.2.1 --- Hyperplastic (metaplastic) Polyps --- p.11 / Chapter 1.2.2.2 --- Aberrant Crypt Foci (ACF) --- p.13 / Chapter 1.2.2.3 --- Adenomas --- p.13 / Chapter 1.2.2.4 --- Serrated adenomas --- p.15 / Chapter 1.2.2.5 --- Colorectal Carcinomas --- p.16 / Chapter 1.2.3 --- Genetic alterations in CRC --- p.18 / Chapter 1.2.4 --- Epigenetic alterations in CRC --- p.21 / Chapter 1.2.5 --- Staging of Colorectal Cancer --- p.23 / Chapter 1.3 --- Hypothesis --- p.25 / Chapter 1.4 --- Aim of Study --- p.26 / Chapter Chapter 2 --- MATERIALS and METHODES / Chapter 2.1 --- Patient Populations --- p.28 / Chapter 2.2 --- Microdissection and Immunohistochemistry --- p.29 / Chapter 2.3 --- DNA Isolation and Modification --- p.31 / Chapter 2.3.1 --- DNA Extraction from Microdissected Tissues --- p.31 / Chapter 2.3.2 --- DNA Extraction from Frozen Biopsy --- p.31 / Chapter 2.3.3 --- Bisulfite Modification of DNA --- p.32 / Chapter 2.4 --- Detection of K-ras Mutation --- p.33 / Chapter 2.5 --- Methylation-specific PCR (MSP) --- p.36 / Chapter 2.6 --- Bisulfite DNA Sequencing --- p.42 / Chapter 2.7 --- Statistical analysis --- p.44 / Chapter Chapter 3 --- RESULTS / Chapter 3.1 --- Promoter Hypermethylation of Tumor Related Genes in the Progression of Colorectal Neoplasia --- p.46 / Chapter 3.1.1 --- Clinico-Pathological parameters --- p.46 / Chapter 3.1.2 --- "Frequencies of Promoter Hypermethylation in Colorectal Cancers, Adenomas and Normal Colonic Tissues" --- p.47 / Chapter 3.1.3 --- Promoter Hypermethylation in Multiple Genes --- p.50 / Chapter 3.1.4 --- Promoter Hypermethylation in Advanced vs. Non-advanced Adenoma --- p.50 / Chapter 3.1.5 --- Methylation Patterns in Paired Adjacent Tissues from Cancer Patients --- p.53 / Chapter 3.1.6 --- Immunohistochemistry --- p.55 / Chapter 3.1.7 --- K-ras mutation --- p.61 / Chapter 3.1.8 --- Clinicopathological Correlations with Promoter Hypermethylation --- p.64 / Chapter 3.2 --- DNA Methylation Spread within HLTF CpG Island in Colorectal neoplasia --- p.67 / Chapter Chapter 4 --- DISCUSSION / Chapter 4.1 --- Methylation is an early event in Colorectal Carcinogenesis --- p.72 / Chapter 4.1.1 --- Methylation is frequently detected in both adenoma and carcinoma --- p.74 / Chapter 4.1.2 --- Concurrent methylation in multiple genes --- p.76 / Chapter 4.1.3 --- Methylation in advanced and non-advanced colorectal adenomas --- p.76 / Chapter 4.1.4 --- Relationship between K-ras mutation and methylation --- p.78 / Chapter 4.1.5 --- Methylation in adjacent tissues --- p.80 / Chapter 4.2 --- DNA Methylation Spread in HLTF gene --- p.81 / Chapter 4.2.1 --- HLTF is Frequently Methylated in Gastrointestinal Neoplasm --- p.82 / Chapter 4.2.2 --- Methylation Spread Patterns in Cancers and Adenomas --- p.83 / Chapter 4.2.3 --- Age Dependent Methylation Spread --- p.85 / Chapter Chapter 5 --- CONCLUSION --- p.87 / References --- p.89

In order to gain insights into the underlying mechanisms, several methods including, flow cytometric, western blot and quantitative real-time PCR analyses were employed. AITC-induced cell growth inhibition in SW620 cells was mainly caused by G2/M arrest, which was accompanied by regulatory proteins modifications. Results of western blot and quantitative real-time PCR analysis showed clear downregulation of pivotal phosphatases Cdc25B and Cdc25C at both transcriptional and post-translational levels in AITC-treated cells. Subsequently, accumulation of inhibitory phosphorylation of Cdc2 on Thr14 and Tyr15 were resulted. Furthermore, an AITC induced apoptosis after prolonged exposure was observed. It was a caspase-mediated apoptosis as evidenced by the activation of initiator caspases (-8 and -9), effector caspases (-3 and -7) and cleavage of Poly (ADP-ribose) polymerase (PARP). Besides in vitro studies, the antitumor activity of AITC was further illustrated by a nude mice xenografts experiment. Treatment with 10 micromol AITC could effectively suppress the growth of SW620 xenografts in vivo. Taken together, our results suggest that AITC is an attractive candidate for future research in chemotherapy and chemoprevention. / Many epidemiological studies indicate that a high intake of cruciferous vegetables, such as cabbage, broccoli and Brussels sprouts, may reduce the risk of certain types of cancer. Glucosinolates in cruciferous vegetables and their digested products are suggested to play an important role in such chemoprevention. When plant tissue is physically damaged, glucosidic bonds are cleaved by endogenous myrosinase to produce various products. Among these products, isothiocyanates (ITCs) draw most of the attention because of their potent antitumor activities. But the molecular mechanism leading to such effects has not yet been defined. / The objective of this study was to investigate the chemotherapeutic potential of allyl isothiocyanate (AITC) towards human colorectal adenocarcinoma cells. Another commonly founded ITC, phenylethyl isothiocyanate (PEITC) was employed as a reference sample. The growth inhibitory effects of ITCs on different colorectal adenocarcinoma cells were investigated using in vitro cell models. Both AITC and PEITC were found to inhibit the growth and proliferation of Caco-2, COLO 201 and SW620 cells in a time- and dose-dependent manner. Based on sensitivity, the most vulnerable SW620 cells were chosen for further studies. In the following BrdU assay, IC50 values for 24-h AITC and PEITC treatments were determined to be 30.2 and 9.21 microM, respectively. At the same time, the effects of ITCs on human normal skin fibroblast Hs68 cells were also investigated. It was found that the survival of Hs68 cells was not affected by the treatments of AITC. However, the survival of Hs68 cells was greatly affected by PEITC-treatments in a dose- and time-dependent manner. / Lau, Wing Sze. / Adviser: Wong Yum Shing. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 115-128). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

A maioria dos pacientes que apresentam metástases hepáticas colorretais (MHCR) não são elegíveis para ressecção. Por isso, outras técnicas para se alcançar o controle locorregional da doença têm sido utilizadas. A Ablação por Radiofrequência (ARF) hepática tem sido empregada frequentemente para o tratamento desta condição devido às boas taxas de resposta, principalmente quando associada ao emprego de quimioterápicos modernos. Apesar da caracterização das MHCR no pré-operatório estar bem estabelecida, os parâmetros de ressonância magnética (RM) após ARF no período pós-cirúrgico requerem maior padronização objetiva. O coeficiente de difusão aparente de água (CDA) tem sido usado na RM como um parâmetro de isquemia e necrose. Entretanto, não está ainda bem definido seu papel e das imagens ponderadas de difusão (DWI) na avaliação da necrose coagulativa gerada pela ARF, especificamente em pacientes com MHCR. O objetivo deste estudo consiste em avaliar o espectro de mudança em RM funcional após a ARF de MHCR. Foi realizado estudo retrospectivo entre 2001 e 2006, avaliando 51 pacientes que foram submetidos à ARF por MHCR no Hospital Johns Hopkins (Baltimore, EUA) dos quais 16 preencheram os critérios de inclusão. Os critérios de inclusão foram: (1) apresentar MHCR tratada cirurgicamente com intenção curativa por ARF guiados por ultrassom per-operatório, e (2) ter uma RM anterior e imediatamente após a cirurgia (até 10 dias). As imagens de RMs antes e após a ablação hepática para MCHR foram identificadas e revistas. As imagens de RM de difusão e captação de contraste foram feitas numa unidade de 1.5 T. Imagens em T2 e T1 foram realizadas na presença e ausência de contraste venoso. Todos os exames tiveram a espessura de 4 a 6 mm e um intervalo de 2 mm, apresentando um angulo de rotação de 150. O índice de difusão foi determinado com um b-valor (intensidade do gradiente de difusão) de 500 seg/mm2. As análises de parâmetros para avaliar e comparar o pré e pós ARF através da RM funcional incluiram: (1) valores do mapa de CDA, (2) captação de contraste, (3) difusão e (4) mudança no tamanho da lesão. Em adição, a sobrevida mediana global e tempo para recorrência local foram calculados. As imagens foram avaliadas por um consenso de dois radiologistas/cirurgiões. Foram avaliados no total 65 lesões, com tamanho médio pré-ablação de 1,7 cm. Após ablação o tamanho médio da lesão aumentou para 3,5 cm (p<0,001). A captação de contraste nas fases arterial e venosa diminuíram significativamente após ARF (diminuição média 10% e 17,5%, respectivamente, p = 0,002 e <0,001). O valor médio do mapa de CDA da lesão foi de 2.79 x 10-3 mm2/seg pré-ARF, e após ARF diminui em média para 1.75 x 10-3 mm2/seg (p<0.001). A sobrevida mediana global foi de 34,7 meses. A ressonância magnética funcional através da captação de contraste e difusão pode prover uma estimativa subjetiva e objetiva da necrose coagulativa tissular e da desidratação celular na área ablada por radiofrequência. Quando combinada ao aumento no tamanho do tumor, podem atuar como um marcador adicional de resposta tumoral. / The majority of patients who have colorectal liver metastases (CLM) are not eligible for resection. Therefore other techniques to achieve locoregional control of the disease have been used. Liver radiofrequency ablation (RFA) have been more frequently used for treatment of this condition due to good response rates, particularly when associated to modern chemotherapy. Although characterization of CLM pre ablation are well established, parameters post RFA require more objective standardization. Apparent water diffusion coefficient (ADC) have been used as a necrosis and ischemic parameters in MR analyzes. Even though it is not yet well defined its rule and the diffusion weighted images (DWI) in evaluation of RFA generated coagulative necrosis, specifically in patients with CLM. The objective of this study is to analyze the spectrum of changes in functional MR after CLM RFA. A retrospective study was done between 2001 and 2006, where 51 patients were submitted to CLM RFA in Johns Hopkins Hospital (Baltimore, USA) and 16 fulfilled inclusion criteria. The inclusion criteria were: (1) to have CLM treated with curative intention on surgery guided by intra-operative ultra-sound (IOUS), and (2) to have an MR immediately and after (until 10 days) the RFA procedure. MR images before and after RFA were identified and reviewed. Contrasted and DWI MR Images were done in 1.5 T unit. T1 and T2 images were done with and without venous contrast. All of exams had 4 to 6 mm thickness, 2mm gap and a flip angle of 150. ADC was determined with a b-value of 500 sec/mm2 (intensity of diffusion gradient). Pre and post RFA functional MR analyzes included the following parameters: (1) ADC value, (2) contrast enhancement, (3) diffusion and (4) change in tumor size. In addition, survival and time to local recurrence were calculated. The images were reviewed by two radiologist/surgeon consensus. A total of 65 lesions were evaluated, with 1,7cm mean size pre RFA. After RFA the mean size increased to 3,5 cm(p<0,001). Arterial and venous contrast enhancement diminished significantly post RFA (lowered to mean 10% and 17,5%, respectively, p = 0,002 and p<0,001). Mean ADC lesion pre RFA was 2.79 x 10-3 mm2/sec, and pré-ARF, after RFA lowered to mean 1.75 x 10-3 mm2/sec (p<0.001). Median overall survival was 34,7 months. Functional MR through diffusion and contrast enhancement can provide coagulative necrosis and cellular dehydration subjective and objective estimation in the ablated area. When associated with increase in tumor size can act as an additional marker of tumor response.

A síndrome do câncer de colo-retal hereditário não relacionado a polipose (HNPCC) foi caracterizada na década de 60 e por volta dos anos 90 os critérios de Amsterdam para o diagnóstico clínico de HNPCC foram estabelecidos, envolvendo história familiar em duas gerações sucessivas, com três indivíduos apresentando acometimento do cólon e/ou reto e um dos indivíduos diagnosticados abaixo dos 45 anos. A instabilidade de microssatélites (MSI) começou a ser descrita em 1993 em pacientes portadores do HNPCC, mas é comum em outras neoplasias esporádicas. Em 1996 os critérios de Bethesda, que envolvem o acometimento preferencial do cólon proximal, histologia indiferenciada ou mucosecretora, presença de tumores sincrônicos e metacrônicos ou associação a tumores extracólicos, além da história familiar, foram propostos pelo Grupo Internacional Colaborativo para o estudo do HNPCC (ICG-HNPCC), com o intuito de rastrear maior número de pacientes suspeitos de serem portadores da síndrome. A MSI é caracterizada pela perda ou ganho de unidades repetitivas em regiões do DNA contendo mono, di, tri ou tetranucleotídeos dispostos seguidamente no genoma. No presente estudo, nosso objetivo foi analisar a freqüência de instabilidade de microssatélites (MSI) pela análise de 7 regiões microssatélites (BAT25, BAT26, D5S346, D2S123, D17S250, BAT40, TP53), correlacionando os dados obtidos com algumas características clinicopatológicas dos pacientes. O DNA de 106 pares de amostras de tecido normal e tumor provenientes de portadores de carcinoma colo-retal (CCR), foi estudado mediante a realização da reação em cadeia pela polimerase (PCR), seguida pela análise em gel de poliacrilamida desnaturante. Os pacientes foram divididos em dois grupos, um com 75 pacientes com pelo menos um dos critérios de Bethesda (tumor no cólon proximal, histologia pouco diferenciada, padrão indiferenciado ou mucinoso, idade igual ou inferior a 45 anos, sincronicidade ou metacronicidade dos tumores) e 31 pacientes sem nenhum desses critérios. Dos 106 casos, 14,1% (15/106) apresentaram MSI em 30% ou mais dos marcadores analisados, sendo classificados com instabilidade de microssatélite de alto grau (MSI-H), 17,9% (19/106) dos casos foram classificados com instabilidade de microssatélite de baixo grau (MSI-L) e 67,9% (72/106) com estabilidade de microssatélites (MSS). Se considerarmos apenas a análise do grupo com pelo menos um dos critérios de Bethesda considerados, observamos que 18,6% (14/75) dos casos apresentaram MSI-H, 18,6% (14/75) foram MSI-L e 62,6% (47/75) MSS. No grupo sem nenhum dos critérios de Bethesda analisados, 3,2% (1/31) apresentaram MSI-H, enquanto 16,1% (5/31) e 80,6% (25/31) foram MSI-L e MSS respectivamente. Quando consideramos os marcadores propostos pelo Grupo Colaborativo Internacional para o estudo do HNPCC - ICG-HNPCC (BAT25, BAT26, D5S346, D2S123, D17S250) observamos que no grupo sem critérios de Bethesda passamos a ter apenas casos classificados como MSI-L e MSS. No grupo com pelo menos um dos critérios passamos a ter 21 ,3% (16/75) dos casos classificados com MSI-H e 14,7% (11/75) de casos MSI-L. Os marcadores mais sensíveis para a análise de MSI-H foram BAT25 e BAT26, enquanto os marcadores D17S250 e TP53 foram os mais freqüentes no casos MSI-L. Ao considerarmos os casos com pelo menos um dos critérios de Bethesda e apenas o painel proposto pelo ICG-HNPCC, o marcador BAT25 identificou os casos MSI-H com 100% de sensibilidade e 96,6% de especificidade, enquanto o BAT26 apresentou 93,7% e 98,9% de sensibilidade e especificidade respectivamente. A avaliação dos critérios de Bethesda considerados neste estudo mostrou que a localização proximal do tumor se correlacionou com os casos MSI-H. / The Hereditary Non-Polyposis Colorectal Cancer Syndrome (HNPCC) was characterized in the 60\'s, and the Amsterdam criteria for the clinical HNPCC diagnosis were established in the 90\'s involving the family history of two successive generations with three individuals having their colon and/or rectum affected, one of them having been diagnosed when under 45 years of age. The microsatellite instability (MSI) was first described in 1993 in bearers of HNPCC, but it is common in other sporadic tumors. In 1996, the Bethesda criteria, which include the preferential involvement of the proximal colon, undifferentiated or mucosecretory histology, presence of synchronic and metachronic tumors or association to extracolonic tumors, besides family history, were proposed by the International Colaborative Group for the study of HNPCC (ICG-HNPCC) with the purpose of tracking a higher number of bearers of that syndrome. The MSI is characterized by the loss or gain of repetitive units in DNA regions containing mono-, di-, tri- or tetranucleotides sequentially arranged in the genome. The aim of this paper was to evaluate the frequency MSI by analyzing 7 microsatellite regions (BAT25, BAT26 , D5S346, D2S123, D17S250, BAT40, TP53), and correlating the data so obtained with clinicopathologic characteristics of the patients. The DNA of 106 pairs of samples taken from normal tissues and colorectal carcinomas (CRC) was studied through the polimerase chain reaction (PCR) followed by analysis in denaturing poliacrylamide gel. The patients were separated into two groups, one consisting of 75 patients with at least one of the Bethesda criteria (tumor in the proximal colon, poorly differentiated histology, undifferentiated or mucinous pattern, age equal to or below 45 years, tumor synchronicity or metachronicity) and 31 patients without any of such criteria. From the 106 cases, 14.1% (15/106) exhibited MSI in 30% or more of the markers, then classified as having high microsatellite instability (MSI-H); 17.9% (19/106) were classified as low microsatellite instability (MSI-L) and 67.9% (72/106) as having microsatellite stability (MSS). If we consider only the analysis of the group with at least one of the Bethesda criteria, we observe that 18.6% (14/75) of the cases showed MSI-H, 18.6% were MSI-L and 62.6% (47/75) were MSS. In the group without any of the Bethesda criteria, 3.2% (1/31) showed MSI-H, while 16.1% (5/31) and 80.6% (25/31) were respectively MSI-L and MSS. When we consider the markers proposed by the Intenational Colaborative Group for the study of HNPCC - ICG-HNPCC (BAT25, BAT26, D5S346, D2S123, D17S250), we observe, in the group without Bethesda criteria, only cases which were classified as MSI-L and MSS. In the group with at least one of the Bethesda criteria we find 21.3% (16/75) of the cases classified as MSI-H and 14.7% (11/75) as MSI-L. The most sensitive markers for MSI-H were BAT25 and BAT26, whereas the markers D17S250 and TP53 were the most frequent in MSI-L cases. When the cases with at least one of the Bethesda criteria, were evalueted only with the panel propose by ICG-HNPCC, the BAT25 marker identified MSI-H cases with 100% sensitivity and 96.6% specificity, while the BAT26 exhibited respectively 93,7% and 98,9%. The evaluation of the Bethesda criteria considered in this paper showed that the proximal location of the tumor correlated significantly with the cases of MSI-H.

INTRODUÇÃO: O câncer colorretal é um dos cânceres mais incidentes no mundo. As maiores incidências são descritas em homens e aumentam com a idade. Porém, estudos recentes reportaram aumento da incidência entre os mais jovens. Apesar das maiores incidências serem descritas em países desenvolvidos, estes apresentam tendência de estabilidade ou declínio. Em países com tendência de aumento, a mudança no padrão alimentar é a principal hipótese para este aumento. A mortalidade apresenta tendência de queda, principalmente em países que investiram em diagnóstico precoce e tratamento oportunos. OBJETIVO: Estudar as desigualdades na incidência e mortalidade do câncer colorretal no Município de São Paulo e Brasil. MÉTODOS: Esta tese está dividida em três manuscritos. MANUSCRITO 1: Simulação e comparação de técnicas de correção de dados incompletos de idade para o cálculo de taxas de incidência. A partir de seis bases com diferentes proporções de dados incompletos para idade (5 até 50%), foram comparados dois métodos de correção. Verificou-se que bases com 5% ou mais de dados incompletos para idade apresentaram taxas de incidência subestimadas. O fator de correção retificou as subestimativas das taxas padronizadas, entretanto, esta técnica não permitiu corrigir taxas específicas por idade. A imputação múltipla foi útil na correção das taxas padronizadas e específicas em bancos com até 30% de dados incompletos. Bases com 5% ou mais de dados incompletos necessitam de aplicação de correção. A imputação múltipla mostrou-se superior ao fator de correção, pois permitiu corrigir as taxas de incidência específicas. MANUSCRITO 2: Descrição e análise das taxas de mortalidade por câncer de colorretal no Brasil, segundo sexo e Unidades da Federação e indicadores socioeconômicos. As tendências das taxas de mortalidade foram estimadas por modelo de regressão linear. No Brasil,ocorreu aumento da tendência da taxa de mortalidade em todos os estados para o sexo masculino e em 21 estados para o sexo feminino. Ao ajustar por taxa de mortalidade por causas mal definidas, Produto Interno Bruto e Coeficiente de Gini, a tendência de aumento manteve-se significativa (p<0,05) no Brasil e em sete estados em homens e em nove estados em mulheres. O aumento da taxa de mortalidade por câncer colorretal em algumas Unidades Federativas e no Brasil pode estar relacionada ao aumento da incidência, ao atraso no diagnóstico e no tratamento. MANUSCRITO 3: descrição e análise das taxas de incidência e mortalidade por câncer colorretal no município de São Paulo, segundo sexo e faixa etária. Foram calculadas as razões das taxas padronizadas de incidência e mortalidade, estimada a mudança percentual anual média (AAPC) e o efeito idade-período-coorte. As razões das taxas de incidência e mortalidade foram superiores a 1 em homens a partir dos 50 anos e para o total da população. Ao comparar com indivíduos de 30 a 39 anos, em ambos os sexos, as razões das taxas foram maiores que 1 após 40 anos. Verificou-se tendência de aumento da incidência em mulheres (AAPC 0,9%) e da mortalidade em homens (AAPC 1,0%) e em mulheres (AAPC 0,2%). O modelo idade-período-coorte apresentou melhor ajuste para a incidência, em ambos os sexos (p<0,001). A mortalidade em homens foi explicada pelo modelo idade-drift (p<0,001). No Munícipio de São Paulo, a tendência crescente da incidência pode estar relacionada à alimentação inadequada e ao aumento do diagnóstico e a da mortalidade por diagnóstico e tratamento inoportunos. / INTRODUCTION: Colorectal cancer is one of the most common cancers worldwide. The highest incidence rates are described in men and with increasing age. However, recent studies have reported an increase in incidence among younger people. Although the highest incidence are described in developed countries, they show a tendency of stability or decline. In countries with increasing trends, the change in dietary pattern is the main hypothesis for this increase. Mortality is declining, especially in countries that have invested in diagnosis and treatment. OBJECTIVE: To study the inequalities in the incidence and mortality from colorectal cancer in the city of São Paulo and Brazil. METHODS: This thesis is divided into three manuscripts. MANUSCRIPT 1: Simulation and comparison of incomplete data correction techniques for the calculation of incidence rates. From six databases with different proportions of incomplete data for age (5 to 50%), two correction methods were compared. Databases with 5% or more of incomplete data for age were found to have underestimated rates. The correction factor mitigated the underestimation of the standardized rates; however, this technique did not allow the correction of age-specific rates. Multiple imputation was useful in correcting standardized and age-specific rates in datasets with up to 30% incomplete data. Databases with 5% or more of incomplete data need to be corrected. Multiple imputation technique was a superior method in comparison to the correction factor. MANUSCRIPT 2: description and analysis of mortality rates from colorectal cancer in Brazil, according to sex and States, according to socioeconomic indicators. For the trend analysis, the linear regression models were chosen through linear regression In Brazil, there was an increase in the mortality rate in all states for males and in 21 states for females. When the mortality rate was controlled for ill-defined causes, Gross Domestic Product and Gini Index, the increasing trend of mortality remained significant (p-value <0.05) in Brazil and in seven states in men and in nine states in women. The increase in the colorectal cancer mortality rate in some States and in Brazil may be related to the possible increase in incidence delayed diagnosis and treatment. MANUSCRIPT 3: description and analysis of incidence and mortality rates for colorectal cancer in the city of São Paulo, according to sex and age group. The incidence and mortality rate ratios were estimated. Joinpoint regression was performed to obtain average annual percent change (AAPC) and age-period-cohort analysis was used to examine the incidence trends. The incidence and mortality rates ratio were higher than 1 in men aged 50 and over. When comparing individuals aged 30 to 39 in both sexes, the rates ratios were higher than 1 after 40 years. There was an upward trend in incidence in women only (AAPC 0.9%) and mortality in men (AAPC 1.0%) and women (AAPC 0.2%). The age-period-cohort model provided the best fit to incidence in both sexes (p <0.001). Mortality in men was explained by the age-drift model (p <0.001). In the city of São Paulo, the increasing trend in incidence may be related to inadequate diet and increased diagnosis and mortality due to untimely diagnosis and treatment.

Colorectal cancer (CRC) is one of the most common malignancies worldwide. However, adjuvant chemotherapeutic agents exhibit poor accumulation in the tumor mass and frequently result in serious side effects due to nonspecific damage to normal organs. Therefore, the development of more selective anticancer drugs with targeted delivery to tumor sites is the current trend in cancer therapies. Among these sites, tumor neovasculature is an attractive target for anticancer agents. It is because tumor growth is largely limited by blood supply which is dependent on the extent of angiogenesis in the tumor. / Experimental analysis suggested that TCP-1 phage and synthetic TCP-1 peptide specifically homed to colorectal cancer tissues and co-localized with the tumor vasculature. Moreover, TCP-1 peptide also recognized the vasculature of human colorectal cancer specimens. Subsequently, the homing abilities of TCP-1 phage were extensively tested in other cancer models. Results showed that TCP-1 peptide could also target the vasculature of orthotopic gastric cancer induced by human colon cancer cell line (MKN45) in BALB/c nude mice. Meanwhile, TCP-1 phage exhibited binding activity to colorectal cancer cells such as colon 26 and SW1116. TCP-1 peptide could carry a pro-apoptotic peptide into these cells and markedly enhanced its pro-apoptotic action. / In summary, we have used the phage display technology to isolate two unique peptides TCP-1 and TCP-2, which targeted the vasculature of orthotopic colorectal cancer and also recognized the vasculature of human colorectal cancer. Moreover, they could deliver fluorescein or pro-apoptotic peptide only to the tumor vasculature but not to other normal tissues, for imaging detection and targeted therapy. In conclusion, both TCP-1 and TCP-2 may have significant clinical applications as carriers in diagnostic imaging and ligand-mediated targeted therapy for human colorectal cancer. / Similarly, TCP-2 phage or its peptide also targeted specifically the orthotopic colorectal cancer, and co-localized with the tumor vasculature in mice. Meanwhile, TCP-2 peptide recognized the vasculature of human colorectal cancer specimens. FITC-labeled TCP-2 peptide could also be used to detect cancer tissues in tumor-bearing mice. / To identify specific ligands targeting the tumor neovasculature, in vivo phage display technology has been extensively used. Several dozens of peptides homing to normal or diseased vasculature have been identified through this technology. However, these peptides target mainly the tumors growing at distant sites but not at the primary organ, thus limiting their clinical application. To obtain specific peptides targeting the neovasculature of colorectal cancer growing in situ, we established an orthotopic colorectal cancer model in normal BALB/c mice by using syngeneic colon cancer cells (colon 26). Subsequently, in vivo phage display technology was utilized to isolate peptides which specifically recognized the vasculature of the cancer. Four peptides (termed TCP-1, 2, 3, 4) were enriched more than once after four-round selections. Further investigation disclosed that TCP-1 and TCP-2 phages had relatively stronger binding abilities to cancer tissues among the four phage clones. They were chosen for further study. / We further demonstrated that TCP-1 could serve as a carrier for image detection and drug delivery. FITC-labeled TCP-1 could specifically produce a strong fluorescence signal in the tumors after intravenous injection into the orthotopic tumor-bearing mice. Moreover TCP-1, when conjugated with a pro-apoptotic peptide, could also specifically induce apoptosis of tumor vasculature in vivo. / Li, Zhijie. / Adviser: Cho Chiltin. / Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 194-221). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Na última década, houve uma significativa melhora nas taxas de resposta, sobrevida livre de progressão e sobrevida global no tratamento do câncer colorretal metastático, resultante do desenvolvimento de novas combinações de quimioterapia padrão e surgimento de drogas alvo-específicas. Considerando o alto custo das terapias e os recursos disponíveis cada vez mais limitados para a atenção à saúde, este estudo teve como objetivo realizar uma análise de custo-efetividade do protocolo XELOX isoladamente (estratégia 1) em comparação ao XELOX acrescido de bevacizumabe (estratégia 2) em tratamento de 1ª linha para pacientes com câncer colorretal metastático sob a perspectiva de um hospital público voltado para a assistência e o ensino. Trata-se de uma avaliação econômica completa do tipo custo-efetividade, empregando-se árvore de decisão simples associada a Modelo de Markov. Os custos foram expressos em unidade monetária local (R$) e os desfechos em meses de vida ganhos. Para a construção do modelo, foi utilizado o software TreeAge Pro 2013®. Foi elaborado um modelo de estados de transição de Markov, em horizonte temporal de 60 meses, sendo que cada ciclo do modelo correspondeu a três meses. Os dados de custos foram coletados retrospectivamente, por microcusteio, e obtidos por meio do sistema interno de dados eletrônico do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Os dados de efetividade e as probabilidades de transição entre os estados de saúde foram calculados utilizandose dados de estudos clínicos selecionados por revisão sistemática. A diferença incremental em meses de vida ganhos foi de 2,25 para um custo extra de R$47 833,57, o que resultou em uma razão de custo-efetividade incremental de R$21 231,43 por mês de vida ganho. Considerando-se um limiar de custo-efetividade de três vezes o valor do Produto Interno Bruto per capita, segundo recomendação da Organização Mundial de Saúde, a adição de bevacizumabe ao esquema XELOX não foi considerada custo-efetiva. Pela análise de sensibilidade, a variável que causou maior impacto foi a efetividade para o estado de saúde \"suporte clínico\" na estratégia 1. Quando este parâmetro foi inserido no modelo com o valor mínimo e o valor máximo, apresentou uma razão de custo-efetividade incremental de R$7 814,47 e R$- 29 614,12 respectivamente. Assim, a estratégia 2 tornou-se dominada pela estratégia 1 / In the last decade, significant improvements have been made in response rates, progression-free survival, and overall survival in the treatment of metastatic colorectal cancer. These improvements are a result of the development of new combinations of standard chemotherapy and new specific targeting drugs. In light of cost of therapies and increasingly limited resources in health care, this study aimed to compare the costeffectiveness of first-line XELOX alone (strategy 1) with XELOX with bevacizumab (strategy 2) in metastatic colorectal cancer patients, in a public hospital which provides education and health care delivery. We conducted a comprehensive economic, costeffectiveness analysis, using the simple decision tree and the Markov model. The costs were expressed in local currency (BRL) and the outcomes in months of life gained. A Markov state transition model was developed over a 60-month time horizon, using a three-month cycle. The model was created using the TreeAge Pro 2013®. Data of costs were collected retrospectively, using the micro-costing method, from the electronic data system of the General Hospital of Ribeirão Preto Medical School of the University of São Paulo. Data of effectiveness and transition probabilities between health states were calculated using data of clinical trials selected in a systematic review. The incremental difference in months of life gained was 2.25 for an extra cost of BRL47,833.57, resulting in an incremental cost-effectiveness ratio of BRL21,231.43 per month of life gained. Considering a cost-effectiveness threshold three times the gross domestic product per capita, following the World Health Organization\'s recommendations, the addition of bevacizumab to XELOX was not considered costeffective. By sensitivity analysis, the highest impact was caused by the variable effectiveness for the health state \"clinical support\" in strategy 1. When this parameter was inserted in the model using the minimum and maximal values, the incremental cost-effectiveness ratio were R$7,814.47 and R$-29,614.12 respectively, indicating that strategy 2 was dominated by the strategy 1

Thesis (Ph. D.)--University of Washington, 2003. / Includes bibliographical references (leaves 101-113).

<p>Diss. (sammanfattning) Umeå : Umeå universitet, 2002</p> / digitalisering@umu