Resumo:O câncer gástrico (CG) é um dos tipos mais comuns de câncer e apresenta altas taxas de mortalidade. Embora seja observada redução em sua incidência, o prognóstico para essa doença permanece ruim, principalmente quando o diagnóstico é feito nos estadios avançados. Recentes evidências têm identificado a metilação do DNA como um mecanismo importante na inativação de genes supressores de tumor. Infecção por Helicobacter pylori é considerada como um dos principais fatores etiológicos e o gene bacteriano CagA é associado com doenças gastroduodenais mais severas, incluindo câncer. Igualmente, o vírus Epstein-Barr é um outro agente infeccioso associado a pelo menos 10% dos casos de câncer gástrico. Neste estudo, nós determinamos o padrão de metilação dos genes CDH1, DAPK, COX2, hMLH1 e CDKN2A e a freqüência da Instabilidade de Microssatélites (MSI) em 89 amostras de tumores gástricos primários e buscamos por correlações com a infecção por Helicobacter pylori e vírus Epstein Barr e também, com características clinicopatológicas dos adenocarcinomas gástricos. COX2 foi o gene com a maior freqüência de metilação (63.5%) nestes pacientes, seguido por DAPK (55.7%), CDH1 (51%), CDKN2A (36%) e hMLH1 (30.3%). Nesse estudo, MSI foi associado com metilação em hMLH1 e inversamente correlacionado com metilação do gene DAPK. Também, MSI foi inversamente correlacionado com presence de cepas H. pylori CagA+, sugerindo novas evidências para a associação entre MSI e melhor prognóstico. / Abstract: Gastric cancer (GC) is one of the most common cancer types and it is associated with high mortality frequencies. Although a decrease in the worldwide incidence is observed, the prognosis of this disease still remains poor, mainly when the diagnosis is carried out at advanced stages. Recent evidences have identified DNA methylation as an important mechanism for tumor suppressor gene inactivation. Helicobacter pylori infection is considered one of the most important etiological factors and the CagA gene is associated with more severe pathologies including cancer. Likewise, EBV is another infectious agent that has been associated with gastric carcinoma in at least 10% of the cases. In this study, we determined the promoter methylation status of the CDH1, DAPK, COX2, hMLH1 and CDKN2A and MSI frequency in 89 primary gastric carcinomas and correlated the findings with the presence of H. pylori and EBV infections and also with clinicopathological features of gastric carcinomas. COX2 was the most frequently hypermethylated gene (63.5%) in these patients, followed by DAPK (55.7%), CDH1 (51%), CDKN2A (36%) and hMLH1 (30.3%). In this study, MSI was correlated with hMLH1 methylation, as shown before, and there was an inverse correlation between DAPK hypermethylation and MSI. Also, MSI was inversely correlated with H. pylori CagA+, providing new evidence for the association of MSI and better prognosis. / Orientador: Maria Inês de Moura Campos Pardini / Coorientador: Nídia Alice Pinheiro / Banca: Silvia Helena B. Rabenhorst / Banca: Clauida Aparecida Rainho / Banca: Fernnado Lopes Alberto / Banca: Magaly Machado Sales / Doutor

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To elucidate the correlation between host susceptible genes and the carcinogenesis of gastric cancer and duodenal ulcer, myeloperoxidase (MPO) -463 G/A polymorphism was detected by PCR-RFLP and nucleotide autosequencing, respectively. On the other hand, E-cadherin (CDH1) -160 C/A polymorphism was analyzed by nucleotide autosequencing. No positive correlation among MPO genotype distributions, gastric cancer (p=0.26,

Abstract The members of interleukin-1 (IL-1) gene family, interleukin-1£] (IL-1b) and Interleukin -1 receptor antagonist (IL-l RN) are cytokines that play a key role in modulating the inflammatory response in the gastrointestinal mucosa. IL-1£]

Background: Gastric cancer is the fourth most common cancer in the world. Non-curative, metastatic disease is frequent in low incidence countries; management strategies for relief of symptoms include surgery, chemotherapy and radiotherapy. The resource utilization of metastatic gastric cancer patients is unstudied in the Canadian system, and predictors of major cost drivers and end-of-life care unknown. Our purpose was to describe the resource utilization of metastatic gastric cancer patients in Ontario, compare resource utilization among Local Health Integration Networks (LHINs) and examine predictors of inpatient hospital days and receipt of homecare. Methods: This is a retrospective cohort study of metastatic gastric adenocarcinoma patients registered in the Ontario Cancer Registry between April 1, 2005 and March 31st, 2008. Chart review and administrative healthcare data were linked to describe non-therapeutic endoscopic, radiologic and surgical investigations and treatment strategies from the healthcare system perspective, using a two-year and two month time horizon. Chi square tests were used to compare proportions of resource utilization, and non-parametric one-way ANOVA compared mean per patient usage. Negative binomial regression was used to model the number of inpatient hospital days. Modified Poisson regression was used to model receipt of homecare. Results: The cohort consisted of 1433 patients with metastatic disease. Less than half of the patients received chemotherapy (43%), gastrectomy (37%) or radiotherapy (28%). Geographic variation existed in the type of health services consumed and in the frequency of their use among LHINs. Location of the primary tumour, resource utilization band, receipt of a gastrectomy and care from a high volume physician were independent predictors of inpatient hospital days. Home care use was predicted by location of the primary tumour, receipt of care from a high volume physician and the number of days survived within the study period. Conclusion: Variation in healthcare resource utilization exists between LHINs in Ontario for the care of metastatic gastric cancer patients. Whether these differences reflect differential access to iii resources, patient preference or physician preference is not known. Further research needs to examine differences and how they impact on clinical disease outcomes. Next steps include incorporating predictors of resource utilization measures into clinical and policy-level decision-making. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-08-30 09:49:34.731

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13388号 / 論医博第2220号 / 新制||医||1048(附属図書館) / (主査)教授 羽賀 博典, 教授 佐藤 俊哉, 教授 妹尾 浩 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Although it is fairly well accepted that Helicobacter pylori infection plays a significant role in causing gastric cancer, the exact mechanisms involved in its pathogenesis are unclear. We have examined the relationship between H. pylori infection and oncogene expression in different stages of disease progression from precursor lesions to gastric carcinoma. We used Diff-Quik stain to diagnose H. pylori infection and immunohistochemical stains against c-erbB-2, p53, ras, c-myc, and bcl-2 to determine expression of oncogenes. H. pylori infection was found in all cases of chronic gastritis, atrophic gastritis, intestinal metaplasia, and early gastric carcinoma, and in 16 of 30 (53%) cases of advanced gastric carcinoma. Overexpression of c-erbB-2 was found in 2 (7%) cases of advanced gastric carcinoma, which were H. pylori negative. Suppressor gene, p53, was overexpressed in 3 (30%) cases of intestinal metaplasia, 2 (33%) cases of early gastric carcinoma, and 18 (60%) cases of advanced gastric carcinoma. Of these 18 p53-positive advanced gastric cancer cases, 11 (61%) were H. pylori positive. Expression of ras p21 was found in 4 (40%) cases of H. pylori-negative normal mucosa, 10 (100%) cases of chronic gastritis, 1 (10%) case of atrophic mucosa, 6 (60%) cases of intestinal metaplasia, 2 (33%) cases of nonneoplastic mucosa adjacent to early gastric carcinoma, and 7 (23%) nonneoplastic mucosa adjacent to advanced gastric carcinoma, all of which showed H. pylori. No evidence of expression of either c-myc or bcl-2 was detected in any of the above-mentioned samples. The data suggest that H. pylori infection may increase expression of ras p21 proteins and induce p53 suppressor gene mutation early in the process of gastric carcinogenesis.

O câncer gástrico é a terceira causa de morte por câncer no mundo e a quimioterapia combinatória é um dos principais tratamentos para esta doença. Contudo, a principal causa de falha do tratamento é a quimiorresistência. Considerando este obstáculo juntamente com a descoberta de que muitas proteínas envolvidas na mitose podem estar associadas à tumorigênese, vários agentes antimitóticos estão sendo desenvolvidos e testados. As proteínas mitóticas AURKB e NDC80 foram recentemente identificadas como proteínas potenciais a serem inibidas no câncer gástrico. Portanto, o objetivo deste estudo foi analisar os efeitos da inibição de AURKB e NDC80 pelos fármacos experimentais ZM447439 e INH1, respectivamente. Analisamos os efeitos em duas linhagens de adenocarcinoma gástrico avaliando expressão gênica, ciclo celular, morte celular, análise morfométrica nuclear, capacidade de migração e presença de células-tronco tumorais. É importante enfatizar que essas duas pequenas moléculas não foram testadas na quimioterapia do câncer gástrico até o momento. Além disso, após uma revisão da literatura, concluímos que os melhores resultados dos ensaios clínicos foram alcançados quando antimitóticos foram combinados com a terapia convencional. Dessa forma, avaliamos também os efeitos da associação de 5- FU com ZM447439. Nossos resultados demonstraram que a monoterapia com 5-FU, ZM447439 e INH1 induziu a expressão gênica diferencial nas linhagens de câncer gástrico (ACP02 e ACP03) de pelo menos 22 de um total de 82 genes envolvidos em várias vias, como apoptose, ciclo celular, senescência e transição epitélio-mesenquimal. Observamos também que ZM447439 e sua combinação com 5-FU induziram apoptose, catástrofe mitótica, senescência e ciclo celular alterado nas linhagens de câncer gástrico. Outro dado interessante foi a expressão dos marcadores de células-tronco tumorais gástricas, LGR5 e CD24, e a capacidade de formar esferas, indicando que ambas ACP02 e ACP03 podem conter células tronco tumorais. Além disso, a monoterapia com ZM447439 ou 5-FU foi capaz de inibir a formação de esferas. Por outro lado, o INH1 mostrou menor atividade antitumoral, uma vez que apresentou o maior valor de IC50 e foi capaz somente de induzir apoptose e reduzir a migração celular. Interessantemente, a combinação do 5-FU com ZM447439 permitiu o uso de doses menores dos compostos, além de ser capaz de induzir a apoptose num tempo mais curto quando comparado com o tratamento com os fármacos isolados. Em síntese, os resultados observados sugerem o inibidor de AURKB, ZM447439, e sua associação com o agente quimioterápico 5-FU, como tratamentos promissores do câncer gástrico com base em sua elevada atividade antitumoral in vitro. / Gastric cancer is the third cause of cancer death worldwide and combinatorial chemotherapy is one of the main treatments for this disease. However, the major cause of treatment failure is chemoresistance. Considering this obstacle together with the discovery that many proteins involved in mitosis might be associated to tumorigenesis, several new anti-mitotics are being developed and tested. The mitotic proteins AURKB and NDC80 were recently shown as potential proteins to be inhibited in gastric cancer. Therefore, the aim of this study was to analyze the effects of AURKB and NDC80 inhibition by the experimental drugs ZM447439 and INH1, respectively. We analyzed the effects in two gastric adenocarcinoma cell lines evaluating gene expression, cell cycle, cell death, nuclear morphometric analysis, migration ability and presence of gastric cancer stem cells. It is important to emphasize these two small molecules have not been tested in gastric cancer chemotherapy until now. Moreover, after reviewing the literature, we concluded the best results of clinical trials were achieved when anti-mitotics were combined with conventional therapy. Thus, we evaluated the effects of 5-FU and ZM447439 combination as well. Our results demonstrated that monotherapy with 5-FU, ZM447439 and INH1 induced differential gene expression in gastric cancer cell lines (ACP02 and ACP03) of at least 22 from 82 genes involved in several pathways such as apoptosis, cell cycle, senescence and epithelial mesenchymal transition. We also observed that ZM447439 and its combination with 5-FU induced apoptosis, mitotic catastrophe, senescence and altered cell cycle in gastric cancer cell lines. Another interesting data was the expression of the gastric cancer stem cell markers LGR5 and CD24, and the ability to form spheres, indicating that both ACP02 and ACP03 may be composed by cancer stem cells. Furthermore, monotherapy with either ZM447439 or 5-FU were capable of inhibiting the formation of spheres. On the other hand, INH1 have shown lower antitumoral activity since it presented the highest IC50 value and was only capable of inducing apoptosis and reducing cell migration. Interestingly, the combination of 5-FU with ZM447439 allowed the use of smaller doses of the compounds, in addition to being able to induce apoptosis in a shorter time when compared to the treatment with the isolated drugs. Taken together, our findings suggest that due to the high antitumoral activity shown by ZM447439 and mainly its association with 5-FU, these might be promising gastric cancer therapies.

Introduction: The incidence of gastro-oesophageal cancers has increased considerably over the last decade. As the disease is associated with a poor prognosis, there is a need to identify markers of treatment response which could be used in the future to improve the management of gastro-oesophageal tumours. Aims: 1) To compare the ability of published histological grading criteria (Becker, Mandard and Ninomiya) to assess response to neo-adjuvant chemotherapy (NCT) in gastro-oesophageal cancers. 2) To evaluate the expression of thymidylate synthase (TS) in pre-treatment diagnostic biopsy samples as a predictive marker of response to NCT. 3) To investigate whether measurements of hypoxia obtained using pimonidazole are prognostic for treatment outcome in patients with gastro oesophageal adenocarcinoma (ACC). 4) To study the prognostic significance and clinicopathological associations of epithelial mesenchymal transition (EMT) related proteins S100A4, Vimentin and Snail1 in gastro-oesophageal junction (GOJ) tumours. 5) To evaluate the ability of dynamic contrast enhanced (DCE) MRI to assess chemoradiotherapy (CRT) induced changes in oesophageal cancer. Methods: 1) Formalin fixed paraffin embedded (FFPE) tumour blocks and haematoxylin and eosin stained slides of samples from resected tumours (n=66) were obtained from patients who received NCT for gastric and GOJ tumours. The slides were scored independently by two observers and kappa scores calculated. 2) Pre-treatment diagnostic tissue biopsy samples were obtained from 45 patients with gastric and GOJ cancer who received NCT. TS expression was assessed using immunohistochemistry (IHC) and scored by two observers. The clinical and pathological data were analysed. 3) 57 patients were prospectively administered intravenous pimonidazole and the tumour specimens were collected both at staging laparoscopy and resection. IHC was performed to assess pimonidazole expression and determine its association with clinico-pathological factors. 4) Tissue microarrays were prepared from resection specimens from GOJ ACC. IHC was performed to investigate EMT related protein expression. 5) DCE-MRI was performed on five patients diagnosed with oesophageal cancer treated with CRT. Multiple pharmacokinetic parameters were evaluated. Findings: 1) Becker's histological grading criteria was the most reproducible and prognostic of outcome. The incidence of complete histological response (5%) was low in patients receiving NCT. 2) No prognostic benefit of TS expression was identified. 3) Results from only 34 patients were available for analysis. 77% pimonidazole positivity was observed. Preoperative anaemia was associated with significant tumour pimonidazole expression (p=0.04). Pimonidazole was not prognostic for outcome. 4) The overall positive expression was S100A4 (85%), Vimentin (14%) and Snail1 (89%). The increased expression of S100A4 at the tumour body (p=0.02) and luminal surface (p=0.01) was associated with a poor outcome. 5) Significant changes were measured in DCE-MRI pharmacokinetic parameters after CRT. Conclusion: 1) Becker's histological response grading criteria should be further studied in routine clinical practice for response assessment to NCT. 2) TS should be explored further as a marker of NCT response in gastro-oesophageal cancer. 3) Hypoxia is a characteristic feature of upper gastrointestinal ACC and is associated with anaemia. 4) S100A4 is the most useful marker of EMT in GOJ adenocarcinoma. 5) DCE-MRI tracer kinetic parameters should be explored in a larger study to assess their ability to monitor the efficacy of and predict response to neo-adjuvant treatment.