Το ετεροτριμερές πρωτεϊνικό σύμπλεγμα IPP (ILK-PINCH-Parvin) εντοπίζεται στις εστιακές συνδέσεις και ρυθμίζει την σηματοδότηση από την εξωκυττάρια ουσία μέσω ιντεγκρινών και αυξητικών παραγόντων, αλληλεπιδρώντας με τον κυτταροσκελετό ακτίνης και με ποικίλες σηματοδοτικές οδούς. Οι πρωτεΐνες του συμπλεγματος IPP ελέγχουν σημαντικές κυτταρικές λειτουργίες όπως ο πολλαπλασιασμός, η επιβίωση, η κυτταρική κίνηση-μετανάστευση και ενέχονται σημαντικά στην καρκινογένεση (Legate et al., 2006). Συγκεκριμένα η πρωτεΐνη ILK (integrin-linked kinase) έχει συσχετιστεί με την εξέλιξη-προαγωγή του όγκου και δυσμενή πρόγνωση στο μη μικροκυτταρικό καρκίνωμα του πνεύμονα (Ζhao et al., 2013). Η πρωτεΐνη Ras supressor protein 1 (Rsu-1), γνωστή για την ογκοκατασταλτική της δράση και την συμμετοχή της στη σηματοδοτική οδό του ογκογονιδίου Ras, πρόσφατα βρέθηκε οτι αλληλεπιδρά με την πρωτεΐνη PINCH του ΙPP συμπλέγματος και μέσω αυτής της αλληλεπίδρασης ρυθμίζει διεργασίες όπως η κυτταρική μετανάστευση και διήθηση(Gonzalez-Nieves et al., 2013). Σκοπός της παρούσας μελέτης είναι η διερεύνηση του ρόλου του IPP συμπλέγματος και της πρωτεΐνης Rsu-1 στο μη μικροκυτταρικό καρκίνωμα του πνεύμονα στον άνθρωπο καθώς και της συμμετοχής του ΙPP συμπλόκου στην σηματοδότηση από το ογκογονιδίο Ras. Για το σκοπό αυτό μελετάται η πρωτεϊνική έκφραση των ILK, PINCH, α-Parvin, β- Parvin και Rsu-1 1) σε ιστικά δείγματα μη-μικροκυτταρικού καρκινώματος του πνεύμονα σε σχέση με κλινικοπαθολογοανατομικές παραμέτρους της νόσου και 2) σε καρκινικές κυτταρικές σειρές με διαφορετικά επίπεδα ενεργοποίησης της Ras σηματοδότησης. Για τα στοιχεία του ΙΡΡ συμπλέγματος παρατηρήθηκε αυξημένη ανοσοϊστοχημική έκφραση ενώ για την πρωτεΐνη Rsu1 βρέθηκε μειωμένη στα μη μικροκυτταρικά καρκινώματα του πνεύμονα σε σχέση με το μη νεοπλασματικό παρέγχυμα του πνεύμονα. Η έκφραση των ILK και PARVA ήταν σημαντικά υψηλότερη στα χαμηλής διαφοροποίησης νεοπλάσματα και σε όγκους προχωρημένου pT αντίστοιχα. Η έκφραση της πρωτεΐνης PINCH σχετίστηκε στατιστικώς σημαντικά με την παρουσία λεμφαδενικών μεταστάσεων. Δεν παρατηρήθηκε εξάρτηση της πρωτεϊνικής έκφρασης των Rsu-1 και PINCH από τη σηματοδοτική οδό Ras. Τα αποτελέσματα υποστηρίζουν ότι η υπερέκφραση των στοιχείων του ΙΡΡ συμπλέγματος και η μειωμένη έκφραση του Rsu1 ενέχονται στην παθογένεια του καρκίνου του πνεύμονα. / The integrin-linked kinase (ILK)-PINCH-parvin (IPP) complex at integrin adhesion sites is a critical regulator of cell migration, invasion and metastasis. Deregulation of the IPP complex has been implicated in human carcinogenesis (Legate et al, 2006). Recent observations suggest that RSU-1, a protein first identified as a suppressor of v-Ras mediated cell transformation is a PINCH-binding partner that regulates PINCH mediated adhesion and migration (Gonzalez-Nieves et al., 2013). This study aims to evaluate the expression of the IPP complex and RSU-1 in human non-small cell lung carcinomas (NSCLC). Protein expression of ILK, PINCH, alpha-parvin, beta-parvin and RSU-1 in relation to clinicopathological parameters was evaluated by immunohistochemistry in 82 FFPE tissue samples of non-small cell lung cancer (NSCLC). All components of the IPP complex were overexpressed while RSU-1 was downregulated in lung cancer cells compared to non-neoplastic lung parenchyma. ILK and alpha-parvin expression was significantly higher in high grade (p=0.002) and high pT (p=0.047) tumors respectively. Expression of PINCH associated significantly with lymph node metastasis (p=0.045). Our results suggest that overexpression of the IPP complex and downregulation of RSU-1 may be implicated in lung carcinogenesis.

No description available.

The aims of this thesis were to investigate the long-term effects of adjuvant tamoxifen treatment on breast cancer recurrence and mortality, cardiovascular disease, and the incidence of secondary cancer. Between 1982 and 1992, postmenopausal patients with early stage breast cancer were included in a randomized clinical study of 2 or 5 years of postoperative tamoxifen therapy. The trial was planned by the Swedish Breast Cancer Group, and it included 4610 patients. Follow-up on causes of death, hospitalizations and secondary cancers were obtained from national population-based registries.  All-cause mortality, breast cancer-specific mortality and mortality from coronary heart disease were decreased in the 5-year group, but the incidence of endometrial cancer was increased (Paper I). The incidence and mortality of cerebrovascular diseases were increased during the active treatment phase, and reduced after the active treatment (Paper II). Similar results were seen for subgroups of cerebrovascular diseases such as stroke and ischemic stroke. In the 5-year group, the morbidity from coronary heart disease was reduced during treatment but not after treatment was stopped (Paper III). This was the case also for heart failure and for atrial fibrillation/flutter. For secondary cancers the lung cancer risk was reduced, as well as the lung cancer mortality (Paper IV). An increased risk was observed for endometrial cancer, but appeared to decrease over time. The risk of contralateral breast cancer was reduced, with most of the reduction after treatment was stopped. For distance recurrences the risk was reduced both during treatment and a few years after treatment was stopped. The breast cancer mortality was also reduced, especially during the post-treatment phase.

No description available.

The purpose of this work is to make an attempt to quantify and model various types of cell death for a small cell lung cancer (SCLC) cell line (U1690) after exposure to a 137Cs source and as well as to compare cell survival models, the Linear-Quadratic (LQ) and Repairable Conditionally – Repairable model (RCR). This study is based on four different experiments that were taken place at Cancer Centrum Karolinska (CCK). A human small cell lung cancer (SCLC) cell line after the exposure to a 137Cs source was used for the extraction of the clonogenic cell survival curve. Additionally for the determination and quantification of various modes of cell death the method of fluorescence staining was implemented, where we categorized the cell death based on morphological characteristics. As next with the flow cytometry analysis we measured the properties of individual particles and more specifically the percentage of cells in each phase of the cell cycle. The quantification of senescent cells was performed by staining the samples with senescence associated-β-gal solution and then scoring as senescent cells those that had incorporated the substance. These data were introduced into a maximum likelihood fitting to calculate the best estimates of the parameters used by the model in section 2.8. In this model we sorted the modes of cell death into three categories: apoptotic, senescent and other types of cell death (nec/apop, necrotic, micronuclei, giant). In regards to the clonogenic cell survival assay the RCR model shows a ρ2 value that is equal to 6.10 whereas for the LQ model is 9.61. Moreover from the fluorescence microscopy and senescence assay we observed an initial increase of the probability of three different categories of cell death on day 2 and at higher doses there was saturation. On day 7 a significant induction of apoptosis in a dose and time dependent manner was evident whereas senescence was slightly increased in response to dose but not to time. As for the „other types of cell death‟ category on day 7 showed a higher probability that the one on day 2 and as well as a prominent dose dependence. A dose dependent accumulation of cells in the G2/M phase of the cell cycle was induced by photons on day 2. The accumulation in the G2/M phase on day 2 is released on day 7 and simultaneously an increase of the probability of apoptosis with time was observed. The RCR model is fitted better to the experimental data rather than the LQ model. On day 2 there is a slight increase of the apoptotic and senescent probability with dose. On the other hand on day 7 the shape of the curve of apoptosis differs and we observe a sigmoidal increase with dose. At both time points the mathematical model fit the data reasonable well. Due to the fact that the clonogenic survival doesn‟t coincide with the one extracted from the fluorescence microscopy, a more accurate way of quantification of cell death need to be used (e.g. CVTL). / Ο σκοπός αυτής της μελέτης είναι η ποσοτικοποίηση και μοντελοποίηση διαφόρων τύπων κυτταρικού θανάτου μικροκυτταρικού καρκίνου πνεύμονα μετά από ακτινοβόληση με πηγή Καισίου (137Cs) καθώς και η σύγκριση μοντέλων κυτταρικής επιβίωσης, Linear-Quadratic (LQ) και Repairable Conditionally-Repairable. Η μελέτη είναι βασισμένη σε τέσσερα ξεχωριστά πειράματα τα οποία πραγματοποιήθηκαν στο Cancer Centrum Karolinska (CCK). Ανθρώπινος μικροκυτταρικός καρκίνος πνεύμονα χρησιμοποιήθηκε για τον υπολογισμό της καμπύλης κυτταρικής επιβίωσης μετά από ακτινοβόληση με πηγή Καισίου (137Cs). Επιπρόσθετα για τον προσδιορισμό και την μοντελοποίηση των διαφόρων ειδών θανάτου εφαρμόστηκε η μέθοδος της φθορίζουσας μικροσκοπίας, με την βοήθεια της οποίας κατηγοριοποιήθηκε ο κυτταρικός θάνατος βάσει μορφολογικών χαρακτηριστικών. Στη συνέχεια μέσω της κυτταρομετρίας ροής υπολογίσαμε τις ιδιότητες μεμονομένων σωματιδίων (κυττάρων) και πιο συγκεκριμένα το ποσοστό των κυττάρων σε κάθε φάση του κυτταρικού κύκλου. Η ποσοτικοποίηση των κυττάρων γήρανσης πραγματοποιήθηκε μέσω της χρώσης των δειγμάτων με διάλυμα συσχετιζόμενο με την γήρανση και μετά καταγράφηκαν σαν κύτταρα γήρανσης αυτά τα οποία είχαν ενσωματώσει την ουσία. Τα δεδομένα χρησιμοποιήθηκαν σε μια διαδικασία προσαρμογής μέγιστης πιθανοφάνειας (maximum likelihood fitting) ώστε να υπολογιστούν οι βέλτιστες τιμές των παράμετρων που χρησιμοποιούνται από το μοντέλο στην ενότητα 2.8. Στο παρόν μοντέλο έχουμε ταξινομήσει τον κυτταρικό θάνατο σε τρεις κατηγορίες: απόπτωση, γήρανση και άλλοι τύποι κυτταρικού θανάτου (νεκ/αποπ, νέκρωση, μικροπυρήνες και γίγαντες). Όσον αφορά την κλωνογόνο κυτταρική επιβίωση το RCR μοντέλο παρουσιάζει τιμή χ2 ίση με 6.10 ενώ για το LQ μοντέλο ίση με 9.61. Επιπλέον μέσω της φθορίζουσας μικροσκοπίας και της χημικής δοκιμής για την κυτταρική γήρανση παρατηρήσαμε την 2η μέρα αρχική αύξηση της πιθανότητας και για τις τρεις κατηγορίες κυτταρικού θανάτου ενώ εμφανής ήταν ο κορεσμός στις υψηλότερες δόσεις. Την 7η μέρα παρουσιάστηκε επαγωγή της απόπτωσης με δοσο/χρονο-εξαρτώμενο τρόπο καθώς και το ότι η γήρανση των κυττάρων αυξήθηκε ελάχιστα με την δόση αλλά όχι με τον χρόνο. Σχετικά με την τρίτη κατηγορία ‘άλλοι τύποι κυτταρικού θανάτου’ την 7η μέρα ανέδειξε υψηλότερη πιθανότητα συγκριτικά με την 2η μέρα καθώς και μια έκδηλη εξάρτηση με την δόση. Κατά την ανάλυση του κυτταρικού κύκλου για την 2η μέρα αναδεικνύεται συσσώρευση των κυττάρων με δοσοεξαρτώμενο τρόπο στην φάση G2/M του κυτταρικού κύκλου. Η συσσώρευση των κυττάρων στην φάση G2/M την 2η μέρα απελευθερώθηκε την 7η μέρα με ταυτόχρονη αύξηση της πιθανότητας για απόπτωση συναρτήσει της δόσης. Βρέθηκε ότι το RCR μοντέλο προσαρμόζεται καλύτερα στα πειραματικά δεδομένα σε σχέση με το LQ μοντέλο. Την 2η μέρα παρατηρήθηκε πολύ μικρή αύξηση της πιθανότητας για απόπτωση και γήρανση συναρτήσει της δόσης. Ενώ την 7η μέρα η μορφή της καμπύλης της απόπτωσης διαφοροποιήθηκε και παρατηρήθηκε σιγμοειδής αύξηση με την δόση. Το μαθηματικό μοντέλο προσαρμόζεται αρκετά καλά στα δεδομένα για την 2η και 7η μέρα. Ένας πιο ακριβής τρόπος υπολογισμού της ποσοτικοποίησης του κυτταρικού θανάτου θα πρέπει να χρησιμοποιηθεί εξ’αιτίας του γεγονότος ότι η καμπύλη της κλωνογόνου επιβίωσης δεν συμπίπτει με αυτή που παράχθηκε από την μικροσκοπία φθορισμού.

Radiation therapy (RT) plays a crucial role in the management of cancer, however, current standards of care have yet to account for patient specific radiation sensitivity. Raman spectroscopy (RS) is a promising technique for radiobiological studies as a way to measure radiation responses in biological samples and could provide a method for monitoring and predicting radiation response in patients. The work in this dissertation gives way to significant advances in the implementation of RS for applications in radiation oncology. Specifically, instrumentation improvements for clinical implementation of RS were achieved through the investigation and development of Raman microfluidic systems. Unique magnesium fluoride based microfluidic systems were engineered and evaluated for applications in radiobiological studies. These systems were found to yield superior spectral quality over traditional microfluidic designs. Furthermore, in order to assert RS as a key technique for clinical monitoring and prediction of radiation responses, human non-small cell lung cancer (NSCLC) and breast adenocarcinoma tumour xenograft models were investigated for Raman signatures of radiation response. These studies found that RS can identify unique and distinct signatures of radiation response in tumours, that can be tracked over time. In particular, NSCLC tumours were found to have key radiation induced modulations in cell cycle and metabolic linked spectral features- including glycogen. Breast adenocarcinoma tumours were found to exhibit distinct fluctuations in spectral features linked to cell cycle as well as protein content. In the case of NSCLC, radiation response signatures were found to be linked to tumour regression and hypoxic status of the tumour- a key factor that dictates radiation resistance in the disease. This work provides the first application of RS to measure radiation response signatures of tumours irradiated \textit{in vivo}. These results show that RS is a versatile technique that can offer insight into radiation induced molecular changes that are unique to the type of cancer and can be monitored over several days following radiation exposure. Together with improved instrumentation for radiobiological studies using microfluidics, the work presented in this dissertation further emphasizes the key role RS can have in radiation oncology and personalization of RT. / Graduate / 2019-08-21

Responsable de 1,6 million de décès par an dans le monde, le cancer du poumon constitue aujourd’hui la première cause de mortalité par cancer. Les cancers bronchiques non-à-petites cellules représentent 85% des cancers du poumon et ont un pronostic vital très mauvais. Les EGFR-TKI (inhibiteurs de l’activité tyrosine kinase de l’EGFR, gefitinib) constituent un réel progrès thérapeutique pour le traitement des cancers du poumon. Cependant, ces traitements ne sont efficaces que dans un petit sous-groupe de patients. Un des enjeux actuels est donc d’identifier les mécanismes de résistance primaire mis en jeu par les tumeurs.Les récepteurs à activité tyrosine kinase (RTK) activent des voies de signalisation intracellulaires depuis la membrane plasmique. Ces dernières années, une translocation nucléaire des RTK a également été mise en évidence. Ces travaux récents suggèrent que la signalisation nucléaire des RTK pourrait contribuer à la résistance des tumeurs en réponse aux thérapies anti-cancéreuses.Dans l’équipe, il a été montré que l’activation de l’IGF-1R est associée à la progression tumorale des adénocarcinomes pulmonaires et que le gefitinib induit une accumulation nucléaire de l’IGF-1R dans un modèle d’adénocarcinome mucineux. Sur la base de ces résultats, nous avons émis l’hypothèse que l’IGF-1R nucléaire pourrait jouer un rôle dans la résistance aux EGFR-TKI des adénocarcinomes pulmonaires mucineux.Nos résultats indiquent que plus de 70% des adénocarcinomes pulmonaires présentent un marquage nucléaire de l’IGF-1R. A l’aide de différents modèles cellulaires résistants aux EGFR-TKI, nous montrons que le gefitinib induit l’accumulation nucléaire de l’IGF-1R dans les adénocarcinomes pulmonaires mucineux. Cette translocation nucléaire implique l’endocytose clathrines-dépendante de l’IGF-1R et la formation d’un complexe entre l’IGF-1R, l’importine β1 et la pro-amphiréguline. La neutralisation de l’amphiréguline prévient le transport nucléaire de l’IGF-1R et resensibilise les cellules à l’apoptose induite par le gefitinib in vitro et in vivo. L’ensemble de ces résultats identifient le trafic intracellulaire de l’IGF-1R comme un nouveau composant de la réponse aux EGFR-TKI et suggèrent que la signalisation nucléaire IGF-1R/Areg contribue à la progression des adénocarcinomes mucineux sous EGFR-TKI. / Responsible of 1.6 million deaths each year worldwide, lung cancer is today the leading cause of cancer mortality in the world. Non-small-cell lung cancers account for about 85% of lung cancer and have a very bad prognosis (5-year survival rate inferior to 10%). EGFR-TKI (EGFR tyrosine kinase inhibitors, gefitinib) are a real medical advance for lung cancers treatment. However, these treatments are efficient in a small subgroup of patients. So, one of the current issues is to identify primary resistance mechanisms involved in tumors.Tyrosine kinase receptors (RTK) activate intracellular signaling pathways from the plasma membrane. These last years, a nuclear translocation of the RTK was shown. Recent works suggest that RTK nuclear signaling could contribute to tumors resistance in response to anti-cancerous therapies.In our team, it was shown that activation of IGF-1R signaling is associated with lung adenocarcinoma progression and that gefitinib induces IGF-1R nuclear accumulation in a mucinous adenocarcinoma cell line. On the basis of these results, we hypothesize that nuclear IGF-1R could play a role in the resistance of mucinous lung adenocarcinoma to EGFR-TKI.Our results indicate that more than 70% lung adenocarcinoma tumors present a positive IGF-1R nuclear staining. Thanks to EGFR-TKI-resistant cell lines, we show that gefitinib induces the nuclear accumulation of IGF-1R in mucinous adenocarcinoma. This nuclear translocation involves clathrin-mediated endocytosis and a complex between IGF-1R, importin β1 and pro-amphiregulin. Amphiregulin silencing prevents IGF-1R nuclear translocation in response to gefitinib and restores gefitinib-induced apoptosis in vitro and in vivo. Our whole results identify that IGF-1R intracellular trafficking is a new component of response to EGFR-TKI and strongly suggest that a nuclear IGF-1R/amphiregulin signaling contributes to mucinous lung adenocarcinoma progression in response to EGFR-TKI.

Câncer de Pulmão de Não-pequenas células (CPNPC) é o maior problema de saúde pública atualmente no mundo.Encontramos em nossas pesquisas que os níveis de mRNA da CFL-1 (cofilina) podem ser usados como um biomarcador prognóstico em biópsias de tumores de CPNPC. Em nossos estudos, estabelecemos e optimizamos um método simples de imunohistoquímica semiquantitativa (SQ-IHC) para quantificar em biópsias de tumores sua aplicação em uma coorte retrospectiva de pacientes diagnosticados com CPNPC, para explorar seu papel prognóstico. Tivemos acesso a uma coleção de arquivos médicos bem delineada de 50 tumores de pacientes, juntamente com informações relevantes clínicopatológicas de 5 anos de acompanhamento hospitalar. A análise imunoistoquímica e semiquantitativa da cofilina foi realizada em um estudo cego para confiabilidade do resultado clínico. A associação entre imunoconteúdo de cofilina e resultado clínico foi assegurando utilizando as curvas de mortalidade de Kaplan-Meier e o test log-rank. Pacientes foram agrupados pela expressão do biomarcador ou pelo seu estadiamento. Imunoconteúdo de cofilina (em densidade óptica) em biópsias de tumor foram capazes de determiner entre bom e mau prognóstico, onde altos níveis de cofilina foram correlacionados com baixa razão de sobrevida. Um método simples de imunoistoquímica semiquantitativa foi bem desenvolvido para avaliação quantitativa de cofilina em CPNPC. Nosso método mostrou boa sensibilidade/especificidade para indicar resultado em pacientes e por isso deve ser empregado em estudo prospectivo, de larga escala, com triagens clínicas randomizadas para estabelecer o valor prognóstico do imunoconteúdo de cofilina em CPNPC. / Nonsmall cell lung cancer (NSCLC) is a major public health problem worldwide. Previously we found that CFL1 (cofilin-1) mRNA levels can be used as a prognostic biomarker in NSCLC tumor biopsies. In this study, we established and optimized a simple semi-quantitative immunohistochemistry (SQ-IHC) method for cofilin quantification in tumor biopsies and applied it in a retrospective cohort of NSCLC patients, to exploit prognostic role. We accessed a well-defined archival collection of tumor samples from 50 patients with relevant clinicopathologic information and 5 years follow-up. Immunohistochemistry and semi-quantitative analysis of cofilin were performed blinded to clinical outcome. Association between cofilin immunocontent and clinical outcome was assessed using standard Kaplan-Meier mortality curves and the log-rank test. Patients were clustered according to either biomarker expression level or NSCLC stage grouping. Cofilin immunocontent (in optical densities) in tumor biopsies was able to discriminate between good and bad prognosis, where high cofilin levels are correlated with lower overall survival rate (P < .05). A simple semi-quantitative immunohistochemical method has been developed for quantitative evaluation of cofilin in NSCLC. Our method showed good sensitivity/specificity to indicate the outcome of patients and should be further employed in a prospective, large-scale, randomized clinical trial to establish the prognostic value of cofilin immunocontent in NSCLC.

O câncer de pulmão é responsável por aproximadamente 13% do total de casos de neoplasias malignas e por cerca de 1.4 milhões de mortes por ano em todo mundo. Esta neoplasia apresenta-se sob dois principais subtipos: câncer de pulmão de pequenas células (CPPC) e câncer de pulmão de não-pequenas células (CPNPC). Cerca de 85% dos casos de câncer de pulmão são do tipo CPNPC. Os sinais e sintomas são secundários ao crescimento do tumor primário, ao comprometimento lobo-regional, à disseminação à distância, ou são secundários às síndromes paraneoplásicas. Essas características refletem diretamente sobre as taxas de mortalidade; de cada 100 novos casos, 80 são inoperáveis e a maioria morre dentro de 3 anos. Isso significa que, apesar dos diversos avanços no diagnóstico e tratamento, o prognóstico do câncer de pulmão permanece sendo extremamente ruim, com sobrevida média de 10 meses, e cumulativa total em 5 anos de aproximadamente 12%. Atualmente, o prognóstico e a decisão terapêutica de pacientes com câncer de pulmão é baseada no TNM, Embora esse seja o procedimento considerado padrãoouro entre os profissionais de saúde, ele não leva em consideração características biológicas do tumor. Nesse contexto, a identificação de biomarcadores para câncer pode agregar importantes informações ao já estabelecido sistema TNM e resultar em tratamentos mais eficientes e em menores taxas de mortalidade. Existem 5 fases distintas que conceitualizam o desenvolvimento de um biomarcador tumoral. Através dessas fases consecutivas, é possível que se desenvolvam ferramentas úteis para triagem populacional, capazes de serem implementadas na rotina clínica para predição de desfecho do paciente, resposta terapêutica e monitoramento da doença. O presente projeto avaliou o valor prognóstico dos principais genes citados na literatura como potenciais biomarcadores para CPNPC, e verificou-se que nenhum deles apresentou significância na correlação estatística que indica poder prognóstico. Além disso, identificamos e validamos o papel prognóstico da cofilina-1 por meio de dados de microarranjo e quantificação de seu imunoconteúdo em biópsias de CPNPC. Para tanto, fizemos uso de meta-análise de bancos de dados e análise densitométrica das reações imuno-histoquímicas, seguida de correlação com dados de grau de diferenciação tumoral, classificação histológica, sexo, idade e desfecho relativo a cada caso. Além disso, desenvolvemos um método de baixo custo, fácil execução e ampla aplicação e reproducibilidade, capaz de quantificar a proteína em amostras biológicas, com potencial para ser implementado na rotina clínica e aplicamos esse método em uma coorte restrospectiva de CPNPC. Confirmamos assim o papel prognóstico da cofilina-1. Estes achados seguem a lógica das fases de desenvolvimento de um biomarcador e representam um grande passo no seu processo de validação. / Lung cancer accounts for approximately 13% of all malignant tumor cases and for about 1.4 million deaths per year worldwide. This cancer has two main subtypes: Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC). About 85% of cases of lung cancer are NSCLC type. The signs and symptoms are secondary to the primary tumor growth, to regional lobe commitment and distant spread, or are secondary to paraneoplastic syndromes. These features reflect directly on mortality rates; 80 in every 100 new cases are inoperable and most die within 3 years. This means that, despite many advances in diagnosis treatment, the prognosis of lung cancer remains extremely poor, with median survival of 10 months, and total cumulative survival in 5-year of approximately 12%. Currently, prognosis and therapeutic decisions in patients with lung cancer is based on TNM. Although this procedure is considered gold standard among health professionals, it does not take into account the biological characteristics of the tumor. In this context, the identification of cancer biomarkers may add important information to the already established TNM system and result in better treatments and lower mortality rates. There are five distinct phases that conceptualize a tumor biomarker development of. Through these successive phases, it is possible to develop useful tools for population screening, capable of implementation in clinical practice for prediction of patient outcome, therapeutic response and disease monitoring. This project evaluated the prognostic value of major genes mentioned in literature as potential biomarkers for NSCLC and found that none of them showed statistical significance in the correlation that indicates prognostic power. It also identified and validated the prognostic role of cofilin-1 by microarray data and quantification of their immunocontent in biopsies of NSCLC. For this purpose, we used data metaanalysis and immunohistochemical reactions densitometric analysis, followed by correlation with data from tumor grade, histological classification, sex, age and outcome for each case. In addition, we developed a low-cost protocol, of easy implementation and wide application and reproducibility, able to quantify the protein in biological samples, with the potential to be implemented in clinical practice. We applied this method in a retrospective cohort of NSCLC and confirm the prognostic role of cofilin-1. These findings follow the logical phases of biomarker development and represent a major step in its validation process.

INTRODUÇÃO: Pacientes com câncer de pulmão metastático compreendem uma população bastante heterogênea. A média de sobrevida é de 8-10 meses, porém 25-30% dos pacientes morrem dentro de 6 meses e aproximadamente 20% sobrevivem mais que 18 meses após a disseminação da neoplasia. Por isso, além da Escala de Karnosfky (KPS) e ECOG, outros fatores são necessários para estimar o prognóstico destes pacientes, proporcionando assim uma melhor programação da terapia antitumoral e qualidade de vida, além da possibilidade de estratificar grupos para avaliação de novas drogas. A circunferência muscular do braço (CMB) estima a reserva de proteína corporal, sendo um indicador precoce de depleção nutricional. É uma medida objetiva, rápida, de baixo custo e nãoinvasiva, em comparação com outras investigações bioquímicas. OBJETIVO: Avaliar a CMB como fator prognóstico em pacientes com câncer de pulmão metastático. MÉTODOS: Foi realizada análise de sobrevida em 56 pacientes com câncer de pulmão não pequenas células (CPNPC), em estadio IV, com mais de uma metástase, os quais tiveram suas CMBs mensuradas logo após o diagnóstico. Os resultados da CMB foram classificados de acordo com o Percentual de Adequação, ajustado por sexo e idade. Os pacientes foram caracterizados como eutróficos (CMB > 90%) ou depletados (CMB <90%), e suas sobrevidas foram comparadas. RESULTADOS: A amostra apresentou idade média de 63 anos (47-80). A média do Percentual de Adequação foi de 89% (66-122), apresentando depleção 55% dos pacientes. A sobrevida média foi de 6,2 meses (95% IC:5,1-7,3). Nos pacientes eutróficos, a média de sobrevida foi 10,2 meses (95% IC: 9,2-11,1), e nos depletados foi de 5 meses (95% IC: 4,2-5,8), apresentando diferença estatisticamente significativa entre os dois grupos (P < 0.001). Esta diferença permaneceu significante na análise multivariada (P<0,001, análise de COX) com as co-variáveis KPS, idade, sexo, quimioterapia. CONCLUSÃO: Avaliação da CMB é um forte fator prognóstico em pacientes com CPNPC. Neste estudo, os pacientes depletados, com Percentual de Adequação da CMB < 90% tiveram baixa sobrevida global. / INTRODUCTION: Stage IV patients with lung cancer comprises a very heterogenous population. The median survival is 8-10 months but 25-30% of patients dies within 6 months and about 20% of patients survive longer than 18 months after metastatic spread. Strong prognostic factors other than karnofsky status or ECOG status are still needed to even better estimate the prognosis of these patients and to help in the decision making process of planning standard treatment options or to stratify patients for inclusion in innovative treatment trials. The mid arm muscular circunference (MAMC) is a bedside anthropometric measurement that estimates corporal protein reserve which is an early indicator of nutritional depletion. It has the advantages of being objective, rapid, repeatable, non-invasive and in-expensive in comparison to various biochemical investigations. OBJECTIVE: Our purpose was to evaluate MAMC as a potential prognostic factor in patients with metastatic lung cancer. METHODS: A prospective survival analysis of 56 non-selected, consecutive patients (29 women) with metastatic non small lung cancer who had their MAMC measured in the first nutritional evaluation. The MAMC results were expressed as a percentage of the expected reference values adjusted for sex and age. Patients were categorized as normal (MAMC > 90%) or depleted (AMC < 90%) and their overall survival was compared. RESULTS: The mean age of patients was 63 years (range 47 - 80). The mean MAMC percentage of the expected value was 89 (range 66 – 122), with 55% of our patients (31) classified as depleted by MAMC measurement. Median overall survival of all patients was 6,2 months (95% CI: 5,1 – 7,3). In the group of patients with normal MAMC, median overall survival was 10,2 months (95% CI: 9.2 – 11.1). In patients classified as depleted, the mean overall survival was 5.0 months (95% CI: 4.2 – 5.8). The overall survival differences between these two groups defined by the MAMC (normal x depleted), was highly statistically significant (P < 0.001 by the logrank test, HR=0.21, 95%CI: 0.09 – 0.5 for patients with normal MAMC). These differences remained significant in a multivariated analysis (P<0.001 by the Cox proportional hazards method), with the Karnofsky status, age, chemotherapy and sex as covariates. CONCLUSIONS: One measurement of mid arm muscular circumference in the first nutritional evaluation is a strong prognostic factor in patients with metastatic non small cell lung cancer. In our series, patients with <90% of expected MAMC had poor overall survival.