This study aimed to understand how the identity of Manitobans with early malignancy is affected through diagnosis, decision making and treatment. Using grounded-theory methodology, semi-structured interviews were conducted with 18 adult patients with early breast, colon, lung, prostate and gynecological cancers, before and after adjuvant treatment decision making. 15 adult friends and family members were also interviewed. Significant findings include: 1) After diagnosis, the “cancer identity” emerged as a new aspect of the patient’s identity; 2) Establishing a post-diagnosis routine was a significant source of distress for patients; 3) Ability to re-establish routine post-diagnosis may be enhanced by providing earlier notification of medical appointment times and information regarding how different treatment options will affect the patient’s identity. This study provides new insight into the experience of patients with malignancy in Manitoba. Additionally, it presents recommendations, based on the insights and concerns of its participants, for improving the cancer journey of Manitobans. / May 2017

Introdução: O câncer de ovário é frequentemente diagnosticado em estágios avançados e é pouco responsivo aos tratamentos empregados atualmente. O tratamento de primeira linha consiste em esquemas incluindo cirurgia citorredutora seguido de quimioterapia adjuvante por derivados de platina e taxano. Os esquemas de segunda linha são baseados em gemcitabina e doxorrubicina lipossomal. Em seguida, a doença tende a progredir rapidamente e a quimioterapia não é indicada pela ausência de resposta e pela alta toxicidade desses medicamentos. Anteriormente, mostramos que nanopartículas lipídicas semelhantes à composição química da LDL, porém sem proteína, e associadas à agentes antineoplásicos são captadas por células neoplásicas. Objetivos: Testamos a hipótese se o paclitaxel associado à nanopartícula poderia beneficiar com segurança pacientes com câncer de ovário avançado e refratário ao tratamento, e portanto, não mais elegíveis para quimioterapia convencional. Métodos: Quatorze mulheres com câncer de ovário avançado de 61 ± 10 anos, com estadiamento clínico IV e TqNqM1 (FIGO e TNM Scale, respectivamente) que não eram responsivas à quimioterapia em terceira linha foram incluídas no estudo. O tratamento consistiu com o paclitaxel associado à nanopartícula na dose 175 mg/m2 de superfície corporal, a cada 3 semanas. As pacientes foram submetidas a exames clínicos antes de cada ciclo de quimioterapia. Determinações bioquímicas séricas e exames de imagem foram realizados para acompanhamento de novas lesões ou progressão da doença. Resultados: Foi realizado o total de 74 ciclos, e não foram observadas toxicidades laboratoriais e clínicas. Em quatro pacientes a doença permaneceu estável. Conclusões: A notável ausência de toxicidade, não registrada na literatura até hoje nos vários sistemas de veiculação descritos abre uma nova perspectiva de tratamento da doença. Evita-se o desconforto e os riscos da quimioterapia convencional, podem ser incluídos pacientes muito idosos ou com outras fragilidades que contraindiquem a quimioterapia e não há limite para a continuação do tratamento. / Introduction: Ovarian cancer is often diagnosed at advanced stages and is poorly responsive to standard treatment. First-line treatment consists in schemes including citorreductive surgery followed by adjuvant chemotherapy schemes with platinum and taxane derivatives. Second-line regimens are based in gemcitabine and liposomal doxorubicin. Thereafter, the disease progresses rapidly and chemotherapy is no longer indicated for lack of response rate together with high toxicity of antineoplastic agents. Previously, we showed that non-protein lipid nanoparticles resembling chemical structure of LDL, however without protein and associated with antineoplastic agents are uptaken by neoplastic cells. Aims: We tested the hypothesis whether paclitaxel associated to the nanoparticle could safely benefit patients with advanced ovarian cancer refractory to previous treatment, thus not eligible for further conventional chemotherapy. Methodology: Fourteen women with advanced ovarian cancer aged 61 ± 10 years were included, with clinical stage IV and TqNqM1 (FIGO and TNM Scale, respectively) that were unresponsive for third line chemotherapy treatments. Treatment consisted with paclitaxel associated to the nanoparticle at 175 mg/m2 body surface dose, every 3 weeks. Patients were submitted to clinical examinations before each chemotherapy cycle. Serum biochemistry determinations and imaging exams were performed to monitoring new lesions or disease progression. Results: Total of 74 cycles of chemotherapy was performed, clinical and laboratorial toxicities were not observed. Four patients stayed with stable disease. Conclusions: The notable absence of toxicity, not recorded in the oncology literature to date described in various drug delivery systems, opens a new perspective on the treatment of cancer. Avoiding the discomfort and risks of conventional chemotherapy, can be included very aged patients or with other weaknesses, that chemotherapy is contraindicated, and there is no limit for continued treatment.

Ovarialkarzinome haben aufgrund fehlender Frühsymptomatik und rascher intraperitonealer Ausbreitung eine sehr schlechte Prognose. Die Ausgangszellen für Ovarialkarzinome sind die Ovaroberflächenepithelien, die wahrscheinlich durch aufeinanderfolgende genetische Alterationen von Onkogenen und Tumorsuppressorgenen mit einer zentralen Rolle bei der Wachstumsregulation, in Karzinomzellen transformiert werden. Im Rahmen dieser Arbeit wurde die Funktion von zwei Rezeptortyrosinkinasen, des c-erbB-2 Onkogenproduktes und des Rezeptors für den insulin-ähnlichen Wachstumsfaktor, in Ovarialkarzinomzellen analysiert. Hierbei konnte gezeigt werden, daß über diese Rezeptoren in Ovarialkarzinomzellen Funktionen vermittelt werdem, die in vivo Tumorwachstum und Tumorprogression begünstigen können. Dies sind Zellproliferation, Transformation und Zellmotilität. Daher besteht vielleicht zukünftig die Möglichkeit die Hemmung dieser Rezeptortyrosinkinasen für die Therapie des Ovarialkarzinoms zu nutzen. Weiterhin wurden Änderungen des Genexpressionsprofils zwischen Normalovar und Ovarialkarzinomen durch eine Microarray-basierte Technik untersucht. Aufgrund dieser Daten konnte das Caveolin-1 Gen (CAV1) als wahrscheinliches Tumorsuppressorgen in Ovar und Weichgewebe charakterisiert werden. Das CAV1 Gen ist in Ovarialkarzinomen und Sarkomen wahrscheinlich reversibel durch epigenetische Mechanismen abreguliert und nicht durch genetische Mutationen (sog. Klasse II Tumorsuppressorgen). Es könnte in Zukunft möglich sein, Klasse II Suppressorgene wie CAV1 in Ovarialkarzinomen und Sarkomen wieder zu exprimieren und die Hemmung des Zellwachstums therapeutisch zu nutzen. / Ovarian cancer is the most lethal cancer of the female genital tract due to the notorious lack of early symptoms and rapid initial peritoneal spreading of the disease. The majority of ovarian carcinomas are believed to arise from the ovarian surface epithelium by subsequent genetic alterations of oncogenes and tumor suppressor genes that have an important role in cell growth regulation. In these studies, the function of the c-erbB-2 oncogene product and the insulin-like growth factor receptor I tyrosine kinases were analyzed in ovarian cancer cell lines. It is shown that these receptors are able to mediate functions in ovarian cancer cell lines that may increase tumor growth and tumor progression in vivo. The relevant functions enhanced are cell proliferation, transformation and tumor cell motility. Therefore, it may be possible to use the inhibition of receptor tyrosine kinases in future therapies of human ovarian cancer. In addition, the alterations of gene expression between normal ovary and serous ovarian cancer were analyzed using micro-array techniques. In these experiments the caveolin-1 gene (CAV1) was identified as a candidate tumor suppressor gene in the ovary and in soft tissues. The CAV1 gene is probably in-activated in ovarian carcinomas and soft tissue sarcomas by epigenetic mechanisms rather by genetic mutations. As defined by the reversible down-regulation of CAV1, it is likely to be an important class II tumor suppressor gene. It may be possible to up-regulate the expression of class II tumor suppressor genes like CAV1 in ovarian cancer and soft tissue sarcomas to use its growth inhibitory properties for future therapies.

Einleitung: Das p53 Tumorsuppressorgen spielt eine zentrale Rolle für Regulation des Zellzyklus und die Induktion der Apoptose. MDM2, das Protein des mdm2 Gens, bindet an p53, hemmt seine Funktion als Transkriptionsfaktor und bewirkt den raschen Abbau des Proteins. Methode: Gefriergewebe von 178 primären Ovarialkarzinomen wurde mittels PCR, SSCP Single Strand Conformation Polymorphism), DNA-Sequenzierung und Immunhistochemie auf p53 Mutationen (exon 2-11) und p53 Proteinüberexpression untersucht. Das mdm2-Gen wurde an 92 Ovarialkarzinomen, neun Borderline-Tumoren, sechs Cystadenomen und 20 normalen Ovargeweben mittels reverse Transkriptase PCR der Gesamt-RNA und Sequenzierung der mdm2-cDNA auf alternatives RNA-splicing untersucht. Ergebnisse: p53 Mutationen waren in 56% (99/178) und eine p53 Proteinüberexpression in 62% (110/178) der Ovarialkarzinome nachweisbar. Bei p53 Mutationen war die rezidivfreie und Gesamtüberlebenszeit der Patientinnen signifikant kürzer als bei p53 Wildtyp (p=0,029 und p=0,014). Patientinnen mit p53 Überexpression (p=0,001) oder p53 missense Mutationen (p=0,008) waren signifikant häufiger resistent oder refraktär gegen eine Chemotherapie mit Cis- oder Carboplatin und Cyclophosphamid als Patientinnen mit normalem p53. mdm2 alternatives oder aberrantes RNA splicing war in 66/92 (72%) der Ovarialkarzinome, 7/9 (78%) der Borderline-Tumore, 5/6 (83%) der Cystadenome und 11/20 (55%) der normalen Ovargewebe nachweisbar. Eine Gesamtzahl von 30 verschiedenen Splice-Varianten-Sequenzen wurde identifiziert, von denen 22 einen partiellen oder vollständigen Verlust der p53 Bindungsstelle aufwiesen. Bei 28/30 der Sequenzen fand das splicing nicht an Exon/Intron-Grenzen statt, so daß diese als aberrantes Splicing klassifiziert wurden. Eine splice-Variante von 654 bp (mdm2b) wurde in 41% der Ovarialkarzinome, aber nur 11% (1/9) der Borderline-Tumore und 5% (1/20) der normalen Ovargewebe exprimiert. Die Expression von mdm2b in Ovarialkarzinomen korrelierte signifikant mit schlechtem Differenzierungsgrad (p=0,004), Resttumor nach Operation (p=0,004), hoher S-phase-Fraktion (p=0,016) und p53 Proteinüberexpression (p=0,018). Eine kürzere Splice-Variante von 221 bp war in nur 16% der Ovarialkarzinome, 56% der Borderline-Tumore und 40% der normalen Ovargewebe nachweisbar und korrelierte mit frühem Stadium (p=0,017) und längerem Gesamtüberleben (p=0,048) bei Ovarialkarzinom. Zusammenfassung: p53 Alterationen korrelieren in der univariaten Analyse signifikant mit einer Resistenz gegen eine platinhaltige Chemotherapie, frühem Rezidiv und kürzerem Gesamtüberleben bei Ovarialkarzinom. In der multivariablen Analyse ist p53 jedoch kein unabhängiger Prognosefaktor. mdm2 alternatives und aberrantes Splicing sind in Ovarialkarzinomen häufig, kommen aber auch in normalem Ovargewebe vor. Während die Expression der mdm2b Splice-Variante mit histologisch aggressiveren Tumoren assoziiert war, kamen kürzere Splice-Varianten typischerweise in frühen Ovarialkarzinomen und benignen Geweben vor. mdm2 Alterationen stabilisieren möglicherweise das p53 Protein und führen ohne Vorhandensein einer p53 Mutation zu einer Proteinakkumulation in Ovarialkarzinomen. / Objective: The p53 tumor suppressor gene plays a central role in cell cycle regulation and induction of apoptosis. MDM2, the protein of the mdm2 gene, binds to p53, inhibits its transcriptional activity and promotes nuclear export and rapid degradation of the p53 protein. Methods: Frozen tissue of 178 ovarian carcinomas was analyzed for mutations of the p53 gene (exons 2-11) and p53 overexpression by SSCP (Single Strand Conformation Polymorphism), DNA-sequencing and immunohistochemistry. 92 cases of ovarian cancer, nine borderline ovarian tumors, six cystadenomas and 20 normal ovarian tissues were analyzed for mdm2 alternative RNA splicing by reverse transcription of total RNA, nested PCR amplification of mdm2 cDNAs and DNA sequencing of RT-PCR products. Results: p53 mutations were found in 56% (99/178) and p53 protein overexpression in 62% (110/178) of the tumors. Time to progression and overall survival were significantly shortened in patients with p53 mutations compared to wildtype p53 (p=0.029 and p=0.014). Resistance to adjuvant Cis- or Carboplatin chemotherapy was significantly more frequent in patients with p53 overexpression (p=0.001) or p53 missense mutations (p=0.008) than patients with normal p53. mdm2 RNA splicing was seen in 66/92 (72%) of the ovarian carcinomas, 7/9 (78%) of borderline tumors, 5/6 (83%) of benign cystadenomas and 11/20 (55%) of the normal ovarian tissues. A total of 30 splice variant sequences were identified, out of which 22 had a partial or complete loss of the p53 binding site. 28/30 do not splice at exon/intron boundaries and were therefore considered aberrant splice variants. The mdm2b splice variant of 654 bp, which splices out most of the p53 binding domain, was expressed in 41% of ovarian carcinomas, but only in 1/9 (11%) LMP tumors, and 1/20 (5%) of the normal ovaries. Expression of mdm2b in ovarian carcinomas was significantly correlated with poor grade of differentiation (p=0.004), residual tumor after surgery (p=0.004), high S-phase fraction (p=0.016) and p53 protein overexpression (p=0.018). A small splice variant of only 221 bp was present in only 16% of the ovarian carcinomas, but 56% of borderline tumors, and 40% of normal ovarian tissues and was correlated with early stage of ovarian cancer (p=0.017) and longer overall survival (p=0.048). Conclusion: p53 alterations correlate significantly with resistance to platinum-based chemotherapy, early relapse and shortened overall survival in ovarian cancer patients in univariate analysis. In multivariable analysis though, p53 was not an independent prognostic factor. mdm2 alternative and aberrant splicing was found frequently in ovarian tumors but also in normal ovarian tissue. While expression of the mdm2b splice variant was associated with histologically more aggressive ovarian carcinomas, smaller size variants were typically seen in early stage ovarian carcinomas and benign tissues. mdm2 alterations may stabilize p53 protein and cause p53 accumulation in the absence of p53 mutation in ovarian tumors.

Objetivo: Até 10% dos casos de câncer de mama estão associados com uma síndrome genética de predisposição ao câncer. A identificação de possíveis portadores dessas síndromes e o consequente encaminhamento para aconselhamento genético permitem a adoção de estratégias direcionadas de prevenção e rastreamento capazes de diminuir morbidade e mortalidade. O objetivo do presente estudo foi avaliar a proporção de pacientes com câncer de mama atendidos no Hospital Universitário de Santa Maria (HUSM) que necessitariam ser encaminhados para avaliação genética. Métodos: Pacientes com câncer de mama que iniciaram tratamento oncológico no HUSM durante o ano de 2014 foram considerados elegíveis. Uma entrevista foi conduzida com cada paciente para coleta de dados e exame físico dirigido. O questionário FSH-7 (Family Story Screening 7) e os critérios do NCCN (National Comprehensive Cancer Network) foram utilizados para identificar os pacientes que deveriam ser encaminhados para avaliação genética. Estes pacientes foram então avaliados quanto à indicação de teste genético - de acordo com as recomendações do NCCN para teste genético – e à probabilidade de mutações nos genes BRCA1 e BRCA2 através de modelos de predição de risco (BOADICEA, Penn II, sistema de escore de Manchester e tabelas da Myriad). Resultados: Dentre os 114 participantes do estudo, 65 (57%) preenchiam critérios de encaminhamento para avaliação genética de acordo com as diretrizes do NCCN. O questionário FHS-7 apresentou uma sensibilidade de 90% para identificar estes pacientes, com uma especificidade de 85%. A presença de história pessoal ou familiar de câncer de mama antes dos 50 anos foi o critério mais comum para indicar avaliação genética. Em relação aos testes genéticos, 52 pacientes (45%) deveriam ser testados para mutações nos genes BRCA1 e BRCA2 e 4 pacientes (3,5%) possuíam indicação de teste para mutações em TP53, de acordo com as recomendações do NCCN. Utilizando os modelos de predição de risco, 10,2% a 57,1% dos pacientes apresentavam uma probabilidade ≥ 10% de mutações em BRCA1 ou BRCA2. Conclusão: Este estudo revelou que a maioria dos pacientes com câncer de mama atendidos no HUSM possui indicação de encaminhamento para avaliação genética. A utilização de um questionário simples e rápido poderia identificar 90% destes pacientes. / Objective: Up to 10% of breast cancers are associated with a hereditary cancer syndrome. The identification of possible carriers of these syndromes and the subsequent referral for genetic counselling allow the adoption of tailored screening and prevention strategies capable of reducing morbidity and mortality. The aim of this study is to assess the proportion of patients with breast cancer treated at the University Hospital of Santa Maria (HUSM) that would need to be referred for genetic evaluation. Methods: Breast cancer patients who began cancer treatment at HUSM during the year 2014 were eligible. An interview was conducted with each patient for data collection and targeted physical examination. The FSH-7 (Family Story Screening 7) questionnaire and the NCCN (National Comprehensive Cancer Network) criteria were used to identify patients who should be referred for genetic evaluation. Then these patients were assessed for genetic testing criteria - according to the NCCN recommendations for genetic testing - and the likelihood of BRCA1 and BRCA2 mutations through risk prediction models (BOADICEA, Penn II, Manchester score system and Myriad tables). Results: Among the 114 study participants, 65 (57%) meet referral criteria for genetic evaluation according to the NCCN guidelines. The FHS-7 questionnaire showed a sensitivity of 90% to identify such patients with a specificity of 85%. The presence of personal or family history of breast cancer before age 50 was the most common criteria to indicate genetic evaluation. With respect to genetic testing, 52 patients (45%) should be tested for BRCA1 and BRCA2 mutations and 4 patients (3.5%) had test indication for TP53 mutations in accordance with the recommendations of the NCCN. Using risk prediction models, 10.2% to 57.1% of patients had a BRCA1 or BRCA2 mutations probability ≥ 10%. Conclusion: This study showed that most of the patients with breast cancer treated at HUSM have referral indication for genetic evaluation. The use of a fast and simple questionnaire could identify 90% of these patients.

Introdução: Anormalidades nos supressores tumorais p14, p16 e p53 são relatadas em diversos tipos de câncer em humanos. Na carcinogênese ovariana, p16 e p53 foram extensivamente estudados, mas p14 foi analisado somente em carcinomas. Objetivo: O estudo visa determinar a expressão imuno-histoquímica de p14, p16 e p53 em tumores ovarianos epiteliais benignos, borderline e malignos. Método: Estudo transversal utilizando imuno-histoquímica em amostras de tumores epiteliais ovarianos emblocados em parafina do Hospital de Clínicas de Porto Alegre. Resultados: p14 foi positivo em 93% dos tumores benignos, 94% dos borderline e 60% dos malignos. A perda de expressão foi estatisticamente associada com carcinomas. p16 foi positivo em 94,6% dos carcinomas, 75% dos tumores borderline e 45,7% dos benignos. p53 foi positivo em 29,7%, 16,7% e 2,9% dos tumores malignos, borderline e benignos, respectivamente. Os subtipos de carcinoma não mostraram diferenças de expressão. Conclusão: Nosso estudo foi o primeiro a descrever a expressão de p14 em tumores benignos e borderline. Ela permanece estável nos benignos e borderline, enquanto os carcinomas exibem uma perda de expressão significativa. Isso pode indicar que anormalidades de p14 acontecem tardiamente na carcinogênese. As taxas de expressão de p16 e p53 foram semelhantes a estudos anteriores. Estudos futuros devem investigar anormalidades genéticas nas sequencias codificadoras de p14 e incluir todos os tipos de tumor epitelial ovariano. / Background: Abnormalities in tumor suppressors p14, p16 and p53 are reported in several human cancers. In ovarian carcinogenesis, p16 and p53 have been extensively studied, but p14 was only analyzed in carcinomas. Aim: This study seeks to determine p14, p16 and p53 immunohistochemical expression in benign, borderline and malignant ovarian epithelial tumors and correlate them with survival and clinical variables. Methods: Cross-sectional study utilizing immunohistochemical staining of p14, p16 and p53 in paraffin-embedded tissue samples from ovarian epithelial tumors obtained from Hospital de Clinicas de Porto Alegre. Results: p14 was positive in 93% of benign, 94% of borderline and 60% of malignant tumors. Loss of expression was statistically associated with carcinomas. p16 was positive in 94.6% of carcinomas, 75% of borderline and 45.7% of benign tumors. p53 was positive in 29.7%, 16.7% and 2.9% of malignant, borderline and benign tumors, respectively. Carcinoma subtypes showed no difference in expression. Conclusions: To our knowledge, this is the first description of p14 expression in benign and borderline tumors. It remains stable in benign and borderline tumors, while carcinomas show a significant absence of staining. This may indicate p14 abnormalities occur later in carcinogenesis. p16 and p53 expression rates show similar results to previous reports. Future studies should investigate genetic abnormalities in p14 coding sequences and include all types of ovarian epithelial tumors.

Le cancer de l’ovaire est le cancer gynécologique avec la plus grande mortalité due à un diagnostique tardif au stade de maladie extensive péritonéale. Malgré les progrès de la chirurgie radicale et de la chimiothérapie les récurrences abdominales demeurent la cause la plus fréquente de mortalité. Il existe peu d’études de la maladie métastatique péritonéale. Notre hypothèse de travail est que les différences entre la maladie métastatique et la tumeur primaire sont primordiales dans la survenue d’une maladie résiduelle ou récurrente. Nous avons utilisé une approche exhaustive comprenant des études du transcriptome, des variations du nombre de copie (VNC) et des sequençages des exomes pour caractériser les différences entre lésions primaires, métastases péritonéales et métastases lymphatiques.Résultats: Notre étude démontre que les VNC varient de façon significative entre la tumeur primaire et la métastase peritonéale. Les différences d’expressions géniques bien que mineures permettent de retrouver les voies de signalisation primordiales pour le développement des métastases. Le séquençage des exomes montre très peu de différences en terme de polymorphisme. Par ailleurs la majorité des polymorphismes présents dans les métastases se retrouvent à une faible fréquence dans la tumeur primaire de façon concordante avec la théorie clonale. Conclusion: L’ensemble des résultats montre la possibilité d’une origine clonale de la maladie métastatique des cancers de l’ovaire comportant la majorité des anomalies au niveau des variations du nombre de copie. L’intégration de ces données permettrait d’optimiser les thérapeutiques ciblées. / Ovarian cancer is the most deadly gynecological cancer. The high rate of mortality is due to the large tumor burden with extensive metastatic lesion of the abdominal cavity. There are few studies on genetic alterations and their consequences in peritoneal metastatic tumors when compared to their matched ovarian primary tumors. Our hypothesis is that differences between the metastatic and primary lesions might be the cause of residual disease and, most importantly may have a role in post-chemotherapeutic recurrences. Methods: We conducted integrated genomics analysis on matched primary and metastatic tumors from 9 patients. In the papers presented here we analyze genome-wide Copy Number Variations (CNVs) using SNP Arrays targeting peritoneal metastasis differences, Gene expression differences using Microarrays also targeting peritoneal metastasis differences, and for some patients, Single Nucleotide Polymorphisms (SNPs) in genes through Exome sequencing.Results: Here we show that CNVs vary significantly between primary and metastatic tumors and include genes that have been considered potential chemotherapeutic targets based on primary tumor only data. Gene expression differences, while minor, showed highly statistically significant enrichment of genes in ovarian cancer critical pathways. In agreement with findings in other cancers, exome sequencing data revealed very few SNP differences of which most metastasis enriched SNPs were present at very low levels in the primary tumor. The results presented here should allow better design of therapies to target residual ovarian cancer disease.

Le cancer de l’ovaire, avec plus de 15.000 décès prévus en 2012, est le cancer gynécologique le plus meurtrier. Alors qu'environ 80% des patientes qui répondent à une chimiothérapie de première ligne, plus de 60% des patientes vont récidiver et seulement 44% seront encore en vie après 5 ans. Le rôle majeur du micro-environnement dans les processus de la carcinogénèse et la progression tumorale a été démontré par de nombreux travaux. Ce concept original de l’initiation et de la progression tumorale fait appel à des approches conceptuelles et expérimentales très diverses. Dans cette étude, nous avons pu démontrer le rôle important de la molécule de tolérance HLA-G (Human Leukocyte Antigene-G), ainsi que son expression et sa régulation par les cellules cancéreuses et les cellules du micro-environnement tumoral. Nous avons étudié les différents facteurs impliqués dans les mécanismes d’échappement tumoral et vérifié in vivo certains protocoles de chimiothérapie à base de médicaments immunomodulateurs. / With more than 15,000 deaths anticipated in 2012, ovarian cancer is the most deadly gynecologic malignancy. While approximately 80% of patients will respond to frontline chemotherapy, more than 60% of patients will experience disease recurrence and only 44% will be alive at 5 years. The role of the microenvironment in the process of carcinogenesis and tumor progression has been demonstrated in various studies. This original concept of initiation and tumor progression solicits a very varied conceptual and experimental approach. In this study, we demonstrate the important role of the immunosuppressive molecule HLA-G (Human Leukocyte Antigen-G), and its expression and regulation by cancer cells and tumor microenvironment cells. We studied the various factors involved in the mechanisms immune of tumor escape from the immune system and finally we analyse in vivo some chemotherapy protocols based on the immunomodulatory drugs.

O câncer de ovário é uma neoplasia ginecológica e alternâncias hormonais poderiam ter um papel na manifestação da doença. As ADAMTS´s são proteases secretadas dependentes de Zn2+/Ca2+. Nosso objetivo foi avaliar se há Influência de hormônios sexuais nos níveis de expressão de mRNA, proteínas e distribuição de ADAMTS 1 e 4 e alteração na migração e invasão em células tumorais humanas de ovário. As linhagens foram tratadas com progesterona, estrógeno ou testosterona e o controle não recebeu tratamento. O estrógeno e a testosterona induziram uma menor e a progesterona uma maior expressão gênica de ADAMTS 1 e 4 em relação ao controle para a linhagem ES-2. A progesterona foi capaz de induzir aumento nos níveis proteicos de ADAMTS 1 e 4 no lisado de ambas as linhagens. A progesterona diminuiu a capacidade migratória e de invasão das linhagens. Observamos na imunofluorescência ADAMTS 1 no núcleo das células. Concluímos que a progesterona regula a expressão das ADAMTS 1 e 4, e reduz a invasão e migração de células derivadas de câncer de ovário. / Ovarian carcinoma is the leading cause of gynecological neoplastic death, being associated primarily with deregulation of sex hormones. ADAMTS are secreted proteases. Our aim is to assess whether sex hormones would affect ADAMTS1 and 4 expressions in ovarian cancer cells. Estrogen and testosterone induced a decrease on gene expression of ADAMTS 1 and 4 compared to the control for the ES-2 cell line, while progesterone led to an increase in the mRNA levels of these same proteases. Progesterone increases ADAMTS\'s protein levels in the lysate and in conditioned medium from NIH-OVCAR-3 and in the lysate from ES-2 cells. Immunofluorescence showed ADAMTS 1 located at the cell nucleus. NIH-OVCAR-3 cells treated with progesterone exhibited decrease migratory activity compared to control and ES-2 exhibited decrease invasion activity. We conclude that progesterone modulates ADAMTS1 and 4 levels in ovarian cancer cell lines and decrease migratory and invasion behavior in ovarian cancer cells.

A carcinogênese epitelial ovariana tem sido foco de estudos científicos em todo o mundo desenvolvido. A angiogênese tumoral ovariana é um processo multifatorial que resulta em vários produtos pró-angiogênicos. Entre eles, o fator de crescimento vascular endotelial (VEGF) é predominante. Os objetivos deste estudo foram relacionar as dosagens do VEGF dos fluidos peritoneais, do plasma periférico e do infundíbulo pélvico aos níveis de citorredução em pacientes operadas de adenocarcinoma epitelial de ovário (CEO); formular um modelo probabilístico de citorredução e utilizar estas dosagens para estimar a probabilidade do desfecho de citorredução. Além disto, foi criada uma nova variável chamada carga de VEGF. Pelo procedimento step-wise a citorredução foi melhor descrita pela carga de VEGF, mas faltou Normalidade aos resíduos, não sendo possível a adequação de um modelo matemático. Porém, a curva ROC, forneceu uma área sob a curva de 0,84, com sensibilidade de 71,4 % e especificidade variando de 69,5 a 73,9%. O ponto de corte ótimo foi 15,52 log de picograma de carga de VEGF. A odds-ratio (OR) calculada para citorredução ótima descrita pela carga de VEGF foi de 11 (IC= 2,59 ; 46,78). No grupo com estágio avançado (III e IV), a OR foi de 6 (IC= 1,15; 31,22). Apesar do pequeno número de casos, esta nova variável pode vir a ser um auxiliar na determinação de situações onde cirurgia citorredutora deixa de ser a pedra fundamental do tratamento primário do CEO e a indução quimioterápica passe a ter o principal papel na citorredução química antes da cirugia nestes casos. / Epithelial ovarian carcinogenesis has been the focus of scientific studies in developed world. The ovarian tumor angiogenesis is a multifactorial process that results in pro-angiogenic products. Among them, vascular endothelial growth factor (VEGF) is predominant. This study aimed to relate VEGF levels in peritoneal fluids, peripheric plasma and pelvic infundibular plasma to debulking levels in patients operated on for epithelial ovarian carcinoma (EOC), formulate a probabilistic model for debulking and use these measurements to estimate the probability of the outcome of debulking. Moreover, it was created a new variable called burden of VEGF. For step-wise procedure, cytoreduction was better described by of burden VEGF, but missed Normality of residuals, so the adequacy of a mathematical model was not possible. Nevertheless, the ROC curve provided an area under the curve of 0.84, with sensitivity of 71.4 % and especificity varying from 69.5 to 73,9%. The optimal cutoff point was 15.52 log of picograms of VEGF burden. An odds-ratio for optimal cytoreduction described by the VEGF burden was 11 (CI= 2.59; 46.78). In the group with advanced stages (III & IV), the OR was 6 (CI= 1.15; 31.22). Apart from the small number of cases, this new variable might help to determine situations where cytoreductive surgery leaves behind the cornerstone of primary treatment of CEO and the chemotherapic induction comes to have main role in chemical cytoreduction prior to surgery in these cases.