No câncer gástrico, o foco do tratamento é a sobrevida, entretanto, para tumores avançados nos quais a indicação da cirurgia apresenta controversias, a qualidade de vida após o tratamento tornou-se importante. O pêso dos sintomas influencia a qualidade de vida e a sobrevida. Os sintomas são relacionados a doença de base, ao tratamento realizado, as co-morbidades associadas ou a combinação de fatores. A avalia-se a qualidade de vida no pré e pós-operatório de gastrectomia através dos questionários QLQC30 (qualidade global, escalas funcionais, escalas de sintomas) e STO22 (escalas de sintomas e itens isolados), associado a escalas funcionais de Karnofsky e Zubrod, além das escalas visuais analógicas e numérica para dor no pré e no primeiro e terceiro mês de pós-operatório. As análises de ambos os questionários não mostraram diferença estatística entre o pré-operatório e o primeiro e terceiro mês de pósoperatório. A escala funcional de karnofsky mostrou melhora da função fisica no primeiro mês de pós-operatório sem diferença com o terceiro mês, enquanto a de Zubrod não mostrou diferenças. A avaliação da dor não mostrou difernça com pós-operatório. A gastrectomia no câncer gástrico estádio III e IV não piora a qualidade de vida e pode ser realizada nos pacientes com perspectiva de sobrevida maior que um mês. / The aim of the treatment is survival when concerning gastric cancer. In those advanced gastric tumors whose surgical indications stay controversial, the Quality-oflife after treatment turned out to be very important. Symptoms are related to the disease. The scoring of symptoms has influence on the Quality-of-life and survival itself. Symptoms are related to the previous disease, chosen treatment and to the comorbidity associated with a combination of factors. One can evaluate the Quality-f-life before and after surgery through questionnaire QLQ-C30 (global quality, functional scales, grades of symptoms) and STO22 (grade of symptoms and isolate data) associated with functional gradation of Karnofsky and Zubrod. The visual analogical scales as well as the numeric one for the pain before and one month after surgery may be used too. For the questionnaire QLQ-C30 and STO22 the quality of life presents no differences to the pre operative status comparing with the post operative on first and third month. Karnofsky function after surgery are better on the first month and present no differences to the third month and the Zubrod showed no difference when compared to each other. The evaluation of pain showed no difference after surgery and no statistic significance in this item. The gastrectomy on gastric cancer stage III and IV dont worst the quality of life and perhaps may be have on patients with survive more than a month.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A gastrectomia com linfadenectomia ampliada ainda à o padrÃo ouro para o tratamento curativo do cÃncer de estÃmago (CaE), embora este procedimento possa levar a alto Ãndice de morbidade ou mortalidade, principalmente nos pacientes que nÃo apresentem disseminaÃÃo linfÃtica da doenÃa. A pesquisa do linfonodo sentinela (LS), jà consagrada nos tumores iniciais de mama e nos melanomas, apresenta-se cada vez mais freqÃente no trato digestÃrio, em especial no CaE com resultados animadores. Estudos iniciados nos meados do ano 2000 retratam busca crescente e bastante prÃspera para esclarecimento desta questÃo. O objetivo deste trabalho à elaborar um modelo experimental que possa demonstrar tecnicamente, em laboratÃrio, a viabilidade da pesquisa do LS no antro gÃstrico da cadela. Foram estudadas 25 cadelas com peso aproximado de 11 Kg e idade de 01 a 02 anos, sem raÃa definida (SRD), clinicamente saudÃveis, proveniente do Centro de Controle de Zoonoses do MunicÃpio de Fortaleza (CCZ) que tinham programaÃÃo para eutanÃsia. Com escolha aleatÃria, estes animais foram estudados individualmente e semanalmente. Utilizou-se, separadamente, TecnÃcio (99mTc) com traÃador/colÃide Fitato e corante vital azul patente V Guerbert 2,5 % (AP) injetados a 01 cm do piloro, na pequena curvatura no antro gÃstrico da cadela e analisados nos tempos zero, 05, 10, 15 e 20 minutos. ApÃs este perÃodo realizou-se pesquisa âin vivoâ do local de injeÃÃo do marcador e linfonodos encontrados e âex-vivoâ destes linfonodos. Para o estudo com o 99mTc utilizou-se o aparelho Gamma Probe modelo Nuclearlab DGC-II - detector para cirurgia radioguiada e sonda captadora de irradiaÃÃo acoplada com unidade de contagem e rastreamento sonoro e para o AP, visÃo direta. Para a anÃlise estatÃstica utilizou-se o teste de McNemar e o Coeficiente de ConcordÃncia de Kappa. Foi estabelecido em 5% o nÃvel de significÃncia (p≤0,05). Com o uso do 99mTc isolado foi identificado a presenÃa do LS em 20 animais (80%). Quando se utilizou o corante AP isolado a presenÃa do LS foi identificada em 24 animais (96 %). NÃo houve significÃncia estatÃstica quanto ao uso destes marcadores para a pesquisa do LS no antro gÃstrico da cadela. Concluiu-se que (1) O estÃmago da cadela à adequado para modelo experimental de pesquisa âin vivoâ do linfonodo sentinela e (2) O tecnÃcio (99mTc) e corante vital â azul patente V Guerbert 2,5 % (AP) sÃo eficientes como marcadores de linfonodo sentinela do antro gÃstrico da cadela. / The gastrectomy with extensive lymphadenectomy still is the gold standard for the dressing treatment of the gastric cancer (GC), even so these procedures can take high index of morbidity or mortality, mainly in the patients who do not present lymphatic dissemination of the illness. The research of sentinel lymph node (SLN), already consecrated in the initial tumors of breast and the melanomas, presents each time more frequent for upper gastrointestinal cancers, specially in GC with encouraging results. Studies initiated in the middles of 2000 portray increasing and sufficiently prosperous search for clarification of this question. The objective of this work is to elaborate an experimental model that can demonstrate technically, in laboratory, the research viability of SLN in gastric antrum of the dog. 25 female dogs had been studied with approach weight of 11 kg and age of 01/02 years, without definite race (WDR), healthful clinically, proceeding from the Control Center of Zoonosis of Fortaleza City with programming for euthanasia. With random choice, these animals had been studied individually and weekly. It was used, separately, radioisotopic 99mtechnetium labeled phytate and patent blue dye (V Guerbert 2.5%) injected at 01 cm above the piloro, on the small bending in the antrum gastric of the dog and analyzed in the times zero, 05, 10, 15 and 20 minutes. After this period, the injection place of the markers and gastric lymph nodes were appraised âin vivoâ (in the animal) and the gastric lymph nodes âex vivoâ (out of the animal). For the study with the 99mtechnetium it was used the device Gamma Probe model Nuclearlab DGC-II (radioguiada surgery with sounding lead of irradiation connected to unit of counting and sonorous tracking) and for the patent blue dye, direct vision. For the analysis statistics were used the test of McNemar and the Quantify agreement with Kappa. The level of significance was established in 5% (p≤0,05). When the radioisotopic 99mtechnetium labeled phytate was used single, the LS was identified in 20 animals (80%). With the patent blue dye single, in 24 animals (96%). There is no statistic significance with the use of those markers for the LS research in the gastric antrum of the dog. The conclusions are (1) The stomach of the dog is adjusted for experimental model in alive research of the sentinel lymph node (2) The radioisotopic 99mtechnetium labeled phytate and patent blue dye (V Guerbert 2.5%) are efficients as markers of sentinel lymph node of the dogâs gastric antrum.

Orientador: Marcelo Lima Ribeiro / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-23T02:53:02Z (GMT). No. of bitstreams: 1 Alvarez_MarisaClaudia_D.pdf: 3342763 bytes, checksum: ef7082f8bb653fcdcf965415a79b4d30 (MD5) Previous issue date: 2012 / Resumo: A infecção por Helicobacter pylori e usualmente adquirida durante a infância e persiste durante toda a vida caso não seja tratada. A bactéria induz uma resposta inflamatória crônica, que esta associada com alterações hipergenéticas em oncogenes, genes supressores tumorais, e genes de reparo ao DNA. O Objetivo deste estudo foi avaliar a influencia da infecção por H. pylori no padrão de metilação de genes envolvidos na carcinogenese gástrica. O perfil de metilação de 106 genes foi caracterizado em biopsias provenientes de 5 pacientes adultos (1 Helicobacter pylori negativo, 3 com gastrite crônica infectados com linhagens de diferentes toxicidades e 1 com câncer gástrico) e em DNA proveniente de células epiteliais gástricas infectadas por H. pylori. Para estas analises foram utilizados o Promoter methylation array system, e o Gastric Cancer Methyl--Profiler DNA PCR Array. Os resultados destas análises mostraram que 20 % dos genes se encontravam metilados na amostra de câncer gástrico e 16 % dos genes na amostra de gastrite crônica, entretanto a analise comparativa entre estas amostras mostrou que compartilhavam 8,5 % dos genes metilados. A analise de metilação apos cocultura mostrou 12% dos genes metilados. Entre estes genes foram selecionados os seguintes: THBS1, HIC1, GATA--4, GATA--5 e MLH1 e MGMT, os quais foram avaliados em 239 amostras de biopsias gástricas, provenientes de 50 crianças e 97 adultos infetados ou não pela bactéria e de 92 adultos com câncer gástrico. O padrão de metilação foi avaliado por metilação PCR especifica (MSP--PCR). Os resultados obtidos neste trabalho mostraram que não houve metilação da região promotora de MLH1, MGMT e HIC1, nas amostras provenientes de crianças, independente do estado de infecção. Os maiores níveis de metilação entre as amostras oriundas de adultos com gastrite crônica infectados foram observados em GATA--4 e THBS1 (p<0.05), MGMT e GATA--5 (p<0.001). Nos pacientes com câncer gástrico os maiores níveis de metilação foram observados em MGMT e GATA--5 (p<0.05, p<0.001, respectivamente). Foi verificado um aumento da instabilidade microssatelites nas amostras de câncer gástrico (p<0.03) e o mesmo foi associado com um aumento nos níveis de metilação de MLH1 e sua consequente diminuição de RNAm. Foi realizado in vitro a analise de expressão de GATA--5 e TFF1 apos cocultura de diferentes linhagens de H. pylori e células AGS, que revelou um aumento nos níveis de RNAm de GATA--5 as 6, 24 e 48h apos infecção, e aumento de TFF1 apos 48h. Estes aumentos foram independentes da presença de cag PAI. O aumento na expressão de GATA--5 foi observado em camundongos C57BL/6 apos 6 meses de infecção. Foi observado in vivo que nas amostras metiladas em GATA--5 apresentavam níveis diminuídos de TFF1. Estes resultados nos permitem sugerir que a metilação acontece precocemente na mucosa gástrica dos pacientes pediátricos e esta associada com a infecção por H. pylori. Entretanto alguns loci como MGMT e MLH1 a metilação parece ser dependente do tempo de infecção. Foi observado que os níveis de metilação aumentaram conforme a idade dos pacientes sugerindo que o maior tempo de exposição induz maiores níveis de metilação / Abstract: Helicobacter pylori infection is usually acquired in childhood and persists into adulthood if untreated. It is known that the bacterium induces a chronic inflammatory response, which is associated with epigenetic alterations in oncogenes, tumor suppressor genes and DNA repair genes. The aim of this study was to evaluate the influence of Helicobacter pylori infection on the methylation pattern of genes related to gastric carcinogenesis. The methylation pattern of 106 genes was characterized in gastric biopsies samples from 5 adult patients (1 H. pylori negative, 3 chronic gastritis infected with strains of different toxicities, and 1 gastric cancer) and DNA extracted from co--cultured cells infected with H. pylori. These analyses were performed with Promoter methylation array system, and Gastric Cancer Methyl--Profiler DNA PCR Array. The results showed that 20 % of genes were methylated in gastric cancer mucosa and 16% were hyper methylated in the mucosa of the chronic gastritis patients. The comparative analysis showed that 8,5 % of genes were methylated in both samples. The results from the co culture showed that 12% of genes were methylated. Among them the following genes were selected: THBS1, HIC1, GATA--4, GATA--5 e MLH1 e MGMT and evaluated in 239 gastric biopsies samples from 50 children and 97 adults infected or uninfected by H. pylori, and 92 adults with gastric cancer. The methylation pattern was analyzed by methylation specific PCR (MSP--PCR). The results from pediatric samples showed no methylation for MLH1, MGMT and HIC1 genes, independent of the infection status. Among the infected adults samples the higher levels of methylation were observed for GATA--4 e THBS1 (p<0.05), MGMT e GATA--5 (p<0.001). Higher levels of methylation were observed for MGMT e GATA--5 (p<0.05, p<0.001, respectively) in gastric cancer samples. It was observed an increase in microsatellite instability among gastric cancer samples, related to hyper methylation of MLH1. The expression levels of GATA--5 and TFF1 was analyzed in vitro. The results from infected cells showed an up regulation at 6, 24, and 48 for GATA-5 and at 48 h for TFF1. This increase was independent of cagPAI status. In an animal model an up regulation of GATA--5 was observed after six months of infection. A decrease in TFF1 mRNA levels was observed in infected children and adults samples methylated in GATA--5 promoter region. These data suggest that promoter hyper methylation occurs in gastric mucosa of children in association with H. pylori infection, however for some loci as MGMT and MLH1 this event seems to be dependent on the time of exposure. Furthermore it was observed an increase in methylation frequencies in adults samples compared to pediatric samples suggesting that the duration of the infection is related to methylation levels / Doutorado / Genetica Animal e Evolução / Doutora em Genética e Biologia Molecular

Introducción: El cáncer de estómago, posee una de las más altas incidencias a nivel mundial. En el Perú, no existe un adecuado registro y reporte de casos, que permita una evaluación de los clásicos y nuevos factores descritos en la literatura, así como de factores propios del carcinoma. Objetivo: Determinar la asociación entre el desarrollo de metástasis en pacientes con adenocarcinoma gástrico y el patrón en anillo de sello. Materiales y Métodos: Ejecutamos un estudio de casos y controles en el Instituto Nacional de Enfermedades Neoplásicas (INEN) en pacientes con diagnóstico de cáncer de estómago. Se definió como caso, a todo paciente que desarrolló metástasis y como control, aquel paciente que no desarrolló metástasis, nuestra exposición de interés fue el tipo de adenocarcinoma. Resultados: Evaluamos 174 casos y 93 controles. La edad promedio en los casos y controles fue de 58,8 y 58,6, respectivamente. El 86,78% de casos y 61,29% de controles fueron diagnosticados en estadios avanzados. Además, se evidenció que los casos presentaron una mayor posibilidad 5,57 veces (IC95%: 1,76 – 17,62) de haber presentado los subtipos anillo de sello en conjunto con otros subtipos histológicos en comparación a los controles. Conclusiones: En pacientes con cáncer gástrico que desarrollaron metástasis, el hallazgo del patrón en anillo de sello no es un factor asociado al pronóstico negativo. Por el contrario, podemos afirmar que en las personas con cáncer gástrico que desarrollaron metástasis es probable que hayan presentado algún patrón histológico que haya co-existido con el subtipo adenocarcinoma en anillo de sello. / Background: Stomach cancer has one of the highest incidences worldwide. In Peru, there is no adequate record and report of cases, which allows an evaluation of the classic and new factors described in the literature, as well as factors typical of carcinoma. Objective: To determine the association between the development of metastasis in patients with gastric adenocarcinoma and the histopathological pattern in signet ring cell. Materials and Methods: We conducted a case-control study at the National Institute of Neoplastic Diseases (INEN) in patients diagnosed with stomach cancer. It was defined as case, to any patient who developed metastases and as a control, that patient who did not develop metastases, our exposure of interest was the type of adenocarcinoma. Results: We evaluated a total of 174 cases and 93 controls. The average age in cases and controls was 58.8 and 58.6, respectively. The majority of cases (86,78%) and controls (61,29%) were diagnosed in advanced stages (greater than 2). Likewise, it was evidenced that the cases presented a greater possibility 5.57 times (IC 95%: 1.76 - 17.62) of having presented the seal ring subtypes in conjunction with other histological subtypes compare to the controls. Conclusions: In patients with gastric cancer who developed metastases, the finding of the signet ring pattern is not a factor associated with the negative prognosis. On the contrary, we can affirm that in people with gastric cancer who developed metastases it is likely that they have presented some histological pattern that has co-existed with the adenocarcinoma subtype in the seal ring. / Tesis

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13552号 / 論医博第2281号 / 新制||医||1067(附属図書館) / (主査)教授 武藤 学, 教授 小濱 和貴, 教授 佐藤 俊哉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

INTRODUÇÃO: O adenocarcinoma gástrico precoce (AGP) atinge até a camada submucosa em profundidade, independentemente da presença de metástases linfonodais (MLF). Tumores mucosos, bem diferenciados, menores que 20 mm e sem ulceração são candidatos à ressecção endoscópica (RE) por mucosectomia com taxas de MLF praticamente nulas. Com o advento da técnica de dissecção endoscópica da submucosa (ESD) e após observar ausência de MLF em grande série de pacientes no Japão, foi sugerido que os critérios clássicos pudessem ser expandidos, evitando a gastrectomia em alguns pacientes. Em países ocidentais autores e sociedades têm visto com restrição a ESD para critérios expandidos devido à observação de MLF em alguns subgrupos. A análise crítica e validação dos critérios expandidos de RE para tratamento do AGP em coorte brasileira poderá indicar os pacientes com menor risco de metástases linfonodais nesta população, de modo a individualizar o tratamento com excelência e qualidade de vida. OBJETIVO: Avaliar a presença MLF em produtos de gastrectomia com linfadenectomia de pacientes elegíveis à ressecção endoscópica seguindo os critérios clássicos e expandidos. MÉTODO: Inclusão de pacientes com AGP submetidos a tratamento cirúrgico com dissecção linfonodal. Estadiamento linfonodal e avaliação de características clínicas, macroscópicas e histopatológicas segundo critérios de RE. RESULTADOS: Foram incluídos 389 espécimens cirúrgicos de gastrectomia, dentre os quais 135 cumpriam critérios para ressecção endoscópica. Nenhum dos 31 pacientes com critérios clássicos apresentou MLF (N = 31; 0% IC95% 0 - 13,4%). Dos 104 com critérios expandidos, 3 apresentaram MLF (N = 104; 2,9% IC95% 0,7 - 8,6%), todos pertencentes ao grupo de tumores indiferenciados sem ulceração e menores que 20 mm. Dos pacientes com indicação de tratamento cirúrgico houve 50 MLF positivos (N = 254; 19,7% IC95% 15,3 - 25,1%). CONCLUSÃO: Existe risco mínimo de metástases linfonodais quando adotados os critérios expandidos de RE. Este risco é praticamente nulo para os critérios clássicos e quando se exclui o tumor indiferenciado do critério expandido / INTRODUCTION: Early gastric cancer (EGC) is known to present low rate of lymph nodal metastasis (LNM). Gastrectomy with D2 lymphadenectomy is usually curative for EGC. Endoscopic submucosal dissection (ESD) is a well-accepted treatment modality for lesions that meet the classic criteria, a well-differentiated adenocarcinoma measuring less than 20 mm size and without ulceration. Expanded criteria for ESD have been recently proposed, based on null LNM rate from large gastrectomies series coming from Japan. The expanded criteria for ESD are as follows: intramucosal non-ulcerative well-differentiated tumor > 20 mm, intramucosal ulc mo <= 30 mm, intramucosal non-ulcera mo <= 20 mm, or superficially submucosal ( m1) mo <= 30 mm. There is some resistance to adoption of the expanded criteria, since patients with positive LNM have already been reported in western centers. OBJECTIVE: Evaluate LNM staging in patients who met the expanded endoscopic treatment criteria for ESD. METHOD: Evaluation of gastrectomy specimens including LNM staging of patients submitted to gastrectomy for EGC in a 39-year retrospective cohort. A senior pathologist reviewed the histology slides. RESULTS: A total of 389 surgical specimens were included, of whose 135 met criteria for endoscopic resection. None of the 31 patients with classic criteria had LNM. Of the 104 patients with expanded criteria, 3 had LNM (n = 104, 2.9% CI 95% 0.7 - 8.6%), all of them with undifferentiated tumors without ulceration and less than 20 mm. In the patients with surgical criteria there were 50 LNM positive (n = 254; 19.7% CI 95% 15.3 - 25.1%). CONCLUSION: There is minimal risk of LNM in EGC when expanded criteria for ESD are met. This risk is practically nil for the classic criteria and when the undifferentiated tumor is excluded of the expanded criteria. Refinement of the expanded criteria for the risk of LNM may be desirable. Meanwhile the decision to complement the endoscopic treatment with LNM dissection or D2 gastrectomy will have to take into consideration the individual risk of perioperative morbidity and mortality

Introdução: Agregação familial é observada em cerca de 10% dos casos de câncer e 1 a 3% é hereditário. O tipo difuso pode estar relacionado à agregação familial e a alterações genéticas no gene CDH1, que codifica a proteína E-caderina. Alterações na imunoexpressão de Beta-catenina e p53 também são observadas. Objetivos: Analisar a imunoexpressão da E-caderina, Beta-catenina e TP53 em adenocarcinomas gástricos de pacientes com câncer gástrico familial e comparar com os dados clinicopatológicos, além dos achados das alterações genéticas destes pacientes, estudadas previamente nesta Instituição. Casuística e Métodos: Vinte e seis casos de adenocarcinoma gástrico em blocos de parafina de pacientes do HC-FMUSP foram submetidos ao estudo imunoistoquímico para detecção e análise do padrão de imunoexpressão da E-caderina, Beta-catenina e TP53 através do método da streptavidina-biotina-peroxidase. A análise da imunoexpressão dos marcadores foi classificada segundo escala de intensidade e distribuição e os testes estatísticos utilizados foram o Teste t de Student e Exato de Fisher. Resultados: A localização predominante do tumor foi no antro (61,5%). 11 (42,3%) casos alterados para a imunoexpressão da E-caderina, sendo todos do tipo difuso; 15 (57,7%) casos normais, sendo 9 do tipo difuso e 6 do tipo intestinal (p=0,02). Em estudo prévio realizado nesta instituição, uma mutação missense no exon 12 do gene CDH1, códon 617, nucleotídeo 1849 G>A foi encontrada no mesmo caso em que foi observada ausência de imunorreatividade da E-caderina. 11 (42,3%) casos alterados para a imunoexpressão de Beta-catenina e 46,2% de imunorreatividade nuclear positiva para TP53. Conclusões: 1) O tipo difuso de Laurén está associado à alteração da imunoexpressão da E-caderina no Câncer Gástrico Familial; 2) Não houve associação entre a imunoexpressão da E-caderina, idade, gênero e localização do tumor; tampouco houve associação entre a imunoexpressão da Beta-catenina e os dados clínico-patológicos; houve associação inversa entre a imunoexpressão da E-caderina e TP53; 3) Nos casos em que foram detectadas alterações na imunoexpressão, parece haver duas rotas distintas de carcinogênese envolvidas no CGF. / Introduction: Familial clustering is observed in about 10% of the gastric cancer cases and 1-3% is hereditary. Diffuse type gastric cancer is related to genetic alterations in CDH1 gene, which translates the E-cadherin protein. The abnormal expression of E-cadherin is characterized by low expression of cytoplasmatic staining, or loss of membranous immunoreactivity. Aim: to analyze the immunoexpression of E-cadherin, Beta-catenin and TP53 in gastric adenocarcinomas in patients with Familial Gastric Cancer and compare with clinical-pathologic data, including the genetic alterations of these patients, found previously on this institution. Methods: 26 cases of paraffin-embedded gastric adenocarcinoma tissue of patients of Hospital das Clinicas - School of Medicine of University of Sao Paulo underwent immunostaining to detect the presence and to analyze the pattern of immunoexpression of E-cadherin, Beta-catenin and TP53 using Streptavidine-Biotine-Peroxidade technique. The immunoexpression evaluation was performed utilizing a semiquantitative scale for intensity and distribution. The statistical analysis was done through Students t test and Fishers Exact test. Results: E-cadherin immunoexpression was negative in 11 cases (42.3%), and all of them were diffuse type of Laurén. 15 cases (57.7%) were positive for E-cadherin, from which 9 were of the diffuse type and 6 of intestinal type (p=0.02). In previous study performed on this institution, one missense mutation in exon 12 of CDH1 gene, codon 617, nucleotide 1849 G>A was found on the same case that absence of E-cadherin immunostaining was observed. 61.5% of the tumors were located in the antrum. Beta-catenin immunoexpression was altered in 43.2% and TP53 nuclear immunoreactivity was positive in 46.2% of the tumors. TP53 was solely detected in 12 (46.2%) of the tumors, while E-cadherin was altered in 10/26 (38.5%) negative TP53 tumors, p=0.01. Conclusions: 1) Diffuse type of Laurén is associated to E-cadherin immunoexpression alteration in Familial Gastric Cancer; 2) There was no association between E-cadherin immunoexpression and age, gender or tumor location, as well as there was no association between Beta-catenin and the clinical-pathologic data; there was an inverse association between immunoexpression of TP53 and E-cadherin; 3) There may be two distinct carcinogenesis pathways on familial gastric cancer cases that imunoexpression alterations were detected.

Li Ka Wai Kay. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references. / Abstracts in English and Chinese. / ACKNOWLEDGEMENTS --- p.i / ABSTRACT (ENGLISH/CHINESE) --- p.ii / TABLE OF CONTENTS --- p.viii / LIST OF FIGURES --- p.xii / LIST OF APPENDICES --- p.xiii / Chapter 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Gastric carcinomas --- p.1 / Chapter 1.1a --- Epidemiology --- p.1 / Chapter 1.1b --- Classification --- p.2 / Chapter 1.1c --- TNM staging --- p.3 / Chapter 1.1d --- Prognosis --- p.4 / Chapter 1.1e --- Etiology --- p.6 / Chapter 1.1f --- Genetic alteration in gastric cancer --- p.10 / Chapter 1.2 --- Treatment --- p.16 / Chapter 1.2a --- "Surgery, chemotherapy, and others" --- p.16 / Chapter 1.2b --- Response rate of treatments in previous studies --- p.18 / Chapter 1.2c --- Chemotherapeutic Drugs --- p.21 / Chapter 1.2c (1) --- 5-fluorouracil (5-FU) --- p.22 / Chapter 1.2c (2) --- cis-diamminedichloroplatinum (Cisplatin) --- p.23 / Chapter 1.2c (3) --- Doxorubicin (Adriamycin) --- p.23 / Chapter 1.2c (4) --- Daunorubicin --- p.25 / Chapter 1.2c (5) --- Epirubicin --- p.25 / Chapter 1.2d --- Toxicity of chemotherapeutic drugs --- p.26 / Chapter 1.2d (1) --- Side effects of 5-FU --- p.26 / Chapter 1.2d (2) --- "Side effects of anthracyc lines (adriamycin, daunobicin, epuirbicin)" --- p.27 / Chapter 1.2d (3) --- Side effects of cisplatin --- p.28 / Chapter 1.3 --- Mechanisms of drug resistance --- p.28 / Chapter 1.3a --- Drug resistance --- p.28 / Chapter 1.3b --- P-glycoprotein (MDR1 gene) --- p.29 / Chapter 1.3c --- p53 tumor suppressor gene --- p.35 / Chapter 1.4 --- Chemosensitivity testing --- p.40 / Chapter 1.4a --- Original of chemosensitivity testing --- p.40 / Chapter 1.4b --- Non-clonogentic assay --- p.40 / Chapter 1.4c --- Clonogenic assay --- p.42 / Chapter 2 --- AIM OF MY STUDY --- p.44 / Chapter 3 --- MATERIALS AND METHODS --- p.45 / Chapter 3.1 --- Patients --- p.45 / Chapter 3.2 --- Tumor collection and handling procedure --- p.46 / Chapter 3.2a --- Large tumor tissue from gastrectomy --- p.46 / Chapter 3.2b --- Pseudo-biopsies --- p.47 / Chapter 3.3 --- Chemosensitivity testing --- p.48 / Chapter 3.3a --- Cell Plating --- p.48 / Chapter 3.3b --- Drug testing --- p.49 / Chapter 3.4 --- Chemosensitivity analysis --- p.50 / Chapter 3.5 --- Conformational sensitive gel electrophoresis analysis (CSGE) and single strand conformational polymorphism (SSCP) --- p.51 / Chapter 3.5a --- Preparation of genomic DNA --- p.51 / Chapter 3.5b --- PCR condition for CSGE analysis --- p.51 / Chapter 3.5c --- Scanning PCR products by CSGE --- p.52 / Chapter 3.5d --- PCR condition for SSCP analysis --- p.53 / Chapter 3.5e --- Scanning PCR products by SSCP --- p.53 / Chapter 3.6 --- Reverse transcription-polymerase chain reaction (RT-PCR) for multi-drug drug resistance (MDR1) gene --- p.54 / Chapter 3.6a --- Isolation of RNA --- p.54 / Chapter 3.6b --- cDNA synthesis --- p.55 / Chapter 3.6c --- PCR primers --- p.55 / Chapter 3.6d --- Optimalization of PCR condition for MDR1 gene expression --- p.56 / Chapter 3.6e --- PCR of β2-m gene --- p.57 / Chapter 3.6f --- PCR of MDR1 gene and analysis of its expression --- p.57 / Chapter 3.7 --- Immunohistochemistry --- p.58 / Chapter 3.7a --- Immunostaining by DO-7 --- p.58 / Chapter 3.7b --- lmmunohistochemistochemical analysis of p53 protein expression --- p.59 / Chapter 3.8 --- Statistics --- p.59 / Chapter 4. --- RESULTS --- p.60 / Chapter 4.1 --- Chemosensitivity testing --- p.60 / Chapter 4.1a --- Tests completed --- p.60 / Chapter 4.1b --- Number of cases tested for each drug --- p.60 / Chapter 4.1c --- 〇D reading of the background samples --- p.60 / Chapter 4.1d --- Dose-dependent response curve --- p.61 / Chapter 4.1e --- Unique IC50 for each tumor in each drug test --- p.61 / Chapter 4.1f --- Wide distribution of ic50 for anti-tumor drugs --- p.61 / Chapter 4.1g --- Chemosensitivity and tumor histologic type --- p.63 / Chapter 4.1h --- Correlation of ic50 with tumor stage --- p.63 / Chapter 4.2 --- Immunohistochemical staining of p53 protein (DO-7) --- p.64 / Chapter 4.2a --- p53 protein accumulation in samples --- p.64 / Chapter 4.2b --- Correlation of p53 IHC expression and chemosensitivity --- p.64 / Chapter 4.3 --- SSCP and CSGE --- p.65 / Chapter 4.3a --- Detection of abnormal band movement --- p.65 / Chapter 4.3b --- Correlation of p53 mutations with chemosensitivity --- p.66 / Chapter 4.3c --- Concordance between IHC and SSCP/CSGE --- p.66 / Chapter 4.4 --- MDR1 gene expression --- p.67 / Chapter 4.4a --- MDR1 gene expression in normal and tumors --- p.67 / Chapter 4.4b --- Correlation of MDR1 expression and chemosensitivity --- p.68 / Chapter 4.5 --- Pseudobiopsies --- p.68 / Chapter 5 --- DISCUSSION --- p.70 / Chapter 5.1 --- p53 analysis of the tumors --- p.70 / Chapter 5.1a --- Immunohistochemistry versus mutational analysis --- p.70 / Chapter 5.1b --- Methods of mutational analysis --- p.73 / Chapter 5.1c --- Comparing IHC results with previous findings --- p.77 / Chapter 5.1d --- Comparing SSCP/ CSGE results with previous findings --- p.78 / Chapter 5.1e --- Correlation of IHC and SSCP/CSGE results --- p.81 / Chapter 5.2 --- MDR1 expression --- p.85 / Chapter 5.2a --- Methods for detecting MDR1 expression --- p.85 / Chapter 5.2b --- Comparing MDR1 expression results with published data --- p.88 / Chapter 5.2c --- Correlation between chemosensitivity and MDR1 gene expression --- p.92 / Chapter 5.3 --- Chemosensitivity testing --- p.94 / Chapter 5.3a --- Chemosensitivity testing method --- p.94 / Chapter 5.3b --- The chemosensitivity results --- p.102 / Chapter 5.3c --- Chemosensitivity and MDR1 expression --- p.108 / Chapter 5.3d --- Chemosensitivity and p53 immunohistochemical expression… --- p.110 / Chapter 5.3e --- Chemosensitivity and p53 mutations --- p.112 / Chapter 5.3f --- Limitation of this study --- p.115 / Chapter 5.3g --- Pseudobiopsies and large tumor samples --- p.118 / Chapter 6. --- conclusions --- p.121 / figures / appendices / references

Chu Wai Kit. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 87-96). / 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 --- p.1 / Chapter 1.1 --- Epidemiology of gastric cancer --- p.1 / Chapter 1.2 --- Risk factors associated with gastric cancer --- p.7 / Chapter 1.3 --- Prevention of Gastric Cancer --- p.9 / Chapter 1.4 --- H. pylori eradication and gastric cancer development --- p.11 / Chapter 1.5 --- Non-steroidal anti-inflammatory drugs and gastric cancer prevention --- p.13 / Chapter 1.6 --- COX-2 independent pathway --- p.14 / Chapter 1.7 --- Animal model of gastric cancer --- p.15 / Chapter 1.8 --- Microarray system --- p.16 / Chapter 1.9 --- Hypothesis --- p.18 / Chapter 1.10 --- Aim of study --- p.19 / Chapter Chapter 2 --- Chemoprevention of gastric cancer by celecoxib --- p.20 / Chapter 2.1 --- Introduction --- p.20 / Chapter 2.2 --- Material and Methods --- p.22 / Chapter 2.2.1 --- Animals --- p.22 / Chapter 2.2.2 --- Chemicals --- p.22 / Chapter 2.2.3 --- Study design --- p.23 / Chapter 2.2.4 --- Cell Culture --- p.24 / Chapter 2.2.5 --- Celecoxib treatment --- p.24 / Chapter 2.2.6 --- Cell proliferation assay --- p.25 / Chapter 2.3 --- Results --- p.26 / Chapter 2.3.1 --- Chemoprevention of gastric cancer by celecoxib in rats --- p.26 / Chapter 2.3.2 --- Effects of celecoxib on growth of human gastric cancer cells --- p.29 / Chapter 2.4 --- Discussion --- p.30 / Chapter 2.4.1 --- MNNG induced gastric cancer effectively --- p.30 / Chapter 2.4.2 --- Celecoxib significantly suppressed gastric carcinogenesis in rats --- p.31 / Chapter 2.4.3 --- Celecoxib inhibited the growth of MKN 45 in a concentration-dependent manner --- p.31 / Chapter 2.4.4 --- Celecoxib may exert its anti-tumor property through COX independent pathway --- p.32 / Chapter Chapter 3 --- Gene expression profiles of celecoxib treated rat gastric tumor and human gastric cells --- p.34 / Chapter 3.1 --- Introduction --- p.34 / Chapter 3.2 --- Material and Methods --- p.34 / Chapter 3.2.1 --- RNA extraction --- p.34 / Chapter 3.2.2 --- Target preparation and Array hybridization --- p.35 / Chapter 3.2.3 --- Post-hybridization processing and Scanning --- p.36 / Chapter 3.2.4 --- Microarray data analysis --- p.36 / Chapter 3.2.5 --- Quantitative RT-PCR --- p.37 / Chapter 3.3 --- Results --- p.39 / Chapter 3.3.1 --- Gene expression profiles of rat gastric tumors --- p.39 / Chapter 3.3.1.1 --- Genes differentially expressed in MNNG induced gastric tumors --- p.39 / Chapter 3.3.1.2 --- Genes differentially expressed in celecoxib treated group --- p.42 / Chapter 3.3.1.3 --- Mechanisms underlying chemoprevention of celecoxib --- p.43 / Chapter 3.3.2 --- Verification of gene expression by quantitative RT-PCR --- p.55 / Chapter 3.3.3 --- Confirmation of the gene expression profiles in human by quantitative RT-PCR --- p.59 / Chapter 3.4 --- Discussions --- p.63 / Chapter Chapter 4 --- Effects of celecoxib on Akt pathway in gastric cancer cells --- p.68 / Chapter 4.1 --- Introduction --- p.68 / Chapter 4.2 --- Material and methods --- p.72 / Chapter 4.2.1 --- Protein extraction --- p.72 / Chapter 4.2.2 --- Western blotting --- p.72 / Chapter 4.3 --- Results --- p.74 / Chapter 4.3.1 --- Expression of the Akt pathway after treatment with celecoxib --- p.74 / Chapter 4.4 --- Discussions --- p.78 / Chapter Chapter 5 --- Conclusion --- p.82 / References --- p.87

Introdução: Câncer gástrico é uma doença multifatorial influenciada por fatores externos e hereditários. Embora a síndrome do câncer gástrico difuso hereditário causada por mutações germinativas no gene CDHl seja uma condição rara, sua influência sobre a incidência de câncer gástrico no Brasil, que é considerado um país de alta incidência desta neoplasia, é desconhecida. Objetivos: Avaliar a frequência de variantes germinativas em CDHl e os hábitos de dieta/estilo de vida em pacientes diagnosticados câncer gástrico com idade precoce «55 anos) no Brasil. Metodologia: De outubro de 2013 a agosto 2015, foram recrutados 88 pacientes consecutivos e não aparentados diagnosticados com câncer gástrico em idade precoce em um hospital público brasileiro. Todos os éxons e regiões intrônicas flanqueadoras do CDHl foram sequenciados. Os hábitos de dieta/estilo de vida dos pacientes com câncer gástrico em idade precoce foram comparados com informações sobre os hábitos da população armazenados em bancos de dados populacionais brasileiros. Resultados: Dos 88 pacientes, 51,1% eram do sexo feminino e a média de idade no momento do diagnóstico do câncer era de 39 anos (variação, 20-55); 23% relataram história familiar de câncer gástrico em parentes de primeiro ou de segundo. A maioria dos tumores era do tipo difuso (74%), pouco diferenciado (74%) e localizava-se no terço médio ou distal do estômago (67%). No total, 24 variantes germinativas foram detectadas: 3 (12.5%) benignas, 17 (70.8%) provavelmente benignas e 4 (16.7%) variantes de significado clínico incerto (VSI). Todas as VSI são mutações missense e nunca foram relatadas previamente na literatura: c.313T> A, c.387G> T, c.1676G> A e c.1806C> A. Os pacientes com câncer gástrico diagnosticados em idade precoce apresentaram maior consumo de carne vermelha (OR: 2.591, IC 95%: 1.371-4.894) e carne processada (OR: 3.093, IC 95%: 1.591- 6.009) em comparação com os hábitos alimentares da população brasileira. Conclusão: De acordo com o nosso conhecimento, esta é a maior série investigando a contribuição de mutações germinativas de CDHl em pacientes diagnosticados com câncer gástrico em idade precoce na América Latina. Para um país considerado de alta incidência, a frequência encontrada de variantes germinativas em CDHl foi maior do que o esperado; 4 novas mutações missense foram identificadas e mais estudos são necessários para confirmar a patogenicidade dessas variantes. Fatores de risco modificáveis, como o consumo de carne vermelha e/ou de carne processada podem ter contribuído para o desenvolvimento de câncer gástrico em idade precoce na população estudada / Introduction: Gastric cancer is a multifactorial disease influenced by inherited and noninherited factors. Although hereditary diffuse gastric cancer syndrome caused by germline mutation in CDHl is arare condition its contribution to gastric cancer burden in Brazil, which is considered a high-incidence country for this neoplasia, is unknown. Objectives: To evaluate the frequency of CDHl germline variants and the dietjlifestyle habits in early-onset gastric cancer (EOGC, < 55 years old) patients in Brazil. Methodology: From October 2013 to August 2015, a total of 88 unrelated and consecutive patients attending a Brazilian public hospital with EOGC were enrolled. Ali CDHl exons and intronic boundaries were sequenced. The dietjlifestyle habits of EOGC patients have been compared to Brazilian population data bases. Results: Of 88 patients, 51.1% were female and the mean age at gastric cancer diagnosis was 39 years (range 20-55); 23% reported family history of gastric cancer in first- or second-degree rei atives. The majority of the tumors were diffuse (74%), poorly differentiated (74%), and located in the middle and distal-third of the stomach (67%). In total, 24 germline variants were detected: 3 (12.5%) benign, 17 (70.8%) likely benign, and 4 (16.7%) variants of unknown significance (VUS). Ali VUS were missense novel mutations: c.313T > A, c.387G > T, c.1676G > A, and c. 1806C > A. EOGC patients had ahigher red (OR: 2.591, 95% CI: 1.371-4.894) and processed (OR: 3.093, 95% CI: 1.591-6.009) meat intake compared to eating habits of the Brazilian population. Conclusion: To our knowledge, this is the largest series investigating the contribution of CDHl germline mutations in EOGC cancer in Latin America. For a high-incidence country, the incidence of CDHl germline variants was higher than expected; 4 novel CDHl missense mutations were identified and further studies are warranted to confirm their pathogenicity. Modifiable risk factors, such as the consumption of red and/or processed meat may have contributed to early- onset gastric cancer development in our studied population