Base teórica: o tratamento do carcinoma endometrial é feito através do estadiamento cirúrgico, que envolve histerectomia com salpingo-oforectomia bilateral e linfadenectomia pélvica e para-aórtica. Questiona-se o benefício da linfadenectomia sistemática em todos os pacientes, já que o risco de disseminação linfática em tumores de baixo risco é pequeno e não há evidências de benefício terapêutico em sua realização. Desse modo, tentam-se encontrar modos de determinar, na avaliação pré-operatória, quais são os pacientes que poderão se beneficiar da linfadenectomia e aqueles que podem prescindir do procedimento. Objetivos: avaliar a concordância da avaliação anatomopatológica entre a amostra endometrial pré-operatória e a peça cirúrgica das pacientes submetidas a tratamento cirúrgico primário do carcinoma de endométrio, correlacionando com características das pacientes e das amostras da patologia. Métodos: foram incluídos pacientes submetidos a tratamento cirúrgico para carcinoma de endométrio que tinham diagnóstico pré-operatório através de amostragem endometrial. Os prontuários foram revisados e as amostras disponíveis na instituição foram procuradas para posterior releitura por dois patologistas cegados para as demais informações anatomopatológicas. Resultados: foram incluídos 166 pacientes, com uma idade média de 64,6 anos. Das biópsias, 118 eram tumores endometrioides, 38 não-endometrioides e as demais, hiperplasia. As taxas de concordância foram de 93,2% para tumores endometrioides e 68,9% para não-endometrioides, com um índice kappa (k) de 0,73 para o tipo histológico. O grau tumoral distribui-se na amostra como G1 em 37,1%, G2 em 35,7% e G3 em 27,1%, com uma taxa de concordância de 61,5%, 56% e 78,9%, respectivamente, e k=0,46. Dos tumores G1, somente 1,9% teve upgrade para G3, em comparação com 16% das lesões G2. Não houve diferença estatística na taxa de concordância do tipo histológico e grau tumoral em função do local de execução da biópsia, método de amostragem e intervalo biópsia-cirurgia. Biópsias com pés > 3g tiveram uma concordância do grau tumoral significativamente melhor (p=0,040). Amostras de 105 pacientes estavam disponíveis no HCPA e foram reavaliadas por dois patologistas, com uma taxa de concordância interobservador geral de 73,3% (k=0,58) para o tipo histológico e 57,9% (k=0,54) para o grau tumoral. Conclusão: a acurácia da biópsia pré-operatória em predizer as características da peça cirúrgica não é ideal. Deve-se ter cuidado ao utilizar essa informação para determinar a extensão da cirurgia a ser realizada, sob risco de ser realizado subestadiamento. Estas baixas taxas de concordância correlacionam-se também com as baixas taxas de concordância interobservador. Novos sistemas de graduação e equipes de especialistas são possibilidades para melhorar esta questão. / Background: endometrial carcinoma treatment is based on surgical staging, including hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraortic lymphadenectomy. The benefits of systematic lymphadenectomy in all patients have been questioned, since the risk of dissemination in low risk tumors is small and there is no evidence of benefits in its execution. Thereby, researches are looking for ways to determine, by preoperative evaluation, which patient will benefit from full staging and those who can do without the procedure. Objectives: evaluate the agreement between the preoperative endometrial samples and the surgical specimens in endometrial carcinoma, correlating it with characteristics of the samples and patients included, and evaluate the interobserver agreement of the preoperative biopsy. Methods: patients submitted to surgery as primary treatment for endometrial carcinoma at HCPA with a preoperative endometrial sampling were included. Their medical charts were reviewed. The available samples of the preoperative biopsies were recollected for reanalyzes by two pathologists. Inadequate transcriptions of the biopsy report were excluded. Results: we included 166 patients, with a mean age of 64.6 years. Of the biopsies, 118 were endometrioid, 38 were non-endometrioid and the remaining, hyperplasia. The agreement rates were 93.2% for endometrioid tumors and 68.9% for non-endometrioid, with a kappa index of 0.73 for the tumor cell type. The tumor FIGO grade distributed as G1 in 37.1%, G2 in 35.7% and G3 in 27.1%, with an agreement rate of 61.5%, 56% and 78.9%, respectively. The general kappa index for FIGO grading was 0.46. Of the G1 tumors, only 1.9% upgraded to G3, while 16% of the G2 lesions upgraded. There was no statistical difference in the agreement rates of tumor cell type and FIGO grading in function of place of biopsy execution, method of endometrial sampling and biopsy-surgery interval. Biopsies weighing more than 3g had a significantly better agreement in FIGO grading (p=0.040). Samples of 105 were available at HCPA and were reevaluated by 2 pathologists, with a general interobserver agreement 73.3/% (k=0.58) for tumor cell type and 57.9% (k=0.54) for grading. Conclusion: the accuracy of the preoperative biopsy in predicting the definite surgical characteristics it is not ideal. Caution must be taken when using this information to determine the surgical extension, due to the risk of under staging. These low rates of agreement are correlated with the low interobserver agreement. New grading systems and specialists teams are possible ways of improving this issue.

Cancer is a group of diseases caused by aberrant continuously proliferating cells capable of metastasis. Despite significant advances in preventive, diagnostic and treatment measures, cancer is one of the major causes of death in the United States, second only to heart diseases. Main treatment approaches are surgery, radiotherapy, chemotherapy, and the recently expanding immunotherapeutic approaches. The main challenge in treating cancer is the ability of cancer cells to mutate and develop resistance to drug treatments therefore lowering the efficacy of chemotherapy in preventing metastatic tumors. Cancer vaccines are a treatment modality that employs the potential of the immune system to recognize and eliminate tumor cells by unmasking tumor cell antigens and generating an effective anti-tumor immune response with an immune memory capable of preventing metastases formation. This dissertation describes and evaluates an innovative cell-particle hybrid cancer vaccine construct involving irradiated tumor cell surface-engineered with polymeric particles using streptavidin-biotin cross-linking. The tumor cells were biotinylated indirectly using biotin-linked antibodies targeting a surface integrin and the particles were loaded with an immune adjuvant and coated with streptavidin. The tumor cells served as the source of tumor antigens and the anchored particles served to confine loaded immune adjuvant to the tumor cells. The vaccine construct was designed to co-deliver tumor antigens and the immune adjuvant to the same antigen presenting cell, a criteria that has been suggested recently to be important for optimal cancer vaccine potency. The first report on this cell-particle construct was published in my master’s thesis defended in May 2013. In that report, the feasibility of assembling the cell-particle hybrid was demonstrated. However, loading of the immune adjuvant, CpG ODN (cytosine phosphate guanine oligonucleotide), into streptavidin-coated particles was not optimal. In the current studies, this problem was addressed and the cancer vaccine potential of the cell-particle construct was assessed. We first evaluated a new TLR4 (toll like receptor 4) agonist, PET lipid A (pentaeryhtritol lipid A), for its potential use in cancer vaccines with the intention to incorporate it in the cell-particle hybrid. PET lipid A is a fully synthetic lipid A analog that has been demonstrated to have immunostimulatory properties. We evaluated the potential use of PET lipid A in cancer vaccine applications and the effect of particulate formulations on its adjuvant properties. Results showed improved in vitro immunostimulatory properties for particle based formulations. Upon testing the immunostimulatory properties of PET lipid A in vivo, moderate enhancement in antigen specific cytotoxic T cells stimulation was observed when PET lipid A was delivered in particles, which then translated into a corresponding trend toward increased survival in a prophylactic tumor study. PET lipid A was concluded to be a weak potential cancer vaccine adjuvant and was not chosen as the immune adjuvant to use in the cell-particle hybrid assembly. Instead, CpG ODN (TLR9 agonist) was chosen due to its strong record of efficacy as a cancer vaccine adjuvant. The second part of this research project aimed at addressing the challenges we encountered previously in achieving acceptable CpG ODN loading of the final streptavidin-coated PLGA (Polylactic-co-glycolic acid) particles. The approach taken was to modify the method used earlier to make the particles in order to circumvent CpG ODN loss. In the modified method the number of steps required to make streptavidin-coated CpG ODN-loaded PLGA particles was reduced and the fabrication media was altered to allow simultaneous particle fabrication and activation of surface carboxyl groups. The modified method resulted in 5-fold higher loading in the final streptavidin-coated particles compared to the original method. Subsequent to establishing the feasibility of constructing the cell-particle hybrid and characterizing the assembled hybrid in vitro, the in vivo cancer vaccine potential of the designed construct was examined. Two independent murine tumor models were chosen for this purpose, namely prostate cancer and melanoma. The proposed cell-particle hybrid vaccine construct had significant therapeutic outcomes in the prostate cancer tumor model where mice vaccinated with cell-particle hybrids were the only group to show significant improvement in survival compared to untreated controls whereas no other vaccine formulation had such an effect. Unfortunately, no prophylactic benefit was observed from any of the vaccine formulations used in the melanoma tumor model involving irradiated GM-CSF (granulocyte macrophage colony stimulating factor)-secreting B16.F10 cells. In vitro examination of the immunostimulatory properties of all cell lines used in these studies revealed that transfected and parent B16.F10 cells (representing murine melanoma) were possibly immunoinhibitory whereas RM11 (representing murine prostate cancer) cells lacked such immunosuppressive effect in vitro. Our objective was to design and evaluate a new cancer vaccine construct that improved the immunostimulatory properties of irradiated tumor cell based vaccines. The approach taken was to surface engineer tumor cells with immune adjuvant loaded polymeric particles. We reported a simple method for fabricating streptavidin-coated PLGA particles and a versatile method of tumor cell surface engineering. We found that the efficacy of tumor cell-based vaccines can be inconsistent across tumor models and the in vitro immunosuppressive effect of tumor cells might be a contributing factor.

Programmed cell death, or apoptosis, has during the last decade received a lot of attention due to its involvement in a large number of pathological conditions. Since death is always irreversible, it is important for cells to fully control the initiation and execution of this process. One of many apoptosis-regulatory proteins is XIAP, which blocks the action of caspases, a family of proteases that are important during apoptosis. However, apoptosis inhibitors have to be tightly controlled since too little cell death can lead to the development of tumors and other diseases. This thesis is the result of an aspiration to fully understand the function and regulation of XIAP. By using the yeast-2-hybrid system, we identified two novel binding partners of XIAP. The first, GPS2, was found to bind XIAP and inhibit its ability to block caspase-activity. In addition, GPS2 induced caspase-mediated cell death in two different tumour cell lines and XIAP inhibited this effect. The second binding partner, Nulp1, preferentially bound XIAP in the presence of the apoptosis-inducer staurosporine. Nulp1 induced or sensitized cell lines to cell death when overexpressed, but this was not blocked by caspase-inhibitors or XIAP, suggesting a different reason for binding than apoptosis regulation. With the aim to understand the Nulp1-XIAP interaction, we continued to study Nulp1 in vivo and in vitro. We studied three different splice variants of Nulp1 and found that they were regulated by poly-ubiquitination and nuclear shuttling. Also, Nulp1 was expressed in embryonic mice, especially in the cortical plate, hippocampal neurons and cerebellar granular neurons. Expression of Nulp1 decreased with age but was still present in cerebellar deep nuclei and Purkinje cells of adult mice. To summarize, we have identified GPS2 as an apoptosis-inducing factor and an inhibitor of XIAP in vitro, and Nulp1 as a XIAP-interacting protein during staurosporine-induced apoptosis.

ABSTRACT Chemotherapy is a common method used for cancer treatment. Especially when it concerns cancers that have grown invasively it seems to be the only efficient treatment due to the substances ability to reach and affect almost the entire body. One major obstacle regarding chemotherapy is that the patients often develop resistance to the cytotoxic substances used. Fluorometric microculture cytotoxicity assay (FMCA) is a method developed to measure sensitivity of tumor cells to different cytotoxic substances in vitro. The assay is based on hydrolysis of fluorescein diacetate to fluorescein by cells with intact cell membranes after incubation with drugs for 72 hours. This study investigated the impact of two methodological factors that may cause errors in the achieved results; namely the possible occurrence of drug decay during incubation and the use of an inappropriate amount of cells. These factors were tested by exposing the cytotoxic drugs to pre-incubation in absence of tumor cells for different times and to use suspensions with different concentrations of cells. The results indicated occurrence of drug decay in 3 of the 18 substances tested and that the amount of cells affected the results for most of the drugs tested but to different extent.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成2年11月22日 竹中徳哉氏の博士論文として提出された

Circulating tumor cells (CTCs) are known to escape from the primary tumor site and may settle down at the distant organ to grow a second tumor. CTCs are one of causes initiating carcinoma metastasis. Detection of CTCs has been considered to be valuable for cancer management, including diagnosis, prognosis, and clinical treatment management. However, efficient isolation, enumeration, characterization, and genetic analysis of CTCs in whole-blood samples from cancer patients are very challenging due to their extremely low concentration and rare nature (per CTC in blood cells is 1:106–109). With the increasing worldwide death rate associated with cancer, there is a desperate demand for a high-sensitivity, high-throughput, and low-cost detection and separation system. My doctoral research focused on the design and fabrications of the screening system for the detection of CTCs with further analysis of captured CTCs, such as immunofluoresce staining and fluorescence in-situ hybridization (FISH). The distinct significance of this research is that the development of the computer-controlled rotational holder with a series of six inverted microfluidic chips reduced the cost by significantly reducing the consumption of magnetic carriers (25% of the consumed amount used in the commercial CellSearch® system), increasing the capture efficiency by manipulating the blood sedimentation in the microchannel, enhancing the system stability by integrating the micromagnets on the plain glass slide substrate, and achieving high throughput because of the high flow rate (2.5 mL/hr) and large screening volume (screening up to six chips in parallel with each containing 2.5 mL of blood). Immunofluorescence staining and the FISH method have been performed to prove the capability of the system. In addition, the system has been successfully applied for patient samples screening. The incorporation of micromagnets has demonstrated that micromagnets provide localized magnetic forces to scatter the target cancer cells and free nanoparticles throughout the whole channel substrate to increase the channel space usage by 13%. Four cancer cell lines, including COLO 205 (colorectal cancer), SK-BR-3 (breast cancer), MCF-7 (breast cancer), and PC3 (prostate cancer), were spiked in blood samples from healthy donors to verify high capture efficiency of the developed system. On average, over a 97% capture rate was demonstrated for all cell lines. Moreover, the developed screening system has been successfully screened over 40 patient samples, including metastatic lung cancer, breast cancer, prostate cancer, and colorectal cancer. After capture of CTCs, immunofluorescence staining was used to identified the captured cancer cells and the FISH method was performed to characterize the isolated cancer cells by studying the gene expression of CTCs from breast cancer. The proposed automated immunomagnetic microchip-based screening system shows high capture efficiency (average 97% for three spiked cell lines), high throughput (15 mL of blood sample per screening), high sensitivity, high specificity, and low nanoparticle consumption (75% less than CellSearch® system). The screening system provides great promise as a clinical tool for early cancer diagnosis, diagnosis, personalized therapy, and treatment monitoring. / text

Base teórica: o tratamento do carcinoma endometrial é feito através do estadiamento cirúrgico, que envolve histerectomia com salpingo-oforectomia bilateral e linfadenectomia pélvica e para-aórtica. Questiona-se o benefício da linfadenectomia sistemática em todos os pacientes, já que o risco de disseminação linfática em tumores de baixo risco é pequeno e não há evidências de benefício terapêutico em sua realização. Desse modo, tentam-se encontrar modos de determinar, na avaliação pré-operatória, quais são os pacientes que poderão se beneficiar da linfadenectomia e aqueles que podem prescindir do procedimento. Objetivos: avaliar a concordância da avaliação anatomopatológica entre a amostra endometrial pré-operatória e a peça cirúrgica das pacientes submetidas a tratamento cirúrgico primário do carcinoma de endométrio, correlacionando com características das pacientes e das amostras da patologia. Métodos: foram incluídos pacientes submetidos a tratamento cirúrgico para carcinoma de endométrio que tinham diagnóstico pré-operatório através de amostragem endometrial. Os prontuários foram revisados e as amostras disponíveis na instituição foram procuradas para posterior releitura por dois patologistas cegados para as demais informações anatomopatológicas. Resultados: foram incluídos 166 pacientes, com uma idade média de 64,6 anos. Das biópsias, 118 eram tumores endometrioides, 38 não-endometrioides e as demais, hiperplasia. As taxas de concordância foram de 93,2% para tumores endometrioides e 68,9% para não-endometrioides, com um índice kappa (k) de 0,73 para o tipo histológico. O grau tumoral distribui-se na amostra como G1 em 37,1%, G2 em 35,7% e G3 em 27,1%, com uma taxa de concordância de 61,5%, 56% e 78,9%, respectivamente, e k=0,46. Dos tumores G1, somente 1,9% teve upgrade para G3, em comparação com 16% das lesões G2. Não houve diferença estatística na taxa de concordância do tipo histológico e grau tumoral em função do local de execução da biópsia, método de amostragem e intervalo biópsia-cirurgia. Biópsias com pés > 3g tiveram uma concordância do grau tumoral significativamente melhor (p=0,040). Amostras de 105 pacientes estavam disponíveis no HCPA e foram reavaliadas por dois patologistas, com uma taxa de concordância interobservador geral de 73,3% (k=0,58) para o tipo histológico e 57,9% (k=0,54) para o grau tumoral. Conclusão: a acurácia da biópsia pré-operatória em predizer as características da peça cirúrgica não é ideal. Deve-se ter cuidado ao utilizar essa informação para determinar a extensão da cirurgia a ser realizada, sob risco de ser realizado subestadiamento. Estas baixas taxas de concordância correlacionam-se também com as baixas taxas de concordância interobservador. Novos sistemas de graduação e equipes de especialistas são possibilidades para melhorar esta questão. / Background: endometrial carcinoma treatment is based on surgical staging, including hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraortic lymphadenectomy. The benefits of systematic lymphadenectomy in all patients have been questioned, since the risk of dissemination in low risk tumors is small and there is no evidence of benefits in its execution. Thereby, researches are looking for ways to determine, by preoperative evaluation, which patient will benefit from full staging and those who can do without the procedure. Objectives: evaluate the agreement between the preoperative endometrial samples and the surgical specimens in endometrial carcinoma, correlating it with characteristics of the samples and patients included, and evaluate the interobserver agreement of the preoperative biopsy. Methods: patients submitted to surgery as primary treatment for endometrial carcinoma at HCPA with a preoperative endometrial sampling were included. Their medical charts were reviewed. The available samples of the preoperative biopsies were recollected for reanalyzes by two pathologists. Inadequate transcriptions of the biopsy report were excluded. Results: we included 166 patients, with a mean age of 64.6 years. Of the biopsies, 118 were endometrioid, 38 were non-endometrioid and the remaining, hyperplasia. The agreement rates were 93.2% for endometrioid tumors and 68.9% for non-endometrioid, with a kappa index of 0.73 for the tumor cell type. The tumor FIGO grade distributed as G1 in 37.1%, G2 in 35.7% and G3 in 27.1%, with an agreement rate of 61.5%, 56% and 78.9%, respectively. The general kappa index for FIGO grading was 0.46. Of the G1 tumors, only 1.9% upgraded to G3, while 16% of the G2 lesions upgraded. There was no statistical difference in the agreement rates of tumor cell type and FIGO grading in function of place of biopsy execution, method of endometrial sampling and biopsy-surgery interval. Biopsies weighing more than 3g had a significantly better agreement in FIGO grading (p=0.040). Samples of 105 were available at HCPA and were reevaluated by 2 pathologists, with a general interobserver agreement 73.3/% (k=0.58) for tumor cell type and 57.9% (k=0.54) for grading. Conclusion: the accuracy of the preoperative biopsy in predicting the definite surgical characteristics it is not ideal. Caution must be taken when using this information to determine the surgical extension, due to the risk of under staging. These low rates of agreement are correlated with the low interobserver agreement. New grading systems and specialists teams are possible ways of improving this issue.

Base teórica: o tratamento do carcinoma endometrial é feito através do estadiamento cirúrgico, que envolve histerectomia com salpingo-oforectomia bilateral e linfadenectomia pélvica e para-aórtica. Questiona-se o benefício da linfadenectomia sistemática em todos os pacientes, já que o risco de disseminação linfática em tumores de baixo risco é pequeno e não há evidências de benefício terapêutico em sua realização. Desse modo, tentam-se encontrar modos de determinar, na avaliação pré-operatória, quais são os pacientes que poderão se beneficiar da linfadenectomia e aqueles que podem prescindir do procedimento. Objetivos: avaliar a concordância da avaliação anatomopatológica entre a amostra endometrial pré-operatória e a peça cirúrgica das pacientes submetidas a tratamento cirúrgico primário do carcinoma de endométrio, correlacionando com características das pacientes e das amostras da patologia. Métodos: foram incluídos pacientes submetidos a tratamento cirúrgico para carcinoma de endométrio que tinham diagnóstico pré-operatório através de amostragem endometrial. Os prontuários foram revisados e as amostras disponíveis na instituição foram procuradas para posterior releitura por dois patologistas cegados para as demais informações anatomopatológicas. Resultados: foram incluídos 166 pacientes, com uma idade média de 64,6 anos. Das biópsias, 118 eram tumores endometrioides, 38 não-endometrioides e as demais, hiperplasia. As taxas de concordância foram de 93,2% para tumores endometrioides e 68,9% para não-endometrioides, com um índice kappa (k) de 0,73 para o tipo histológico. O grau tumoral distribui-se na amostra como G1 em 37,1%, G2 em 35,7% e G3 em 27,1%, com uma taxa de concordância de 61,5%, 56% e 78,9%, respectivamente, e k=0,46. Dos tumores G1, somente 1,9% teve upgrade para G3, em comparação com 16% das lesões G2. Não houve diferença estatística na taxa de concordância do tipo histológico e grau tumoral em função do local de execução da biópsia, método de amostragem e intervalo biópsia-cirurgia. Biópsias com pés > 3g tiveram uma concordância do grau tumoral significativamente melhor (p=0,040). Amostras de 105 pacientes estavam disponíveis no HCPA e foram reavaliadas por dois patologistas, com uma taxa de concordância interobservador geral de 73,3% (k=0,58) para o tipo histológico e 57,9% (k=0,54) para o grau tumoral. Conclusão: a acurácia da biópsia pré-operatória em predizer as características da peça cirúrgica não é ideal. Deve-se ter cuidado ao utilizar essa informação para determinar a extensão da cirurgia a ser realizada, sob risco de ser realizado subestadiamento. Estas baixas taxas de concordância correlacionam-se também com as baixas taxas de concordância interobservador. Novos sistemas de graduação e equipes de especialistas são possibilidades para melhorar esta questão. / Background: endometrial carcinoma treatment is based on surgical staging, including hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraortic lymphadenectomy. The benefits of systematic lymphadenectomy in all patients have been questioned, since the risk of dissemination in low risk tumors is small and there is no evidence of benefits in its execution. Thereby, researches are looking for ways to determine, by preoperative evaluation, which patient will benefit from full staging and those who can do without the procedure. Objectives: evaluate the agreement between the preoperative endometrial samples and the surgical specimens in endometrial carcinoma, correlating it with characteristics of the samples and patients included, and evaluate the interobserver agreement of the preoperative biopsy. Methods: patients submitted to surgery as primary treatment for endometrial carcinoma at HCPA with a preoperative endometrial sampling were included. Their medical charts were reviewed. The available samples of the preoperative biopsies were recollected for reanalyzes by two pathologists. Inadequate transcriptions of the biopsy report were excluded. Results: we included 166 patients, with a mean age of 64.6 years. Of the biopsies, 118 were endometrioid, 38 were non-endometrioid and the remaining, hyperplasia. The agreement rates were 93.2% for endometrioid tumors and 68.9% for non-endometrioid, with a kappa index of 0.73 for the tumor cell type. The tumor FIGO grade distributed as G1 in 37.1%, G2 in 35.7% and G3 in 27.1%, with an agreement rate of 61.5%, 56% and 78.9%, respectively. The general kappa index for FIGO grading was 0.46. Of the G1 tumors, only 1.9% upgraded to G3, while 16% of the G2 lesions upgraded. There was no statistical difference in the agreement rates of tumor cell type and FIGO grading in function of place of biopsy execution, method of endometrial sampling and biopsy-surgery interval. Biopsies weighing more than 3g had a significantly better agreement in FIGO grading (p=0.040). Samples of 105 were available at HCPA and were reevaluated by 2 pathologists, with a general interobserver agreement 73.3/% (k=0.58) for tumor cell type and 57.9% (k=0.54) for grading. Conclusion: the accuracy of the preoperative biopsy in predicting the definite surgical characteristics it is not ideal. Caution must be taken when using this information to determine the surgical extension, due to the risk of under staging. These low rates of agreement are correlated with the low interobserver agreement. New grading systems and specialists teams are possible ways of improving this issue.

In dieser Arbeit wurde in einem Maus Tumormodell untersucht, ob durch eine intraoperative Vakzination mit gentechnisch modifizierten autologen Tumorzellen ein antitumoraler Effekt erzielt werden kann. Das Experiment erfolgte mit zwei Tumorzelllinien (B16 Melanom und Lewis Lung Karzinom). Nach Implantation der Tumorzellen in C57/BL 6 Mäuse wurden diese chirurgisch entfernt. Intraoperativ erhielten die Mäuse eine Vakzination. Dazu wurden folgende Impfstoffe verwendet: 1. subletal bestrahlte mIL-12 transfizierte Tumorzellen, 2. subletal bestrahlte pRSC transfizierte Tumorzellen und 3. frostgeschockte Tumorzellen. Die Impfung erfolgte entweder subcutan oder direkt in die Milz. Es wurde die Hypothese aufgestellt, dass eine Injektion in die Milz und eine Modifikation mit IL-12 den besten Effekt erzielt. Eine Kontrollgruppe blieb ohne Vakzin. Beobachtet wurde das Tumorwachstum, der Zeitpunkt bis zum makroskopischen Wiederauftreten eines Tumors, Überlebenszeit und die Metastasierungsrate. Versuchstiere ohne Rezidivtumor erhielten erneut einen Tumor. Es erfolgte eine erneute Evaluation des Tumorwachstums, des Zeitpunktes bis zum makroskopischen Wiederauftreten eines Tumors, der Überlebenszeit und der Metastasierungsrate. In beiden Tumorzelllinien profitierten alle Therapiegruppen nach Tumorresektion und Vakzination bezüglich Tumorrezidivrate, Zeit bis zum makroskopischenWiederauftreten des Tumors, Überlebenszeit, Metastasierungsrate und Tumorwachstumsgeschwindigkeit gegenüber der Kontrollgruppe. Vereinzelt konnten signifikante Vorteile für die direkt in die Milz applizierte Vakzine bezüglich der Tumorwachstumsgeschwindigkeit aufgezeigt werden. Weiterhin ergab sich eine geringere Tumorrezidivrate, wenn IL-12 modifizierte autologe Tumorzellen nach R0 Resektion direkt in die Milz appliziert wurden. Auch nach Tumorreimplantation konnte bezüglich Überlebenszeit und Tumorwachstumsgeschwindigkeit ein Vorteil für alle Therapiegruppen gegenüber der Kontrollgruppe herausgearbeitet werden. Nach Impfung in die Milz zeigte sich tendenziell eine geringere Metastasierungsrate. Intraoperative autologe Tumorzellvakzinationen konnten im Tiermodell in einem adjuvanten Setting einen antitumoralen Effekt auslösen. Möglicherweise kann diese Art der Impfung eine zusätzlich hilfreiche Behandlungsform zu den bisherigen adjuvanten Chemotherapeutika werden.

No description available.