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Characterization and Clinical Implications of Microsatellite Instability in Human Adult Mesenchymal and Hematopoietic Stem CellsThomas, Emily A. January 2008 (has links)
No description available.
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Clinical relevance of studies on microsatellite instability and DNA mismatch repair system protein expression in endometrial carcinomas / Mikrosatelitų nestabilumo ir DNR pažaidų taisymo sistemos baltymų raiškos tyrimų klinikinė svarba sergant gimdos kūno vėžiuKanopienė, Daiva 09 December 2014 (has links)
The evaluation of microsatellite instability in cancer patients might be of clinical importance as a prognostic and predictor factor. The aim of this study − evaluate the frequency and status of microsatellite instability and DNA mismatch repair protein expression in endometrial cancer and to relate the obtained results to clinicopathologic characteristics as well as patient survival. This study enrolled 109 patients.The objectives of the study: to determine the frequency and status of microsatellite instability by using two marker panels (earlier created BAT-25, BAT-26, NR-21, NR-24, MONO-27 and a new BAT-52, BAT-55, BAT-56, BAT-57, BAT-59 panels) recommended by Promega Corporation (USA); to compare the frequency and status of microsatellite instability with tumor clinicopathologic characteristics; to investigate the expression of DNA mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6) in tumors with high-frequency microsatellite instability; to evaluate the impact of microsatellite instability on the survival of patients. The results showed that high-frequency microsatellite instability was detected two times more frequently with the new panel of markers in comparison while using earlier created panel. A statistically significant difference regarding tumor grade and myometrial invasion was found between the groups with high-frequency microsatellite instability and stable phenotype. There was no association between the survival of patients and microsatellite instability. / Mikrosatelitų nestabilumo tyrimai svarbūs vėžio ligos prognozei vertinti bei parenkant individualų gydymą. Darbo tikslas − ištirti mikrosatelitų nestabilumo dažnį, pobūdį ir klaidingai suporuotų nukleotidų DNR pažaidų taisymo sistemos baltymų raišką sergant gimdos kūno vėžiu ir gautus rezultatus susieti su pacienčių klinikinėmis-patologinėmis charakteristikomis bei jų išgyvenamumu. Į stebėsenos perspektyvinį tyrimą buvo įtrauktos 109 pacientės. Darbo uždaviniai: nustatyti mikrosatelitų nestabilumo dažnį ir pobūdį tarp sergančiųjų gimdos kūno vėžiu, panaudojus Promega Corporation (JAV) sukurtus du žymenų rinkinius (anksčiau sukurtą BAT-25, BAT-26, NR-21, NR-24, MONO-27 ir naująjį BAT-52, BAT-55, BAT-56, BAT-57, BAT-59); palyginti mikrosatelitų nestabilumo dažnį ir pobūdį su pacienčių klinikinėmis-patologinėmis charakteristikomis; ištirti DNR pažaidų taisymo sistemos baltymų (MLH1, PMS2, MSH2, MSH6) raišką gimdos kūno navikuose, kuriuose nustatytas didelio dažnio mikrosatelitų nestabilumas; įvertinti mikrosatelitų nestabilumo įtaką pacienčių išgyvenamumui. Tyrimų rezultatai parodė, kad mikrosatelitų didelio dažnio nestabilumas dvigubai dažniau nustatytas naudojant naująjį žymenų rinkinį, palyginti su anksčiau sukurtu žymenų rinkiniu. Statistiškai reikšminga sąsaja konstatuota tarp mikrosatelitų didelio dažnio nestabilumo arba jo nebuvimo ir naviko diferenciacijos laipsnio bei invazijos į miometriumą gylio. Sergančiųjų išgyvenamumas nebuvo susijęs su mikrosatelitų nestabilumu.
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Mikrosatelitų nestabilumo ir DNR pažaidų taisymo sistemos baltymų raiškos tyrimų klinikinė svarba sergant gimdos kūno vėžiu / Clinical relevance of studies on microsatellite instability and DNA mismatch repair system protein expression in endometrial carcinomasKanopienė, Daiva 09 December 2014 (has links)
Mikrosatelitų nestabilumo tyrimai svarbūs vėžio ligos prognozei vertinti bei parenkant individualų gydymą. Darbo tikslas − ištirti mikrosatelitų nestabilumo dažnį, pobūdį ir klaidingai suporuotų nukleotidų DNR pažaidų taisymo sistemos baltymų raišką sergant gimdos kūno vėžiu ir gautus rezultatus susieti su pacienčių klinikinėmis-patologinėmis charakteristikomis bei jų išgyvenamumu. Į stebėsenos perspektyvinį tyrimą buvo įtrauktos 109 pacientės. Darbo uždaviniai: nustatyti mikrosatelitų nestabilumo dažnį ir pobūdį tarp sergančiųjų gimdos kūno vėžiu, panaudojus Promega Corporation (JAV) sukurtus du žymenų rinkinius (anksčiau sukurtą BAT-25, BAT-26, NR-21, NR-24, MONO-27 ir naująjį BAT-52, BAT-55, BAT-56, BAT-57, BAT-59); palyginti mikrosatelitų nestabilumo dažnį ir pobūdį su pacienčių klinikinėmis-patologinėmis charakteristikomis; ištirti DNR pažaidų taisymo sistemos baltymų (MLH1, PMS2, MSH2, MSH6) raišką gimdos kūno navikuose, kuriuose nustatytas didelio dažnio mikrosatelitų nestabilumas; įvertinti mikrosatelitų nestabilumo įtaką pacienčių išgyvenamumui. Tyrimų rezultatai parodė, kad mikrosatelitų didelio dažnio nestabilumas dvigubai dažniau nustatytas naudojant naująjį žymenų rinkinį, palyginti su anksčiau sukurtu žymenų rinkiniu. Statistiškai reikšminga sąsaja konstatuota tarp mikrosatelitų didelio dažnio nestabilumo arba jo nebuvimo ir naviko diferenciacijos laipsnio bei invazijos į miometriumą gylio. Sergančiųjų išgyvenamumas nebuvo susijęs su mikrosatelitų nestabilumu. / The evaluation of microsatellite instability in cancer patients might be of clinical importance as a prognostic and predictor factor. The aim of this study − evaluate the frequency and status of microsatellite instability and DNA mismatch repair protein expression in endometrial cancer and to relate the obtained results to clinicopathologic characteristics as well as patient survival. This study enrolled 109 patients.The objectives of the study: to determine the frequency and status of microsatellite instability by using two marker panels (earlier created BAT-25, BAT-26, NR-21, NR-24, MONO-27 and a new BAT-52, BAT-55, BAT-56, BAT-57, BAT-59 panels) recommended by Promega Corporation (USA); to compare the frequency and status of microsatellite instability with tumor clinicopathologic characteristics; to investigate the expression of DNA mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6) in tumors with high-frequency microsatellite instability; to evaluate the impact of microsatellite instability on the survival of patients. The results showed that high-frequency microsatellite instability was detected two times more frequently with the new panel of markers in comparison while using earlier created panel. A statistically significant difference regarding tumor grade and myometrial invasion was found between the groups with high-frequency microsatellite instability and stable phenotype. There was no association between the survival of patients and microsatellite instability.
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Etude du récepteur d’endocytose LRP1 dans les adénocarcinomes coliques : caractéristiques cliniques, pathologiques et moléculaires associées et valeur pronostique / Study of endocytosis receptor LRP1 in colon adenocarcinomas : associated clinical, pathological and molecular characteristics and prognosis impactBoulagnon-Rombi, Camille 28 June 2017 (has links)
LRP1 (low-density lipoprotein receptor–related protein 1), un récepteur endocytaire multifonctionnel, a récemment été identifié comme pivot d’un réseau de biomarqueurs pour la prédiction pronostique de plusieurs types de cancers. Son rôle dans le cancer du côlon n'a pas été caractérisé. Notre travail porte sur l’étude de la relation entre expression de LRP1 et cancer du côlon.L'expression de l'ARNm LRP1 a été déterminée dans des échantillons d'adénocarcinome et de muqueuses coliques appariées, ainsi que dans les cellules stromales et tumorales obtenues après microdissection laser. Les associations clinicopathologiques et moléculaires ont été étudiées par immunohistochimie dans une série de cancer colique (n = 307). La présence de méthylation ou mutation du gène LRP1 et l'expression de miR-205 ont été évaluées et comparées aux niveaux d'expression de LRP1.L’ARNm de LRP1 est sous exprimé dans les cellules d'adénocarcinome colique par rapport à la muqueuse colique par rapport aux cellules stromales. La faible expression immunohistochimique de LRP1 dans les adénocarcinomes était associée à un âge plus élevé, à localisation droite, une perte d'expression de CDX2, une expression d'Annexine A10, un statut CIMP-H, MSI-H et BRAFV600E muté. Cette faible expression était associée à un mauvais pronostic, en particulier chez les patients de stade IV. Les mutations du gène LRP1 entrainaient une sous-expression de LRP1. L’expression était peu modifiée par miR-205. Le promoteur de LRP1 n'était jamais méthylé.La perte d'expression de LRP1 est associée à un profil clinico-pathologique et moléculaire particulier et à un un mauvais pronostic dans les cancers du côlon. / LRP1 (low-density lipoprotein receptor–related protein 1), a multifunctional endocytic receptor, has recently been identified as a hub in a biomarker network for multi-cancer clinical outcome prediction. Its role in côlon cancer has not been characterized. Here, we investigate the relationship between LRP1 and colon cancer.LRP1 mRNA expression was determined in colon adenocarcinoma and paired colon mucosa samples, and in stromal and tumoral cells obtained after laser capture microdissection. The clinical potential was further investigated by immunohistochemistry in a population-based colon cancer series (n = 307). LRP1 methylation, mutation and miR-205 expression were evaluated and compared to LRP1 expression levels.LRP1 mRNA levels are significantly decreased in colon adenocarcinoma cells compared to colon mucosa and stromal cells. Low LRP1 immunohistochemical expression in adenocarcinomas was associated with higher age, right-sided tumor, loss of CDX2 expression, Annexin A10 expression, CIMP-H, MSI-H and BRAFV600E mutation. Low LRP1 expression correlates with poor clinical outcome, especially in stage IV patients. LRP1 expression was downregulated by LRP1 mutation. LRP1 expression was slightly modified by miR-205 expression. LRP1 promoter was never methylated.Loss of LRP1 expression is associated with peculiar clinocopathological and molecular characteristics and with worse colon cancer outcomes.
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Possible Causes of Testicular Germ Cell Tumor and its Association with Male InfertilityBadran, Wael Ahmed 11 May 2013 (has links)
Testicular germ cell tumors (TGCTs) are thought to arise during early embryogenesis due to the arrest of germ cell differentiation at primordial germ cells (PGCs) or gonocytes. Oxidative stress (OS) is implicated in cancer development as a factor leading to DNA damage. Reactive oxygen species (ROS) -induced instability occurs as a series of progressive steps. The cell has several defense mechanisms against the deleterious effect of ROS (e.g. antioxidants and DNA repair). When the defense mechanisms are exhausted by increasing OS, DNA damage leads to genomic instability with subsequent mutations that can be transmitted during cell division. On the other hand, male infertility is a representation of testicular dysgenesis syndrome, which carries a risk for TGCTs development. The mechanisms underlying both TGCTs and male infertility are thought to be overlapping to some extent. The central hypothesis of this work is that OS induces germ line genomic instability leading to testicular germ cell tumors. To test this hypothesis, mouse germ cell lines were established and subjected to different doses of OS in the form of H2O2. The mutation frequency was associated with the treatment dose 2 uM at days 3, 6, and 9 (p<0.001, p<0.001, and p<0.0003, respectively). The mBAT27 marker showed a mutation frequency fitting quadratic response surface regression. The mutation frequencies pointed to the possible role of OS leading to accumulation of DNA damage and initiating events that lead to TGCTs development that may occur early in life, possibly during the prenatal period. In addition, different panels of microsatellite markers from across the genome were analyzed to test for differential instability in both somatic cells and germline cells. Blood and semen samples from 18 infertile patients and 7 ethnically matched controls were used. Microsatellite markers were selected; 26 on the Y chromosome, 16 on the X chromosome, and 20 on different autosomes. Microsatellite instability was detected in markers located near genes responsible for testis development, spermatogenesis, cell differentiation, and proteins involved in mismatch repair mechanisms. This supports the hypothesis that testicular germ cell tumors may arise during early embryogenesis through acquiring multiple mutations that accumulate over time.
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A link between TGF[beta] and intraepithelial tumor inflitrating lymphocytes in microsatellite instability-high colorectal cancer /Baker, Kristi Dorothy. January 2007 (has links)
No description available.
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Analyse von Mikrosatelliteninstabilität und hMSH2-Expression bei Patienten mit akuter myeloischer Leukämie / Analysis of microsatellite instability and hMSH2 expression in patients with acute myeloid leukemiaKohaus, Petra 20 June 2017 (has links)
No description available.
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Mikrosatellitenalterationen in der Serum-DNA bei Patienten mit BronchialkarzinomBruhn, Norbert 20 October 1999 (has links)
Die Bedeutung von Mikrosatellitenalterationen in malignen Tumoren ist trotz intensiver Forschungstätigkeit bisher nicht ausreichend geklärt. Bei Patienten mit einem hereditären nichtpolypösen kolorektalen Karzinom-Syndrom (HNPCC) konnte aber ein möglicherweise kausaler Zusammenhang zwischen einer Keimbahnmutation der Gene, die an dem DNA-"mismatch"-Reparaturmechanismus beteiligt sind, und der Ätiologie dieser Erkrankung nachgewiesen werden. Der Nachweis von Mikrosatelliteninstabilitäten wird zur Identifizierung des HNPCC-Syndroms genutzt. Der Anteil nachgewiesener Mikrosatelliteninstabilitäten bei sporadischen Tumorerkrankungen ist deutlich niedriger als beim HNPCC-Syndrom. Die Mechanismen zur Entstehung von Mikrosatelliteninstabilitäten bei sporadischen Tumor-erkrankungen sind bisher ungeklärt. Der gelungene Nachweis von Mikrosatellitenalterationen im Serum, Fäzes, Urin und Sputum von Tumorpatienten könnte das diagnostische Repertoire erweitern und möglicherweise die frühzeitige Erkennung von Tumorerkrankungen verbessern. Eine auf eine PCR basierende Methode zur Analyse von Mikrosatellitenalterationen in Tumor- und Serumproben wurde in dieser Arbeit etabliert. Drei Mikrosatellitenmarker (AR, ACTBP2, UT762) wurden bei der Untersuchung eingesetzt. Es wurden Tumor- und Serum-DNA mit der DNA von Lymphozyten verglichen und analysiert. Es wurden 43 Patienten mit Bronchialkarzinom untersucht, darunter 16 Patienten mit kleinzelligem und 27 Patienten mit nichtkleinzelligem Bronchialkarzinom. Es wurden bei 5 von 16 (31 %) Patienten mit SCLC und bei 9 von 27 (33 %) Patienten mit NSCLC in mindestens einem Mikrosatellitenlocus eine Mikrosatelliteninstabilität oder ein LOH nachgewiesen. In der Kontrollgruppe mit gesunden Probanden waren keine Mikrosatellitenalterationen nachweisbar. Die unverändert sehr schlechte Prognose von Patienten mit Bronchialkarzinom unterstreicht die Notwendigkeit der Entwicklung einer zuverlässigen und sensitiven Methode zur verbesserten Frühdiagnostik. Dazu wird es notwendig sein, weitere Mikrosatellitenmarker hinsichtlich ihrer Tumorsensitivität und -spezifität an einer ausreichenden Anzahl von Patienten zu testen und die prognostische Bedeutung von Mikrosatellitenalterationen bei Patienten mit einem Bronchialkarzinom zu klären. / Background: Despite intensive research efforts, the significance of microsatellite alterations in malignant tumors is not sufficiently understood. Since a possible causal connection between disease etiology and a germination mutation of the genes, involved in the mismatch repair mechanism, could be demostrated in patients with hereditary nonpolyposis colorectal cancer (HNPCC), the detection of microsatellite instabilities may be used to identify the so-called HNPCC syndrome. While the amount of proven microsatellite instabilities in sporadic tumor diseases is significantly lower than in the HNPCC syndrome, the mechanisms generating these instabilities have not been clarified yet. Their succesful measurement in serum, feces, urine, and sputum would extend the diagnostic repertory for tumor patients and possibly improve the early detection of neoplastic disease or its recurrence. Results: In this thesis, a PCR-based method was established for the analysis of microsatellite alterations in tumor specimens and serum samples. Three microsatellite markers were employed, including AR, ACTBP2, and UT762. The DNA of tumors and serum was analyzed and compared with the DNA of lymphocytes. Specimens of 43 patients with bronchial carcinoma (16 small cell lung carcinoma (SCLC), 27 non-small cell lung carcinoma (NSCLC)) were examined. In 5 of the patients with SCLC (31%) and in 9 of those with NSCLC (33%) a microsatellite instability or a loss of heterozygosity (LOH) was demonstrated in at least one microsatellite locus. The controls, which included samples of serum and lymphocytes of 10 healthy volunteers, did not show any microsatellite alterations. Outlook: The still poor prognosis of patients with bronchial carcinoma warrants further development of sensitive and reliable methods to improve early detection. Beyond this study, further microsatellite markers need to be tested in a sufficient number of patients with respect to sensitivity and specificity of tumor diagnosis. In addition, the prognostic significance of microsatellite alterations in tumor patients requires further investigation.
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DNA plasmático e urinário em pacientes com câncer de mama - possibilidade de um novo marcador de instabilidade genética tumoral induzida por quimioterapia / Plasmatic and Urinary DNA in patients with breast cancer - possibility of a new tumoral genomic instability marker induced by chemotherapyPinto, Jorge Luiz Freire 04 December 2009 (has links)
O câncer de mama é a neoplasia com maior mortalidade entre as mulheres. O emprego de agentes alquilantes no tratamento desta neoplasia pode ocasionar o surgimento de instabilidades genômicas. Tais instabilidades podem estar associadas ao desenvolvimento de neoplasias secundárias como, por exemplo, leucemias. A presente tese avaliou a instabilidade de microssatélites em amostras de sangue, sedimento urinário e plasma de pacientes portadoras de carcinoma mamário ao diagnóstico, 3 e 6 meses após o início do tratamento quimioterápico. Também foi avaliada a concentração do DNA plasmático livre como possível marcador tumoral junto aos marcadores séricos CEA e CA15.3, empregados no acompanhamento do câncer de mama. Foram avaliadas as regiões de microssatélites: Tp53-ALU, Tp53.PCR15.1, BAT 40, BAT26, FMR2 e APC. Entre as 40 pacientes incluídas no presente estudo 88,57% apresentaram instabilidade de microssatélites na fração mononuclear do sangue periférico, 85,8% nas amostras de sedimento urinário e 62,5% no DNA plasmático livre. Não houve concordância significativa entre as instabilidades encontradas nos três tipos de amostra. A concentração de DNA plasmático livre das pacientes quando comparada às doadoras sadias apresentou correlação estatisticamente significativa (p>0,0001), e em paciente em regimes neoadjuvantes que responderam objetivamente à quimioterapia (p=0,02) e não houve correlação com os marcadores séricos CEA e CA15.3. / Breast cancer has the major mortality in women among all kind of cancer. The use of alkylating agents at the treatment of this disease is associated with genomic instability. This instability could be associated with the development of secondary cancer, for example, leukemia. The present thesis evaluated microsatellite instability in blood, pellet cells urinary and plasma in patients with breast cancer at diagnosis, 3 and 6 months after the beginning of chemotherapy. There were evaluated also Free Plasmatic DNA concentration as a possible tumoral marker with the serum markers CEA and CA15.3 used in breast cancer follow up. The microsatellites regions assayed were: Tp53-ALU,Tp53.PCR15.1, BAT 40, BAT26, FMR2 e APC. Among the 40 patients included at the present study 88,57% showed microsallite instability in peripheral mononuclear blood cells, 85,8% in urinary pellet cells samples and 62,5% in Free Plasmatic DNA. There werent statistical significant relationship for the instability found at the three kind of samples assayed. The Free Plasmatic DNA concentration of the patients when compared with healthy donors, showed a statistical significant relationship (p<0,0001). And among patients in neoadjuvant chemotherapy regime who reacted positively by treatment (p=0,02). And there werent statistical significant relationship between Free Plasmatic DNA and serum markers CEA and CA15.3.
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Vírus Epstein-Barr, instabilidade de microssatélite e expressão de PD-L1 nos adenocarcinomas gástricos: aspectos clínico-patológicos e prognósticos / Epstein-Barr virus, microsatellite instability and PD-L1 expression in gastric adenocarcinomas: clinicopathological and prognostic aspectsPereira, Marina Alessandra 13 August 2018 (has links)
Introdução: O câncer gástrico (CG) foi recentemente categorizado em subtipos moleculares, os quais incluem os tumores Epstein-Barr (EBV)-positivo e com instabilidade de microssatélites (MSI). Esta distinção pode nos fornecer informações prognósticas e identificar alvos terapêuticos, tais como o PD-L1. Objetivo: O objetivo desse estudo foi avaliar a presença de EBV, MSI e expressão de PD-L1 no CG e suas associações com características clinicopatológicas e prognósticas. Métodos: Foram avaliados retrospectivamente 287 pacientes com CG submetidos à gastrectomia D2 com intenção curativa entre 2009 e 2016, através da técnica de tissue microarray. As proteínas de reparo do DNA (MLH1, MSH2, MSH6, PMS2) e o PD-L1 foram avaliados por imuno-histoquímica. O EBV foi avaliado por hibridação in situ. Resultados: Identificou-se a presença de EBV e MSI em 10,5% e 27% dos CGs, respectivamente. A maioria dos CGs com MSI apresentou perda simultânea da expressão de MLH1 e PMS2 (60%). O CG EBV-positivo associou-se ao sexo masculino (p=0,032), localização proximal (p < 0,001), tipo indeterminado de Lauren (p < 0,001), histologia pouco diferenciada (p=0,043) e infiltrado inflamatório acentuado (p < 0,001). Os tumores com MSI foram associados à idade mais avançada (p=0,002), gastrectomia subtotal (p=0,004), pN0 (p=0,024) e ao estágio pTNM menos avançado (p=0,020). Observou-se a imunoexpressão de PD-L1 em 8,8% dos casos, com expressão predominante no CG EBV-positivo (p < 0,001). O CG com MSI apresentou melhor sobrevida livre de doença (p=0,006) e sobrevida global (p=0,049) comparado ao EBV-negativo/microssatélite estável (MSS). Na análise multivariada, o status MSI/MSS permaneceu como fator de risco independente associado à recidiva da doença. Conclusão: O CG EBV-positivo apresentou aumento da expressão de PD-L1, enquanto o CG com MSI relacionou-se à melhor sobrevida. Ambos os subgrupos representam entidades distintas de CG e sua identificação é viável por técnicas diagnósticas convencionais. A caracterização destes subtipos de CG possibilita a aplicação de terapias direcionadas e permite ampliar o poder prognóstico dos atuais sistemas de classificação e estadiamento / Introduction: Gastric cancer (GC) has recently been categorized in molecular subtypes, which include Epstein-Barr (EBV)-positive and microsatellite instable (MSI) tumors. This distinction provides prognostic information and identifies therapeutic targets, such as PD-L1. Objective: The aim of this study was to evaluate the presence of EBV, MSI and PD-L1 expression in GC and their associations with clinicopathological characteristics and prognosis. Methods: We retrospectively evaluated 287 patients with GC who underwent D2-gastrectomy with curative intent from 2009 to 2016 through tissue microarray technique. DNA mismatch repair proteins (MLH1, MSH2, MSH6, PMS2) and PD-L1 were assessed by immunohistochemistry. EBV was detected by in situ hybridization. Results: The presence of EBV and MSI was identified in 10.5% and 27% of GCs, respectively. Most MSI GCs showed simultaneous loss of MLH1 and PMS2 expression (60%). EBV positivity was related to male (p=0.032), proximal location (p < 0.001), undetermined Lauren type (p < 0.001), poorly differentiated histology (p=0.043) and intense inflammatory infiltrate (p < 0.001). MSI-tumors were associated with older age (p=0.002), subtotal gastrectomy (p=0.004), pN0 (p=0.024) and more initial pTNM stage (p=0.020). PD-L1 immunoexpression was observed in 8.8% of cases, with predominant expression in EBV-positive GC (p < 0.001). MSI correlated with better disease-free survival (p=0.006) and overall survival (p=0.049) compared to the EBV-negative/microsatellite stable (MSS). In the multivariate analysis, the MSI/MSS status remained as independent risk factor associated with disease recurrence. Conclusion: EBV-positive GCs had increased PD-L1 expression, while MSI GC had better survival outcome. Both subgroups are distinct GC entities and their recognition is feasible by conventional diagnostic techniques. The characterization of these GC subtypes enables the application of targeted therapies and allows to extend the prognostic power of current classification and staging systems
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