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Previous issue date: 2016-02-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / A queilite act?nica (QA) ? uma les?o potencialmente maligna que acomete o vermelh?o do l?bio e resulta da exposi??o cr?nica aos raios solares. Atualmente, n?o ? poss?vel predizer quais os casos de QA progredir?o para o carcinoma de c?lulas escamosas e, portanto, alguns marcadores biomoleculares t?m sido estudados. A ciclo-oxigenase 2 (COX-2) ? uma enzima associada com a resposta inflamat?ria e superexpressa no c?ncer oral; no entanto, pouco se sabe sobre o papel desta prote?na em queilites act?nicas. Al?m disso, as modalidades terap?uticas atualmente dispon?veis para QA podem ocasionar efeitos delet?rios e citot?xicos aos pacientes. Portanto, o objetivo desse trabalho foi avaliar a express?o imuno-histoqu?mica da COX-2 em QAs de diferentes riscos de transforma??o maligna e analisar, atrav?s de acompanhamento cl?nico, a efic?cia do gel de diclofenaco s?dico a 3% no tratamento dessa les?o. A imunoexpress?o da COX-2 foi analisada semi-quantitativamente em 90 casos de QAs graduadas em baixo risco (n = 55) e alto risco (n = 35) de transforma??o maligna. O teste Qui-quadrado de Pearson foi realizado para verificar poss?veis associa??es entre a imunoexpress?o da COX-2 e a grada??o histol?gica das queilites act?nicas. O coeficiente ponderado de Kappa denotou uma boa concord?ncia interobservador (0.677). Para o estudo cl?nico, dezenove pacientes diagnosticados com QA foram orientados a realizar aplica??o t?pica do gel de diclofenaco, tr?s vezes por dia, durante 90 dias. A cada visita, os casos foram documentados atrav?s de fotografia digital e, ao final do tratamento, dois pesquisadores analisaram todas as imagens para avaliar o aspecto cl?nico do l?bio. Tamb?m foi avaliada a tolerabilidade ao f?rmaco e satisfa??o do paciente ao final do tratamento. A COX-2 esteve superexpressa em 74.4% dos casos de queilites act?nicas. Ambos os grupos, de baixo e alto risco, revelaram predomin?ncia do escore 3 (elevada imunoexpress?o), seguida dos escores 2 e 1 (baixa express?o e aus?ncia de express?o, respectivamente). N?o foi observada associa??o significativa (p = 0.283) entre a express?o de COX-2 e a grada??o histol?gica das QAs analisadas. Dos indiv?duos que participaram do estudo cl?nico, dez apresentaram remiss?o total das caracter?sticas cl?nicas da les?o (escore 1), e em tr?s pacientes, a melhora foi considerada parcial (escore 2). Um participante apresentou piora do quadro cl?nico (escore 4). Em cinco casos, o tratamento foi descontinuado devido ao desenvolvimento de leves efeitos adversos no local de aplica??o do gel. Quanto ? an?lise de satisfa??o e tolerabilidade ao f?rmaco, a maioria dos pacientes mostrou-se plenamente satisfeita com a terapia (n = 11) e relatou que o f?rmaco n?o era irritante para os l?bios (n = 9). Os resultados desse estudo demonstram que a elevada imunoexpress?o da COX-2 ? frequente em QAs; no entanto, essa prote?na n?o esteve associada ao risco de transforma??o maligna nos casos analisados. A aplica??o t?pica do gel de diclofenaco s?dico a 3% forneceu uma abordagem conveniente, n?o invasiva e bem tolerada na maioria dos casos, podendo constituir uma alternativa promissora no tratamento da queilite act?nica. / Actinic cheilitis (AC) is a potentially malignant disorder which affects the lip vermilion and results from chronic exposure to sunlight. Currently, it is not possible to predict which cases of AC may progress to squamous cell carcinoma, and therefore, some biomolecular markers have been researched. Cyclooxygenase 2 (COX-2) is an enzyme associated with inflammatory response which is overexpressed in oral cancer; however, little is known about the role of this protein in actinic cheilitis. About the treatment of this lesion, currently available therapeutic modalities to AC may cause cytotoxic effects and deleterious results to patients. Therefore, the aim of this study was to evaluate the immunoexpression of COX-2 in AC of different risks of malignant transformation and analyse, through clinical follow-up, the efficacy of diclofenac sodium 3% gel in the treatment of this condition. Epithelial immunoexpression of COX-2 was analysed semi-quantitatively in 90 cases of AC classified as low risk (n = 55) and high risk (n = 35) of malignant transformation, in which the scores were assigned: (0) 0 to 5% of positive cells - Negative; (1) 6 to 30% of positive cells - Low expression; (2) 31 to 100% of positive cells - High expression. The chi-square test of Pearson was conducted to verify possible associations between immunoexpression of COX-2 and histologic grade of actinic cheilitis. The weighted kappa coefficient denoted a good interobserver agreement (0.677). Nineteen patients diagnosed with AC were instructed to perform topical application of the gel three times a day for a period of 90 days. In each biweekly visit, a follow-up record was accomplished through digital photographs and after treatment was completed, two researchers analysed all the images to assess clinical aspects of the lip. Furthermore, tolerability to the drug and patient satisfaction after treatment were evaluated. COX-2 was overexpressed in 74.4% of AC cases. Both low and high-risk groups revealed predominance of score 3, followed by scores 2 and 1. There was no significant association (p = 0.315) between COX-2 expression and histological grading. Among the total number of participants of this clinical study, ten showed total remission of all clinical features of the lesion and three had partial improvement of these characteristics. One participant presented worsening of the clinical condition. In five cases, the treatment was discontinued due to development of mild adverse effects at the site of gel application. Regarding analysis of satisfaction and tolerability to the drug, most patients were fully satisfied with the therapy (n = 11) and reported that the drug was not irritating to the lips (n = 9). Our study demonstrates that high expression of COX-2 is common in AC; however, this protein was not associated with malignant transformation risk of the analysed cases. Topical application of
diclofenac sodium 3% gel provided a convenient and well tolerated approach in most cases, and may be a promising alternative for the treatment of actinic cheilitis.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/20947 |
| Date | 19 February 2016 |
| Creators | Gonzaga, Amanda Katarinny Goes |
| Contributors | 14068850453, http://lattes.cnpq.br/8375651517819318, Queiroz, Lelia Maria Guedes, 59539224420, http://lattes.cnpq.br/3265824235655776, Nonaka, Cassiano Francisco Weege, 02781932426, http://lattes.cnpq.br/0224522010734716, Medeiros, Ana Miryam Costa de |
| Publisher | Universidade Federal do Rio Grande do Norte, PROGRAMA DE P?S-GRADUA??O EM PATOLOGIA ORAL, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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