Avaliação imunoistoquímica da expressão das proteínas Akt e VEGFR e seu valor prognóstico em tumores estromais do trato gastrointestinal (GISTs)

• Autor(a) principal: Carvalho, Gisele Pereira de
• Data de Publicação: 2012
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
• Texto Completo: http://tede2.pucrs.br/tede2/handle/tede/1694
• topic: MEDICINA; IMUNOISTOQUÍMICA; NEOPLASIAS GASTROINTESTINAIS; PROTEÍNAS; CNPQ::CIENCIAS DA SAUDE::MEDICINA

Gastrointestinal sarcomatoid tumors (GIST) are rare malignancies, corresponding to 1 - 3% of alli GI cancers. Nevertheless, GISts are the most common GI mesenchimal malignancies. GISTs are heterogeneous in presentation, clinical course and response to therapy. Their prognosis can be roughly estimated at diagnosis by assessing tumor size, mitotic index and the topography of the primary lesion. Despite the proved utility of these prognostic factors, their limitations are well documented, and a more refined set of biological markers are much needed. The abnormal activation of the cell survival signaling pathway provided by PI3K/Akt/PTEN proteins is a well known feature in advanced epithelial and hematological malignancies, impacting the aggressiveness of the disease as well as the resistance to different traditional therapies or biological agents. Besides their multi-effect in cell survival mechanisms, the PI3K/Akt/PTEN pathway is a powerful activator of angiogenesis via VEGF protein family transcription. The different isoforms of VEGF will in turn activate the VEGF receptor (VEGFR) at the surface of endothelial cells. Therefore, VEGFR is a reliable marker of angiogenesis in human tumors. We sought to evaluate the expression of VEGFR and Akt proteins in a series of GIST patients at diagnosis, treated in a single institution, in order to correlated the levei of expression of these proteins to clinical outcomes, such as overall survival (OS) and disease free survival (DFS). The levei of expression of these proteins was also correlated to the same outcomes in a subgroup of patients with advanced disease who received more than three months of therapy with Imatinib Mesylate (GleeveC®). Methods - 48 GIST patients were evaluated. Immunohystochemistry for VEGFR and Akt was performed by tissue microarray. Results - Akt hyperexpression was statistically correlated with a shorter DFS in the group of patients with metastatic disease (ali of them receiving GleeveC®). This correlation was not observed in early cases (defined as curable disease - stages I to III). We have not observed correlation between Akt expression and OS in any clinical stage. Lower VEGFR expression was associated to a significant better OS in ali stages (including patients receiving GleeveC®). Conversely, DFS was not affected by the levei of expression of VEGFR. CONCLUSIONS - Low VEGFR expression was related to a better prognosis in any clinicalstage of GIST, reflected in larger OS. The fact that this effect was observed in GleeveC® treated patients suggests that the betler response to the drug is much more related to the biology of the tumor than to the treatment itself. Akt showed also a promising role as a prognostic marker for disease free survival in advanced disease, indicating that GISTs with hyperexpressed Akt pathway behave more aggressively or may be less sensitive to GleeveC®.