Abordagens estereológica e imunohistoquímica no câncer de próstata: uma reavaliação diagnóstica e possível terapêutica

• Autor(a) principal: Leze, Eduardo Moussa de Jabur
• Data de Publicação: 2015
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/12319
• topic: Prostate cancer; Mean nuclear volume; Gleason grading system; Diagnosis; Stereology; Câncer de próstata; Volume médio nuclear; Sistema de Escore de Gleason; Diagnóstico; Estereologia; Próstata Câncer; Imunohistoquímica; Volume médio nuclear; Neoplasias da Próstata Classificação; Neoplasias da Próstata Diagnóstico; Estereologia; CNPQ::CIENCIAS DA SAUDE::MEDICINA

Efforts to improve the diagnosis, prognosis and surveillance of prostate cancer (PCa) are relevant. Gleason score (GSc) overestimation may subject individuals to unnecessary aggressive treatment. The purpose is to use stereology in PCa evaluations and investigate whether mean nuclear volume (MNV) correlates with the Gleason primary pattern (Gpp) and to improve the subjective GSc to obtain an objective and reliable method without inter-observer dissension. We identified 74 radical prostatectomy specimens that were divided into six groups based on Gpp, from 3 to 5. Controls (C) were designed in paired non-tumour regions of the same specimens. MNV was estimated using the point-sampled intercepts method. Differences in MNV among the C groups and the Gpp groups were tested with the Kruskall-Wallis test and Dunn post-hoc test. Differences between each Gpp group and its control counterpart were tested with the Wilcoxon test. Correlations were evaluated with the Spearman rank correlation (R[Spearman]). The correlations between prostate-specific antigen (PSA) and GSc (R[Spearman] of 0.76) and between PSA and MNV (R[Spearman] of 0.78) were moderately strong and highly significant, and the correlation between MNV and Gpp (R[Spearman] of 0.53) was moderate and highly significant. MNV was significantly greater in cancerous regions than in paired-control regions. Limitations included sample size. Proper planning of a study, as well as the availability of equipment and software for morphological quantification, can provide incentive to quickly and accurately estimate MNV as an adjunct parameter in the assessment of PCa. Inter-observer reproducibility of GSc is a problem. MNV represents an objective and reproducible grading method for PCa. Current data favour the use of MNV associated with GSc and PSA in the assessment of PCa.