Analysis of the expression of cytokines and chemokines, platelet-leukocyte aggregates, sCD40L and sCD62P in cutaneous melanoma.

BACKGROUND: Cutaneous melanoma (CM) is a malignancy with a variable incidence worldwide and a poor advanced-stage prognosis. Melanoma growth is closely associated with the immune system. METHODS: A cross-sectional study was performed on CM patients admitted at the Hospital de Cancer de Pernambuco (HCP) between 2015 and 2018. Fifty-one CM patients were included, and 30 healthy individuals. The study aimed to evaluate the association of platelet activation mechanisms and inflammatory response in patients with cutaneous melanoma. RESULTS: Elevated serum IL10 and low serum TNF levels in CM patients compared to controls (p < 0.05). High IL6 levels in patients with negative lymph nodes LN (-) compared to positive lymph nodes group (LN +, p = 0.0005). Low RANTES levels in patients compared to controls (p < 0.05). Elevated levels of platelet-lymphocyte (PLA), platelet-monocytes (PMA), and platelet-neutrophils (PNA) aggregates were observed in patients compared to controls (p < 0.05). CM patients with stage II had lower PMA levels than stages I and III (p < 0.05). High PMA levels were observed in patients with LN (+) compared to the LN (-) group (p < 0.0001). Patients with SSM had high levels of sCD40L and sCD62P compared to controls (p < 0.05)). High sCD40L levels in stage II compared to the stage III group, and sCD62P in stages I and II compared to the stage III group (p < 0.05). High sCD62P levels in patients with LN (-) compared to the group LN (+) (p < 0.05). CONCLUSION: It was observed the immunosuppressive profile in CM may favor tumor progression. High levels of platelet-leukocyte aggregates, sCD40L, and sCD62P may be associated with the worst prognosis.

Análise da expressão de citocinas e quimiocinas, dos agregados de plaquetas-leucócitos e dos mediadores solúveis sCD40L e sCD62P no melanoma cutâneo / Analysis of the expression of cytokines and chemokines, platelet-leukocyte aggregates and soluble mediators sCD40L and sCD62P in cutaneous melanoma

Introdução: O melanoma cutâneo é uma neoplasia maligna dos melanócitos da pele com incidência variável no mundo e o prognóstico é desfavorável nos estágios mais avançados. O desenvolvimento do melanoma está associado ao sistema imunológico e a maior evolução no seu tratamento se deu a partir de medicamentos baseados no estímulo da resposta imune contra o tumor. Objetivo: Avaliar a expressão de citocinas e quimiocinas, dos agregados de plaquetas-leucócitos e de mediadores solúveis sCD40L e sCD62P no sangue de pacientes com melanoma cutâneo. Métodos: Foi realizado um estudo transversal em pacientes com melanoma cutâneo admitidos para tratamento cirúrgico no Hospital de Câncer de Pernambuco (HCP), entre os anos de 2015 e 2018. Foram incluídos 51 pacientes (média de 57,6 anos) com diagnóstico de melanoma cutâneo, e como grupo controle, 30 indivíduos saudáveis (média de 56,7 anos). As coletas de sangue foram realizadas antes da ressecção do melanoma. A determinação dos níveis de citocinas IL6, IL10, TNF, IL1 e IL12p70 e das quimiocinas CXCL10 (IP10), CCL2 (MCP-1), CXCL9 (MIG), CCL5 (RANTES) e CXCL8 (IL8), sCD40L e sCD62P, e agregados plaquetas-leucócitos foi realizada por citometria de fluxo. Foram realizadas análises entre os grupos de pacientes e controles, e pelos parâmetros como tipo histológico, estadio, espessura de Breslow e presença de metástases linfonodais. O teste de Mann-Whitney foi utilizado para comparação entre dois grupos, e de Kruskal-Wallis para as análises entre três ou mais grupos. Foi considerado significativo p<0,05. Resultados: Não houve detecção de IL1 e IL12 no sangue dos pacientes e controles. Verificou-se níveis elevados das citocinas IL10 e diminuídos de TNF nos pacientes comparados ao grupo controle, (p<0,0001). A IL6 esteve aumentada nos pacientes com estadio II em relação ao III (p=0,017) e em pacientes com linfonodos negativos (p<0,0001). Foram encontrados níveis reduzidos da quimiocina CCL5 (p=0,009) nos pacientes quando comparados ao grupo controle. O percentual de agregação plaquetária em linfócitos, monócitos e neutrófilos também foi elevado nos pacientes comparado ao grupo controle (p<0,0001, p=0,009 e p<0,0001 respectivamente). Foram encontrados níveis elevados de agregados plaquetas-monócitos nos pacientes com linfonodos positivos (p=0,008). Os níveis solúveis sCD40L e sCD62P foram elevados nos pacientes comparados aos controles (p=0,03 e p=0,006, respectivamente). Conclusão: Os dados obtidos das análises realizadas mostram que os pacientes com melanoma cutâneo apresentam um perfil imunossupressor com a participação de plaquetas e monócitos/macrófagos que favorecem a progressão tumoral

Cutaneous melanoma is a malignancy originated from the skin melanocytes, with a variable incidence worldwide and a poor prognosis in advanced stages. Melanoma growth is closely associated with the immune system and the most important treatment advances resulted from stimulation of immune response against the tumor. Objective: To evaluate the expression of cytokines and chemokines, platelet-leukocyte aggregates and soluble mediators sCD40L and sCD62P in the blood of patients with cutaneous melanoma. Methods: A cross-sectional study was performed in cutaneous melanoma patients admitted for surgical treatment at the Hospital de Câncer de Pernambuco (HCP) between 2015 and 2018. Fifty-one patients (mean age 57.6 years) with a diagnosis of melanoma were included, and 30 healthy individuals (mean age 56.7 years) were chosen as the control group. The blood samples were taken before resection of the melanoma. The determination of cytokines IL6, IL10, TNFα, IL1ß and IL12p70 and chemokines CXCL10 (IP10), CCL2 (MCP-1), CXCL9 (MIG), CCL5 (RANTES) and CXCL8 (IL8), sCD40L and sCD62P, and platelet-leukocyte aggregate was performed by flow cytometry. Analysis were performed between patient and control groups, and by parameters such as histological type, stage, Breslow thickness, and presence of lymph node metastases. Mann-Whitney test was used for comparison between the two groups, and Kruskal-Wallis test for analysis between three or more groups. It was considered significant p <0.05. Results: There was no detection of IL1ß and IL12 in the blood of patients and controls. Elevated levels of IL10 and decreased TNFα cytokines were found in patients compared to the control group (p <0.0001). IL6 was increased in patients with stage II compared to III (p=0.017) and in patients with negative lymph nodes (p <0.0001). Reduced CCL5 chemokine levels (p=0.009) were found in patients compared to the control group. The percentage of platelet aggregation in lymphocytes, monocytes and neutrophils was also high in patients when compared to the control group (p <0.05). High levels of platelet-monocyte aggregates were found in patients with positive lymph nodes (p=0.008). Soluble sCD40L and sCD62P levels were elevated in patients compared to controls (p=0.03 and p=0.006, respectively). Conclusion: The data obtained from the analysis performed show that patients with cutaneous melanoma have an immunosuppressive profile with platelet participation and monocytes/macrophages that favor tumor progression

A PHASE II TRIAL EXPLORING THE EXTENSIVE INTRA-OPERATIVE PERITONEAL LAVAGE (EIPL) AS A PROPHYLACTIC STRATEGY FOR PERITONEAL RECURRENCE IN LOCALLY ADVANCED GASTRIC CANCER: reporting postoperative morbidity and mortality after early closure.

BACKGROUND: The Extensive Intraoperative Peritoneal Lavage (EIPL) has been proposed as a practical prophylactic strategy to decrease the risk of peritoneal metastasis in gastric cancer. OBJECTIVE: To explore the safety and efficacy of the EIPL in our locally advanced gastric cancer patients. METHODS: This study is an open-label, double-center, single-arm phase II clinical trial developed at two tertiary hospitals from Recife (Pernambuco, Brazil). RESULTS: The study protocol was prematurely closed due to slow accrual after only 16 patients had been recruited to participate. Eight of them were excluded of the protocol study during the laparotomy, whereas four cases were also excluded from the per-protocol analysis. Two patients had died in hospital before 30 days and six were alive with no evidence of cancer relapses after a follow-up ranging from five to 14,2 months (median of 10.6 months). In the intention-to-treat analysis, three of eight patients suffered of gastrointestinal leakages and two of them had died. On a per-protocol basis, two of four patients presented this type of postoperative complication and one of them had died. All deaths occurred as a somewhat consequence of gastrointestinal leakages. CONCLUSION: We could not make any conclusion about the safety and efficacy of the EIPL, but the possibility of this approach might increase the rate of gastrointestinal leakage is highlighted.