Avaliação da densidade vascular linfática intratumoral em adenocarcinomas primários de endométrio / Evaluation of intratumoral lymphatic vessel density in primary endometrial adenocarcinomas

INTRODUÇÃO: A metástase linfonodal em adenocarcinomas de endométrio reduz significativamente as taxas de sobrevida. Poucos estudos relacionando a microdensidade vascular linfática (MDVL) intratumoral e sobrevida em adenocarcinomas endometriais estão disponíveis atualmente. OBJETIVO: O propósito deste estudo foi avaliar a microdensidade vascular linfática intratumoral dos adenocarcinomas de endométrio e investigar a sua associação com fatores patológicos clássicos, metástase linfonodal e sobrevida. MÉTODOS: Cinquenta e sete pacientes com adenocarcinoma de endométrio, diagnosticadas entre 2000 a 2008 submetidas a estadiamento cirúrgico completo e avaliação da MDVL intratumoral e outras variáveis histológicas. Os micro vasos linfáticos foram identificados através de reação imunoistoquímica utilizando um anticorpo monoclonal contra a podoplanina humana (clone D2-40) e avaliados pela contagem do número de vasos linfáticos marcados em 10 campos com maior densidade vascular em aumento de 400 vezes. A MDVL foi expressa pela média do número de vasos nestes 10 campos microscópicos de maior densidade vascular. A seguir, investigamos a associação entre MDVL com achados clínico-patológicos e prognóstico. Nossos resultados demonstraram que a média do número de vasos linfáticos contados em todos os casos variou de 0 a 4.7. O valor da mediana obtida da média da MDVL foi de 0,5 e foi definido como valor de corte entre baixa e alta MDVL. RESULTADOS: Identificamos baixa MDVL intratumoral em 27 (47,4%) pacientes e alta MDVL em 30 (52,6%) das pacientes. A elevada MDVL intratumoral foi associada com menor comprometimento linfonodal e casos fatais, menor infiltração miometrial e de anexos e menor comprometimento cervical e peritoneal. Não foi obtida associação entre MDVL e idade, tipo histológico pelo sistema da FIGO, invasão vascular ou comprometimento linfonodal. CONCLUSÃO: Nossos resultados mostram associação entre elevada MDVL intratumoral com fatores prognósticos favoráveis...

INTRODUCTION: Lymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. OBJECTIVE: Our aim was to assess the intratumoral LMVD of endometrial adenocarcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival. METHODS: Fifty-seven patients with endometrial adenocarcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400X magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis. Our results demonstrated that the mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. RESULTS: We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser nodal involvement and fatal cases, lesser miometrial and adnaexal infiltration, and lesser cervical and peritoneal involvement. No association was seen between LMVD and age, FIGO staging histological type, vascular invasion, or lymph node involvement. CONCLUSION: Our results show association of high intratumoral LMVD with favorable prognosis in endometrial cancer...

Association between intratumoral lymphatic microvessel density (LMVD) and clinicopathologic features in endometrial cancer: a retrospective cohort study.

BACKGROUND: Lymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. Our aim was to assess the intratumoral LMVD of endometrial carcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival. METHODS: Fifty-seven patients with endometrial carcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400× magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis. RESULTS: The mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser miometrial and adnaexal infiltration, lesser cervical and peritoneal involvement, and fewer fatal cases. Although there was lower lymph node involvement among cases with high LMVD, the difference did not reach significance. No association was seen between LMVD and FIGO staging, histological type, or vascular invasion. On the other hand, low intratumoral LMVD was associated with poor outcome. Seventy-five percent of deaths occurred in patients with low intratumoral LMVD. CONCLUSION: Our results show association of high intratumoral LMVD with features related to more localized disease and better outcome. We discuss the role of lymphangiogenesis as an early event in the endometrial carcinogenesis.

Avaliação da presença de acompanhante durante as sessões de quimioterapia no Instituto Brasileiro de Controle do Câncer (IBCC) / Evaluación de la presencia de un acompañante durante sesiones de quimioterapia en el Instituto Brasileño para el Control del Cáncer (IBCC) / Evaluation of the presence of an accompanying person during chemotherapy sessions at Brazilian Institute for Cancer Control (IBCC)

O objetivo deste estudo foi avaliar o impacto da quimioterapia nas atividades diárias do paciente submetido a sessões de quimioterapia no IBCC. Para tanto, foram avaliados de forma prospectiva por questionários aplicados quanto à doença primária, meios de transporte utilizados para chegar ao IBCC e à presença ou não de acompanhante durante suas sessões no Hospital Dr. João Sampaio Góes Jr. – IBCC, no mês de julho de 2008. Foram obtidos os seguintes resultados: o câncer de mama foi a doença primária mais frequente, encontrada em 59 por cento dos pacientes. Observamos que 10 por cento dos pacientes compareceram às sessões de quimioterapia sem acompanhante, o que denota uma boa evolução e menores efeitos colaterais das medicações. A maior parte das pacientes foi acompanhada por parentes de primeiro grau. O principal meio de transporte das pacientes foi particular (69 por cento), porém proximadamente um quarto utilizou transporte público. Podemos notar que, das pacientes que compareceram sem acompanhantes, a maioria utilizou transporte público, denotando mais uma vez a condição biopsíquica adequada para esta situação.Concluiu-se que a evolução dos agentes quimioterápicos e a redução dos efeitos colaterais, associadas a maior eficácia, têm relação direta com menor dependência da paciente que realiza este tratamento, gerando menor transtorno tanto a ela quanto a seus familiares, interferindo na presença ou não de acompanhante e até no meio de transporte que a paciente utiliza.

The objective of this study was to evaluate the impact of chemotherapy in daily activities of patients submitted to sessions at IBCC. For doing this, a prospective study was done using questionnaires applied regarding primary disease, what transportation means was used to arrive at IBCC and the presence or not of an accompanying person during sessions at Dr. João Sampaio Góes Jr. Hospital - IBCC in July 2008. The following results were obtained: breast cancer was the most frequent primary illness in 59 per cent of the patients. We observed that 10 per cent of the patients had sessions of chemotherapy without an accompanying person, an indication of good evolution and lesser side effects of medication.Most patients were accompanied, when they were, by first degree relatives. The main means of transport of patients was a car (69 per cent), but about 25 per cent used public transport. We can notice that from patients who were not accompanied, most used public transport, another indication of agood biopsychic condition for this situation. One concluded that with the evolution of chemotherapic agents, and the reduction of side effects associated to a greater effectiveness, there is a direct relation with lesser dependence of the patient who is submitted to this treatment, generating lesser troubles for her and the family, something which affects the presence or not of an accompanying person and even the transportation means the patient uses.

El objetivo de este estudio fue evaluar el impacto de la quimioterapia en las actividades diarias de pacientes sometidos a sesiones en IBCC. Para hacerlo, un estudio prospectivo fue hecho utilizando cuestionarios aplicados respecto a enfermedad primaria, qué medios de transporte fueron utilizados como para llegar a IBCC y la presencia o no de una persona acompañante durante sesiones en el hospital Dr. João Sampaio Góes Jr. - IBCC en julio de 2008. Los resultados siguientes fueron obtenidos: el cáncer de mama fue la enfermedad primaria más frecuente del 59 por cientode los pacientes. Observamos que el 10 por ciento de los pacientes tenían sesiones de quimioterapia sin una persona acompañante, una indicación de la buena evolución y de los pocos efectos secundarios de la medicación. Parientes del primer grado acompañaban a la mayoría de los pacientes acompañados. El medio de transporte principal de los pacientes fue el coche (el 69 por ciento), pero unos 25 por ciento utilizaban transporte público. Podemos notar que, de los pacientes no acompañados, la mayoría utilizaba transporte público, otra indicación de una buena condición biopsíquica para esta situación. Uno concluye que con la evolución de los agentes de quimioterapia y la reducción de efectos secundarios, asociados a una mayor eficacia, hay una relación directa con la poca dependencia del paciente que se somete a este tratamiento, generando pocos apuros para ella y lafamilia, algo que afecta a la presencia o no de una persona acompañante e incluso los medios de transporte utilizados por el paciente.