Leucoplasia verrucosa proliferativa, análise de biomarcadores presentes na progressão da lesão / Proliferative verrucous leukoplakia, analysis of biomarkers present in lesion progression

Múltiplas lesões orais que progridem em um curso irreversível lento mediante expansão de áreas afetadas, no sentido de um pior prognóstico, caracterizam a leucoplasia verrucosa proliferativa. A referida lesão apresenta perfil agressivo circunstanciando indeterminado número de recidivas e alto potencial de transformação neoplásica. A tal fato, se atribui a frequente incidência em carcinoma verrucoso bem como em carcinoma espinocelular de boca invasivo e potencialmente metastático, inserindo-se este em índices de maior prevalência quando comparado ao carcinoma verrucoso em pacientes com leucoplasia verrucosa proliferativa. Vincula-se ao contexto supracitado, o envolvimento de vias de sinalização celular ocasionando o desarranjo de um complexo sistema o qual abarca atividade de oncogenes, inibição de genes supressores de tumor e alteração de reguladores do sistema de reparo do DNA, encerrando-se, por sua vez, em diversos fatores favoráveis à carcinogênese, dentro os quais a regulação negativa de cascatas pró-apoptóticas e estímulo à proliferação celular desordenada. A este processo se pode relacionar o desconcerto da via PI3K/Akt/mTOR e de um membro do complexo de pré-replicação, o MCM3. Para tanto, a análise pormenorizada do perfil evolutivo da lesão por meio do rol de diagnósticos pregressos, bem como por meio do cruzamento de dados epidemiológicos, além da caracterização de neoplasias malignas provenientes da leucoplasia verrucosa proliferativa por meio da expressão dos biomarcadores pAkt, pmTOR e MCM3, vêm a explanar aspectos ainda pouco estudados desta intrigante entidade clinicopatológica. Neste sentido, o presente trabalho analisou o histórico diagnóstico de 28 pacientes com leucoplasia verrucosa proliferativa submetendo à análise imuno-histoquímica para as supracitadas proteínas, o montante de 34 amostras dos mesmos pacientes, integrando estas, 28 de leucoplasia verrucosa proliferativa, 4 de carcinoma verrucoso e 2 de carcinoma espinocelular. Dos resultados obtidos, foi possível depreender a prevalência de lesões em mucosa jugal, rebordo alveolar e língua confirmando ainda seu perfil evolutivo em face às múltiplas lesões com alto potencial recidivante e latente insurgir do carcinoma espinocelular, este podendo ainda ser embasado por expressiva marcação de pmTOR, pAkt e MCM3.

Evaluation of the Ki-67 and MCM3 expression in cytologic smear of oral squamous cell carcinoma

Statement of the Problem: Squamous cell carcinoma [SCC] is the most frequent oral cancer whose 5-year survival rate is 80% for early-detected lesions and nearly 30-50% for advanced lesions. Early detection of oral cancers and precancerous lesions can improve the patient's survival and decrease the morbidity

Purpose: This study aimed to evaluate and compare the Ki-67 and MCM3 expression in cytologic smear of oral SCC [OSCC]

Materials and Method: We examined 48 oral brush biopsies including 28 OSCC and 20 healthy non-smoking samples. Immunocytochemistry staining was performed for Ki-67 and MCM3 by using an EnVision-labeled peroxidase system, and labeling index [LI] was calculated

Results: Out of 28 OSCC cases, 27[96.4%] cases contained MCM3 positive cells and 22[78%] cases contained Ki-67 positive cells. All normal mucosa were Ki-67 and MCM3 negative. MCM3 and Ki-67 LI were significantly higher in OSCC than normal mucosa [p< 0.001]. MCM3 LI was significantly higher than Ki-67 LI in OSCC group [p< 0.001]

Conclusion: Immunocytologic evaluation of Ki-67 and MCM3 can be used for early detection of OSCC. Furthermore, MCM3 may be a more sensitive cytologic bi-omarker than Ki-67 in SCC patients

Ki-67 protein predicts survival in oral squamous carcinoma cells: an immunohistochemical study

Abstract The aim of this study was to identify the expression of Ki-67 and MCM3 in oral squamous cell carcinoma (OSCC) as well as to address the correlation with patient survival and clinical features. Samples were collected from 51 patients with OSCC who presented for follow-up. Immunohistochemical expression of Ki-67 and MCM3 in all groups was performed. The scoring system was previous published by Tsurutani in 2005. We used Kappa index to evaluate observers agreement degree. The associations between protein expression and clinical variables were examined for statistical significance using the chi-squared test. The overall survival rates were estimated by the Kaplan-Meier method and the relationship between protein expression and survival was compared using the log-rank test (p < 0.05). The overall survival time for a patient with positive immunostaining for Ki-67 is shorter than for a patient with negative immunostaining, (log-rank test, p = 0.00882). Patients with tumor size T3 and T4 showed a statistically significant relationship with Ki-67 immunoexpression (log-rank test, p = 0.0174). The relationship between Ki-67 expression and the relation between age, gender, smoking, tumor site, lymph node metastasis and disease stage was not significant. The examiners agreement degree by Kappa presented p value < 0.05. There was not a significant correlation when we evaluated MCM3 expression regarding clinical characteristics and survival rate. From these results, the present study suggests that positive Ki-67 expression found in OSCC patients may contribute to predict the survival in OSCC samples, as well as the relation between the protein and the tumor size.