Avalição de neutrófilos circulantes em pacientes com neoplasia pré-invasiva e invasiva de colo uterino.

Abstract

Cervical cancer is the second most common type of cancer in women worldwide. In Brazil, the number of new cases awaited for 2006 is 19.260 (MS/INCA-2005). Considering that neutrophils may present anti-tumor activity and that sistemic leucocyte functions can be altered in cancer patients, our aim was to verify if patients with cervical neoplasia, at different tumor stage, present alterations in the number and/or chemotactic and phagocytic function of circulating neutrophils and the effect of treatment on these parameters. It was enrolled twenty one healthy women (Control Group) and 23 patients, being 11 diagnosed as cervical intraepithelial neoplasia grade III or microinvasive carcinoma (NIC/MICRO Group) and 12 as invasive carcinoma (INV Group) through biopsy. According to tumor stage, patients were submitted to surgery (NIC/MICRO Group) or chemotherapy (group INV). Leucogram of patients upon diagnosis showed neutrofilia and increased neutrophil/lymphocyte ratio in most patients of advanced tumor stage (INV Group), in opposite to results found in patients at early stage group (NIC/MICRO Group). The chemotactic activity of blood peripheral neutrophils was evaluated in icrochemotaxis chamber assay towards the chemotactic stimuli (10-7M) fMLP, LTB4 and IL-8, compared to random migration (RPMI). Total patient group had significant neutrophil migration in response to the chemotactic stimuli, however lesser for LTB4 and IL-8 compared to controls (p<0,05). Moreover, it was observed that patients from INV group had reduced neutrophil migration to all the chemotactic stimuli compared with NIC/MICRO group (p<0,01). After surgical treatment (around 30 days) neutrophil migration was increase towards fMLP and LTB4 in patients of NIC/MICRO group (p<0,05). Phagocytic function was evaluated using sensitized zimosan as phagocytic particle, and the results were presented as the phagocytic index (IF). It was not observed differences in IF between controls and patients. However considering tumor stage, a reduction of phagocytic activity was observed in patients of INV group compared to NIC/MICRO group (p=0,015). After surgical treatment in pacients of NIC/MICRO group (n=6) no significant differences were observed compared to time upon diagnosis. It can be concluded that advanced tumor stage in cervical cancer is a determinant factor for the increase in the number of circulating neutrophils and reduction in the function of these cells. The withdrawal of neoplasia cells increased the capacity of neutrophil migration suggesting the production of circulating mediators by tumor cells. Cervical cancer, even at initial stages, can be seen as an illness with systemic findings.