<?xml version="1.0" encoding="ISO-8859-1"?><cms:container xmlns:cms="http://edoc.hu-berlin.de/diml/module/cms"><cms:document><cms:meta><cms:entry id="front" part="front" ref="front" type="front"/><cms:entry type="title">Deregulation von Zellzyklus und Apoptose beim Plattenepithelkarzinom des Ösophagus</cms:entry><cms:entry type="author">Dilek  Güner</cms:entry><cms:entry id="chapter1" part="chapter1" ref="chapter1" type="chapter">1.</cms:entry><cms:entry id="N10052" part="chapter1" ref="N10052" type="section">1.1</cms:entry><cms:entry id="N10059" part="chapter1" ref="N10059" type="citenumber">1</cms:entry><cms:entry id="N1006C" part="chapter1" ref="N1006C" type="subsection">1.1.1</cms:entry><cms:entry id="N10081" part="chapter1" ref="N10081" type="citenumber">2</cms:entry><cms:entry id="N10084" part="chapter1" ref="N10084" type="table"/><cms:entry id="N10223" part="chapter1" ref="N10223" type="citenumber">3</cms:entry><cms:entry id="N10226" part="chapter1" ref="N10226" type="mm">311#427</cms:entry><cms:entry id="N10234" part="chapter1" ref="N10234" type="mm">354#576</cms:entry><cms:entry id="N10242" part="chapter1" ref="N10242" type="citenumber">4</cms:entry><cms:entry id="N102CA" part="chapter1" ref="N102CA" type="subsection">1.1.2</cms:entry><cms:entry id="N102D4" part="chapter1" ref="N102D4" type="citenumber">5</cms:entry><cms:entry id="N10348" part="chapter1" ref="N10348" type="citenumber">6</cms:entry><cms:entry id="N10355" part="chapter1" ref="N10355" type="subsection">1.1.3</cms:entry><cms:entry id="N10362" part="chapter1" ref="N10362" type="citenumber">7</cms:entry><cms:entry id="N1038A" part="chapter1" ref="N1038A" type="citenumber">8</cms:entry><cms:entry id="N1039B" part="chapter1" ref="N1039B" type="mm">605#528</cms:entry><cms:entry id="N103A9" part="chapter1" ref="N103A9" type="citenumber">9</cms:entry><cms:entry id="N103AC" part="chapter1" ref="N103AC" type="table"/><cms:entry id="N105FA" part="chapter1" ref="N105FA" type="subsection">1.1.4</cms:entry><cms:entry id="N10607" part="chapter1" ref="N10607" type="citenumber">10</cms:entry><cms:entry id="N1061B" part="chapter1" ref="N1061B" type="citenumber">11</cms:entry><cms:entry id="N1062F" part="chapter1" ref="N1062F" type="table"/><cms:entry id="N106F6" part="chapter1" ref="N106F6" type="subsection">1.1.5</cms:entry><cms:entry id="N106FD" part="chapter1" ref="N106FD" type="citenumber">12</cms:entry><cms:entry id="N1071F" part="chapter1" ref="N1071F" type="citenumber">13</cms:entry><cms:entry id="N1072D" part="chapter1" ref="N1072D" type="subsection">1.1.6</cms:entry><cms:entry id="N10736" part="chapter1" ref="N10736" type="subsection">1.1.7</cms:entry><cms:entry id="N1073D" part="chapter1" ref="N1073D" type="citenumber">14</cms:entry><cms:entry id="N10745" part="chapter1" ref="N10745" type="subsection">1.1.8</cms:entry><cms:entry id="N1074E" part="chapter1" ref="N1074E" type="subsection">1.1.9</cms:entry><cms:entry id="N10755" part="chapter1" ref="N10755" type="citenumber">15</cms:entry><cms:entry id="N1075B" part="chapter1" ref="N1075B" type="section">1.2</cms:entry><cms:entry id="N107A0" part="chapter1" ref="N107A0" type="citenumber">16</cms:entry><cms:entry id="N107A3" part="chapter1" ref="N107A3" type="mm">269#305</cms:entry><cms:entry id="N107BF" part="chapter1" ref="N107BF" type="subsection">1.2.1</cms:entry><cms:entry id="N107C6" part="chapter1" ref="N107C6" type="citenumber">17</cms:entry><cms:entry id="N107FB" part="chapter1" ref="N107FB" type="subsection">1.2.2</cms:entry><cms:entry id="N10802" part="chapter1" ref="N10802" type="citenumber">18</cms:entry><cms:entry id="N10819" part="chapter1" ref="N10819" type="subsection">1.2.3</cms:entry><cms:entry id="N10820" part="chapter1" ref="N10820" type="citenumber">19</cms:entry><cms:entry id="N1083E" part="chapter1" ref="N1083E" type="mm">540#336</cms:entry><cms:entry id="N10857" part="chapter1" ref="N10857" type="citenumber">20</cms:entry><cms:entry id="N1086A" part="chapter1" ref="N1086A" type="subsection">1.2.4</cms:entry><cms:entry id="N10877" part="chapter1" ref="N10877" type="citenumber">21</cms:entry><cms:entry id="N1089D" part="chapter1" ref="N1089D" type="citenumber">22</cms:entry><cms:entry id="N108B5" part="chapter1" ref="N108B5" type="mm">571#352</cms:entry><cms:entry id="N108C3" part="chapter1" ref="N108C3" type="citenumber">23</cms:entry><cms:entry id="N108FC" part="chapter1" ref="N108FC" type="subsection">1.2.5</cms:entry><cms:entry id="N10903" part="chapter1" ref="N10903" type="citenumber">24</cms:entry><cms:entry id="N10936" part="chapter1" ref="N10936" type="citenumber">25</cms:entry><cms:entry id="N1096A" part="chapter1" ref="N1096A" type="mm">332#115</cms:entry><cms:entry id="N1097E" part="chapter1" ref="N1097E" type="citenumber">26</cms:entry><cms:entry id="N109AB" part="chapter1" ref="N109AB" type="mm">348#369</cms:entry><cms:entry id="N109E5" part="chapter1" ref="N109E5" type="subsection">1.2.6</cms:entry><cms:entry id="N109EC" part="chapter1" ref="N109EC" type="citenumber">27</cms:entry><cms:entry id="N10A36" part="chapter1" ref="N10A36" type="mm">511#300</cms:entry><cms:entry id="N10A44" part="chapter1" ref="N10A44" type="citenumber">28</cms:entry><cms:entry id="N10A80" part="chapter1" ref="N10A80" type="subsection">1.2.7</cms:entry><cms:entry id="N10A8A" part="chapter1" ref="N10A8A" type="citenumber">29</cms:entry><cms:entry id="N10AA2" part="chapter1" ref="N10AA2" type="citenumber">30</cms:entry><cms:entry id="N10ACA" part="chapter1" ref="N10ACA" type="subsection">1.2.8</cms:entry><cms:entry id="N10AE9" part="chapter1" ref="N10AE9" type="citenumber">31</cms:entry><cms:entry id="N10B02" part="chapter1" ref="N10B02" type="mm">583#312</cms:entry><cms:entry id="N10B27" part="chapter1" ref="N10B27" type="citenumber">32</cms:entry><cms:entry id="N10B48" part="chapter1" ref="N10B48" type="subsection">1.2.9</cms:entry><cms:entry id="N10B7C" part="chapter1" ref="N10B7C" type="citenumber">33</cms:entry><cms:entry id="N10BD1" part="chapter1" ref="N10BD1" type="citenumber">34</cms:entry><cms:entry id="N10BEA" part="chapter1" ref="N10BEA" type="mm">499#361</cms:entry><cms:entry id="chapter2" part="chapter2" ref="chapter2" type="chapter">2.</cms:entry><cms:entry id="N10C04" part="chapter2" ref="N10C04" type="citenumber">35</cms:entry><cms:entry id="chapter3" part="chapter3" ref="chapter3" type="chapter">3.</cms:entry><cms:entry id="N10C17" part="chapter3" ref="N10C17" type="section">3.1</cms:entry><cms:entry id="N10C1C" part="chapter3" ref="N10C1C" type="helpercitenumber">35</cms:entry><cms:entry id="N10C21" part="chapter3" ref="N10C21" type="table"/><cms:entry id="N10E56" part="chapter3" ref="N10E56" type="citenumber">36</cms:entry><cms:entry id="N10E61" part="chapter3" ref="N10E61" type="section">3.2</cms:entry><cms:entry id="N10E6B" part="chapter3" ref="N10E6B" type="citenumber">37</cms:entry><cms:entry id="N10E86" part="chapter3" ref="N10E86" type="citenumber">38</cms:entry><cms:entry id="N10E89" part="chapter3" ref="N10E89" type="table"/><cms:entry id="N111EA" part="chapter3" ref="N111EA" type="section">3.3</cms:entry><cms:entry id="N111F1" part="chapter3" ref="N111F1" type="citenumber">39</cms:entry><cms:entry id="N111F9" part="chapter3" ref="N111F9" type="section">3.4</cms:entry><cms:entry id="N11220" part="chapter3" ref="N11220" type="citenumber">40</cms:entry><cms:entry id="N11230" part="chapter3" ref="N11230" type="table"/><cms:entry id="N11372" part="chapter3" ref="N11372" type="section">3.5</cms:entry><cms:entry id="N1137C" part="chapter3" ref="N1137C" type="citenumber">41</cms:entry><cms:entry id="N11390" part="chapter3" ref="N11390" type="citenumber">42</cms:entry><cms:entry id="N113A3" part="chapter3" ref="N113A3" type="section">3.6</cms:entry><cms:entry id="N113AA" part="chapter3" ref="N113AA" type="citenumber">43</cms:entry><cms:entry id="N113C7" part="chapter3" ref="N113C7" type="citenumber">44</cms:entry><cms:entry id="chapter4" part="chapter4" ref="chapter4" type="chapter">4.</cms:entry><cms:entry id="N113D8" part="chapter4" ref="N113D8" type="section">4.1</cms:entry><cms:entry id="N113DF" part="chapter4" ref="N113DF" type="citenumber">45</cms:entry><cms:entry id="N113E7" part="chapter4" ref="N113E7" type="section">4.2</cms:entry><cms:entry id="N11401" part="chapter4" ref="N11401" type="citenumber">46</cms:entry><cms:entry id="N1140A" part="chapter4" ref="N1140A" type="mm">551#375</cms:entry><cms:entry id="N1141E" part="chapter4" ref="N1141E" type="citenumber">47</cms:entry><cms:entry id="N1142A" part="chapter4" ref="N1142A" type="mm">349#336</cms:entry><cms:entry id="N11441" part="chapter4" ref="N11441" type="citenumber">48</cms:entry><cms:entry id="N1144C" part="chapter4" ref="N1144C" type="section">4.3</cms:entry><cms:entry id="N11453" part="chapter4" ref="N11453" type="citenumber">49</cms:entry><cms:entry id="N11472" part="chapter4" ref="N11472" type="citenumber">50</cms:entry><cms:entry id="N11475" part="chapter4" ref="N11475" type="mm">336#336</cms:entry><cms:entry id="N11494" part="chapter4" ref="N11494" type="citenumber">51</cms:entry><cms:entry id="N1149F" part="chapter4" ref="N1149F" type="section">4.4</cms:entry><cms:entry id="N114AC" part="chapter4" ref="N114AC" type="citenumber">52</cms:entry><cms:entry id="N114C4" part="chapter4" ref="N114C4" type="citenumber">53</cms:entry><cms:entry id="N114C7" part="chapter4" ref="N114C7" type="mm">313#651</cms:entry><cms:entry id="N114DF" part="chapter4" ref="N114DF" type="section">4.5</cms:entry><cms:entry id="N114F2" part="chapter4" ref="N114F2" type="citenumber">54</cms:entry><cms:entry id="N1150D" part="chapter4" ref="N1150D" type="citenumber">55</cms:entry><cms:entry id="N11519" part="chapter4" ref="N11519" type="mm">573#376</cms:entry><cms:entry id="N11538" part="chapter4" ref="N11538" type="citenumber">56</cms:entry><cms:entry id="N1156E" part="chapter4" ref="N1156E" type="citenumber">57</cms:entry><cms:entry id="N1157A" part="chapter4" ref="N1157A" type="mm">343#639</cms:entry><cms:entry id="N1159D" part="chapter4" ref="N1159D" type="citenumber">58</cms:entry><cms:entry id="N115AF" part="chapter4" ref="N115AF" type="mm">343#635</cms:entry><cms:entry id="N115C3" part="chapter4" ref="N115C3" type="citenumber">59</cms:entry><cms:entry id="N115D2" part="chapter4" ref="N115D2" type="citenumber">60</cms:entry><cms:entry id="N11611" part="chapter4" ref="N11611" type="citenumber">61</cms:entry><cms:entry id="N11614" part="chapter4" ref="N11614" type="mm">307#227</cms:entry><cms:entry id="N1162A" part="chapter4" ref="N1162A" type="section">4.6</cms:entry><cms:entry id="N1163B" part="chapter4" ref="N1163B" type="table"/><cms:entry id="N11A04" part="chapter4" ref="N11A04" type="citenumber">62</cms:entry><cms:entry id="N11A07" part="chapter4" ref="N11A07" type="table"/><cms:entry id="N11CB8" part="chapter4" ref="N11CB8" type="table"/><cms:entry id="N11DB0" part="chapter4" ref="N11DB0" type="citenumber">63</cms:entry><cms:entry id="N11DBE" part="chapter4" ref="N11DBE" type="section">4.7</cms:entry><cms:entry id="N11DF8" part="chapter4" ref="N11DF8" type="citenumber">64</cms:entry><cms:entry id="N11E0D" part="chapter4" ref="N11E0D" type="citenumber">65</cms:entry><cms:entry id="N11E1C" part="chapter4" ref="N11E1C" type="mm">343#640</cms:entry><cms:entry id="N11E2D" part="chapter4" ref="N11E2D" type="mm">330#435</cms:entry><cms:entry id="N11E3E" part="chapter4" ref="N11E3E" type="citenumber">66</cms:entry><cms:entry id="N11E47" part="chapter4" ref="N11E47" type="mm">336#446</cms:entry><cms:entry id="N11E5D" part="chapter4" ref="N11E5D" type="section">4.8</cms:entry><cms:entry id="N11E64" part="chapter4" ref="N11E64" type="citenumber">67</cms:entry><cms:entry id="N11E73" part="chapter4" ref="N11E73" type="citenumber">68</cms:entry><cms:entry id="N11E79" part="chapter4" ref="N11E79" type="mm">294#230</cms:entry><cms:entry id="N11E87" part="chapter4" ref="N11E87" type="mm">310#243</cms:entry><cms:entry id="N11E95" part="chapter4" ref="N11E95" type="citenumber">69</cms:entry><cms:entry id="N11E9E" part="chapter4" ref="N11E9E" type="mm">383#325</cms:entry><cms:entry id="N11EAB" part="chapter4" ref="N11EAB" type="section">4.9</cms:entry><cms:entry id="N11EB8" part="chapter4" ref="N11EB8" type="citenumber">70</cms:entry><cms:entry id="N11EBB" part="chapter4" ref="N11EBB" type="mm">235#256</cms:entry><cms:entry id="N11ECF" part="chapter4" ref="N11ECF" type="mm">306#230</cms:entry><cms:entry id="N11EDD" part="chapter4" ref="N11EDD" type="citenumber">71</cms:entry><cms:entry id="N11EF2" part="chapter4" ref="N11EF2" type="table"/><cms:entry id="N1207B" part="chapter4" ref="N1207B" type="citenumber">72</cms:entry><cms:entry id="N1207E" part="chapter4" ref="N1207E" type="table"/><cms:entry id="chapter5" part="chapter5" ref="chapter5" type="chapter">5.</cms:entry><cms:entry id="N1220C" part="chapter5" ref="N1220C" type="helpercitenumber">72</cms:entry><cms:entry id="N12218" part="chapter5" ref="N12218" type="citenumber">73</cms:entry><cms:entry id="N12227" part="chapter5" ref="N12227" type="citenumber">74</cms:entry><cms:entry id="N1222F" part="chapter5" ref="N1222F" type="section">5.1</cms:entry><cms:entry id="N12240" part="chapter5" ref="N12240" type="citenumber">75</cms:entry><cms:entry id="N12245" part="chapter5" ref="N12245" type="section">5.2</cms:entry><cms:entry id="N12275" part="chapter5" ref="N12275" type="citenumber">76</cms:entry><cms:entry id="N12278" part="chapter5" ref="N12278" type="table"/><cms:entry id="N128CD" part="chapter5" ref="N128CD" type="section">5.3</cms:entry><cms:entry id="N12912" part="chapter5" ref="N12912" type="citenumber">77</cms:entry><cms:entry id="N12931" part="chapter5" ref="N12931" type="section">5.4</cms:entry><cms:entry id="N12938" part="chapter5" ref="N12938" type="citenumber">78</cms:entry><cms:entry id="N12960" part="chapter5" ref="N12960" type="citenumber">79</cms:entry><cms:entry id="N129C4" part="chapter5" ref="N129C4" type="section">5.5</cms:entry><cms:entry id="N129CB" part="chapter5" ref="N129CB" type="citenumber">80</cms:entry><cms:entry id="N12A01" part="chapter5" ref="N12A01" type="section">5.6</cms:entry><cms:entry id="N12A08" part="chapter5" ref="N12A08" type="citenumber">81</cms:entry><cms:entry id="N12A6A" part="chapter5" ref="N12A6A" type="citenumber">82</cms:entry><cms:entry id="N12AA1" part="chapter5" ref="N12AA1" type="citenumber">83</cms:entry><cms:entry id="N12AC7" part="chapter5" ref="N12AC7" type="section">5.7</cms:entry><cms:entry id="N12AD3" part="chapter5" ref="N12AD3" type="section">5.8</cms:entry><cms:entry id="N12AE0" part="chapter5" ref="N12AE0" type="citenumber">84</cms:entry><cms:entry id="N12AF7" part="chapter5" ref="N12AF7" type="citenumber">85</cms:entry><cms:entry ref="chapter6" type="chapter">6.</cms:entry><cms:entry ref="N12B02" type="helpercitenumber">85</cms:entry><cms:entry 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type="citation"/><cms:entry id="_bib193" part="N12B17" ref="_bib193" type="citation"/><cms:entry id="_bib423" part="N12B17" ref="_bib423" type="citation"/><cms:entry id="_bib2600" part="N12B17" ref="_bib2600" type="citation"/><cms:entry id="N1493E" part="N1493E" ref="N1493E" type="appendix">Publikationen</cms:entry><cms:entry id="N14940" part="N1493E" ref="N14940" type="head"/><cms:entry id="N14943" part="N1493E" ref="N14943" type="p"/><cms:entry id="N14963" part="N14963" ref="N14963" type="acknowledgement">Danksagung</cms:entry><cms:entry id="N14972" part="N14972" ref="N14972" type="declaration">Erklärung an Eides Statt</cms:entry><cms:entry part="chapter6" type=":current"/><cms:entry type=":lang">de</cms:entry><cms:entry id=":contents" part="front" ref=":contents" type=":contents">Inhaltsverzeichnis</cms:entry><cms:entry type=":help"><url href="http://...">Hilfe</url></cms:entry></cms:meta><cms:content><chapter id="chapter6" label="6.">
			<head>Zusammenfassung</head>
			<p><citenumber helper="true" id="N12B02" start="85"/>Störung des G1-Restriktionspunkts des Zellzyklus und Verlust der Wachstumskontrolle in Folge der Inaktivierung des Rb-Signalwegs ist ein häufiges Ereignis in malignen Tumoren. Gemeinsam mit der Hemmung von Apoptose-Signalwegen sind solche genetischen Ereignisse zentrale pathogenetische Faktoren der Tumorentstehung. Diese Veränderungen prägen aber auch entscheidend die Tumorbiologie und bestimmen somit intrinische und erworbene Therapieresistenz und konsequenterweise auch die klinische Prognose der Tumorerkrankung. In der vorliegenden Arbeit wurden Veränderungen im Rb- und im p53-Signalweg in Plattenepithelkarzinomen des Ösophagus untersucht. Diese retrospektive Studie wurde an Tumorproben von 53 mit kurativer Intention R0-resezierten Patienten durchgeführt. Proteinexpression wurde mittels Immunhistochemie und Mutationen mittels SSCP-PCR analysiert. Aktivierende Punktmutationen des K-ras Onkogens wurden mittels mutationsselektiver genomischer PCR und eines sequenzspezifischen Festphasen-Hybridisierungstests nachgewiesen. Die Analyse der individuellen Gene zeigte, dass Expressionsverlust der Rb-Signalwegskomponenten p16<sup>INK4a</sup>, p21<sup>CIP/WAF-1</sup>, p27<sup>KIP1</sup> und von Rb selbst, sowie die Überexpression von Cyclin D1 bzw. Verlust des pro-apoptotischen Bcl-2 Homologs Bax mit schlechter Prognose, d.h. kürzerem Überleben korrelierte. Überexpression von Cyclin E, p53 oder Bcl-2, sowie Mutation von p53 bzw. K-ras zeigten hingegen keinen Einfluss auf die Prognose. Das längste Überleben wurde in einer Subgruppe von Patienten beobachtet deren Tumore eine Kombination günstiger Genotypen zeigte, und zwar niedrige Cyclin D1 Expression, sowie hohe Expression von Rb, p21<sup>CIP/WAF-1</sup>, p16<sup>INK4a</sup> und Bax. Diese Ergebnisse zeigen, dass eine Multigen- oder &#8222;Multimarker&#8220;-Analyse von Genen, die konsekutiv oder synergistisch in Zellzyklus- und Apoptose-Signalwegen agieren, zur Prognoseabschätzung der Analyse individueller Gene deutlich überlegen ist. Die Identifikation solcher genetischer Markerprofile sollte sich auch zukünftig als nützlich für die klinische Entscheidungsfindung in der Therapie maligner Tumore erweisen und wird konventionelle klinische und pathologische Faktoren komplementieren, die bisher keine ausreichende Prognoseabschätzung erlauben. </p>
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