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Prognóstico em osteossarcoma: análise clínica, epidemiológica, histopatológica e imuno-histoquímica

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Emilio Carlos Curcelli

PROGNÓSTICO EM OSTEOSSARCOMA:

análise clínica, epidemiológica, histopatológica e imuno-histoquímica

Tese apresentada à Faculdade de

Medicina de Botucatu - Unesp para

obtenção do título de doutor em

Bases Gerais da Cirurgia

Botucatu

2008

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Emilio Carlos Curcelli

PROGNÓSTICO EM OSTEOSSARCOMA:

análise clínica, epidemiológica, histopatológica e imuno-histoquímica

Tese apresentada à Faculdade de

Medicina de Botucatu – Unesp para

obtenção do título de doutor em Bases

Gerais da Cirurgia.

Orientador: Prof. Dr. Sérgio Swain Müller

Co-orientadora: Profa. Dra Anete Kinumi Ueda

Botucatu

2008

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mpjohGjh{hsvnyÇmpjhGlshivyhkhGwlshGzlÍÉvG{ÏjupjhGGklGhx|pzpÍÉvGlGG{yh{htlu{vGG khGpumvythÍÉvG kp}pzÉvG{ÏjupjhGklGipispv{ljhGlGkvj|tlu{hÍÉvGTGjhtw|zGklGiv{|jh{|GTG|ulzwG i‰“–›ŒŠç™ˆG™Œš—–•šçŒ“aGzŒ“”ˆGtˆ™ˆG‹ŒGqŒšœš G jœ™ŠŒ““SGl”“–Gjˆ™“–šUG GGGGw™–Ž•ùš›Š–GŒ”G–š›Œ–ššˆ™Š–”ˆaGˆ•ç“šŒGŠ“󕐊ˆSGŒ—‹Œ”–“ùŽŠˆSGGš›–—ˆTGG ›–“ùŽŠˆGŒG”œ•–Tš›–˜œó”ŠˆGVGl”“–Gjˆ™“–šGjœ™ŠŒ““UGˀ Gi–›œŠˆ›œGaG‚šU•U„SG YWW_UGG GGG GGGG{ŒšŒGO‹–œ›–™ˆ‹–PGGˀ GGmˆŠœ“‹ˆ‹ŒG‹ŒGtŒ‹Š•ˆG‹ŒGi–›œŠˆ›œSG|•Œ™š‹ˆ‹ŒG lš›ˆ‹œˆ“Gwˆœ“š›ˆSGYWW_UG GGGGv™Œ•›ˆ‹–™aGz–Gzžˆ•GtӓŒ™GG GGGGj–T–™Œ•›ˆ‹–™ˆaGh•Œ›ŒGr•œ”G|Œ‹ˆG GGGGhššœ•›–GjhwlzaG[WXWXX_]G G GGGGXUGvš›Œ–ššˆ™Š–”ˆGTGw™–Ž•ùš›Š–GGYUGv™›–—Œ‹ˆGTGj™œ™ŽˆG GG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGjkkG]X^UZG G wˆ“ˆ™ˆšGŠˆŒaGl—‹Œ”–“–ŽˆbGl–“œíé–GŠ“󕐊ˆbGp”œ•–š›–˜œó”ŠˆbG vš›Œ–šˆ™Š–”ˆbGwˆ›–“–ŽˆbGw™–Ž•ùš›Š–G

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Dedicatória

G G G G G G G G G G G G G G G G G G G G G G G G G G G G G G G G G G G G h–šG”ŒœšG—ˆŠŒ•›ŒšG

G

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Agradecimento

AGRADECIMENTO G G wŒ“–šGŠˆ”•–šG˜œŒG—Œ™Š–™™GšŒ”—™ŒGŒ•Š–•›™ŒG—Œšš–ˆšG‹š—–š›ˆšGˆG ”ŒG ˆ‘œ‹ˆ™SG Œ•›œšçš›ŠˆG ŒG ‹Œš—™Œ›Œ•Š–šˆ”Œ•›ŒUG tŒœšG š•ŠŒ™–šG ˆŽ™ˆ‹ŒŠ”Œ•›–šG ˆ–šG ˜œŒG Š–•›™‰œó™ˆ”G —ˆ™ˆG ”•ˆG –™”ˆíé–G ŒG —ˆ™ˆG ˆG Œ“ˆ‰–™ˆíé–G‹Œš›ŒG›™ˆ‰ˆ“–UG G ÆG”•ˆG”éŒGtˆ™ˆGh—ˆ™ŒŠ‹ˆSGŽœŒ™™Œ™ˆSGˆ–G”ŒœG—ˆGl”“–G˜œŒGšŒG –GŠŒ‹–GŒGˆ–šG”ŒœšG™”é–šGš–“‹ç™–šGsœ¡ˆSGwˆœ“–GŒGhŽ•ˆ“‹–UG G ÆG”•ˆGŒš—–šˆGsˆ™ˆGŒGˆ–šG”ŒœšG˜œˆ›™–G“–šGl”“–SGqĀ“ˆSG}›–™GŒG h•‹™ïSG”•ˆG”–›ˆíé–UG G h–šGˆ”Ž–šG‹ˆGkšŠ—“•ˆG‹ŒGv™›–—Œ‹ˆSGoˆ”“›–•G‹ˆGy–šˆGwŒ™Œ™ˆSG h“™Œ‹–G h“Šè•›ˆ™ˆG iˆ™™Œ›–SG n“‰Œ™›–G q–šïG jˆíé–G wŒ™Œ™ˆSG wˆœ“–G y–‰Œ™›–G ‹ŒG h“”Œ‹ˆGz“ˆ™ŒšSGyŒ•ˆ“‹–G‹–šGzˆ•›–šG}–“—SG{™ˆ‘ˆ•–Gzˆ™‹Œ•‰Œ™ŽSGtˆœ™–G‹–šG zˆ•›–šG }–“—SG h”ˆœ™G w••ˆSG yŠˆ™‹–G }–“ˆ•›ŒG wŒ™Œ™ˆSG kˆ•Œ“G p••–ŠŒ•›G k•ˆ•ŒSG kŒ•šG }ˆ™ˆ•‹ˆSG kˆ‹G uŠ–“Œ››G nœ”Œ™–SG y–‹™Ž–G }ˆ•••SG m牐–G mŒ™•ˆ•‹–G l“– G w•›–G ŒG tˆœ™óŠ–G hŽœˆ™G m–“–•G —Œ“ˆG ˆ‘œ‹ˆG ŒG šœ—–™›ŒUG G l”G Œš—ŒŠˆ“SG ˆ–G q–šïG sœ¡G }““ˆšG i–ˆšG u–Œ““SG ‹ŒG ˆ“œ•–G ŒŸŒ”—“ˆ™G ˆG —™–šš–•ˆ“G ŒŸŠŒ—Š–•ˆ“SG›–™•ˆG”—Œ™ŠŒ—›óŒšG”•ˆšGˆœšð•ŠˆšUG G h–šG ‹–œ›–™ŒšG h‹Œ”ˆ™G s–—ŒšSG iŒ•Œ‹›–G tˆœ™–G y–ššSG tˆ™Š–G {Ā“–G ‹ŒG hšššG mŽœŒ™Œ‹–SG zˆ“”G Œ˜œG nˆ™ŠˆG ŒG }ˆ“›Œ™G wŒ•ˆSG ‹–G o–š—›ˆ“G hUjUG jˆ”ˆ™Ž–SG–•‹ŒSG–™Žœ“–T”ŒSGŠ–”ŒŠŒG•ˆG–•Š–“–ŽˆUG G h–šG ”ŒœšG •Œš›”睌šG Š–”—ˆ•Œ™–šG ‹ŒG ‘–™•ˆ‹ˆG ‹–G o–š—›ˆ“G lš›ˆ‹œˆ“G iˆœ™œSG šŒ”G –šG ˜œˆšG •–ššˆšG Š–•˜œš›ˆšG •é–G šŒ™ˆ”G —–ššóŒšSG Œ”G Œš—ŒŠˆ“SGˆ–G‹–œ›–™Gjˆ™“–šGh“‰Œ™›–GtˆŠˆ™Œ““UG G

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Curcelli EC. Prognóstico em osteossarcoma

ÆG—™–Œšš–™ˆG‹–œ›–™ˆGtˆ™“¡ˆG}Œ™ˆGjœ•ˆGyœ‹ŽŒSG—Œ“ˆšGšœŽŒš›ûŒšG ŒG•ŠŒ•›–UGG G h–šG–™›–—Œ‹š›ˆšG‹–Go–š—›ˆ“Gh”ˆ™ˆ“Gjˆ™ˆ“–SG‹–œ›–™ŒšGwŒ‹™–Gsœ¡G iœ‹•G ŒG nœš›ˆ–G nˆ™ŠˆG ‹ŒG h™™œ‹ˆG mˆ“Šé–SG ŒŠŒ•›ŒšG Š–”—ˆ•Œ™–šG ‹ŒG Š™œ™ŽˆšGŒG—™–ŠŒ‹”Œ•›–šG–•Š–“ùŽŠ–šUG G h–šG ‹–œ›–™ŒšG }󙎐“–G h•›–•–G yŒ•šG j–“›œ™ˆ›–SG tˆ™ŠœšG hœŽœš›–G tˆœˆ‹SGj“ˆĀ‹ˆG{Œ™ŒšˆG‹ŒGv“Œ™ˆGŒGæGœ•Š–•ç™ˆGt癊ˆGt–™Œ““Gwˆˆ•Œ““SG‹–G kŒ—ˆ™›ˆ”Œ•›–G ‹ŒG oŒ”ˆ›–“–ŽˆG ŒG v•Š–“–ŽˆG j“󕐊ˆG ‹–G o–š—›ˆ“G h”ˆ™ˆ“G jˆ™ˆ“–UG G h–G —ˆ›–“–Žš›ˆG ‹–œ›–™G m™ˆ•ŠšŠ–G jˆ™“–šG xœŒŒ‹–SG ‹–G o–š—›ˆ“G h”ˆ™ˆ“Gjˆ™ˆ“–UG G h–šG —ˆ›–“–Žš›ˆšG ‹–œ›–™ŒšG h‹ˆœ›–G q–šïG mŒ™™Œ™ˆG uœ•ŒšG ŒG |“ššŒšG m™Œ‹Œ™ŽœŒG qœ•–™G ‹–G zŒ™í–G ‹ŒG wˆ›–“–ŽˆG ‹–G o–š—›ˆ“G lš›ˆ‹œˆ“G iˆœ™œG —Œ“ˆšG šœŽŒš›ûŒšSGŠ–™™ŒíûŒšGŒG“Œ›œ™ˆG‹ˆšG“蔐•ˆšUG G hGtˆ™ˆGjŒ“•ˆGjˆ”ˆ™Ž–Gyˆ”–šGŒGˆ–šG—™–Œšš–™ŒšG‹–œ›–™ŒšGh•›Œ™–G m™Œ‹Œ™Š–G tˆŠŒ‹–G ‹ŒG t™ˆ•‹ˆSG k–”•Ž–šG h“ŒšG tŒ™ˆG ŒG wˆš˜œˆ“G iˆ™™Œ››SG —Œ“ˆšGšœŽŒš›ûŒšGŒGŠ–™™ŒíûŒšUG G h–šG —™–Œšš–™ŒšG ‹–œ›–™ŒšG jˆ™“–šG y–‰Œ™›–G wˆ‹–ˆ•G ŒG z–G h“‰Œ™›–G yœ——G ‹ŒG wˆˆG —Œ“ˆšG —ˆŠŒ•›ŒšG –™Œ•›ˆíûŒšG ŒG ”Œ›Šœ“–šˆšG ˆ•ç“šŒšG Œš›ˆ›óš›ŠˆšUG G hG ˆššš›Œ•›ŒG š–Šˆ“G l“ˆ•ŒG j™š›•ˆG tˆ™ŠšSG —Œ“ˆG —Œš˜œšˆG ŒG Š–”—“Œ”Œ•›ˆíé–G‹ŒG•–™”ˆíûŒšSG™ŒšŽˆ›ŒG‹–šG‰“–Š–šG‹ŒGˆ•ˆ›–”ˆG—ˆ›–“ùŽŠˆGŒG Œ“ˆ‰–™ˆíé–G‹ŒG›ˆ‰Œ“ˆšUG

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Agradecimento

G

hGl•“¡ŒG‹ŒGz–œ¡ˆGu–ŽœŒ™ˆG}–“—ˆ›–SGtˆ™“œŠGiŒ›•SGkˆGh—ˆ™ŒŠ‹ˆG sUG nUG y–‹™ŽœŒšSG sœŠˆ•ˆG w¡¡ˆ•G ŒG zŒ“”ˆG tˆ™ˆG ‹ŒG qŒšœšSG ‹ˆG i‰“–› ŒŠˆG ‹–G jˆ”—œšG ‹ŒG i–›œŠˆ›œSG œ”G ŒŸŒ”—“–G ‹Ž•Šˆ•›ŒG ‹ŒG Š–”—Œ›ð•ŠˆSG Š–”—™–”Œ›”Œ•›–GŒG‹Œˆ“š”–UG

G

h–šG œ•Š–•ç™–šG ‹ˆG zŒíé–G wùšTŽ™ˆ‹œˆíé–G ‹ˆG mˆŠœ“‹ˆ‹ŒG ‹ŒG tŒ‹Š•ˆG‹ŒGi–›œŠˆ›œSGqˆ•Œ›ŒGh—ˆ™ŒŠ‹ˆGoŒ™Šœ“ˆ•–Guœ•ŒšGz“ˆSGs“ˆ•Gj™š›•ˆG uˆ‹ˆ“G iˆ•ŠSG uˆ›ˆ•ˆŒ“G w•Œ™–G zˆ““ŒšSG h•‹™ïˆG wˆœ“ˆG s–•Ž–G kŒ‹ïSG Œ”G Œš—ŒŠˆ“SGæGyŒŽ•ˆGjˆGz—ˆ‹•SG—Œ“–Gˆ—––SGšŒŽœ™ˆ•íˆGŒGšŒ™Œ•‹ˆ‹ŒUG G hG jŒ“Œ•ŒG tˆ™ˆG jˆ™ˆ“–G nˆ•‹•G ŒG ˆ–G tˆ™Š–šG y–‰Œ™›–G m™ˆ•ŠSG œ•Š–•ç™–šG ‹–G sˆ‰–™ˆ›ù™–G ‹ŒG p”œ•–š›–˜œó”ŠˆG ‹–G kŒ—ˆ™›ˆ”Œ•›–G ‹ŒG wˆ›–“–ŽˆG‹ˆGmˆŠœ“‹ˆ‹ŒG‹ŒGtŒ‹Š•ˆG‹ŒGi–›œŠˆ›œUG G h–Gjˆ™“–šGsœ¡GtŽœŒ“SG›ïŠ•Š–G‹ŒG•–™”盐ŠˆSG‹–GkŒ—ˆ™›ˆ”Œ•›–G‹ŒG j™œ™ŽˆG ŒG v™›–—Œ‹ˆG ‹ˆG mˆŠœ“‹ˆ‹ŒG ‹ŒG tŒ‹Š•ˆG ‹ŒG i–›œŠˆ›œSG —Œ“ˆG ˆ‘œ‹ˆG •ˆG ‹Ž›ˆíé–GŒG”—™Œššé–G‹Œš›ŒG›™ˆ‰ˆ“–UG

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Curcelli EC. Prognóstico em osteossarcoma

G hnyhkljptlu{vGlzwljphsG G h–G —™–Œšš–™G ‹–œ›–™G z–G zžˆ•G tӓŒ™SG ”ˆšG ˜œŒG –™Œ•›ˆ‹–™SG ˆ”Ž–G‹Œš‹ŒG–šG—™”Œ™–šG›Œ”—–šG‹ˆGˆŠœ“‹ˆ‹ŒG˜œŒSGŠ–”G”œ›ˆGŠ–”—Œ›ð•ŠˆSG —Œ™šŒŒ™ˆ•íˆGŒG—ˆŠð•ŠˆSGŠ–•šŒŽœœGŒŸ›™ˆ™G‹ŒG””GŒš›ˆG›ŒšŒUG G ÆG —™–Œšš–™ˆG ‹–œ›–™ˆG h•Œ›ŒG r•œ”G |Œ‹ˆSG ‰™“ˆ•›ŒG ŒG ”Œ›Šœ“–šˆG —ˆ›–“–Žš›ˆSGŠ–T–™Œ•›ˆ‹–™ˆG‹Œš›ŒG›™ˆ‰ˆ“–UG G h–G —™–Œšš–™G ‹–œ›–™G v‹ˆ™G jˆ™“›–G tŠŒ“•SG ˜œŒG çG ”œ›–G ›Œ”—–G –™Œ•›ˆGŒGŒŸŒŠœ›ˆGˆG”ˆ–™ˆG‹–šG›™ˆ›ˆ”Œ•›–šG˜œ”–›Œ™ç—Š–šG‹–G o–š—›ˆ“G‹ˆšG j“󕐊ˆšG‹ˆGmˆŠœ“‹ˆ‹ŒG‹ŒGtŒ‹Š•ˆG‹ŒGi–›œŠˆ›œSGšŒ”—™ŒG‹ŒG”ˆ•Œ™ˆG‹š—–š›ˆSG ŒŠŒ•›ŒGŒGŠœ‹ˆ‹–šˆUG

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Curcelli, EC. Prognóstico em osteossarcoma

G G G G G G G G G G G G G G G G G

oçGœ”G›Œ”—–GŒ”G˜œŒGïG—™ŒŠš–G

ˆ‰ˆ•‹–•ˆ™GˆšG™–œ—ˆšGœšˆ‹ˆšSG

G˜œŒG‘çG›ð”GˆG–™”ˆG‹–G•–šš–GŠ–™—–SG

GŒGŒš˜œŒŠŒ™G–šG•–šš–šGŠˆ”•–šSG

˜œŒG•–šG“Œˆ”GšŒ”—™ŒGˆ–šG”Œš”–šG“œŽˆ™ŒšUG

GÏG–G›Œ”—–G‹ˆG›™ˆŒššˆaG

ŒSGšŒG•é–G–œšˆ™”–šGˆ¡ðT“ˆSG

G›Œ™Œ”–šGŠˆ‹–SG—ˆ™ˆGšŒ”—™ŒSG

GæG”ˆ™ŽŒ”G‹ŒG•ùšG”Œš”–šUG

mŒ™•ˆ•‹–GwŒšš–ˆG

G

G

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Curcelli EC. Prognóstico em osteossarcoma

ylz|tvG G jœ™ŠŒ““G ljUG G w™–Ž•ùš›Š–G Œ”G –š›Œ–ššˆ™Š–”ˆaG ˆ•ç“šŒG Š“󕐊ˆSG Œ—‹Œ”–“ùŽŠˆSG š›–—ˆ›–“ùŽŠˆG ŒG ”œ•–Tš›–˜œó”ŠˆG ‚{ŒššG ˀG k–œ›–™ˆ‹–„UG i–›œŠˆ›œaG mˆŠœ“‹ˆ‹ŒG‹ŒGtŒ‹Š•ˆG‹ŒGi–›œŠˆ›œSG|•Œ™š‹ˆ‹ŒGlš›ˆ‹œˆ“Gwˆœ“š›ˆbGYWW_UG l”G ]`G —ˆŠŒ•›ŒšG Š–”G ‹ˆŽ•ùš›Š–G ‹ŒG –š›Œ–ššˆ™Š–”ˆG ùššŒ–SG —™”癐–G ŒG šŒŠœ•‹ç™–SGšœ‰”Œ›‹–šGˆG›™ˆ›ˆ”Œ•›–G•–Go–š—›ˆ“G‹ˆšGj“󕐊ˆšG‹ˆGmˆŠœ“‹ˆ‹ŒG‹ŒG tŒ‹Š•ˆG‹ŒGi–›œŠˆ›œSG|•Œš—GOi–›œŠˆ›œGTGzwPGŒG•–Go–š—›ˆ“Gh”ˆ™ˆ“Gjˆ™ˆ“–G OqˆĀG TG zwPSG •–G —Œ™ó–‹–G ‹ŒG X``WG ˆG YWW[SG –G Œ™Šˆ‹ˆG ˆG —–ššóŒ“G ˆšš–Šˆíé–G Œ•›™ŒG —™–Ž•ùš›Š–G ŒG ˆ›–™ŒšG Š“󕐊–šSG Œ—‹Œ”–“ùŽŠ–šSG š›–—ˆ›–“ùŽŠ–šG ŒG ”œ•–Tš›–˜œó”Š–šUGvšG—ˆŠŒ•›ŒšG–™ˆ”Gšœ‰”Œ›‹–šGˆG‹Œ™Œ•›ŒšG—™–›–Š–“–šG ‹ŒG ›™ˆ›ˆ”Œ•›–G ŒSG •ˆG ”ˆ–™ˆG ‹ˆšG —ŒíˆšG ‹ŒG ™ŒššŒŠíé–G ›œ”–™ˆ“SG —™–ŠŒ‹ŒœTšŒG æG ˜œˆ•›Šˆíé–G ‹–G ŒŒ›–G ˜œ”–›Œ™ç—Š–G •Œ–Tˆ‹‘œˆ•›ŒG ‹ŒG ˆŠ–™‹–G Š–”G –šG Š™›ï™–šG —™ŒŠ–•¡ˆ‹–šG —–™G oœ–šG OX``XPUG všG ‹ˆ‹–šG –™ˆ”G Š–“Œ›ˆ‹–šG ‹–šG —™–•›œç™–šG –š—›ˆ“ˆ™ŒšG ŒG •ˆšG ˆ”–š›™ˆšG ‹ˆG ‰ù—šˆG ùššŒˆSG ™Œˆ“¡ˆ‹ˆG —™ïT ›™ˆ›ˆ”Œ•›–SG –G Œ™Šˆ‹ˆG ˆG –Š–™™ð•ŠˆG ‹ŒG ˆ—–—›–šŒG ŒG ‹ˆG ŒŸ—™Œššé–G ‹ˆG —™–›Œó•ˆG—\ZSG—Œ“–G”ï›–‹–G”œ•–Tš›–˜œó”Š–GO{œ•Œ“GŒGhijPUGvšG ™Œšœ“›ˆ‹–šG –™ˆ”Gšœ‰”Œ›‹–šGæGˆ•ç“šŒGœ•ˆ™ˆ‹ˆG‹ŒGš–‰™Œ‹ˆGŠ–”GŠ–•š›™œíé–G‹ŒGŠœ™ˆšG ‹ŒG rˆ—“ˆ•TtŒŒ™UG hšG ˆšš–ŠˆíûŒšG Œ•›™ŒG —™–ŠŒ‹”Œ•›–G Š™Ā™ŽŠ–G ŒG Ž™ˆœG ‹ŒG •ŒŠ™–šŒGŒSGŒ•›™ŒG™ŒŠ‹ˆGŒGŽ™ˆœG‹ŒG•ŒŠ™–šŒSG–™ˆ”Gˆ•ˆ“šˆ‹ˆšG—Œ“–G{Œš›ŒG‹ŒG n––‹”ˆ•GOn––‹”ˆ•SGX`][SX`]\PUGm–GŠ–•š›ˆ›ˆ‹–G˜œŒGˆšGˆ™çŒšSG‹ˆ‹ŒSGšŒŸ–SG Š“ˆššŠˆíé–Gš›–“ùŽŠˆGŒG“–Šˆ“¡ˆíé–G‹–G›œ”–™SG•é–Gˆ—™ŒšŒ•›ˆ™ˆ”Gˆšš–Šˆíé–G Š–”G —™–Ž•ùš›Š–bG —ˆŠŒ•›ŒšG Š–”G ›œ”–™ŒšG Œš›ç‹–G pppG ˆ—™ŒšŒ•›ˆ”G —–™G —™–Ž•ùš›Š–UG h‰ˆ•‹–•–G ‹ŒG ›™ˆ›ˆ”Œ•›–G Œš›çG ˆšš–Šˆ‹–G ˆG —–™G —™–Ž•ùš›Š–G ŒG ™Œ“ˆŠ–•ˆ‹–G æG Œ–“œíé–G Š“󕐊ˆG •šˆ›šˆ›ù™ˆbG Š™œ™ŽˆG ‹ŒG ˆ”—œ›ˆíé–G –G •‹Šˆ‹–™G •‹™Œ›–G ‹ŒG ”ˆœG —™–Ž•ùš›Š–SG —–šG –G ™Œˆ“¡ˆ‹ˆG Œ”G G —ˆŠŒ•›ŒšG Š–”G ›œ”–™ŒšG ˆˆ•íˆ‹–šG –œG ˜œŒG •é–G ™Œš—–•‹Œ™ˆ”G ˆ–G ›™ˆ›ˆ”Œ•›–G ˜œ”–›Œ™ç—Š–G •Œ–Tˆ‹‘œˆ•›ŒbG Š–”—“ŠˆíûŒšSG š–‰™Œ›œ‹–G ™ŒŠ‹ˆG “–Šˆ“SG Œš›é–G ™Œ“ˆŠ–•ˆ‹ˆšG ˆG ”ˆœG —™–Ž•ùš›Š–G ŒG •ŒŠ™–šŒG —ùšT˜œ”–›Œ™ˆ—ˆG ˆ—™ŒšŒ•›–œG ˆšš–Šˆíé–G

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Resumo

šŽ•Šˆ›ˆG Š–”G š–‰™Œ‹ˆUG o–œŒG –Š–™™ð•ŠˆG ‹ŒG ˆ—–—›–šŒG ŒG ŒŸ—™Œššé–G ‹ˆG —™–›Œó•ˆG —\ZG ”œ›ˆ•›ŒG •ˆšG ˆšŒšG •ŠˆšG ‹–G –š›Œ–ššˆ™Š–”ˆSG —–™ï”G šŒ”G ˆšš–Šˆíé–GŠ–”G—™–Ž•ùš›Š–UG wˆ“ˆ™ˆšTŠˆŒaG –š›Œ–šˆ™Š–”ˆbG —™–Ž•ùš›Š–bG Œ–“œíé–G Š“󕐊ˆbG Œ—‹Œ”–“–ŽˆbG —ˆ›–“–ŽˆbG”œ•–š›–˜œó”ŠˆUG

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Abstract

hiz{yhj{G G jœ™ŠŒ““G ljUG w™–Ž•ùš›Š–G Œ”G –š›Œ–ššˆ™Š–”ˆaG ˆ•ç“šŒG Š“󕐊ˆSG Œ—‹Œ”–“ùŽŠˆSG š›–—ˆ›–“ùŽŠˆG ŒG ”œ•–Tš›–˜œó”ŠˆG ‚{ŒššG ˀG k–œ›–™ˆ‹–„UG i–›œŠˆ›œaG mˆŠœ“‹ˆ‹ŒG‹ŒGtŒ‹Š•ˆG‹ŒGi–›œŠˆ›œSG|•Œ™š‹ˆ‹ŒGlš›ˆ‹œˆ“Gwˆœ“š›ˆbGYWW_UG hG —–šš‰“ŒG ˆšš–Šˆ›–•G ‰Œ›žŒŒ•G —™–Ž•–ššG ˆ•‹G Š“•Šˆ“SG Œ—‹Œ”–“–ŽŠˆ“SG š›–—ˆ›–“–ŽŠˆ“SG ˆ•‹G ””œ•–š›–ŠŒ”Šˆ“G ˆŠ›–™šG žˆšG Œˆ“œˆ›Œ‹G •G ]`G —ˆ›Œ•›šG ž›G Š–•™”Œ‹G ‹ˆŽ•–ššG –G —™”ˆ™ G ˆ•‹G šŒŠ–•‹ˆ™ G ‰–•ŒG –š›Œ–šˆ™Š–”ˆG›™Œˆ›Œ‹G•G›ŒG|•Œ™š› Go–š—›ˆ“G–Gi–›œŠˆ›œGtŒ‹Šˆ“GzŠ––“SG zŠ––“G –G tŒ‹Š•ŒG |•Œ™š› G o–š—›ˆ“SG |•Œš—G Oi–›œŠˆ›œSG zwSG i™ˆ¡“PG ˆ•‹G •G h”ˆ™ˆ“Gjˆ™ˆ“–Go–š—›ˆ“GOqˆĀSGzwSGi™ˆ¡“PSG™–”GX``WG›–GYWW[UGwˆ›Œ•›šGžŒ™ŒG ›™Œˆ›Œ‹G ‰ G ‹Œ™Œ•›šG ›™Œˆ›”Œ•›G —™–›–Š–“šG ˆ•‹G •G ›ŒG ”ˆ‘–™› G –G ™ŒšŒŠ›Œ‹G ›œ”–œ™Gšˆ”—“ŒšG›ŒGŒŒŠ›šG–G•Œ–ˆ‹‘œˆ•›GŠŒ”–›Œ™ˆ— GžŒ™ŒGˆ•ˆ“ ¡Œ‹Gœš•ŽG oœ–šGŠ™›Œ™ˆGOX``XPUGkˆ›ˆGžŒ™ŒGŠ–““ŒŠ›Œ‹G™–”G”Œ‹Šˆ“G™ŒŠ–™‹šGˆ•‹G•G—™ŒT ›™Œˆ›”Œ•›G‰–•ŒG‰–—šŒšSGˆ—–—›–ššGˆ•‹G—\ZG—™–›Œ•GŒŸ—™Œšš–•GžŒ™ŒGŒˆ“œˆ›Œ‹G ‰ G ””œ•–š›–ŠŒ”š›™ G O{œ•Œ“G ˆ•‹G hijPUG {ŒG ™Œšœ“›šG G žŒ™ŒG šœ‰”››Œ‹G ›–G œ•ˆ™ˆ•›ˆ›ŒGˆ•ˆ“ ššGˆ•‹GŽ“–‰ˆ“Gšœ™ˆ“Gˆ•ˆ“ ¡Œ‹G‰ Grˆ—“ˆ•TtŒŒ™Gšœ™ˆ“G Šœ™ŒšUGhšš–Šˆ›–•G‰Œ›žŒŒ•Gšœ™ŽŠˆ“G—™–ŠŒ‹œ™ŒGˆ•‹G•ŒŠ™–šš“ŒŒ“G–™G™Œ“ˆ—šŒG žˆšG ›Œš›Œ‹G œš•ŽG n––‹”ˆ•G ›Œš›G –™G ‹Œ™Œ•ŠŒšG ‰Œ›žŒŒ•G ˆ•‹G •G ”œ“›•–”ˆ“G —–—œ“ˆ›–•šG On––‹”ˆ•SG X`][SG X`]\PUG u–G ˆšš–Šˆ›–•G žˆšG –œ•‹G ‰Œ›žŒŒ•G —™–Ž•–ššGˆ•‹GˆŽŒSGŽŒ•‹Œ™SG›ššœŒG—™Œ‹–”•ˆ•ŠŒGˆ•‹G›œ”–œ™G“–Šˆ›–•bG—ˆ›Œ•›šG ž›G š›ˆŽŒG pppG ›œ”–œ™šG —™ŒšŒ•›Œ‹G ž–™šŒG —™–Ž•–ššUG {™Œˆ›”Œ•›G ž›‹™ˆžˆ“G ”—“Œ‹G •G ž–™šŒG —™–Ž•–ššSG ˆšG ˆG Š–•šŒ˜œŒ•ŠŒG –G œ•šˆ›šˆŠ›–™ G Š“•Šˆ“G

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Curcelli EC. Prognóstico em osteossarcoma

Œ–“œ›–•bGˆ”—œ›ˆ›–•GžˆšGˆ•G•‹™ŒŠ›Œ‹GˆŠ›–™G–G‰ˆ‹G—™–Ž•–ššGˆšGˆG—–šš‰“ŒG Š–•šŒ˜œŒ•ŠŒG–G›šG•‹Šˆ›–•G–™G—ˆ›Œ•›šGž›Gˆ‹ˆ•ŠŒ‹G›œ”–œ™šG–™G–™G›–šŒG ž›–œ›G ™Œš—–•šŒG ›–G •Œ–ˆ‹‘œˆ•›G ŠŒ”–›Œ™ˆ— UG j–”—“Šˆ›–•šSG Œš—ŒŠˆ““ G “–Šˆ“G ™Œ“ˆ—šŒSG žŒ™ŒG ™Œ“ˆ›Œ‹G ›–G ‰ˆ‹G —™–Ž•–ššbG ž“ŒG —–š›G ŠŒ”–›Œ™ˆ— G •ŒŠ™–ššG ˆ‹G ˆG š›ˆ›š›Šˆ““ G šŽ•Šˆ•›G ˆšš–Šˆ›–•G ž›G šœ™ˆ“UG {Œ™ŒG žˆšG ˆ—–—›–ššG ˆ•‹G ”œ›ˆ•›G —™–›Œ•G —\ZG ŒŸ—™Œšš–•G ›ˆ›G •›ˆ“G —ˆšŒšG –G –š›Œ–šˆ™Š–”ˆSG‰œ›Gž›–œ›Gˆ• Gˆšš–Šˆ›–•Gž›G—™–Ž•–ššUGG rŒ ž–™‹šaG –š›Œ–šˆ™Š–”ˆbG —™–Ž•–ššbG Š“•Šˆ“G Œ–“œ›–•bG Œ—‹Œ”–“–Ž bG —ˆ›–“–Ž bG””œ•–š›–ŠŒ”š›™ UG G

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Curcelli EC. Prognóstico em osteossarcoma

z|tÇypvG G yŒšœ”–G h‰š›™ˆŠ›G XGp•›™–‹œíé–UUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUYXG YGyŒšé–G‹ˆG“›Œ™ˆ›œ™ˆUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGY\G YUXGp‹ˆ‹ŒUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGY^G YUYGzŒŸ–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGY_G YUZGs–Šˆ“¡ˆíé–G‹–G›œ”–™GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGY`G YU[Gk”Œ•šé–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGZWG YU\Gj“ˆššŠˆíé–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGZXG YU]Glš›ˆ‹ˆ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGZ\G YU^G{™ˆ›ˆ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGZ^G YU^UXGxœ”–›Œ™ˆ—ˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGZ^G YU^UYGj™œ™ŽˆG‹–G›œ”–™G—™”癐–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGZ_G YU_GyŒš—–š›ˆGš›–“ùŽŠˆGæG˜œ”–›Œ™ˆ—ˆG—™ïT–—Œ™ˆ›ù™ˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGZ`G YU`Gvœ›™–šGˆ›–™ŒšGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG[XG YUXWGvGŽŒ•ŒG

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Sumário

G \GyŒšœ“›ˆ‹–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU^_G \UXG{Œ”—–G‹ŒGšŒŽœ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG^`G \UYGp‹ˆ‹ŒGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG^`G \UZGzŒŸ–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_WG \U[Gs–Šˆ“¡ˆíé–G‹–G›œ”–™GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_XG \U\Gj“ˆššŠˆíé–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_YG \U]Glš›ˆ‹ˆ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_ZG \U^Gh‹Œšé–Gˆ–G›™ˆ›ˆ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_ZG \U_Gw™–›–Š–“–G‹ŒG›™ˆ›ˆ”Œ•›–G˜œ”–›Œ™ç—Š–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_[G \U`Gj™œ™ŽˆG‹–G›œ”–™G—™”癐–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_\G \UXWGj–”—“ŠˆíûŒšG‹–G›™ˆ›ˆ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_^G \UXXGyŒš—–š›ˆGš›–“ùŽŠˆGæG˜œ”–›Œ™ˆ—ˆG—™ïT–—Œ™ˆ›ù™ˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUG_`G \UXYGl–“œíé–GŠ“󕐊ˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG`WG \UXZGlŸ—™Œššé–G‹ˆG—™–›Œó•ˆG—\ZGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG`WG \UX[Gӕ‹ŠŒG‹ŒGˆ—–—›–šŒGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG`XG \UX\Gh•ç“šŒG‹ˆGš–‰™Œ‹ˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUG`XG \UX]Gjœ™ˆšG‹ŒGš–‰™Œð•ŠˆG‹ŒGˆŠ–™‹–GŠ–”G”ï›–‹–G‹ŒGrˆ—“ˆ•TtŒŒ™GUUUUUG`\G ]GkšŠœššé–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXWYG ]UXGjˆšœóš›ŠˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXWZG ]UYGlš›ˆ‹ˆ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXWZG ]UZG{™ˆ›ˆ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUXW\G ]UZUXG{™ˆ›ˆ”Œ•›–G˜œ”–›Œ™ç—Š–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXW\G ]UZUYG{™ˆ›ˆ”Œ•›–GŠ™Ā™ŽŠ–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXW]G ]UZUZGj–”—“ŠˆíûŒšG‹–G›™ˆ›ˆ”Œ•›–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXW^G ]U[GyŒš—–š›ˆGš›–“ùŽŠˆGæG˜œ”–›Œ™ˆ—ˆG—™ïT–—Œ™ˆ›ù™ˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXXWG ]U\Gz–‰™Œ‹ˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXXXG ]U]GlŸ—™Œššé–G‹ˆG—™–›Œó•ˆG—\ZGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXXYG ]U]UXGtŒ›–‹–“–ŽˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXXYG ]U]UYGyŒšœ“›ˆ‹–šGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXX[G

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Curcelli EC. Prognóstico em osteossarcoma

G ]U^Gӕ‹ŠŒG‹ŒGˆ—–—›–šŒGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXX^G ]U^UXGtŒ›–‹–“–ŽˆGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXX^G ]U^UYGyŒšœ“›ˆ‹–šGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXX`G ^Gj–•š‹Œ™ˆíûŒšG•ˆšGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXYYG _Gj–•Š“œšé–GUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXY\G yŒŒ™ð•ŠˆšGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGXY^G h—𕋐ŠŒGUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGX]YG

G

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Curcelli EC. Prognóstico em osteossarcoma

22

X pu{yvk|ÍÉv G w–‹ŒTšŒG Š–•š‹Œ™ˆ™G ˜œŒG ŒŸš›ŒG Š–•šŒ•š–G ˆŠŒ™ŠˆG ‹–šG ˆˆ•í–šG –‰›‹–šG•–G›™ˆ›ˆ”Œ•›–G‹–šG—ˆŠŒ•›ŒšG—–™›ˆ‹–™ŒšG‹ŒG–š›Œ–ššˆ™Š–”ˆUG hšG •–ˆšG —™–—–š›ˆšG ›Œ™ˆ—𜛐ŠˆšG ŒG ›ïŠ•ŠˆšG ‹ˆŽ•ùš›ŠˆšG ˆ“ˆ‹ˆšG æG ˆ‰–™‹ˆŽŒ”G ”œ“›‹šŠ—“•ˆ™G Š–•›™‰œó™ˆ”G —ˆ™ˆG Œ“Œˆ™G ˆG š–‰™Œ‹ˆG ‹ˆG ”ˆ–™ˆG ‹–šG—ˆŠŒ•›ŒšGŠ–”G–š›Œ–ššˆ™Š–”ˆUGhGˆšš–Šˆíé–GŒ•›™ŒG˜œ”–›Œ™ˆ—ˆGˆ‹‘œˆ•›ŒG ŒG Š™œ™ŽˆG ›–™•–œG —–ššóŒ“G –G Š–•›™–“ŒG šš›ð”Š–G ‹ˆG ‹–Œ•íˆG ŒG ˆG ŒŸŠšé–G Š–”—“Œ›ˆG‹–G›œ”–™G—™”癐–SG”œ›ˆšGŒ¡ŒšGšŒ”G•ŒŠŒšš‹ˆ‹ŒG‹ŒGˆ”—œ›ˆíé–UG j–•›œ‹–SGœ”G›Œ™í–G‹–šG—ˆŠŒ•›ŒšG—–™›ˆ‹–™ŒšG‹ŒG–š›Œ–ššˆ™Š–”ˆG•é–G œšœ™œ™é–G ‹ŒššŒšG ‰Œ•ŒóŠ–šUG l”G ŽŒ™ˆ“SG šé–G —ˆŠŒ•›ŒšG ˜œŒSG •–G ‹ŒŠ–™™Œ™G ‹–G ›™ˆ›ˆ”Œ•›–SGˆ—™ŒšŒ•›ˆ™é–G‰ˆŸ–G󕋐ŠŒG‹ŒG•ŒŠ™–šŒG›œ”–™ˆ“GŒ”G‹ŒŠ–™™ð•ŠˆG‹–G ›™ˆ›ˆ”Œ•›–G˜œ”–›Œ™ç—Š–SGˆ“›–G™šŠ–G‹ŒG™ŒŠˆó‹ˆG‹ˆG‹–Œ•íˆGŒSG•Œ›ˆŒ“”Œ•›ŒSG Šœ™›ˆGš–‰™Œ‹ˆUGkˆG”Œš”ˆG–™”ˆSG–šG—ˆŠŒ•›ŒšG˜œŒGˆ—™ŒšŒ•›ˆ”G”Œ›çš›ˆšŒšGˆ–G ‹ˆŽ•ùš›Š–SG —Œ™”ˆ•ŒŠŒ”G Š–”G —Œ™š—ŒŠ›ˆG Š“󕐊ˆG ˆ‹Œ™šˆG OmŒ™Žœš–•G MG n––™•SGYWWXbG~ˆ•ŽSGYWW\PUGG l”G X``YSG tŒ Œ™šG Œ›G ˆ“UGG ˆ“Œ™›ˆˆ”G —ˆ™ˆG ˆG •ŒŠŒšš‹ˆ‹ŒG ‹ŒG šŒG ˆœ”Œ•›ˆ™G–G•Ā”Œ™–G‹ŒG—ˆŠŒ•›ŒšGŠ–”G™Œš—–š›ˆGˆ–™çŒ“SG‹Œ•›Šˆ•‹–G–šG˜œŒG —–‹Œ™ˆ”G›Œ™G™Œš—–š›ˆG‹Œšˆ–™çŒ“GŒSG—ˆ™ˆGŒššŒšSG‰œšŠˆ™G•–ˆšGŒš›™ˆ›ïŽˆšG‹ŒG ›™ˆ›ˆ”Œ•›–UG

oˆ”G Œ›G ˆ“UG OX``_PG ™ŒŠ–•ŒŠŒ™ˆ”G ˜œŒG –G —™–Ž™Œšš–G •Šˆ“G ‹–G ›™ˆ›ˆ”Œ•›–G‹–G–š›Œ–ššˆ™Š–”ˆG‰ˆšŒˆ‹–G•ˆGˆ›œˆíé–G”œ“›—™–šš–•ˆ“Gˆœ”Œ•›ˆˆG ˆG —–šš‰“‹ˆ‹ŒG ‹ŒG š–‰™Œ‹ˆG ŒG ˆG ›ˆŸˆG ‹ŒG Š™œ™ŽˆG Š–•šŒ™ˆ‹–™ˆUG u–G Œ•›ˆ•›–SG Gw™–‘Œ›–Gˆ—™–ˆ‹–G—Œ“–Gj–”›ðG‹ŒGϛŠˆGŒ”GwŒš˜œšˆG‹ˆGmˆŠœ“‹ˆ‹ŒG‹ŒGtŒ‹Š•ˆG‹ŒGi–›œŠˆ›œGˀG |•Œš—SG—ˆ™ŒŠŒ™GXY_GVYWW[TjlwSG‹ŒGW\G‹ŒGˆ‰™“G‹ŒGYWW[UG w™–‘Œ›–G—ˆ™Šˆ“”Œ•›ŒG•ˆ•Šˆ‹–G—Œ“ˆGmœ•‹œ•Œš—UG yŒŽ™ˆšG‹ŒG•–”Œ•Š“ˆ›œ™ˆGŽŒ•ï›ŠˆGˆ‹–›ˆ‹ˆšaG o|nvGnŒ•ŒGu–”Œ•Š“ˆ›œ™ŒGj–””››ŒŒUG‚œ—‹ˆ›Œ‹Gtˆ™ŠGYWW^„bGŠ›Œ‹GY]Gh—™GYWW_UGGhˆ“ˆ‰“ŒG ™–”aG››—aVVžžžUŽŒ•ŒUœŠ“UˆŠUœ’V•–”Œ•Š“ˆ›œ™ŒUG z—“Œ•‹–™ŒGhUGwˆ™ˆG˜œŒGŒŸš›Œ”GˆšG™ŒŽ™ˆšG‹ŒG•–”Œ•Š“ˆ›œ™ˆGŽŒ•ï›ŠˆUGyŒGi™ˆšGoŒ”ˆ›–“G oŒ”ˆ›–›Œ™UGYWW\bGY^SX[_T\YUG

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Introdução

23

”ˆšG‹ŒG[WLG‹–šG—ˆŠŒ•›ŒšGˆ•‹ˆG—–‹Œ™ˆ”G”–™™Œ™GŠ–”G‹–Œ•íˆG”Œ›ˆš›çš›ŠˆSGˆG ‹Œš—Œ›–G‹–G™ŒŽ”ŒG›Œ™ˆ—𜛐Š–UGwˆ™ˆGŒššŒšG—ˆŠŒ•›ŒšSG—™–—œšŒ™ˆ”GˆG‰œšŠˆG‹ŒG •–ˆšGˆ‰–™‹ˆŽŒ•šG›Œ™ˆ—𜛐ŠˆšGŒG•‹Šˆ‹–™ŒšG‹ŒG—™–Ž•ùš›Š–UG wˆ™ˆG ~œ•‹Œ™G Œ›G ˆ“UG OYWW\PSG Œ”‰–™ˆG ˆG Œ–“œíé–G ‹–šG —ˆŠŒ•›ŒšG Š–”G –š›Œ–ššˆ™Š–”ˆG ›Œ•ˆG ˆ—™ŒšŒ•›ˆ‹–G šŽ•Šˆ›ˆG ”Œ“–™ˆG •ˆšG ‹œˆšG Ā“›”ˆšG ‹ïŠˆ‹ˆšSG ˆ•‹ˆG •é–G –G —–ššóŒ“G ‹”•œ™G –G •Ā”Œ™–G ‹ŒG —ˆŠŒ•›ŒšG ˜œŒG •é–G ™Œš—–•‹Œ”Gˆ–G›™ˆ›ˆ”Œ•›–UGÏG•ŒŠŒššç™–SGˆ•‹ˆSG‹ŒšŒ•–“Œ™G•–ˆšGŒš›™ˆ›ïŽˆšG ›Œ™ˆ—𜛐ŠˆšG ŒG ‹Œ•›Šˆ™G •–G ”–”Œ•›–G ‹–G ‹ˆŽ•ùš›Š–SG –šG —ˆŠŒ•›ŒšG ˜œŒG —–›Œ•Šˆ“”Œ•›ŒG ™Œš—–•‹Œ™é–G ‹ŒG ”–‹–G ‹Œšˆ–™çŒ“SG šœ‰”Œ›Œ•‹–T–šG ˆG —™–—–š›ˆšG›Œ™ˆ—𜛐ŠˆšG‹Œ™Œ•Šˆ‹ˆšUGG hG ˆ—–—›–šŒSG –œG ”–™›ŒG ŠŒ“œ“ˆ™G —™–Ž™ˆ”ˆ‹ˆSG ›Œ”G —ˆ™›Š—ˆíé–G ”—–™›ˆ•›ŒG •–G ‹ŒšŒ•–“”Œ•›–G ›œ”–™ˆ“SG ‹Œ›Œ™”•ˆ•‹–G Š™ŒšŠ”Œ•›–G ŒG ˆŽ™Œšš‹ˆ‹ŒG Oz‰ˆ›ˆGMGGtˆ›šœ‰ˆ™ˆSGYWWXbGrŒ““ GŒ›Gˆ“USGGYWWZbGGwŒ™Œ™ˆGŒ›Gˆ“USG YWWZPUG wˆ™ˆ

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iˆšœG Œ›G ˆ“UG OYWW]PG •‰íé–G ‹ˆG ˆ—–—›–šŒG —–‹ŒG Š–•š››œ™G ˆš—ŒŠ›–G Š–”œ”GˆG›–‹ˆšGˆšG•Œ–—“ˆšˆšSG•“œŒ•Šˆ•‹–G•óŠ–SG—™–Ž™Œššé–GŒGŠœ™š–GŠ“󕐊–UGG n™ˆ•‹ŒG•Ā”Œ™–G‹ŒGŒš›œ‹–šGš–‰™ŒGˆ—–—›–šŒG‰œšŠˆGŒ“œŠ‹ˆ™G–G—ˆ—Œ“G‹ˆG ”–™›ŒGŠŒ“œ“ˆ™G—™–Ž™ˆ”ˆ‹ˆG•ˆG–•Š–Žð•ŒšŒGŒG•–G›™ˆ›ˆ”Œ•›–G‹–GŠè•ŠŒ™GOqˆGŒ›Gˆ“USG YWW[PUGwŒš˜œšˆšG•ŒššŒGŠˆ”—–G›ð”Gš‹–G™Œˆ“¡ˆ‹ˆšGŠ–”G™Œ˜Ă𕊐ˆGŒG–G󕋐ŠŒG ‹ŒG ˆ—–—›–šŒG ›Œ”G š‹–G ™Œ—–™›ˆ‹–G Š–”–G •‹Šˆ‹–™G ‹ŒG —™–Ž•ùš›Š–G —ˆ™ˆG ç™–šG ›œ”–™ŒšSG š–‰™Œ›œ‹–G Šˆ™Š•–”ˆšG Oz‰ˆ›ˆG MG tˆ›šœ‰ˆ™ˆSG YWWXbG rŒ““ G Œ›G ˆ“USG YWWZbGwŒ™Œ™ˆSGŒ›Gˆ“USGYWWZPUGG vGŽŒ•ŒGšœ—™Œšš–™G

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G—ˆ™ŒŠŒG›Œ™G”—–™›ˆ•›ŒGœ•íé–G•–GŠ–•›™–“ŒG‹–G ŠŠ“–G ŠŒ“œ“ˆ™SG ”ˆ•œ›Œ•íé–G ‹ˆG Œš›ˆ‰“‹ˆ‹ŒG ŽŒ•ú”ŠˆSG ‹Œ™Œ•Šˆíé–G ŠŒ“œ“ˆ™G ŒG ˆ—–—›–šŒUGhG”œ›ˆíé–G‹–GŽŒ•ŒG

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ŒGˆGŒŸ—™Œššé–G‹ˆG—™–›Œó•ˆG—\ZG›ð”Gš‹–G ™Œ“ˆŠ–•ˆ‹ˆšGˆG”Ā“›—“–šGˆš—ŒŠ›–šG•ˆG”ˆ–™ˆG‹ˆšG•Œ–—“ˆšˆšGOqˆGŒ›Gˆ“USGYWW[PUGG wˆ™ˆG ~œ•‹Œ™G Œ›G ˆ“UG OYWW\PSG –G ŽŒ•ŒG šœ—™Œšš–™G ‹ŒG ›œ”–™G

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G ŒG ˆG —™–›Œó•ˆG —\ZG šŒ™ˆ”G —–ššóŒšG Šˆ•‹‹ˆ›–šG ˆG ”ˆ™Šˆ‹–™ŒšG ‹ŒG —™–Ž•ùš›Š–G ‹ŒG –š›Œ–ššˆ™Š–”ˆšUG n™ˆ•‹ŒG ˆ™Œ‹ˆ‹ŒG ‹ŒG ›œ”–™ŒšSG •Š“œšŒG –G –š›Œ–ššˆ™Š–”ˆSG ‹ŒšŒ•–“ŒTšŒG •ˆG ‹ŒŠð•ŠˆG ‹–G

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Š–•š‹Œ™ˆ‹–G œ”G ‹–šG ŽŒ•ŒšG ”ˆšG ™Œ˜ĂŒ•›Œ”Œ•›ŒG”œ›ˆ‹–GŒ”G•Œ–—“ˆšˆšGœ”ˆ•ˆšUGl”Gœ”ˆGŽ™ˆ•‹ŒGˆ™Œ‹ˆ‹ŒG‹ŒG

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Curcelli EC. Prognóstico em osteossarcoma

24

›œ”–™ŒšSG ˆG ”œ›ˆíé–G ‹–G ŽŒ•ŒG

{w\ZG

–œG ˆG ŒŸ—™Œššé–G ‹ˆG —™–›Œó•ˆG —\ZG šé–G —™Œ‹›–šG‹ŒGŒ•ù›—–G›œ”–™ˆ“G”ˆšGˆŽ™Œšš–GŒG‹ŒG—–™GŠœ™š–GŠ“󕐊–UGG n™ˆ•‹ŒšG Œš–™í–šG ›ð”G š‹–G ‹Œš—Œ•‹‹–šG •–G ‹Œ“•Œˆ”Œ•›–G ‹ŒG ˆš—ŒŠ›–šG”–“ŒŠœ“ˆ™ŒšG‹ˆGŠˆ™Š•–Žð•ŒšŒGOmœŠšGMGw™›Šˆ™‹SGYWWYPUGvšGĀ“›”–šG ˆˆ•í–šSG •ˆG 癌ˆG ‹ˆG ‰–“–ŽˆG ”–“ŒŠœ“ˆ™SG ›ð”G Š–•›™‰œó‹–G Š–”G ˆ“–šˆšG •–™”ˆíûŒšG ˆŠŒ™ŠˆG ‹–šG ”ŒŠˆ•š”–šG Œ•–“‹–šG •–G —™–ŠŒšš–G ›œ”–™ˆ“SG —Œ™”›•‹–GˆGŠ–”—™ŒŒ•šé–SGŠˆ‹ˆGŒ¡G”ˆšG‹Œ›ˆ“ˆ‹ˆSG‹ˆšG•Ā”Œ™ˆšG•›Œ™ˆíûŒšG Œ•›™ŒG –šG —™–ŠŒšš–šG ˜œŒG Š–•›™‰œŒ”G Š–”G ˆG —ˆ›–Žð•ŒšŒG ‹–šG ›œ”–™ŒšG OmŒ››T j–•›ŒGMGzˆ““ŒšSGYWWYPUGG wˆ™ˆGmœŠšGMGw™›Šˆ™‹GOYWWYPSGG–

G

”Œ“–™GŒ•›Œ•‹”Œ•›–G‹–šGŒŒ•›–šG ”–“ŒŠœ“ˆ™ŒšG •–šG ›œ”–™ŒšG —–‹Œ™çG ™Œšœ“›ˆ™G Œ”G ‹ˆŽ•ùš›Š–šG ”ˆšG ˆŠœ™ˆ‹–šSG ”Œ“–™ŒšG›Œ™ˆ—ˆšGŒG—™–‘Œ›ˆ™G—™–Ž•ùš›Š–šUGG w–™›ˆ•›–SG Š–•š‹Œ™ˆTšŒG ˜œŒG ˆ”—“ˆ™G –G Š–•ŒŠ”Œ•›–G ŒG ˆ—“Šˆíé–G ‹ˆG ‰–“–ŽˆG ”–“ŒŠœ“ˆ™G —–‹ŒG Š–•›™‰œ™G —ˆ™ˆG ”Œ“–™ˆ™G ˆG Š–”—™ŒŒ•šé–G ‹ˆG ‰–“–ŽˆG ‹–G –š›Œ–ššˆ™Š–”ˆSG ŒG —™–—Šˆ™G ‹ˆŽ•ùš›Š–G —™ŒŠ–ŠŒSG ‹Œ•›Šˆ™G ”ˆœšG ™Œš—–•‹Œ‹–™ŒšG ŒSG š–‰™Œ›œ‹–SG —Œ™”›™G –—íûŒšG ›Œ™ˆ—𜛐ŠˆšG ”ˆšG ™ˆŠ–•ˆšG ŒG ŒŒ›ˆšSG ˜œŒG ˆœ”Œ•›Œ”G ˆG š–‰™Œ‹ˆG ‹–šG —ˆŠŒ•›ŒšG Ooˆ•šŒ•SG X``XbG ~ˆ•ŽSG YWW\PUG

(27)
(28)

G

Curcelli EC. Prognóstico em osteossarcoma

26

YGyl}pzÉvGklGsp{lyh{|yhG hG ‰œšŠˆG —Œ“ˆG ‹Œ•›Šˆíé–G ‹ŒG ˆ›–™ŒšG ˜œŒG —–ššˆ”G ˆ—–•›ˆ™SG ˆ–G ‹ˆŽ•ùš›Š–GŒGŠ–”G—™ŒŠšé–SGˆG™Œš—–š›ˆG›Œ™ˆ—𜛐ŠˆGŒGš–‰™Œ‹ˆG‹–šG—ˆŠŒ•›ŒšG —–™›ˆ‹–™ŒšG ‹ŒG –š›Œ–ššˆ™Š–”ˆG ›Œ”G š‹–G •ŠŒššˆ•›ŒUG w™Œšœ”™G ˆG ˆŽ™Œšš‹ˆ‹ŒG ›œ”–™ˆ“SGŠˆ—ˆŠ‹ˆ‹ŒG‹ŒG•ˆšé–G›ŒŠ‹œˆ“SG—™–‰ˆ‰“‹ˆ‹ŒG‹ŒG™ŒŠ‹ˆSG—™–—Œ•šé–G ˆ–G ‹ŒšŒ•–“”Œ•›–G ‹ŒG ”Œ›çš›ˆšŒšG ŒG ™Œš—–š›ˆG ˆ–G ›™ˆ›ˆ”Œ•›–SG —–‹Œ™çG šŒ™G ˆ“–š–GŒŸ—Œ‹Œ•›ŒG•ˆGŒšŠ–“ˆG‹ˆG—™–—–š›ˆG›Œ™ˆ—𜛐ŠˆUG tˆ•’•GŒ›Gˆ“UGOYWW[PGŠ–•š‹Œ™ˆ™ˆ”G”—–ššóŒ“G‹Œ•™Gœ”GĀ•Š–Gˆ›–™G ˜œŒG—–ššˆG—™Œ‹¡Œ™GˆGŒ–“œíé–G‹–šG—–™›ˆ‹–™ŒšG‹ŒG–š›Œ–ššˆ™Š–”ˆGŒGšœŽŒ™™ˆ”G ˜œŒG —ˆŠŒ•›ŒšG Š–”G ”Œ•–šG ‹ŒG •›ŒG ˆ•–šG ‹ŒG ‹ˆ‹ŒSG Š–”G “Œšé–G ‹ŒG —Œ˜œŒ•ˆG ‹”Œ•šé–SG“–Šˆ“¡ˆ‹ˆGˆ‰ˆŸ–G‹–G‘–Œ“–G–œG‹–GŠ–›–Œ“–SGŒš›ç‹–GpG–œGppSGŠ–”G`WLG –œG ”ˆšG ‹ŒG •ŒŠ™–šŒG ›œ”–™ˆ“G ˆ—ùšG ˆG ˜œ”–›Œ™ˆ—ˆG •Œ–Tˆ‹‘œˆ•›ŒSG —™–ˆŒ“”Œ•›ŒSG ˆ—™ŒšŒ•›ˆ™é–G š–‰™Œ‹ˆG “–•ŽˆUG w–™G šœˆG Œ¡SG —ˆŠŒ•›ŒšG Š–”G ‹ˆ‹ŒG ”ˆšG ˆˆ•íˆ‹ˆSG Š–”G Ž™ˆ•‹ŒšG “ŒšûŒšSG Œš›ç‹–G ppG –œG pppSG “–Šˆ“¡ˆ‹ˆšG Œ”G ™ŒŽé–G—ŠˆSGð”œ™G–œGĀ”Œ™–G—™–Ÿ”ˆ“GŒG™Œš—–š›ˆGæG˜œ”–›Œ™ˆ—ˆG”Œ•–™G˜œŒG `WLSGˆ—™ŒšŒ•›ˆ™ˆ”Gˆ“›–G™šŠ–G‹ŒG‹ŒšŒ•–“”Œ•›–G‹ŒG”Œ›çš›ˆšŒšG ŒGù‰›–GŒ”G ›™ðšG ˆ•–šUG všG —ˆŠŒ•›ŒšG Š–”G ™ŒŠ–™™ð•ŠˆG “–Šˆ“G –œG Š–”G ”Œ›çš›ˆšŒšG ˆ–G ‹ˆŽ•ùš›Š–G›Œ™ˆ”G—™–Ž•ùš›Š–G™œ”UGG hšGŠ–•Š“œšûŒšG‹ŒGtˆ•’•GŒ›Gˆ“UGOYWW[PGˆššŒ”Œ“ˆ”TšŒGˆ–G󕋐ŠŒG‹ŒG —™–Ž•ùš›Š–SG —™–—–š›–G —–™G {ˆ “–™G Œ›G ˆ“UG OX`_\PSG ˜œŒG ˆ‹–›ˆ™ˆ”G Š–”–G •‹Šˆ‹–™ŒšG ‹Œšˆ–™çŒšaG ‹ˆ‹ŒG ”Œ•–™G ˜œŒG ‹Œ¡G ˆ•–šSG šŒŸ–G ”ˆšŠœ“•–SG ›œ”–™ŒšG ”ˆ–™ŒšG ˜œŒG X\G Š”SG —™Œ‹–”•è•ŠˆG š›–“ùŽŠˆG ùš›Œ–G –œG Š–•‹™–‰“çš›ŠˆSG ‹œ™ˆíé–G ‹–šG š•›–”ˆšG Žœˆ“G –œG •Œ™–™G ˆG ‹–šG ”ŒšŒšG ŒG Œ•–“”Œ•›–G ‹–G ð”œ™G –œG Ā”Œ™–UG všG —ˆŠŒ•›ŒšG Š–”G Š•Š–G –œG šŒšG ‹ŒššŒšG •‹Šˆ‹–™ŒšG ›Œ™ˆ”G ‰ˆŸˆG š–‰™Œ‹ˆUG l”G Š–•›™ˆš›ŒSG –šG —ˆŠŒ•›ŒšG Š–”G ˆ—Œ•ˆšG œ”ˆG–œG‹œˆšG‹ŒššˆšGŠˆ™ˆŠ›Œ™óš›ŠˆšGˆ—™ŒšŒ•›ˆ™ˆ”G‰–ˆGŒ–“œíé–GŠ“󕐊ˆUG h—Œšˆ™G‹ˆGŽ™ˆ•‹ŒG˜œˆ•›‹ˆ‹ŒG‹ŒG—œ‰“ŠˆíûŒšG˜œŒGˆ—–•›ˆ”SGšœŽŒ™Œ”G –œG‹šŠœ›Œ”GˆGˆšš–Šˆíé–GŒ•›™ŒGç™–šGˆ›–™ŒšGŒG—™–Ž•ùš›Š–SGˆ›œˆ“”Œ•›ŒSG•é–G çG œ”G Ā•Š–G ˆ›–™G –œG Š–”‰•ˆíé–G ‹ŒG ˆ›–™ŒšG ˜œŒG —–ššˆSG ˆŠœ™ˆ‹ˆ”Œ•›ŒSG

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Revisão da literatura

27

—™Œ‹¡Œ™G ˜œˆšG —ˆŠŒ•›ŒšG ˆ—™ŒšŒ•›ˆ™é–G ‰–ˆG ™Œš—–š›ˆG ˆ–G ›™ˆ›ˆ”Œ•›–G ŒSG Š–•šŒ˜ĂŒ•›Œ”Œ•›ŒSG ”ˆ–™G š–‰™Œ‹ˆG O~œ•‹Œ™G Œ›G ˆ“USG YWWWbG rœ‰š›ˆG Œ›G ˆ“USG YWW[PUG všG ˆ›–™ŒšG ”ˆšG ™Œ˜ĂŒ•›Œ”Œ•›ŒG •Œš›Žˆ‹–šSG Š–”–G —™Œ‹›–šG ‹ŒG —™–Ž•ùš›Š–SG •–šG —ˆŠŒ•›ŒšG —–™›ˆ‹–™ŒšG ‹ŒG –š›Œ–ššˆ™Š–”ˆSG šé–G Š–”Œ•›ˆ‹–šG ˆG šŒŽœ™UG G YUXGp‹ˆ‹ŒG G kŒG ˆŠ–™‹–G Š–”G oœ–šG OX``XPSG ]WLG ‹–šG —ˆŠŒ•›ŒšG Š–”G –š›Œ–ššˆ™Š–”ˆG šŒG š›œˆ”G •ˆG ˆŸˆG Œ›ç™ˆG ˆ‰ˆŸ–G ‹ŒG YXG ˆ•–šUG u–G Œš›œ‹–G ‹ŒG mŒŠ•Œ™G MG t““šG OX``ZPSG _\LG ‹Œ“ŒšG ›•ˆ”G ”Œ•–šG ‹ŒG ›™•›ˆG ˆ•–šSG Š–”G ]WLG Œ•›™ŒG ‹Œ¡G ˆG •›ŒG ˆ•–šUG }ˆ™ˆ•G Œ›G ˆ“UG OYWW^PSGG Œ•Š–•›™ˆ™ˆ”G ”ˆG ‹ŒG ‹ˆ‹ŒG ‹ŒG XZSZGˆ•–šUGGwŒ›™““GOYWW\PGŒ•Š–•›™–œG^WS^LG‹–šG—ˆŠŒ•›ŒšGŒ•›™ŒG‹Œ¡GŒGX_Gˆ•–šSG X]S`LGŠ–”G‹ˆ‹ŒG”Œ•–™G˜œŒG‹Œ¡Gˆ•–šGŒGXYS[LG”ˆ–™ŒšG˜œŒGX_Gˆ•–šUG|™‰ŒT i–›Œ™–GŒ›Gˆ“UGOX`^^PSG™Œ“ˆ›ˆ™ˆ”G”ˆ–™G•Š‹ð•ŠˆG‹–G›œ”–™G•ˆGšŒŽœ•‹ˆG‹ïŠˆ‹ˆG ‹ŒG‹ˆSGŠ–”G^]S\LG‹–šGŠˆš–šG–Š–™™Œ•‹–GŒ”G—ˆŠŒ•›ŒšG”Œ•–™ŒšG˜œŒGY\Gˆ•–šUGG

tŒ Œ™šG Œ›G ˆ“UG OX``YPSG w–Šˆ•œŽ––“G Œ›G ˆ“UG OX``^PG ŒG {–”Œ™G Œ›G ˆ“UG OX```PG•é–G‹Œ•›Šˆ™ˆ”G™Œ“ˆíé–GŒ•›™ŒG‹ˆ‹ŒG‹–G—ˆŠŒ•›ŒGŒG•›Œ™ˆ“–G“™ŒG‹ŒG ‹–Œ•íˆUGG

y ››•ŽG Œ›G ˆ“UG OYWWWPG •é–G ‹Œ•›Šˆ™ˆ”G ‹Œ™Œ•íˆG Œš›ˆ›š›Šˆ”Œ•›ŒG šŽ•Šˆ•›ŒGˆ–GŠ–”—ˆ™ˆ™Œ”G•›Œ™ˆ“–G“™ŒG‹ŒG‹–Œ•íˆGŒGš–‰™Œ‹ˆG‹ŒG—ˆŠŒ•›ŒšG —™ïTˆ‹–“ŒšŠŒ•›ŒšGŠ–”G–šG‹ŒGˆŸˆšGŒ›ç™ˆšG”ˆšGˆ“›ˆšUG l•›™Œ›ˆ•›–SG —ˆ™ˆG {ˆ “–™G Œ›G ˆ“UG OX`_\PSG ˆG –Š–™™ð•ŠˆG ‹ˆG ‹–Œ•íˆG Œ”G —ˆŠŒ•›ŒšG Š–”G ‹ˆ‹ŒG ”Œ•–™G ˜œŒG ‹Œ¡G ˆ•–šSG •‹ŠˆG —™–Ž•ùš›Š–G ‹Œšˆ–™çŒ“UG zŒ™™ˆG Œ›G ˆ“UG OYWWZPG ‹Œ”–•š›™ˆ™ˆ”G šŒ™SG šŽ•Šˆ›ˆ”Œ•›ŒG ”ˆšG ˆ“›ˆSG ˆG •Š‹ð•ŠˆG‹ŒG™ŒŠ–™™ð•ŠˆGŒG‹ŒG—–™G™Œšœ“›ˆ‹–šG•–šG—ˆŠŒ•›ŒšGŠ–”G‹ˆ‹ŒG”Œ•–™G ˜œŒG XYG ˆ•–šUG wˆ™ˆG iˆŠŠG Œ›G ˆ“UG OYWW]‰PSG ‹ˆ‹ŒG •Œ™–™G ˆG X[G ˆ•–šG Œš›ˆ™ˆG ™Œ“ˆŠ–•ˆ‹ˆGˆG—–™G—™–Ž•ùš›Š–SGŒ”G—ˆŠŒ•›ŒšG—–™›ˆ‹–™ŒšG‹ŒG–š›Œ–ššˆ™Š–”ˆG‹ŒG ŒŸ›™Œ”‹ˆ‹ŒšGŒG‹ŒGˆ“›–GŽ™ˆœUG

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G

Curcelli EC. Prognóstico em osteossarcoma

28

oœ–šGOX`_]PGG™Œ“ˆ›–œG˜œŒG—ˆŠŒ•›ŒšGŠ–”G ‹ˆ‹ŒGˆŠ”ˆG‹ŒGšŒššŒ•›ˆG ˆ•–šG›ð”G—–™G—™–Ž•ùš›Š–SGŒ•˜œˆ•›–GiŒ•›¡Œ•GŒ›Gˆ“UGOX`__PG‹Œ•›Šˆ™ˆ”G˜œŒG–G ˆœ”Œ•›–G ‹ˆG ‹ˆ‹ŒG —–™ˆˆG –G —™–Ž•ùš›Š–UG wˆ™ˆG tˆ•’•G Œ›G ˆ“UG OYWW[PSG –šGG —ˆŠŒ•›ŒšG”ˆšG‹–š–šG›ð”G”Œ•–™G›ˆŸˆG‹ŒGš–‰™Œ‹ˆSGš–‰™Œ›œ‹–SGˆ˜œŒ“ŒšGˆŠ”ˆG ‹ŒG\\Gˆ•–šUGG wˆ™ˆGtŒ Œ™šGŒ›Gˆ“UGOX``YPSGiŒ•›¡Œ•GŒ›Gˆ“UGOX`__PGŒGz¡Œ•‹™–GŒ›G ˆ“UG OYWWWPSG –šG ˆ›–™ŒšG ‹Œ›Œ™”•ˆ•›ŒšG ‹ŒG —–™G —™–Ž•ùš›Š–SG Œ•Š–•›™ˆ‹–šG •–šG —ˆŠŒ•›ŒšG”ˆ–™ŒšG‹ŒG›™•›ˆGˆ•–šSG›ð”G™Œ“ˆíé–GŠ–”GˆG›Œ•‹ð•ŠˆGŒ”Gˆ—™ŒšŒ•›ˆ™G ›œ”–™ŒšG“–Šˆ“¡ˆ‹–šG•–GŒš˜œŒ“Œ›–GˆŸˆ“SG”ˆ–™G•›–“Œ™è•ŠˆGæšG‹™–ŽˆšGŒG”Œ•–™G ˆ‹Œšé–Gˆ–G›™ˆ›ˆ”Œ•›–UG wˆ™ˆG n™”Œ™G Œ›G ˆ“UG OYWWZPSGG —ˆŠŒ•›ŒšG Š–”G ”ˆšG ‹ŒG ˜œˆ™Œ•›ˆG ˆ•–šG —–™›ˆ‹–™ŒšG‹ŒG–š›Œ–ššˆ™Š–”ˆšSG—–‹Œ”GšŒ™GŠœ™ˆ‹–šG—Œ“–G›™ˆ›ˆ”Œ•›–G•›Œ•š–G Š–”G ˜œ”–›Œ™ˆ—ˆG ŒG Š™œ™ŽˆUG l•›™Œ›ˆ•›–SG v’ˆ‹ˆG Œ›G ˆ“UG OYWW[PSG ˆ–G ˆ•ˆ“šˆ™Œ”G ][G Šˆš–šG ‹ŒG –š›Œ–ššˆ™Š–”ˆSG Œ”G —ˆŠŒ•›ŒšG ˆŠ”ˆG ‹ŒG Š•˜ĂŒ•›ˆG ˆ•–šSG Š–•Š“œó™ˆ”G˜œŒG–G›™ˆ›ˆ”Œ•›–G˜œ”–›Œ™ç—Š–G•é–GïGŒŒ›–G—ˆ™ˆGŒššŒGŽ™œ—–GGŒG šœŽŒ™™ˆ”G•–ˆšGŒš›™ˆ›ïŽˆšG›Œ™ˆ—𜛐ŠˆšUG

iˆŠŠG Œ›G ˆ“UG OYWW\ˆPSGG Œ”G ˆ”—“–G Œš›œ‹–G Š–”G XUXZ]G —ˆŠŒ•›ŒšG —–™›ˆ‹–™ŒšG‹ŒG–š›Œ–ššˆ™Š–”ˆG‹ŒGˆ“›–GŽ™ˆœGŒG›™ˆ›ˆ‹–šGŠ–”G–G”Œš”–G—™–›–Š–“–G ‹ŒG ˜œ”–›Œ™ˆ—ˆG –‰šŒ™ˆ™ˆ”G Œ”G ZX^G —ˆŠŒ•›ŒšG —™ïTˆ‹–“ŒšŠŒ•›ŒšG ŒG _X`G ˆ‹œ“›–šSG˜œŒGˆGš–‰™Œ‹ˆSG–G•›Œ™ˆ“–G“™ŒG‹ŒG‹–Œ•íˆGˆ—ùšGŠ•Š–Gˆ•–šSGˆG›ˆŸˆG ‹ŒG ˆ”—œ›ˆíé–SG –G ›Œ”—–G ‹ŒG ˆ—ˆ™ŒŠ”Œ•›–G ŒG “–Šˆ“¡ˆíé–G ‹ˆšG —™”Œ™ˆšG ”Œ›çš›ˆšŒšG ŒG –G Ž™ˆœG ‹ŒG •ŒŠ™–šŒG •‹œ¡‹ˆG —Œ“ˆG ˜œ”–›Œ™ˆ—ˆG –™ˆ”G šŒ”Œ“ˆ•›ŒšG ŒG Š–•Š“œó™ˆ”G ˜œŒG •é–G çG •ŒŠŒšš‹ˆ‹ŒG ‹ŒG šŒG ˆ—“Šˆ™G ‹Œ™Œ•›ŒšG ›™ˆ›ˆ”Œ•›–šG•ŒššŒšG‹–šGŽ™œ—–šUG G YUYGzŒŸ–G G hG ”ˆ–™ˆG ‹–šG —ˆŠŒ•›ŒšG —–™›ˆ‹–™ŒšG ‹ŒG –š›Œ–ššˆ™Š–”ˆG ïG ‹–G šŒŸ–G ”ˆšŠœ“•–UG kŒG ˆŠ–™‹–G Š–”G oœ–šG OX``XPSG •ˆG šï™ŒG ™Œ—–™›ˆ‹ˆG •–G tŒ”–™ˆ“G z“–ˆ•TrŒ››Œ™•ŽG j蕊Œ™G jŒ•›Œ™G ˆG —™–—–™íé–G ïG ‹ŒG XSZG —ˆŠŒ•›ŒšG ‹–G šŒŸ–G

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”ˆšŠœ“•–G—ˆ™ˆGœ”G‹–GšŒŸ–GŒ”••–GŒG•ˆGj“󕐊ˆGtˆ –SG‹ŒGXS]aGXUGr“Œ•GŒ›Gˆ“UG OX`_`PGŒ•Š–•›™ˆ™ˆ”G™Œ“ˆíé–G‹ŒGXS]aGXGŒGGtˆ•’•GŒ›Gˆ“UGOYWW[PSGGXSX\aGXUG zŠ™ˆ•›–•GŒ›Gˆ“UGOX`^\PSG{ˆ “–™GŒ›Gˆ“UGOX`_\PSGwŒ›™““GŒ›Gˆ“UGOX``XPGŒG nŒ™GŒ›Gˆ“UGOX``ZPG™Œ“ˆ›ˆ™ˆ”G”ˆ–™Gš–‰™Œ‹ˆG•–šG—ˆŠŒ•›ŒšG‹–GšŒŸ–GŒ”••–UG j–•›œ‹–G—ˆ™ˆGtŒ Œ™šGŒ›Gˆ“UGOX``YPSGz¡Œ•‹™–GŒ›Gˆ“UGOYWWWPSGtˆ•’•GŒ›Gˆ“UGOYWW[PG ŒGiˆŠŠGŒ›Gˆ“UGOYWW]‰PSG–GšŒŸ–G‹–G—ˆŠŒ•›ŒG•é–G›Œ™ˆGˆ“–™G—™–Ž•ùš›Š–G—ˆ™ˆG–šG —–™›ˆ‹–™ŒšG‹ŒG–š›Œ–ššˆ™Š–”ˆUG G YUZGss–Šˆ“¡ˆíé–G‹–G›œ”–™G G všG–š›Œ–ššˆ™Š–”ˆšG“–Šˆ“¡ˆ”TšŒSG”ˆšG™Œ˜ĂŒ•›Œ”Œ•›ŒSG•ˆšG™ŒŽûŒšG ”Œ›ˆšç™ˆG ‹š›ˆ“G ‹–G ð”œ™G ŒG ”Œ›ˆšç™ˆG —™–Ÿ”ˆ“G ‹ˆG ›ó‰ˆUG všG –šš–šG “–•Ž–šG šé–G–šG”ˆšGˆŠ–”Œ›‹–šSGšŒ•‹–G”ˆšG™Œ˜ĂŒ•›ŒšG•–Gð”œ™SG›ó‰ˆSGĀ”Œ™–GŒGó‰œ“ˆG O|™‰ŒTi–›Œ™–G Œ›G ˆ“USG X`^^bG zŠˆ‘–žŠšSG X`_YbG oœ–šSG X``XbG tˆ™•ˆG Œ›G ˆ“USG YWW[PUG

oçGŠ–•›™–ï™šˆGˆŠŒ™ŠˆG‹ˆG™Œ“ˆíé–GŒ•›™ŒG“–Šˆ“¡ˆíé–GŒG—™–Ž•ùš›Š–G Œ”G ›œ”–™ŒšG ‹ŒG ŒŸ›™Œ”‹ˆ‹ŒšUG wˆ™ˆG kˆšG Œ›G ˆ“UG OX``[PSG w–Šˆ•œŽ––“G Œ›G ˆ“UG OX``^PSG{–”Œ™GŒ›Gˆ“UGOX```PSGy ››•ŽGŒ›Gˆ“UGOYWWWPSGmŒ™™ˆ™GŒ›Gˆ“UGOYWWXPGŒGiˆŠŠG Œ›Gˆ“UGOYWW]‰PSG•é–GçGˆšš–Šˆíé–GŒ•›™ŒGšó›–G›œ”–™ˆ“GŒGš–‰™Œ‹ˆG•–šG—ˆŠŒ•›ŒšG —–™›ˆ‹–™ŒšG‹ŒG–š›Œ–ššˆ™Š–”ˆG‹ŒGŒŸ›™Œ”‹ˆ‹ŒšGŒG‹ŒGˆ“›–GŽ™ˆœUG zŒŽœ•‹–G {ˆ “–™G Œ›G ˆ“UG OX`_\PSG –GG Œ•–“”Œ•›–G ‹–G ð”œ™G –œG ‹–G Ā”Œ™–G ïG •‹Šˆ‹–™G ‹ŒG —™–Ž•ùš›Š–G ‹Œšˆ–™çŒ“SG Œ•˜œˆ•›–G —ˆ™ˆG n––™•G Œ›G ˆ“UG OX`_^PSGG –šG ›œ”–™ŒšG “–Šˆ“¡ˆ‹–šG •–G Ā”Œ™–G —™–Ÿ”ˆ“G ›ð”G —–™G —™–Ž•ùš›Š–UG qçG n“ˆššŒ™G MG sˆ•ŒG OX``XPGG ™Œ“ˆ›ˆ™ˆ”G ˜œŒGG ˆšGG “ŒšûŒšG œ”Œ™ˆšG › ð”G ”ˆ–™G —™–‰ˆ‰“‹ˆ‹ŒG ‹ŒG ”Œ“–™G š–‰™Œ‹ˆSG ŒG •–G Œš›œ‹–G Š–•‹œ¡‹–G —–™G s•’G Œ›G ˆ“UG OX``XPSGG–šG—ˆŠŒ•›ŒšGŠ–”G›œ”–™ŒšG—™”癐–šG“–Šˆ“¡ˆ‹–šG•ˆG›ó‰ˆGˆ—™ŒšŒ•›ˆ™ˆ”G —™–Ž•ùš›Š–G”ˆšGˆ–™çŒ“UG wˆ™ˆG n“ˆššŒ™G Œ›G ˆ“UG OX``YPSG –šG ›œ”–™ŒšG “–Šˆ“¡ˆ‹–šG •–G ð”œ™G —™–Ÿ”ˆ“G›ð”G™šŠ–G‹ŒG™ŒŠ–™™ð•ŠˆG“–Šˆ“G›™ðšGŒ¡ŒšG”ˆ–™G˜œŒG–šG‹ŒG“–Šˆ“¡ˆíé–G

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‹š›ˆ“GŒSG—–™›ˆ•›–SG—–™G—™–Ž•ùš›Š–GŒG—ˆ™ˆGGz¡Œ•‹™–GŒ›Gˆ“UGOYWWWPSGGˆGG“–Šˆ“¡ˆíé–G ‹š›ˆ“G‹–šG›œ”–™ŒšGïGˆ›–™G‹ŒG—™–Ž•ùš›Š–G—–š›–UG

hG“–Šˆ“¡ˆíé–G•–GŒš˜œŒ“Œ›–GˆŸˆ“GïG—–œŠ–G™Œ˜ĂŒ•›ŒSG”ˆšGˆšš–Šˆ‹ˆG ˆG —–™G —™–Ž•ùš›Š–G OiŒ•›¡Œ•G Œ›G ˆ“UG X`__bG tŒ Œ™šG Œ›G ˆ“USG X``YbG tˆ•’•G Œ›G ˆ“USG YWW[bGzˆˆ‰GŒ›Gˆ“USGYWW\PUGkŒGˆŠ–™‹–GŠ–”GGoˆ”GŒ›Gˆ“UGOX``_PSGGšš–G–Š–™™Œ™ˆGŒ”G ‹ŒŠ–™™ð•ŠˆG‹ˆG‹Šœ“‹ˆ‹ŒG•ˆGˆ‰–™‹ˆŽŒ”GŠ™Ā™ŽŠˆSG—–šSG•ˆG”ˆ–™ˆG‹–šGŠˆš–šSG šé–G ›œ”–™ŒšG ‹ŒG ”ˆ–™G ‹”Œ•šé–SG Š–”G ”ˆ™ŽŒ•šG ‹ŒG ™ŒššŒŠíé–G ŒŸóŽœˆšG –œG ˆ›ïG ”Œš”–G™™ŒššŒŠçŒšUG wˆ™ˆGG zˆŒ›Œ™G Œ›G ˆ“UG OX``^PSG –G —–™G —™–Ž•ùš›Š–G ‹–šG —ˆŠŒ•›ŒšG Š–”GG ›œ”–™ŒšG“–Šˆ“¡ˆ‹–šG•–GŒš˜œŒ“Œ›–GˆŸˆ“GïGŠ–•šŒ˜Ă𕊐ˆG‹ˆG”Œ•–™G—–šš‰“‹ˆ‹ŒG ‹ˆG ˆ‹Œ˜œˆ‹ˆG ™ŒššŒŠíé–G Š™Ā™ŽŠˆG ŒG ‹ŒG •Š‹™Œ”G ”ˆšG Œ”G —ˆŠŒ•›ŒšG ‹–š–šSG Š–”G‰ˆŸˆG™Œš—–š›ˆGæG˜œ”–›Œ™ˆ—ˆUG wˆ™ˆGtˆ›šœ–GŒ›Gˆ“UGOYWW\PSG—ˆŠŒ•›ŒšGŠ–”G›œ”–™G“–Šˆ“¡ˆ‹–G•–GšˆŠ™–G ›ð”G—–™G—™–Ž•ùš›Š–UG G YU[Gk”Œ•šé–G G hG ‹”Œ•šé–G ‹–G ›œ”–™G ïG Š–•š‹Œ™ˆ‹ˆG ”—–™›ˆ•›ŒG ˆ›–™G —™–Ž•ùš›Š–G O{ˆ “–™G Œ›G ˆ“USG X`_\bG wŒ›™““G Œ›G ˆ“USG X``XbG kˆšG Œ›G ˆ“USG X``[bG z¡Œ•‹™–G Œ›G ˆ“USG YWWWbG iˆŠŠG Œ›G ˆ“USG YWW]‰bG wŒ›™““G Œ›G ˆ“USG YWW]PUG wˆ™ˆG z”–•G OX`^_PG ˜œˆ•›–G ”Œ•–™G–G›œ”–™SG”Œ“–™G–G—™–Ž•ùš›Š–UGG

iŒ“•ŽG Œ›G ˆ“UG OX``]PG ˆˆ“ˆ™ˆ”G ™ˆ‹–Ž™ˆˆšG •ŠˆšG ‹ˆG ™ŒŽé–G ›œ”–™ˆ“G‹ŒGXY_G—ˆŠŒ•›ŒšUGk–šG—ˆŠŒ•›ŒšG˜œŒGˆ—™ŒšŒ•›ˆˆ”G›œ”–™ŒšG”Œ•–™ŒšG ˜œŒG X\WG Š”ZSG ˆ—Œ•ˆšG _LG ‹ŒšŒ•–“Œ™ˆ”G ”Œ›çš›ˆšŒšSG ŒG Œ”G —ˆŠŒ•›ŒšG Š–”G ›œ”–™ŒšG”ˆ–™ŒšSGˆG›ˆŸˆG‹ŒG™ŒŠ‹ˆG–Gšœ—Œ™–™GˆG[WLUG rˆš›ŒG Œ›G ˆ“UG OYWW[PG ˆ•ˆ“šˆ™ˆ”G –G ˆ“–™G —™Œ‹›–G ‹ˆG ‹”Œ•šé–G ›œ”–™ˆ“SG ”Œ•šœ™ˆ‹ˆG —–™G ”Œ–G ‹ŒG ”ˆŽŒ•šG ‹ŒG ™Œšš–•è•ŠˆG ”ˆŽ•ï›ŠˆSG –‰›‹ˆšG •ˆG–Šˆšé–G‹–G‹ˆŽ•ùš›Š–UGj–•Š“œó™ˆ”G˜œŒGˆG‹”Œ•šé–G›œ”–™ˆ“GïG•‹Šˆ›ˆG‹ŒG —™–Ž•ùš›Š–G ŒG —–‹ŒG ‹šŠ™”•ˆ™G Ž™œ—–šG ‹ŒG ”ˆ–™G ™šŠ–G —ˆ™ˆG ˆ‹–íé–G ‹ŒG —™–—–š›ˆšG‹Œ™Œ•Šˆ‹ˆšG‹ŒG›™ˆ›ˆ”Œ•›–UG

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zŒ™™ˆGŒ›Gˆ“UGOYWWZPG”–š›™ˆ™ˆ”G˜œŒGˆG•Š‹ð•ŠˆG‹ŒG™ŒŠ–™™ð•ŠˆGŒG‹ŒG —–™G ™Œšœ“›ˆ‹–G ›Œ™ˆ—𜛐Š–G ïG šŽ•Šˆ›ˆ”Œ•›ŒG ”ˆšG ˆ“›ˆG •–šG —ˆŠŒ•›ŒšG Š–”G –“œ”ŒG›œ”–™ˆ“G”ˆ–™G˜œŒGX\W”“SGˆ–G‹ˆŽ•ùš›Š–UG {œ”–™ŒšG”ˆ–™ŒšG—™–ˆŒ“”Œ•›ŒG›ð”G”ˆ–™G›Œ”—–G‹ŒGŒ–“œíé–G–œG Š™ŒšŠŒ”G ”ˆšG ™ˆ—‹ˆ”Œ•›ŒSG •‹Šˆ•‹–G ”ˆ–™G ˆŽ™Œšš‹ˆ‹ŒSG –G ˜œŒG —–‹ŒG •›Œ™Œ™™G•–G—™–Ž•ùš›Š–UGué–GçSG•–GŒ•›ˆ•›–SGŠ–•šŒ•š–GˆŠŒ™ŠˆG‹ŒG—ˆ™è”Œ›™–šG —ˆ™ˆGšŒGŒš›ˆ‰Œ“ŒŠŒ™GˆG—ˆ™›™G‹ŒG˜œˆ“G‹”Œ•šé–G›œ”–™ˆ“SG–G—ˆŠŒ•›ŒG›Œ™çG”Œ“–™G –œG —–™G —™–Ž•ùš›Š–SG —–™˜œŒG –šG ”ï›–‹–šG ‹ŒG ˆŒ™íé–G •é–G šé–G œ•–™”ŒšUG kˆG ”Œš”ˆG ”ˆ•Œ™ˆSG Œ•›™ŒG ›œ”–™ŒšG ‹–G ”Œš”–G ›ˆ”ˆ•–SG •é–G ïG —–ššóŒ“G —™Œ‹¡Œ™G ˜œˆšG›Œ™é–GŠœ™š–GŠ“󕐊–Gˆ–™çŒ“G–œG‹Œšˆ–™çŒ“UGG G YU\Gjj“ˆššŠˆíé–G G z–‰GˆG‹Œ•–”•ˆíé–G‹ŒG–š›Œ–ššˆ™Š–”ˆSG•Š“œTšŒGˆ”—“–GŒš—ŒŠ›™–G‹ŒG “ŒšûŒšGŠ–”Gˆš—ŒŠ›–šGŠ“󕐊–šSGˆ•ˆ›–”–—ˆ›–“ùŽŠ–šGŒGŠ–”—–™›ˆ”Œ•›–G‰–“ùŽŠ–G ‹š›•›–šUG xœˆ•›–G æG “–Šˆ“¡ˆíé–G •–G –šš–SG –šG –š›Œ–ššˆ™Š–”ˆšG —–‹Œ”G šŒ™G Š“ˆššŠˆ‹–šGŒ”GŠŒ•›™ˆšGŒG—Œ™ï™Š–šGOzŠˆ‘–žŠ¡SGX``ZPUG všG–š›Œ–ššˆ™Š–”ˆšGŠŒ•›™ˆšGGšé–G”ˆšGŠ–”œ•šSGG™Œ—™ŒšŒ•›ˆ•‹–G”ˆšG ‹ŒG `WLG ‹–šG –š›Œ–ššˆ™Š–”ˆšG OmŒŠ•Œ™G MG t““šSG X``ZbG kˆ”™–•G Œ›G ˆ“UG YWW^PUG lŸ‰Œ”G ‹Œ™Œ•›ŒšG ˆš—ŒŠ›–šSG ”ˆŠ™–šŠù—Š–šG ŒG ”Š™–šŠù—Š–šSG Œ”G ™ˆ¡é–G ‹ˆG ‹Œš›™œíé–G ùššŒˆG ŒG ‹ˆG –™”ˆíé–G ùššŒˆG ™Œˆ›ˆSG ŠŒ•›™ˆ“G ŒG ŒŸ›™ˆTŒš˜œŒ“ŠˆUG j–•Š–”›ˆ•›ŒSG ˆ—™ŒšŒ•›ˆ”G ”Ā“›—“–šG Œš›ç‹–šG ‹ŒG ‹Œ™Œ•Šˆíé–G ‹ˆšG Šï“œ“ˆšG ›œ”–™ˆšG ˜œŒG —Œ“ˆG Šˆ—ˆŠ‹ˆ‹ŒG ”œ“›—–›Œ•Šˆ“G —–‹Œ”G —™–‹œ¡™G ‹Œ™Œ•›ŒšGG ›ŒŠ‹–šGOzŠˆ‘–žŠ¡SGX`_YPUG všG ›—–šG š›–“ùŽŠ–šG ‹–šG –š›Œ–ššˆ™Š–”ˆšG ŠŒ•›™ˆšG šé–aG –š›Œ–‰“çš›Š–SG Š–•‹™–‰“çš›Š–SG ‰™–‰“çš›Š–SG ›Œ“ˆ•ŽŒŠ›çšŠ–SG ‹ŒG —Œ˜œŒ•ˆšG Šï“œ“ˆšGŒG•›™ˆTùššŒ–G‰Œ”G‹Œ™Œ•Šˆ‹–GOzŠˆ‘–žŠ¡SGX``ZPUGGG u–G ›—–G –š›Œ–‰“çš›Š–SG ˆG ”ˆ›™¡G —™Œ‹–”•ˆ•›ŒG ïG –G ›ŒŠ‹–G ùššŒ–G –œG –š›Œù‹ŒUG u–G Š–•‹™–‰“çš›Š–SG Šˆ™›“ˆŽŒ”G ˆ“•ˆG –Š–™™ŒG Œ”G Ž™ˆ•‹ŒG ˜œˆ•›‹ˆ‹ŒG

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Š–•Š–”›ˆ•›ŒG ˆG Œ“Œ”Œ•›–šG •é–G Š–•‹™ù‹ŒšUG vG –š›Œ–ššˆ™Š–”ˆG ‰™–‰“çš›Š–G ïG –™”ˆ‹–G—–™GŠï“œ“ˆšGœš–™”ŒšG”ˆ“Ž•ˆšGˆŠ–”—ˆ•ˆ‹ˆšG‹ŒG”ˆ›™¡GùššŒˆSGŠ–”G –œGšŒ”GŠˆ™›“ˆŽŒ”GOyˆ ”–•‹GŒ›Gˆ“USGYWWYPUGG l”‰–™ˆG–G›œ”–™GŠ–”G—™Œ‹–”•è•ŠˆG–š›Œ–‰“çš›ŠˆGšŒ‘ˆG™ŒŒ™‹–G•ˆG ”ˆ–™ˆG ‹–šG ›™ˆ‰ˆ“–šG Š–”–G –G ”ˆšG ™Œ˜ĂŒ•›ŒSG ˆG •Š‹ð•ŠˆG ïG ˆ™çŒ“SG —™–ˆŒ“”Œ•›ŒGŒ”Gœ•íé–G‹ˆGŒŸš›ð•ŠˆG‹ŒGŠ™›ï™–šG‹ˆŽ•ùš›Š–šG‹Œ™Œ•›ŒšUGGG

zŒŽœ•‹–G yˆ ”–•‹G Œ›G ˆ“UG OYWWYPSG –G ›—–G –š›Œ–‰“çš›Š–G ™Œ—™ŒšŒ•›ˆG ŠŒ™ŠˆG ‹ŒG \WLG ‹–šG Šˆš–šSG Œ•˜œˆ•›–G –G Š–•‹™–‰“çš›Š–G ŒG –G ‰™–‰“çš›Š–G ™Œ—™ŒšŒ•›ˆ”G–šG–œ›™–šG\WLSGˆ”‰–šGŠ–”GGY\LUGGG

wŒ›™““G OYWW\PG Œ•Š–•›™–œG _XSZLG ‹–šG —ˆŠŒ•›ŒšG Š–”G ›œ”–™ŒšG ‹ŒG —™Œ‹–”•è•ŠˆG–š›Œ–‰“çš›ŠˆSGXXS]LSGŠ–•‹™–‰“çš›ŠˆGŒGZSZLSG‰™–‰“çš›ŠˆUG

}ˆ™ˆ•G Œ›G ˆ“UG OYWW^PG ˆ•ˆ“šˆ™ˆ”G ]`G ›œ”–™ŒšSG ‹–šG ˜œˆšSG ]^G O`^SXLPG Œ™ˆ”G ŠŒ•›™ˆšSG šŒ•‹–G \^G ‹–G ›—–G –š›Œ–‰“çš›Š–G O_\LPSG ˜œˆ›™–G Œ™ˆ”G ‹–G ›—–G Š–•‹™–‰“çš›Š–G ŒG œ”SG ‰™–‰“çš›Š–SG ™Œ—™ŒšŒ•›ˆ•‹–G \S`LG ŒG XS[LSG ™Œš—ŒŠ›ˆ”Œ•›ŒUG

|™‰ŒTi–›Œ™–G Œ›G ˆ“UG OX`^^PSG Œ•Š–•›™ˆ™ˆ”G ^^LG ‹ŒG ›œ”–™ŒšG Š–”G —™Œ‹–”•è•ŠˆG–š›Œ–‰“çš›ŠˆSGXZLSG‰™–‰“çš›ŠˆGŒG`LSGŠ–•‹™–‰“çš›ŠˆUG

vG –š›Œ–ššˆ™Š–”ˆG ›Œ“ˆ•ŽŒŠ›çšŠ–G ïG Šˆ™ˆŠ›Œ™¡ˆ‹–G —–™G •œ”Œ™–š–šG Œš—ˆí–šG—™ŒŒ•Š‹–šG—–™Gšˆ•ŽœŒSGšŒ—ˆ™ˆ‹–šG—–™GšŒ—›–šG‰™–š–šUGÏGˆ“›ˆ”Œ•›ŒG ˆ•ˆ—“皐Š–GŠ–”G”󕐔ˆG˜œˆ•›‹ˆ‹ŒG‹ŒG›ŒŠ‹–G–š›Œù‹ŒUGÏG™ˆ™–GŒG™Œ—™ŒšŒ•›ˆG‹ŒG XLGˆG\LG‹ŒG›–‹–šG–šG–š›Œ–ššˆ™Š–”ˆšGOoœ–šSGX``XbGmŒŠ•Œ™GMGt““šSGX``ZbG yˆ ”–•‹G Œ›G ˆ“USG YWWYPUG G h—™ŒšŒ•›ˆSG Š–”–G Šˆ™ˆŠ›Œ™óš›ŠˆSG ˆ“›ˆG •Š‹ð•ŠˆG ‹ŒG ™ˆ›œ™ˆšG—ˆ›–“ùŽŠˆšSG‹–Šœ”Œ•›ˆ‹ˆšGŒ”GŠŒ™ŠˆG‹ŒGY\LG‹–šGŠˆš–šGOyˆ ”–•‹GŒ›G ˆ“USGYWWYPUG

uˆG “›Œ™ˆ›œ™ˆSG ™Œ“ˆ›ˆTšŒG ˜œŒG ˆG •Š‹ð•ŠˆG ‹–G ›œ”–™G ‹ŒG Šï“œ“ˆšG ™Œ‹–•‹ˆšG –œSG Š–”–G ›ˆ”‰ï”G ïG ‹Œ•–”•ˆ‹–SG –š›Œ–ššˆ™Š–”ˆG ‹ŒG —Œ˜œŒ•ˆšG Šï“œ“ˆšSGˆ™ˆG‹ŒGXLGˆG[LSGŒ”G™Œ“ˆíé–GˆG›–‹–šG–šG–š›Œ–ššˆ™Š–”ˆšGOmŒŠ•Œ™GMG t““šSG X``ZSG rˆ““G MG i™‹ŽŒSG YWWYSG }ˆ™ˆ•G Œ›G ˆ“USG YWW^PUG G ÏG Š–•š››œó‹–G —–™G —Œ˜œŒ•ˆšGŠï“œ“ˆšG”ˆ“Ž•ˆšSGšŒ”Œ“ˆ•›ŒšGGæšGŒ•Š–•›™ˆ‹ˆšG•–Gšˆ™Š–”ˆG‹ŒGlž•ŽG ŒG•–G“•–”ˆUGhG—™–‹œíé–G–š›Œù‹ŒG—Œ“ˆšGŠï“œ“ˆšG•Œ–—“皐ŠˆšSGˆ—Œšˆ™G‹ŒG–Šˆ“SGïG

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šŒ”—™ŒG —™ŒšŒ•›ŒG OmŒŠ•Œ™G MG t““šSG X``ZPUG iŒ™›–•G Œ›G ˆ“UG OX`_`PG ŒG z”G Œ›G ˆ“UG OX`^`PGŠ–•š‹Œ™ˆ™ˆ”G˜œŒG–šG›œ”–™ŒšG‹ŒGŠï“œ“ˆšG™Œ‹–•‹ˆšG›ð”G—–™G—™–Ž•ùš›Š–G ˜œŒG–šG–š›Œ–ššˆ™Š–”ˆšGŠ–•Œ•Š–•ˆšUGl•›™Œ›ˆ•›–SG—ˆ™ˆGh ˆ“ˆGŒ›Gˆ“UGOX`_`PSG–G —™–Ž•ùš›Š–GïGšŒ”Œ“ˆ•›ŒG–œGˆ—Œ•ˆšG‹šŠ™Œ›ˆ”Œ•›ŒG—–™UGG vG–š›Œ–ššˆ™Š–”ˆG•›™ˆTùššŒ–G‰Œ”G‹Œ™Œ•Šˆ‹–GŠ–”—™ŒŒ•‹ŒG”Œ•–šG ‹ŒG XLG ‹ŒG ›–‹–šG –šG –š›Œ–ššˆ™Š–”ˆšG ŒG Šœ™šˆG Š–”G ‰–”G —™–Ž•ùš›Š–G Ooœ–šSG X``XbGmŒŠ•Œ™GMGt““šSGX``ZbG~–“‹GŒ›Gˆ“USGYWWYbGkˆ”™–•GŒ›Gˆ“USGYWW^PUG wˆ™ˆGw–Šˆ•œŽ––“GŒ›Gˆ“UGOX``^PSG{–”Œ™GŒ›Gˆ“UGOX```PSGy ››•ŽGŒ›Gˆ“UG OYWWWPSG iˆŠŠG Œ›G ˆ“UG OYWW]‰PSG ˆG ‹šé–G ‹–šG –š›Œ–ššˆ™Š–”ˆšG ‹ŒG ˆ“›–G Ž™ˆœSG ‹ŒG ˆŠ–™‹–G Š–”G ˆG —™Œ‹–”•è•ŠˆG š›–“ùŽŠˆSG •é–G ïG Ā›“G Š–”–G •‹Šˆ‹–™G ‹ŒG —™–Ž•ùš›Š–UG zŒŽœ•‹–

G

tˆ™•ˆGŒ›G ˆ“UG OYWW[PSG •é–G çG Œ‹ð•ŠˆG ‹ŒG ‹Œ™Œ•íˆG •–G Š–”—–™›ˆ”Œ•›–GŠ“󕐊–SG‰ˆšŒˆ‹ˆG•–G›—–Gš›–“ùŽŠ–UGG zŠˆ‘–žŠ¡G OX`_YPG ˆ™”–œG ˜œŒSG •ˆG ”ˆ–™ˆG ‹–šG –š›Œ–ššˆ™Š–”ˆšSG Š–”G ŒŸŠŒíé–G ‹–šG ›œ”–™ŒšG ™ˆ•Šˆ”Œ•›ŒG ŒšŠ“Œ™–š–šSG –šG ˆš—ŒŠ›–šG ”ˆŠ™–G ŒG ”Š™–šŠù—Š–šG šé–G ›é–G ˆ™çŒšG ˜œŒSG æšG Œ¡ŒšSG ïG ”—–ššóŒ“G ‹Œ›Œ™”•ˆ™G –G ›ŒŠ‹–G —™Œ‹–”•ˆ•›ŒbG —™ŒŒ™ŒG •é–G ˆ‹–›ˆ™G ›ˆ“G ‹šé–G Š–•š‹Œ™ˆ•‹–TˆG •Ā›“SG •Š“œšŒSG—ˆ™ˆG—™–Ž•ùš›Š–UG l•›™Œ›ˆ•›–SGˆ“Žœ•šGˆœ›–™ŒšG™Œ“ˆ›ˆ™ˆ”G‹Œ™Œ•íˆšG‹ŒG—™–Ž•ùš›Š–GŒ”G œ•íé–G ‹ˆG Š“ˆššŠˆíé–G š›–“ùŽŠˆG ‹–G ›œ”–™UG wˆ™ˆG {ˆ “–™G Œ›G ˆ“UG OX`_\PSG ˆG —™Œ‹–”•è•ŠˆG –š›Œ–‰“çš›ŠˆG –œG Š–•‹™–‰“çš›ŠˆSG •‹Šˆ™ˆG —™–Ž•ùš›Š–G ‹Œšˆ–™çŒ“UGkˆG”Œš”ˆG”ˆ•Œ™ˆSGn––™•GŒ›Gˆ“UGOX`_^PGŒ•Š–•›™ˆ™ˆ”GŒ–“œíé–G Š“󕐊ˆG ”ˆšG ˆ–™çŒ“G •–šG —ˆŠŒ•›ŒšG Š–”G ›œ”–™ŒšG Šœ‘ˆG —™Œ‹–”•è•ŠˆG š›–“ùŽŠˆG •é–G Œ™ˆG Š–•š››œó‹ˆG —–™G Šï“œ“ˆšG –š›Œ–‰“çš›ŠˆšUG iŒ•›¡Œ•G Œ›G ˆ“UG OX``_PGG ™Œ—–™›ˆ™ˆ”G ”Œ“–™G Œ–“œíé–G Š“󕐊ˆG •–šG ›œ”–™ŒšG ‰™–‰“çš›Š–šSG Œ•˜œˆ•›–Gz¡Œ•‹™–GŒ›Gˆ“UGOYWWWPGGˆ™”ˆ™ˆ”G˜œŒG›œ”–™ŒšGŠ–”G”Œ•–šG‹ŒGYWLG‹ŒG šœ‰š›è•ŠˆGŠˆ™›“ˆŽ•–šˆG›ð”G”Œ“–™G—™–Ž•ùš›Š–UGwˆ™ˆGiˆŠŠGŒ›Gˆ“UGOX``_‰PSG–šG ›œ”–™ŒšGŠ–•‹™–‰“çš›Š–šGšé–G”Œ•–šGšŒ•šóŒšGˆ–G›™ˆ›ˆ”Œ•›–G˜œ”–›Œ™ç—Š–UG všG›œ”–™ŒšG—Œ™ï™Š–šGšé–GŠ“ˆššŠˆ‹–šGŒ”G—ˆ™ˆ–š›ˆ“SG—Œ™–š›ˆ“GŒG ‹ŒGˆ“›–GŽ™ˆœG‹ŒGšœ—Œ™óŠŒSGšŒ•‹–G”ˆšG™ˆ™–šG˜œŒG–šGŠŒ•›™ˆšUG

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vG –š›Œ–ššˆ™Š–”ˆG —ˆ™ˆ–š›ˆ“G ïG –G ›—–G ”ˆšG Š–”œ”G ‹–šG –š›Œ–ššˆ™Š–”ˆšG ‹ŒG šœ—Œ™óŠŒG O|••G MG r•œœ›“ˆSG YWWYbG kˆ”™–•G Œ›G ˆ“USG YWW^PSG Šˆ™ˆŠ›Œ™¡ˆ•‹–TšŒG —–™G š›œˆ™TšŒG •ˆG šœ—Œ™óŠŒG ŒŸ›Œ™•ˆG ‹–G –šš–G ŒG —Œ“–G ˆ“›–G Ž™ˆœG‹ŒG‹Œ™Œ•Šˆíé–UGhŠ–”Œ›ŒG”ˆšG™Œ˜ĂŒ•›Œ”Œ•›ŒG•‹ó‹œ–šGŠ–”G”ˆG‹ŒG ‹ˆ‹ŒG ”ˆ–™G ˜œŒG ˆG ‹–šG —ˆŠŒ•›ŒšG Š–”G –š›Œ–ššˆ™Š–”ˆG Š–•Œ•Š–•ˆ“UG vG ›™ˆ›ˆ”Œ•›–GïGˆGˆ‰“ˆíé–GŠ™Ā™ŽŠˆG‹–G›œ”–™SGšŒ”G•ŒŠŒšš‹ˆ‹ŒG‹ŒG˜œ”–›Œ™ˆ—ˆSG Š–”G›ˆŸˆG‹ŒGš–‰™Œ‹ˆGŒ”GŠ•Š–Gˆ•–šGŒ•›™ŒG^WLGˆG`XLGOv’ˆ‹ˆGŒ›Gˆ“UGX``[PUG vG–š›Œ–ššˆ™Š–”ˆG—Œ™–š›ˆ“GïG‹ŒG—™Œ‹–”•è•ŠˆGŠ–•‹™–‰“çš›ŠˆSGŽ™ˆœG •›Œ™”Œ‹ç™–G ŒG ˆŠ–”Œ›ŒG ˆG šœ—Œ™óŠŒG ùššŒˆSG Š–”G —™Œ‹“Œíé–G —Œ“ˆG ‹çšŒG ‹–šG –šš–šG“–•Ž–šUGhG›ó‰ˆGïG–G–šš–G”ˆšGˆŠ–”Œ›‹–SGšŒŽœ‹–G—Œ“–Gð”œ™GŒGĀ”Œ™–UG yŒ—™ŒšŒ•›ˆG ”Œ•–šG ‹ŒG YLG ‹ŒG ›–‹–šG –šG –š›Œ–ššˆ™Š–”ˆšG Or“Œ•G Œ›G ˆ“USG X`_`bG zŠˆ‘–žŠ¡SG X``ZbG h ˆ“ˆG MG j¡Œ™•ˆ’SG YWWYbG kˆ”™–•G Œ›G ˆ“USG YWW^PSG ŒG ïG ”ˆšG ™Œ˜ĂŒ•›ŒGŒ”G—ˆŠŒ•›ŒšGŠ–”G”ˆG‹ŒG‹ˆ‹ŒG‹šŠ™Œ›ˆ”Œ•›ŒG”ˆ–™G˜œŒGˆ˜œŒ“ŒšG Š–”G–š›Œ–ššˆ™Š–”ˆGŠ–•Œ•Š–•ˆ“GŒG”ˆšG‰ˆŸˆG˜œŒGˆ˜œŒ“ŒšGŠ–”G—ˆ™ˆ–š›ˆ“UGG

všG –š›Œ–ššˆ™Š–”ˆšG ‹–šG ›—–šG —ˆ™ˆ–š›ˆ“G ŒG —Œ™–š›ˆ“G ›ð”G ”Œ“–™G —™–Ž•ùš›Š–G ˜œŒG –G ŠŒ•›™ˆšG ‹ŒG ˆ“›–G Ž™ˆœG Or“Œ•G Œ›G ˆ“USG X`_`bG oœ–šSG X``XbG mŒŠ•Œ™G MG t““šSG X``ZbG zŠˆ‘–žŠ¡SG X``ZbG h ˆ“ˆG MG j¡Œ™•ˆ’SG YWWYbG |•G MG r•œœ›“ˆSG YWWYPUG vG –š›Œ–ššˆ™Š–”ˆG ‹ŒG ˆ“›–G Ž™ˆœG ‹ŒG šœ—Œ™óŠŒSG —–œŠ–G Š–”œ”SG ›Œ”G–G”Œš”–G—™–Ž•ùš›Š–G˜œŒG–šG–š›Œ–ššˆ™Š–”ˆšGŠ–•Œ•Š–•ˆšGO~–“‹GŒ›Gˆ“USG X`_[PUG vš›Œ–ššˆ™Š–”ˆšG šŒŠœ•‹ç™–šG šé–G ˆ˜œŒ“ŒšG ˜œŒG šŒG ‹ŒšŒ•–“Œ”G Œ”G –šš–šG Š–”G ˆ•–™”ˆ“‹ˆ‹ŒšG —™ïTŒŸš›Œ•›ŒšG ›ˆšG Š–”–G ‹–Œ•íˆG ‹ŒG wˆŽŒ›SG ™™ˆ‹ˆíé–G ŒG –œ›™ˆšG “ŒšûŒšG Otˆ“ˆžŒ™G Œ›G ˆ“USG X`_`PUG {ð”G ˆš—ŒŠ›–G š›–“ùŽŠ–G šŒ”Œ“ˆ•›ŒG ˆ–G ‹–G –š›Œ–ššˆ™Š–”ˆG Š–•Œ•Š–•ˆ“G ŒG šé–G ‹ŒG —–™G —™–Ž•ùš›Š–G Or“Œ•G Œ›G ˆ“USG X`_`bG m–™Œš›G Œ›G ˆ“USG YWWYPUG zŒŽœ•‹–G m–™Œš›G Œ“G ˆ“UG OYWWYPSG ˆG •Š‹ð•ŠˆG‹ŒG–š›Œ–ššˆ™Š–”ˆGšŒŠœ•‹ç™–GæG™ˆ‹–›Œ™ˆ—ˆGŠ–™™Œš—–•‹ŒGˆGZS[LGˆG \S\LG ‹ŒG ›–‹–šG –šG –š›Œ–ššˆ™Š–”ˆšSG Œ•˜œˆ•›–G ˆ“›Œ™ˆíûŒšG šˆ™Š–”ˆ›–šˆšG •ˆG ‹–Œ•íˆG‹ŒGwˆŽŒ›G–Š–™™Œ”GŒ”GWS^GˆGWS`LG‹–šG—ˆŠŒ•›ŒšUGkˆ”™–•GŒ›Gˆ“UGOYWW^PG ‹Œ•›Šˆ™ˆ”GXS^LG‹ŒG•Š‹ð•ŠˆG‹ŒG–š›Œ–ššˆ™Š–”ˆGšŒŠœ•‹ç™–SGŒ”G—ˆŠŒ•›ŒšG Š–”GŒššˆG‹–Œ•íˆUGG

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Revisão da literatura

35

G YU]Glš›ˆ‹ˆ”Œ•›–G G všGšš›Œ”ˆšG‹ŒGŒš›ˆ‹ˆ”Œ•›–Gšé–G”—–™›ˆ•›ŒšG—ˆ™ˆG–G—“ˆ•Œ‘ˆ”Œ•›–G ›Œ™ˆ—𜛐Š–SG —–šš‰“›ˆ”G Š–”—ˆ™ˆíé–G Œ•›™ŒG –šG ‹Œ™Œ•›ŒšG ”ï›–‹–šG ‹ŒG ›™ˆ›ˆ”Œ•›–G ŒG ˆŠ“›ˆ”G ˆG ›™–ŠˆG ‹ŒG •–™”ˆíé–G Œ•›™ŒG –šG ‹Œ™š–šG ŠŒ•›™–šG OlŠ’ˆ™‹›SGX``ZPUG vGšš›Œ”ˆG”ˆšGˆŠŒ›–GïG–G—™–—–š›–G—–™Gl••Œ’•ŽGŒGˆ‹–›ˆ‹–G‹Œš‹ŒG X`_WG—Œ“ˆGtœšŠœ“–š’Œ“Œ›ˆ“G{œ”–™Gz–ŠŒ› GOl••Œ’•ŽSGX`_ZPGŒG—Œ“–Gh”Œ™Šˆ•G q–•›G j–””›ŒŒG –™G jˆ•ŠŒ™G z›ˆŽ•ŽG ˆ•‹G l•‹G yŒšœ“›šG yŒ—–™›•ŽG OoŒˆ™ŒG Œ›G ˆ“UG X`_`bGk–™”ˆ•GŒ›Gˆ“USGYWWYPUG lššŒG šš›Œ”ˆG Š–•š‹Œ™ˆG ›™ðšG Šˆ™ˆŠ›Œ™óš›ŠˆšG ™Œ—™ŒšŒ•›ˆ‹ˆšG —–™G “Œ›™ˆšaGnSG—ˆ™ˆGˆGŽ™ˆ‹œˆíé–Gš›–“ùŽŠˆbG{SG—ˆ™ˆGˆGšŒ‹ŒGˆ•ˆ›ú”ŠˆbGŒGtSG—ˆ™ˆGˆG —™ŒšŒ•íˆG –œG ˆœšð•ŠˆG ‹ŒG ”Œ›çš›ˆšŒšUG w–ššœG ›™ðšG •óŒšG ‹ŒšŽ•ˆ‹–šG —Œ“–šG •œ”Œ™ˆšG ™–”ˆ•–šG pSG ppG ŒG pppSG šœ‰‹‹‹–šG Œ”G hSG —ˆ™ˆG ›œ”–™ŒšG •›™ˆŠ–”—ˆ™›”Œ•›ˆšGŒGiSGŒŸ›™ˆŠ–”—ˆ™›”Œ•›ˆšUG

kŒG ˆŠ–™‹–G Š–”G oŒˆ™ŒG Œ›G ˆ“UG OX`_`PSG ‹–šG —ˆŠŒ•›ŒšG Š–”G “Œšé–G ›œ”–™ˆ“G ”ˆ“Ž•ˆG ‹–G šš›Œ”ˆG ”ĀšŠœ“–TŒš˜œŒ“Š–SG ˆ—™–Ÿ”ˆ‹ˆ”Œ•›ŒSG ZWLG ˆ—™ŒšŒ•›ˆ”SGˆ–G‹ˆŽ•ùš›Š–SG›œ”–™G•–GŒš›ç‹–GpbG]WLSG•–GŒš›ç‹–GppGŒGXWLSG•–G Œš›ç‹–G pppUG všG ”ˆšG ™Œ˜ĂŒ•›ŒšSG •–G Œš›ç‹–G pSG šé–G –šG •›™ˆŠ–”—ˆ™›”Œ•›ˆšG O]]LPSGŒ•˜œˆ•›–G˜œŒSG•–GŒš›ç‹–GppSGšé–G–šGŒŸ›™ˆŠ–”—ˆ™›”Œ•›ˆšGO`WLPUGG wˆŠŒ•›ŒšG —–™›ˆ‹–™ŒšG ‹ŒG –š›Œ–ššˆ™Š–”ˆG •–G Œš›ç‹–G pppG O‹–Œ•íˆG ”Œ›ˆš›ç›ŠˆPSGˆ–G‹ˆŽ•ùš›Š–SG›Œ”G—–™G—™–Ž•ùš›Š–G–G˜œŒSG—ˆ™ˆG”œ›–šGˆœ›–™ŒšSG ‘œš›ŠˆG –G œš–G ‹ŒG ”–‹ˆ“‹ˆ‹ŒšG ›Œ™ˆ—𜛐ŠˆšG ”ˆšG ˆŽ™ŒššˆšG OiˆŠŠG Œ›G ˆ“USG X``_ˆSG YWWWbG ~œ•‹Œ™G Œ›G ˆ“USG YWWWbG wˆ›÷–Tnˆ™ŠˆG Œ›G ˆ“USG YWWZbG tˆ•’•G Œ›G ˆ“USG YWW[bGyŒŠGŒ›Gˆ“USGYWW[bGtˆ“–œGŒ›Gˆ“USGYWW\bGtŠ{Œ™•ˆ•GŒ›Gˆ“USGYWW]bGwŒ›™““GŒ›G ˆ“USGYWW]PUGxœˆ•‹–G–G–š›Œ–ššˆ™Š–”ˆGšŒG›–™•ˆG”Œ›ˆš›ç›Š–SG–šG—œ“”ûŒšGšé–G–šG “–ŠˆšG”ˆšG™Œ˜ĂŒ•›Œ”Œ•›ŒGˆŠ–”Œ›‹–šGOsˆ•ŒGŒ›Gˆ“USGX`_]PUG

tˆ™•ˆG Œ›G ˆ“UG OX``YPG ™Œ—–™›ˆ™ˆ”G ˜œŒG ˆG —™–‰ˆ‰“‹ˆ‹ŒG ‹ŒG š–‰™Œ‹ˆG Œ”G›™ðšGˆ•–šGšŒ™ˆG‹ŒG\WLGŒGŒ”G˜œˆ›™–Gˆ•–šG‹ŒGZWLG•ˆšGŠ™ˆ•íˆšG—–™›ˆ‹–™ˆšG

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G

Curcelli EC. Prognóstico em osteossarcoma

36

‹ŒG –š›Œ–ššˆ™Š–”ˆG Š–”G ”Œ›çš›ˆšŒšG —œ“”–•ˆ™ŒšG ˆ–G ‹ˆŽ•ùš›Š–UG tŒ Œ™šG Œ›G ˆ“UG OX``ZPG ™Œ“ˆ›ˆ™ˆ”G ˜œŒSG Œ”G ]YG —ˆŠŒ•›ŒšG —–™›ˆ‹–™ŒšG ‹ŒG –š›Œ–ššˆ™Š–”ˆG ”Œ›ˆš›ç›Š–Gˆ–G‹ˆŽ•ùš›Š–SGˆ—Œ•ˆšGXXLG›Œ™ˆ”Gš–‰™Œ‹ˆG‹ŒG•›ŒG”ŒšŒšUGqçG Œ”G Œš›œ‹–G Š–•‹œ¡‹–G —–™GG iˆŠŠG Œ›G ˆ“UG OX``^PSG ˆ—ùšG šŒŽœ”Œ•›–G ”–G ‹ŒG ZWG ”ŒšŒšSG\\LG‹–šG—ˆŠŒ•›ŒšG”ˆ•›Œ™ˆ”TšŒG“™ŒšG‹ŒG‹–Œ•íˆGˆ—ùšG–G›™ˆ›ˆ”Œ•›–UG tŒ›çš›ˆšŒšGùššŒˆšGŒGŠ–”—™–”Œ›”Œ•›–G‹ŒG“•–•–‹–šG•–G”–”Œ•›–G ‹–G‹ˆŽ•ùš›Š–Gšé–G™ˆ™–šGŒG™Œ“ˆŠ–•ˆ‹–šGˆG—–™G—™–Ž•ùš›Š–GOzŠˆ‘–žŠ¡SGX`_YbG oœ–šSGX``XbGmŒ™Žœš–•GMGn––™•SGYWWXbGkŒ“Gw™ŒŒ™GŒ›Gˆ“USGYWW\PUGGrˆš›ŒGŒ›Gˆ“UG OX```PGGŒ•Š–•›™ˆ™ˆ”Gˆ—Œ•ˆšGWS\LG‹ŒG”Œ›çš›ˆšŒšGùššŒˆšGŒG{–‰ˆšGŒ›Gˆ“UGOX`_\PGG Œ•Š–•›™ˆ™ˆ”G ”Œ›çš›ˆšŒšG Œ”G “•–•–‹–šSG Œ”G YSZG LG ‹–šG Šˆš–šSG Š–”G ”ˆG ‹ŒG š–‰™Œ‹ˆG‹ŒG_S\G”ŒšŒšUG hšG ”Œ›çš›ˆšŒšG šˆ“›ˆ›ù™ˆšG šé–G –Š–šG ‹ŒG –š›Œ–ššˆ™Š–”ˆG šŒ—ˆ™ˆ‹–šG ‹–G –Š–G —™”癐–SG •–™”ˆ“”Œ•›ŒG Œ”G “–Šˆ“G —™–Ÿ”ˆ“G æG “Œšé–G —™”癐ˆUG hG –Š–™™ð•ŠˆG ïG ™Œ“ˆ›ˆ‹ˆG Œ•›™ŒG XS[LG ˆG ]S\LG Ozˆ‘ˆ‹G Œ›G ˆ“UG YWW[bG rˆŽŒ™G Œ›G ˆ“USG YWW]bPUG zé–G ™Œ“ˆŠ–•ˆ‹ˆšG ˆ–G ˆœ”Œ•›–G ‹ŒG ™ŒŠ–™™ð•ŠˆG “–Šˆ“G ŒG ”Œ›çš›ˆšŒšG —œ“”–•ˆ™ŒšG Ol••Œ’•ŽG MG rˆŽˆ•SG X`^\PUG ~œš”ˆ•G MG l••Œ’•ŽG OX``WPG Œ•Š–•›™ˆ™ˆ”G ›ˆŸˆG ‹ŒG š–‰™Œ‹ˆG ‹ŒššŒšG —ˆŠŒ•›ŒšG šŒ”Œ“ˆ•›ŒG 昜Œ“ŒšG Š–”G Œš›ç‹–G pppiG ˆ–G ‹ˆŽ•ùš›Š–UG G wˆ™ˆG sŒˆŒ G Œ›G ˆ“UG OYWWZPSG ˆšG ”Œ›çš›ˆšŒšG šˆ“›ˆ›ù™ˆšGšé–G™ˆ™ˆšGŒG•‹Šˆ”G—™–Ž•ùš›Š–Gˆ‹Œ™š–UG j–”G –G Œš›ˆ‹ˆ”Œ•›–G ïG —–ššóŒ“G Œš›ˆ‰Œ“ŒŠŒ™G ‹–šG Ž™œ—–šG ‹ŒG —ˆŠŒ•›ŒšG Š–”G —™–Ž•ùš›Š–šG ‹Œ™Œ•›ŒšUG všG —ˆŠŒ•›ŒšG Š–”G ›œ”–™ŒšG Š“ˆššŠˆ‹–šG Š–”–G pSG ‰Œ”G ‹Œ™Œ•Šˆ‹–šSG ›ð”G ”Œ“–™G —™–Ž•ùš›Š–G ŒG –šG —ˆŠŒ•›ŒšGŠ–”G›œ”–™ŒšGŠ“ˆššŠˆ‹–šGŠ–”–GpppSG”Œ›ˆš›ç›Š–šSG—–™G—™–Ž•ùš›Š–UG u–GŒ•›ˆ•›–SG—ˆ™ˆGˆG”ˆ–™ˆG‹–šG—ˆŠŒ•›ŒšGŠ–”G›œ”–™ŒšGŠ“ˆššŠˆ‹–šGŠ–”–GppSG •é–GïG—–ššóŒ“G—™Œ‹¡Œ™G–G—™–Ž•ùš›Š–SG–G˜œŒG“”›ˆGˆGˆ—“Šˆíé–G‹–Gšš›Œ”ˆG‹ŒG Œš›ˆ‹ˆ”Œ•›–GŠ–”–Gˆ›–™G—™–Ž•ùš›Š–UG

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