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Background Mesothelium VCAM-1 expression in the metastatic epithelial ovarian cancer (EOC) microenvironment is induced by tumor and mediates tumor cell invasion. VCAM-1 imaging suggests expression during treatment is an indicator of platinum resistance. Here, we assess the potential prognostic significance of mesothelium VCAM-1 expression and prospectively evaluate whether soluble VCAM-1 (sVCAM-1) is a surrogate for mesothelium expression. Methods A retrospective review of EOC patients was performed to evaluate outcomes with mesothelium VCAM-1 expression determined by immunohistochemistry of peritoneum or omentum specimens. A prospective cohort of EOC patients was identified and followed through primary treatment. Serum for sVCAM-1 evaluation, determined by ELISA, was collected prior to surgery or neoadjuvant chemotherapy and at each treatment cycle. Peritoneal specimens were obtained during debulking to assess mesothelial VCAM-1 expression. Results Retrospective review identified 54 advanced stage EOC patients. Patients expressing mesothelium VCAM-1 had shortened overall (44 vs 79 months, p=0.035) and progression-free survival (18 vs 67 months, p=0.010); median time to platinum-resistance was 36 months for VCAM-1 expressing patients and not yet determined for the VCAM-1 negative group. In our prospective observational cohort, eighteen EOC patients completed primary treatment; 3 were negative for mesothelium VCAM-1 expression, and sVCAM-1 did not vary between groups. Conclusions Mesothelium VCAM-1 expression negatively associates with progression-free and overall survival in EOC. This is especially compelling in light of prior data suggesting that persistent VCAM-1 expression during treatment is an indicator of platinum resistance. Our pilot study had insufficient cases to determine whether sVCAM-1 would substitute for mesothelium expression.

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