Association of Color Doppler Vascularity Index and Microvessel Density With Survival in Patients with Gastric Cancer

Abstract

ObjectiveThe purpose of this study was to investigate the clinical usefulness of microvessel density (MVD) and an in vivo angiogenesis parameter, color Doppler vascularity index (CDVI), in patients with gastric cancer. Summary Background DataMany studies have reported a significant association between the degree of MVD-evaluated angiogenesis with the clinicopathologic factors and prognosis of patients with various solid tumors. All these studies were accomplished on tissue sections retrospectively obtained from surgical specimens. However, an in vivo method to assess tumor angiogenesis for human malignancies is highly desirable for diagnostic purpose, treatment planning, and follow-up. The CDVI is a new ultrasound parameter for evaluating in vivo angiogenesis, has a good correlation with status of lymph node metastasis in cervical carcinoma, and can predict distant metastasis and survival in colon cancer patients. Therefore, the CDVI may also be useful to assess in vivo angiogenesis in human gastric cancer. MethodsA total of 79 patients with gastric cancer were enrolled in this study, and microvessel density was evaluated by using immunohistochemical staining of surgical specimens with anti-CD-34 antibody. Tumors were sonographically visible in 31 patients. The CDVI of each tumor was determined using transabdominal color Doppler ultrasound. The CDVI was defined as the ratio of the number of the colored pixels within a tumor section to the number of total pixels in that specific tumor section, and was calculated by using Encomate software (Electronic Business Machine Co. Ltd., Taipei, Taiwan). Correlation between MVD, CDVI and clinicopathologic factors and patient survival was studied. ResultsThe MVD was significantly correlated with vascular invasion by multiple linear regression analysis. Although the survival of patients with high MVD (Ͼ 32) was significantly worse than those with low MVD (Ͻ 32) by univariate analysis, vascular invasion was an independent prognostic factor by Cox proportional hazard model. There was a linear correlation between CDVI and MVD (r ϭ .495, P ϭ .005). Moreover, in patients with a high CDVI (Ͼ 11%), the survival rate was significantly lower than that in those with low CDVI (Յ 11%, P ϭ .005). None of the patients with high CDVI (Ͼ 11%) survived 2 years after curative resection. In addition to vascular invasion, the CDVI was another independent prognostic factor in the patients with stage III gastric cancer. ConclusionsVascular invasion was an important prognostic indicator in gastric cancer. The high CDVI was a good preoperative indicator of early death in stage III gastric cancer patients. Thus, the CDVI may be helpful in selecting patients with gastric cancer for neoadjuvant chemotherapy and/or anti-angiogenic therapy.Angiogenesis is a very complex phenomenon and essential for the growth of solid tumors measuring more than a few millimeters.1 It permits rapid tumor growth and potential presence of tumor metastasis.2,3 It is not easy to develop a single method capable of detecting su...

Aberrant expression of EphA3 in gastric carcinoma: correlation with tumor angiogenesis and survival

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Role of Perfusion CT in Assessing Tumor Blood Flow and Malignancy Level of Gastric Cancer

“…A report on colorectal cancer also failed to show a relationship between perfusion parameters and lymph node metastasis [20] . The reason for this may be that tumor perfusion is closely related to vascular invasion and hematogenous spreading rather than lymphatic metastasis [21] . Our study included 2 patients with hepatic metastasis, and although we could not see any significance in the decrease with such few cases, both patients had an extremely low blood flow average of 27.0.…”

Tumour Angiogenesis in Rectal Cancer-Computer-Assisted Endosonographic and Immunohistochemical Methods for Assessment

“…With the pulse Doppler one can assess the blood flow speed and the resistance of a particular vessel at a certain time point. Several studies have suggested that color Doppler ultrasonography may provide a reliable preoperative quantitation of tumor angiogenesis and prognostic information in cancer patients (Ogura et al, 2001;Chen et al, 2002).…”

“…The determination of the vascular endothelial growth factor (VEGF) expression of the tumour sections is an alternative method of estimating the angiogenic activity of the tumour. Doppler ultrasound is an attractive modality for imaging angiogenesis in vivo which can be repeated without exposing the patient to any risk (Chen et al, 2002;Ogura et al, 2001;Yang et al, 2002). Because of its high sensitivity in measuring slow flows and the improved detailed information about the curved and irregular vessel ways, power Doppler is a suitable technique for depicting the vessels inside the tumour.…”