Tumor Angiogenesis in Stage II Colorectal Carcinoma:Association With Survival

Abstract

We studied the frequency of microvessels in T3 NO MO colorectal carcinomas from patients with widely different survival times. Microvessels (<50 nm diameter) were enhanced by immunostaining with antibody to factor VHI-related antigen and counted in 40x high-power fields in sections of resected carcinomas from 9 patients who died of disease in 24 months or less (short-term survivors) and 13 who had no evidence of disease at 109 months or longer (longterm survivors). The means of the 10 highest counts for each case were compared between the long-and short-term survivor groups. The mean ± SD microvessel count was 25.4 ± 6.5 for the short-term survivors and 30.3 ± 6.4 for the long-term survivors. Median counts There is ample evidence that angiogenesis is a major factor supporting the growth of tumors.1,2 Morphologic studies enumerating microvessels in tissue sections have shown an association between higher frequency of tumor microvessels and poor patient survival, increased risk for recurrence, and metastasis in tumors from many sites, including breast, lung, genitourinary tract, and skin.3 , 4 These studies suggested that microvessel counts performed on tissue sections of tumors may be of prognostic value in the workup of patients with cancer.Although stage at presentation is the most important prognostic factor for colorectal carcinoma, 5-year survival for stage II (T3) colorectal carcinomas ranges from 60% to 80%.5 It would be advantageous to have additional prognostic information to further refine the definition of stage II and to help predict whether patients will have good or poor clinical outcomes. Findings in previous studies of tumor vessels in his- were 27.2 and 29.4, respectively. The distribution of microvessel counts was skewed toward higher counts in the long-term survivors. There was no correlation between microvessel counts and tumor site, size, or grade; lymphovascular invasion; or the presence of a mucinous component. Although there was a trend toward a higher frequency of microvessels in patients with longer survival, it is unlikely that microvessel count is an independent prognostic indicator for patients with T3 NO M0 colorectal carcinoma because there is only a small difference in microvessel frequency between patients with widely different survival times. (Key words: Microvessel counts; Colorectal carcinoma) Am J Clin Pathol 1998;109:733-737. tologic sections of resected colorectal carcinomas agree that microvessel counts may be prognostically useful, but they do not agree on what a high or low count should indicate. Some studies showed an association between high microvascular count and shortterm survival [6][7][8] and between a high microvascular count and tumor recurrence. 8,9 However, Lindmark et al 10 found higher microvessel counts in patients with longer survivals.The aim of this study was to compare microvessel counts in T3 NO M0 colorectal carcinomas from patients with long-term (>109 months) and shortterm (<24 months) survival to determine whether microvessel counts differ in pat...

Role of biological markers in the clinical outcome of colon cancer

“…It is difficult to compare our findings with those reported in other studies due to the heterogeneity of case series with respect to stage and treatment. While some studies (Bossi et al, 1995;Frank et al, 1995;Mooteri et al, 1996;Takebayashi et al, 1996;Amaya et al, 1997;Takahashi et al, 1997;Banner et al, 1998;Giatromanolaki et al, 1999;Vermeulen et al, 1999) found a direct or no relation between high angiogenic activity and poorer prognosis, we observed a trend of a better prognosis for patients with high MVD tumours, in agreement with recently published results obtained on large case series (Lindmark et al, 1996;Abdalla et al, 1999). Similar results have already been reported in breast cancer (Protopapa et al, 1993;Axelsson et al, 1995;Medri et al, 2000).…”

Microvessel density and VEGF expression are prognostic factors in colorectal cancer. Meta-analysis of the literature

“…After exclusion of the references which were out of the scope of our meta-analysis, there remained 45 studies dealing with MVD (see Appendix B) and 27 dealing with VEGF expression (see Appendix C), representing a total of 56 independent studies. Some of these articles did not fulfil our inclusion criteria (mainly because they did not mention survival data), six for MVD (Vermeulen et al, 1995;Banner et al, 1998;Nanashima et al, 1998;Kondo et al, 2000;Barozzi et al, 2002;Saad et al, 2004) and five for VEGF (Nanashima et al, 1998;Kondo et al, 2000;Seto et al, 2000;Barozzi et al, 2002;Saad et al, 2004). One study was written in Chinese language, with an English abstract and did not seem to mention survival data (Liu et al, 1999).…”

Angiogenesis in advanced colorectal adenocarcinoma with special reference to tumoral invasion

“…Although most studies of advanced colorectal cancer have highlighted the prognostic value of microvessel counting, there have been some controversial data (3,17) which can be attributed to the use of methodology that vary considerably in the microvessel counting method, originally introduced by WEIDNER et al (32) and recently modified by VERMEULEN et al (30) . However, authors using this conventional microvessel counting method as BANNER et al (1) found higher MVD in colorectal carcinoma patients who had longer survival, but it was not statistically significant and PAVLOPOULOS et al (19) found prognostic significance in advanced colorectal carcinoma regarding only vascular ramifications and the total vascular area.…”