Microvessel density is a prognostic indicator for patients with astroglial brain tumors

Abstract

BACKGROUND. Microvessel density in tumors, a measure of angiogenesis, has been shown to be a prognostic indicator that correlates with an increased risk of metasta-sis in various epithelial cancers and with overall and relapse free survival in patients with breast cancer. Astrocytic brain tumors, particularly malignant astrocytomas, are recognized to be highly vascular tumors with potent angiogenic activity. However , the prognostic significance of microvessel density in these tumors is not known. METHODS. Sections from formalin fixed paraffin embedded tumor tissue from 93 unselected adult patients with supratentorial astrocytic brain tumors were inimu-nostained for factor VIII-related antigen in order to highlight microvessel endothe-lial cells. Microvessels were counted at 2 0 0 ~ and 400x magnification. Microvessel density was graded as 1+ to 4 + on 1 low power field, without knowledge of clinical outcome. Microvessel count and microvessel grade were correlated with postoperative survival using the Cox proportional hazards regression model. The prognostic significance of microvessel count and grade were also compared with established prognostic indicators, including patient age, Karnofsky performance status, and tumor histology using multivariate analyses. RESULTS. Both microvessel grade and microvessel count correlated significantly with postoperative survival by univariate analysis in both previously untreated and treated patients. Patients with tumors containing a microvessel Grade of 3+ or 4+ had significantly shorter survival time than patients with a microvessel Grade of 1+ or 2 f (P = 0.0022). Likewise, patients with microvessel counts of 70 or greater had significantly shorter survival than those with microvessel counts of fewer than 70 (P = 0.041). Patient age, Karnofsky performance status, tumor histology, and extent of resection were also correlated with survival by univariate analysis. Mi-crovessel count was further shown to be an independent prognostic indicator by multivariate analyses. There were correlations between microvessel density and patient age and between microvessel density and astrocytic tumor grade. CONCLUSIONS. These findings support the importance of microvessel density as a prognostic indicator of postoperative survival of patients with astroglial brain tumors. Regional tumor heterogeneity may limit the use of these techniques for routine pathologic examination.

Relationship between vascularity, age and survival in non-small-cell lung cancer

“…In contrast, ibetween age and vascularity has been found in romanolaki et al, 1996) and other types of tumours al, 1994;Miliaras et al, 1995;Leon et al, 1996). i, tumours from younger patients had higher vascuthan those from older patients.…”

Pseudoprogression, radionecrosis, inflammation or true tumor progression? challenges associated with glioblastoma response assessment in an evolving therapeutic landscape

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Prognostic value of preoperative von Willebrand factor plasma levels in patients with Glioblastoma

“…Indeed, GBM is considered the most hypervascularized tumor with activation of multiple proangiogenic signaling pathways that enhance tumor growth. In GBM patients, microvascular density has been correlated with postoperative survival 7. The identification of prognostic markers for GBM in more accessible specimens, such as blood, would be of help in the treatment of patients accompanied to the aforementioned genetic/epigenetic factors.…”

“…VWF is synthesized and released into the blood stream by endothelial cells, where it is also stored in the WPB from which it can be rapidly released upon stimulation 13. Several reports have described a direct interaction between VWF and tumor cells 14, 15, and a direct relationship between staining intensity of VWF in microvessels and different grades of astrocytomas 7.…”