Vascularization in Primary Breast Carcinomas: Its Prognostic Significance and Relationship with Tumor Cell Dissemination

Abstract

Purpose: The interaction between tumor cells, stroma, and endothelial cells is important for the dissemination of tumor cells. The aim of the present study is to examine vascularity in primary breast carcinomas and its prognostic significance and relationship with tumor cell dissemination. Experimental Design: A total of 498 invasive breast carcinomas were analyzed. Representative tumor sections were stained for CD34 and CD105, and vascularity was quantified by the Chalkley method. The relationship between Chalkley counts, vascular invasion, disseminated tumor cells (DTC) in the bone marrow, other clinicopathologic variables, and clinical outcome was evaluated. Results: High vascular grades determined by Chalkley counts were significantly associated with shorter distant disease^free survival and breast cancer^specific survival in all patients (P < 0.001, log-rank) and in node-negative patients not receiving adjuvant systemic therapy (P < 0.05). In multivariate analysis, both CD34 and CD105 Chalkley counts showed prognostic significance for distant disease^free survival (P = 0.014 and P = 0.026), whereas CD34 also showed prognostic significance for breast cancer^specific survival (P = 0.007). Vascular invasion and DTCs in the bone marrow showed independent prognostic significance. DTC did not discriminate survival for CD34 low Chalkley counts, whereas a very poor prognosis was observed for DTC-positive patients with high CD34 counts. In node-negative patients not receiving systemic chemotherapy, high CD34 and high CD105 counts in combination identified patients with unfavorable outcome, as opposed to all other CD34/CD105 combinations. Conclusions: Improved identification of risk groups could be obtained by adding CD34 and CD105 vascular analysis to DTC, vascular invasion, and other primary tumor factors. This may facilitate the selection of candidates for adjuvant systemic therapy.

Expression of endoglin (CD105) in cervical cancer

“…The prognostic value of CD105 and CD31 has been assessed earlier in breast, colon and ovarian carcinomas (Dales et al, 2004;Erdem et al, 2006;Minhajat et al, 2006;Dhakal et al, 2008). High expression of CD105 correlated with increased risk of metastasis in lymph node-positive breast carcinoma patients (Dales et al, 2004).…”

Correlation between Blood Flow Signal of Color Flow Imaging and Nottingham Prognostic Index in Patients with Breast Carcinoma

“…Sonographic measurement of tumor vascularity also correlates well with microvessel density, confirmed by postoperative immunohistochemical analysis, which was shown to be a prognostic factor of breast cancer [5]. High vascular grades have been associated with shorter disease-free survival [8]. The Nottingham Prognostic Index (NPI) was established by Haybittle et al [9] in 1982 and is still one of the most important biological predictors for breast cancer today [10].…”

Oct-4+/Tenascin C+ neuroblastoma cells serve as progenitors of tumor-derived endothelial cells

“…Strong correlations have been established in different malignancies between high degree of tumor vascularization and unfavorable outcome [2][3][4][5][6].…”