ENDOTHELIAL AREA AS A PROGNOSTIC INDICATOR FOR INVASIVE BREAST-CARCINOMA

BACKGROUND. Vascular enumeration using antibodies to Factor VIII has b een reported to be an independent prognostic indicator of invasive bre ast carcinoma. METHODS. To eliminate potential subjectivity in disting uishing between individual vessels, especially in areas of tangled cap illaries, total endothelial area (EA) was assessed using a Samba 4000 image analyzer. One hundred seventy-eight invasive breast carcinomas ( Stage 1 and 2, mean follow-up: 71 months) were immunostained for the p resence of CD34, the human hematopoietic progenitor cell antigen also present in endothelium, and EA was quantitated within 5 adjacent 20x f ields (0.74 mm(2)). Additionally, these same vessels were manually cou nted from the image analyzer. Manual counts were also made from a phot omicrograph representative of a single 10x field (1.06 mm(2)). RESULTS . High grade carcinomas contained greater endothelial area than low gr ade carcinomas (P = 0.0001). Endothelial area was prognostically signi ficant (P = 0.004) in univariate analysis of disease-free survival (DF S) and overall survival (OS), as were stage of disease, tumor size, an d combined histologic grade (P less than or equal to 0.024). Manual ve ssel counts from the monitor were significant for OS only. Manual vess el counts from photomicrographs showed no statistically significant as sociation with DFS or OS. In multivariate analysis, EA, but not vessel enumeration, remained as an independent predictor for OS (lymph node negative patients only, n = 87) and for DFS (lymph node positive patie nts only, n = 91). For the entire group of patients (lymph node negati ve and lymph node positive) independent predictors of DFS and OS were tumor grade and size (P less than or equal to 0.006). CONCLUSIONS. Of the three methods used to evaluate tumor angiogenesis, total endotheli al area, as objectively evaluated by image analysis, was the only inde pendent prognostic indicator for OS for patients with lymph node negat ive invasive breast carcinoma. (C) 1996 American Cancer Society.