PROGNOSTIC VALUE OF ANGIOGENESIS IN OPERABLE NON-SMALL-CELL LUNG-CANCER

Tumour angiogenesis is an important factor for tumour growth and metas tasis. Although some recent reports suggest that microvessel counts in non-small lung cancer are related to a poor disease outcome, the resu lts were not conclusive and were not compared with other molecular pro gnostic markers. In the present study, the vascular grade was assessed in 107 (T1,2-N0,1) operable non-small cell lung carcinomas, using the JC70 monoclonal antibody to CD31. Three vascular grades were defined with appraisal by eye and by Chalkley counting: high (Chalkley score 7 -12), medium (5-6), and low (2-4). There was a significant correlation between eye appraisal and Chalkley counting (P<0.0001). Vascular grad e was not related to histology, grade, proliferation index (Ki67), or EGFR or p53 expression. Tumours from younger patients had a higher gra de of angiogenesis (P=0.05). Apart from the vascular grade, none of th e other factors examined was statistically related to lymph node metas tasis (P<0.0001). A univariate analysis of survival showed that vascul ar grade was the most significant prognostic factor (P=0.0004), follow ed by N-stage (P=0.001). In a multivariate analysis, N-stage and vascu lar grade were not found to be independent prognostic factor (P=0.007) . Kaplan-Meier survival curves showed a statistically significant wors e prognosis for patients with high vascular grade, but no difference w as observed between low and medium vascular grade. These data suggest that angiogenesis in operable non-small cell lung cancer is a major pr ognostic factor for survival and, among the parameters tested, is the only factor related to cancer cell migration to lymph nodes. The integ ration of vascular grading in clinical trials on adjuvant chemotherapy and/or radiotherapy could substantially contribute in defining groups of operable patients who might benefit from cytotoxic treatment.