TUMOR ANGIOGENESIS AS A PROGNOSTIC FACTOR IN OVARIAN-CARCINOMA - QUANTIFICATION OF ENDOTHELIAL IMMUNOREACTIVITY BY IMAGE-ANALYSIS

BACKGROUND, The growth of a malignant tumor requires the formation of new capillaries. Quantification of these microvessels is difficult. Th e purpose of this study was to establish an objective technique for qu antifying angiogenesis and to evaluate whether microvessel quantity ma y predict tumor aggressiveness in patients with ovarian carcinoma. MET HODS, Endothelial area was used to quantify microvessel density in imm unohistochemically stained sections of 28 International Federation of Gynecology and Obstetrics Stage IIIC ovarian carcinomas. The endotheli al area was measured with a computer-aided image analysis system in th e subepithelial stroma of highest vascularization. The endothelial are a in the specimens of 14 patients who survived for greater than or equ al to 6 years was compared with that of 14 patients matched for stage and treatment who died of the disease. RESULTS, The mean tumor area an alyzed was 5.04 +/- 0.23 mm(2). The mean endothelial area per mm(2) of stroma from survivors and dead patients was 0.038 +/- 0.026 mm(2) and 0.110 +/- 0.034 mm(2), respectively (P < 0.0001). No significant diff erences were found in histology, tumor grade, status of lymph nodes, a nd amount of residual tumor. CONCLUSIONS, Image analysis was used to o vercome the potential subjectivity of manual counts. Computer-assisted image analysis can evaluate accurately the angiogenic potential in ov arian carcinomas. Tumor angiogenesis may prove to be a prognostic fact or in patients with ovarian carcinoma. This study suggests that the me asurement of the endothelial area would be clinically useful in determ ining microvessel density [See editorial on pages 2219-21, this issue. ] (C) 1997 American Cancer Society.