Jd. Jacquemier et al., ANGIOGENESIS AS A PROGNOSTIC MARKER IN BREAST-CARCINOMA WITH CONVENTIONAL ADJUVANT CHEMOTHERAPY - A MULTIPARAMETRIC AND IMMUNOHISTOCHEMICALANALYSIS, Journal of pathology, 184(2), 1998, pp. 130-135
It has now been clearly established that quantitative immunohistochemi
cal methods applied to tumour angiogenesis under suitable quality cont
rol conditions are a powerful prognostic tool for use in the initial a
ssessment of breast carcinomas. Appropriate parameters for predicting
the aggressiveness of tumours and their sensitivity to treatment are,
however, still required. To determine whether the microvessel count (M
VC) may serve to predict the chemotherapeutic response, a retrospectiv
e study was carried out on a series of 162 patients with breast carcin
oma, who were all treated with the same standard adjuvant chemotherapy
. Angiogenesis was assessed by performing CD31 immunostaining and MVC
per mm(2). Several other factors such as P53, ERBB2, BCL2, and Ki67 we
re also measured, and their prognostic value was compared with that of
the MVC. The MVC was not found to be correlated with any of the other
prognostic parameters, but turned out to be of great prognostic value
whatever the threshold value chosen, which suggests that it is contin
uously, and at all levels. The median value of the MVC (43.5 per mm(2)
) divided this series into two significantly different prognostic cate
gories, in terms of both disease-free survival (P=0.0002) and overall
survival (P=0.037). Univariate analysis showed that most of the parame
ters analysed were of prognostic value regarding the disease-free surv
ival, namely grade (P=0.029), mitotic index (P=0.049), size (P=0.015),
oestrogen receptors (P=0.022), progesterone receptors (P=0.018). P53
(P=0.0045), ERBB2 (P=0.046), and Ki67 (P=0.0008). As regards overall s
urvival, grade and ERBB2 showed a loss of prognostic value. In multiva
riate analysis on disease-free survival, the MVC was the most accurate
prognostic factor (RR=2.64), followed by Ki67 (RR=2.06) and P53 (RR=1
.69). With respect to overall survival, the MVC ranked third among the
prognostic parameters analysed. Standard chemotherapy did not reduce
the high prognostic value of the MVC performed on tumour angiogenesis.
This suggests that the MVC may predict the degree of resistance to ch
emotherapy. Patients with high levels of angiogenesis, particularly no
de-negative patients, might therefore be able to benefit from adjuvant
therapy of another kind. (C) 1998 John Wiley & Sons, Ltd.