Comparative study of tumor angiogenesis and immunohistochemistry for p53, c-ErbB2, c-myc and EGFr as prognostic factors in gastric cancer

Gastric cancer (GC) continues to be a highly aggressive malignancy with poo r prognosis and low survival rates. The survival of patients with GC depend s mainly on the stage of the disease, with early GC having a 5 year surviva l of 90-100% and advanced tumors a 5 year survival of 15-25%. The role of o ther prognostic factors in these tumors is still under investigation. 28 ga stric dysplasia, 45 Early GC and 98 Advanced Gastric Cancers were evaluated for expression of the oncogenes p53, c-ErbB2, c-myc and the EGFr in paraff in-embedded material utilizing Avidin-Biotin immunohistochemistry technique s. In 34 cases of GC microvessel density (MVD) was determined in CD34 stain ed sections. Statistical correlations with stage, histologic type, differen tiation degree, location, size, ploidy patterns and overall survival were d one. The Mantel-Cox test was performed to evaluate which factors had an ind ependent prognostic value. Both, tumor angiogenesis and p53 protein expression were statistically asso ciated (95% confidence intervals) with overall survival in patients with GC . p53 protein expression was also correlated with cardial location, nodal i nvolvement and tumor stage. c-ErbB2 may recognize a group of highly aggress ive well differentiated adenocarcinomas with worse prognosis. c-myc was als o significantly enhanced in well differentiated tumors. EGFr showed no sign ificant associations. Mantel-Cox was performed to compare the prognostic value of tumor stage, p5 3 protein expression and tumor angiogenesis. Tumor angiogenesis was the mos t important prognostic indicator to predict overall survival in our series. p53 expression was not independent and did not provide additional prognost ic information to tumor stage. Our study suggests that angiogenesis as demo nstrated by microvessel counts in CD34 stained sections is a significantly important prognostic factor for predicting survival in gastric cancer.