Prognostic implication of apoptosis and angiogenesis in cervical uteri cancer

Purpose: A retrospective study was performed to investigate the relationshi p between spontaneous apoptosis and angiogenesis uterine cervix squamous ce ll carcinoma patients. The prognostic value of each (and both) of these bio logic parameters was also tested. Methods and Materials: The pathologic materials of 40 cervical uteri squamo us cell carcinoma patients were examined and immunohistochemically stained to determine the tumor angiogenesis (tumor microvascular score), using fact or Vm-related antigen, and their tumor apoptotic index (AI), using the TdT- mediated dUTP nick end-labeling (TUNEL) method. Three patients were Stage I , 18 were Stage II, 15 were Stage III, and 4 were Stage IV (FIGO classifica tion). All patients were treated with radical radiotherapy and all had foll ow-up for more than 2 years. Results: The mean AI was 15.1 +/- 12.8, with a median of 8.3. The mean tumo r microvascular score was 3 9.7 +/- 14.4, with a median of 3 8. The patient s' age and tumor grade did not seem to significantly affect the prognosis. On the other hand, AI and angiogenesis (tumor microvascular score) were of high prognostic significance. The 3-year disease-free survival (DFS) rate f or the patients having AI above the median was 78% (confidence interval [CI ] 69-87%), compared to 32% (CI 22-42%) for those having AI below the median . The DFS was 18% (CI 9-27%) for patients having an angiogenesis score abov e the median, while it was 86% (CI 78-94%) for those patients having a scor e below the median. Conclusion: Determination of both tumor microvascular score and AI can iden tify patients with the best prognosis of 100% DFS (with low angiogenesis sc ore and high AI). Women with a high score and low AI had the worst prognosi s (DFS = 3%, CI 1-5%). Moreover, high AI can compensate partially for the a ggressive behavior of tumors showing a high rate of angiogenesis. (C) 2000 Elsevier Science Inc.