Increased expression of the vascular endothelial growth factor is a pejorative prognosis marker in papillary thyroid carcinoma

Vascular endothelial growth factor (VEGF) is a potent stimulator of endothe lial cell proliferation. It has been implicated in tumor growth of human th yroid carcinomas. Using the VEGF immunohistochemistry staining score, we co rrelated the level of VEGF expression with the metastatic spread of 19 case s of thyroid papillary carcinoma. The VEGF immunostaining score, ranging fr om 0-9, was determined as the multiplication of a percentage of labeled thy rocytes score (0, no labeling; 1, <30%; 2, 31-60%; 3, >61% of labeled thyro cytes) and an intensity score (0, no staining; 1, weak; 2, mild; 3, strong staining). The mean score +/- SD was 5.74 +/- 2.59 for all carcinomas. The mean score for metastatic papillary carcinoma was 8.25 +/- 1.13 vs. 3.91 +/ - 1.5 for nonmetastatic papillary cancers (P < 0.001). By discriminant anal ysis, we found a threshold value of 6.0, with a sensitivity of 100% and a s pecificity of 87.5%. There were no statistical differences between metastat ic and nonmetastatic carcinomas when age, tumor size, or thyroglobulin leve ls were considered. The VEGF immunostaining score seems to be a helpful marker for metastasis s pread in differentiated thyroid cancers. An increased production of VEGF co uld assess an aggressive disease and be the hallmark of a trend to produce metastasis. We propose the VEGF immunostaining score as a marker for the pr ognosis in differentiated thyroid cancers. A value of 6 or more, should be considered as at high risk for metastasis threat, prompting the physician t o institute a tight follow up of the patient.