Tumour versus patient: vascular and tumour survival versus prognosis

The concept that malignant solid tumour growth depends on angiogenesis is w idely recognized. For some tumour types, there is a measurable range of vas cularity and the link between prognosis and increased vascular density, bes t observed at the hotspots at the edge, is now established. What is less di scussed are the corollaries: that tumour invasion requires tissue destructi on; that the neovasculature must be not only protected but also sustained, especially at the tumour edge; that for tumour survival the edge is the fut ure and the centre is history; and that angiogenesis is essential not only for tumour growth but also for tumour invasion. Different patterns of vascu lar density in tumour edge and centre have been observed, and these are lin ked to lymphatic spread and prognosis. The variation is attributable to dif fering interactions between endothelium and the tumour cell that dictate va scular and tumour survival; this may become relevant to antiangiogenesis th erapies. Copyright (C) 2001 John Wiley & Sons, Ltd.