ANGIONEOGENESIS IN BREAST-CANCER

Tumour growth and early development of metastases depend on the capaci ty of the tumour to induce neovascularisation, and hence on angioneoge nesis. To evaluate the prognostic relevance of microvessel density, es tablished prognostic parameters as well as Vascular density were deter mined in the tumour tissue of 67 patients with breast cancer. Vascular isation of the tumour was identified immunohistochemically with a mono clonal antibody against the vascular endothelium-associated antigen CD 31.A morphometric, stereological procedure was used for microvascular quantitation, establishing microvascular volume, surface and length. T he vascular density thus calculated was correlated with conventional p rognostic factors such as tumour size, nodal status, receptors, s-phas e fraction. A statistically significant correlation was found between vessel length and oestrogen as well as progesterone receptors (p = 0.0 07, p = 0.005). Thus receptor negative tumours were shown to be charac terised by increased vessel length and hence higher vascularisation. A t a median follow-up of 38 months, in the group of n = 48 patients, wh ich could be followed-up, with a microvessel length of greater than or equal to 190 mm/mm(3), had a statistically significant shorter overal l survival (p = 0.014), and also a statistically relevant higher rate of metastasising and recurrence (p < 0.001). Comparison with establish ed prognosticators such as tumour size, nodal status, s-phase, fractio n, grading, oestrogen and progesterone receptors, in univariate analys is, revealed the vessel length to be the prognostic factor with the hi ghest predictive value (p < 0.001), followed by oestrogen receptor (p = 0.01) and grading (p = 0.024). In summary, microvessels length deter mined by the method described, is a reliable prognostic parameter, whi ch, at a threshold of 190 mm/mm(3), is associated with a statistically significantly higher rate of development of metastases and recurrence s, as well as a shorter overall survival.