ANGIOGENESIS IN ENDOMETRIAL CARCINOMA

BACKGROUND. Tumor angiogenesis is essential for tumor growth and metas tases. Recently, microvessel density (MVD), a measure of tumor angioge nesis, has been found to have prognostic significance for predicting m etastasis and survival in many tumor types. This study was conducted t o determine how MVD was related to several clinicopathologic parameter s and correlated with metastasis and survival in patients with endomet rial carcinoma. METHODS. From 1979 through 1989, 85 cases of clinical Stage I and II endometrial carcinomas treated initially by hysterectom y with pelvic lymph node dissection were reviewed histologically. AU h ysterectomy specimens were stained immunohistologically for factor VII I-related antigen. MVD was counted in a x200 field (x20 objective lens and x10 ocular lens, 0.785 mm(2) per field) in the most active area o f neovascularization. Results were expressed as the highest number of microvessels identified within any single x200 field. Statistical anal ysis included the Mann-Whitney U test, Kruskal-Wallis test of variance , and the Spearman rank correlation test. Survival was calculated usin g the Kaplan-Meier method and differences in survival were analyzed us ing the log rank test. MVD and several other prognostic parameters wer e examined for their correlation with progression free survival (PFS) and overall survival (OS) by a multivariate analysis according to the Cox proportional hazards model. RESULTS. MVD was significantly correla ted with tumor grade (P = 0.0281), myometrial invasion (P = 0.0282), a nd lymph-vascular space invasion (P = 0.0073). There was no correlatio n between microvessel count and lymph node status and stage. Patients with a high MVD (greater than or equal to 60) had significantly worse PFS and OS than those with a low MVD (< 60) (log rank test, P = 0.0116 and P = 0.0096, respectively. Multivariate analysis showed that MVD c orrelated significantly and independently with PFS and OS. CONCLUSIONS . In this study, MVD was found to be an independent prognostic factor for PFS and OS in patients with endometrial carcinoma. (C) 1997 Americ an Cancer Society.