Clinical significance of cell proliferation, microvessel density, and CD44adhesion molecule expression in renal cell carcinoma

Renal cell carcinoma (RCC) is known to have a wide variation in Clinical ou tcome despite the use of conventional prognostic factors, such as staging o r grading. A better knowledge of the biologic aggressiveness of RCC could f acilitate the selection of patients at high risk of tumor progression. The aim of this study was to determine if use of measurements of vascular densi ty, cell proliferation, and cell adhesion could better predict the biologic behavior of RCC. We immunohistochemically analyzed CD34, Ki-67, and CD44H expression on formalin-fixed, paraffin-embedded tissues from 73 RCCs for qu antifying microvessel density (MVD), Ki-67 labeling index (LI), and CD44H L I, respectively. Univariate cancer-specific survival analysis showed that t umor stage (P <.01), tumor size (P <.001), nuclear grade (P <.01), metastas is (P <.001), MVD (P <.03), Ki-67 LI (P <.001), and CD44H Ll (P <.0001) wer e predictors of tumor-related death. There was a statistical correlation be tween CD44H LI and both Ki-67 Ll (r' =.3) and MVD (r' = -.44). Ki-67 LI (P <.04) and CD44H LI (P <.02), as well as metastasis (P <.008), emerged as in dependent predictors of cancer-specific survival in multivariate analysis i n patients with metastases (P <.04 and P <.02, respectively) and in patient s without metastases (P <.006 and P <.00001, respectively). Our study sugge sts that vascular density, cell proliferation, and cell adhesion represent a complex tumor-host interaction that may favor progression of RCC. Cell pr oliferation and CD44H expression appear to be powerful markers to identify patients with an adverse prognosis. HUM PATHOL 32:1209-1215. Copyright (C) 2001 by W.B. Saunders Company.