Prognostic analysis of tumour angiogenesis, determined by microvessel density and expression of vascular endothelial growth factor, in high-risk primary breast cancer patients treated with high-dose chemotherapy

In contrast to early breast cancer, the prognostic effect of tumour angiogenesis in tumours with advanced axillary spread has been less studied. We retrospectively analysed the effect of microvessel density (MVD) and vascular endothelial growth factor (VEGF) by immunohistochemistry on the outcome of 215 patients treated uniformly within prospective trials of high-dose chemotherapy for 4-9 and >/=10 positive nodes, and followed for a median of 9 (range 3-13) years. Microvessel density was associated with epidermal growth factor receptor (EGFR) expression (P<0.001) and tumour size (P=0.001). Vascular endothelial growth factor overexpression (51% of patients) was associated with overexpression of EGFR (P=0.01) and HER2 (P<0.05), but not with MVD (P=0.3). High MVD was associated with worse relapse-free survival (74 vs 44%, P<0.001) and overall survival (76 vs 44%, P<0.001). Vascular endothelial growth factor overexpression had no effect on outcome. Multivariate analyses showed a prognostic effect of MVD independently of other known prognostic factors in this patient population. In conclusion, tumour angiogenesis, expressed as MVD, is a major independent prognostic factor in breast cancer patients with extensive axillary involvement.     

HER3 genomic gain and sensitivity to gefitinib in advanced non-small-cell lung cancer patients

In non-small-cell lung cancer (NSCLC), sensitivity to tyrosine kinase inhibitors (TKIs) is associated with activating mutations and genomic gain of the epidermal growth factor receptor (EGFR). Preclinical data suggested that HER3 overexpression increases sensitivity to TKIs. A total of 82 NSCLC patients treated with gefitinib (250 mg), and previously evaluated for EGFR and HER2 status by fluorescence in situ hybridisation (FISH) and DNA sequencing, and for Phospho-Akt status by immunohistochemistry, were investigated for HER3 genomic gain by FISH. Patients with high polysomy and gene amplification were considered as HER3 FISH positive (+). HER3 FISH+ pattern was significantly associated with female gender (P=0.02) and never smoking history (P=0.02). Patients with HER3+ tumours (26.8%) had a significantly longer time to progression (3.7 vs 2.7, P=0.04) than patients with HER3- tumours, but not a significantly better response rate or survival. Patients with EGFR+/HER3+ tumours had higher objective response rate (36.4 vs 9.9%, P=0.03) and time to progression (7.7 vs 2.7 months, P=0.03) than patients with EGFR- and/or HER3- tumours, but no significantly longer survival. No difference in response was observed according to HER3 status in patients with EGFR+ tumours. Patients with HER2+/HER3+ tumours had similar outcome as patients with HER2- and/or HER3- tumours. Significantly different clinical end points were not observed between patients with HER3+/P-Akt+ and HER3- and/or P-Akt- tumours. Genomic gain for HER3 is not a marker for response or resistance to TKI therapy in advanced NSCLC patients.     

p53 and VEGF expression are independent predictors of tumour recurrence and survival following curative resection of gastric cancer

This study was undertaken to determine the value of tumour microvessel density (MVD) and the expression of p53 and vascular endothelial growth factor (VEGF) as prognostic markers in patients with gastric cancer operated on for cure. In all, 156 patients with curatively resected gastric cancer constituted the basis of this blinded retrospective evaluation. Patients were treated with either surgery alone (n=53) or surgery plus adjuvant chemotherapy (n=103). Tumour MVD, p53 expression, and VEGF expression were assayed using immunohistochemical techniques. After a mean follow-up of 43 months, 64 (41%) patients had died and 55 (35%) patients developed tumour recurrence. Positive correlations between MVD and both p53 (P=0.005) and VEGF (P=0.005) expression were observed. Both MVD >/=100 (P=0.05) and positive VEGF expression (P<0.02) were associated with shorter disease-free survival, and positive VEGF expression (P=0.01) was also associated with shorter overall survival. Multivariate analysis confirmed that, in addition to the pathological tumour stage, lymph node ratio, the extent of lymphadenectomy and perineural invasion, p53 expression, and VEGF expression were independently associated with both disease-free survival (P<0.0005 and 0.02, respectively) and overall survival (P<0.02 and 0.01, respectively). Finally, patients whose tumours did not show p53 expression had a survival benefit compared to those expressing p53 when treated with adjuvant chemotherapy (P=0.01).This investigation demonstrates that p53 expression and VEGF expression are independent prognostic factors for both disease-free survival and overall survival in patients with curatively resected gastric cancer, and that p53 status may also influence response to chemotherapy.     

Vascular endothelial growth factor expression predicts outcome and lymph node metastasis in squamous cell carcinoma of the esophagus.

Vascular endothelial growth factor (VEGF) expression and tumor microvessel density (MVD) were examined by immunohistochemical staining in 117 cases of thoracic esophageal squamous cell carcinoma. Thirty-six (31%) of the 117 cases were evaluated as VEGF-positive. The average number of metastatic lymph nodes at surgery was 5.6 in the VEGF-positive cases and 3.0 in the VEGF-negative cases and was significantly higher in those with VEGF-positive cases (P = 0.04). The incidence of pathological tumor (PT)2-4 cases among the high-MVD cases was significantly higher than among the low-MVD cases (P = 0.01). MVD was 59.4 +/- 4.7 (mean +/- SE)/mm2 in the VEGF-positive cases and 47.9 +/- 3.8/mm2 in the VEGF-negative cases. The MVD of the VEGF-positive tumors was higher than that of VEGF-negative tumors, but the difference was not significant (P = 0.08). The survival rate of the patients with high-MVD tumors was significantly poorer than those with low-MVD tumors, and the survival rate of those patients with VEGF-positive tumors was significantly poorer than in those with VEGF-negative tumors (P = 0.009 and P = 0.04, respectively). The cumulative survival rates in the VEGF-positive groups were found to be significantly poorer in the pT3 and pathological node (pN)1 groups when stratified according to pT factor (pathological T category) and pN factor (pathological N category) in the tumor-node-metastasis (TNM) classification. VEGF expression had the second highest hazard ratio in the multivariate analysis, after pN factor. These results indicate that VEGF is a useful marker for predicting the outcome in patients with more advanced esophageal squamous cell carcinoma. It seems that TNM factors and VEGF expression are important factors in the selection of appropriate treatments.     

胃癌基质金属蛋白酶-2与血管生成的关系

背景与目的:肿瘤的增殖和转移依赖于血管生成,实验研究证明基质金属蛋白酶-2(matrixmetalloproteinase-2,MMP-2)在肿瘤血管生成中有重要作用。本研究的目的是观察胃癌组织、癌旁组织和手术切缘区正常组织中基质金属蛋白酶-2(matrixmetalloproteinase-2,MMP-2)表达及其与微血管密度(microvesseldensity,MVD)的关系,探讨MMP-2对胃癌血管生成的作用和意义。方法:应用S-P法,对50例胃癌手术切除标本进行抗人MMP-2单克隆抗体和抗因子FⅧ相关抗原抗体(FⅧRAg)免疫组织化学染色,检测癌组织、癌旁组织、手术切缘区正常组织各区域MMP-2表达和MVD,并分析MMP-2表达与MVD及它们与胃癌临床病理特征之间的关系。结果:癌组织MMP-2高表达显著高于癌旁组织(64%比28%,χ2=7.48,P<0.01),癌旁组织MMP-2低表达亦明显高于切缘区正常组织(52.0%比26.0%,χ2=6.18,P<0.05)。无论在癌组织、癌旁组织MMP-2高表达的MVD均显著高于MMP-2低表达者(30.71±7.41比26.15±4.82,t=2.11,P<0.05;15.31±5.23比9.61±2.17,t=3.98,P<0.01)。此外,在浸润浆膜、低分化及伴有淋巴结转移、肝脏转移的癌组织MMP-2高表达(81%比51.7%,χ2=4.67,P<0.05;87.0%比44.4%,χ2=9.47,P<0.01;81.8%比50.0%,χ2=5.41,P<0.05;89.5%比48.4%,χ2=8.63,P<0.01)及其MVD(     

Clinical heterogeneity in childhood acute lymphoblastic leukemia with 11q23 rearrangements.

To assess the clinical heterogeneity among patients with acute lymphoblastic leukemia (ALL) and various 11q23 abnormalities, we analyzed data on 497 infants, children and young adults treated between 1983 and 1995 by 11 cooperative groups and single institutions. The substantial sample size allowed separate analyses according to age younger or older than 12 months for the various cytogenetic subsets. Infants with t(4;11) ALL had an especially dismal prognosis when their disease was characterized by a poor early response to prednisone (P=0.0005 for overall comparison; 5-year event-free survival (EFS), 0 vs 23+/-+/-12% s.e. for those with good response), or age less than 3 months (P=0.0003, 5-year EFS, 5+/-+/-5% vs 23.4+/-+/-4% for those over 3 months). A poor prednisone response also appeared to confer a worse outcome for older children with t(4;11) ALL. Hematopoietic stem cell transplantation failed to improve outcome in either age group. Among patients with t(11;19) ALL, those with a T-lineage immunophenotype, who were all over 1 year of age, had a better outcome than patients over 1 year of age with B-lineage ALL (overall comparison, P=0.065; 5-year EFS, 88+/-+/-13 vs 46+/-14%). In the heterogeneous subgroup with del(11)(q23), National Cancer Institute-Rome risk criteria based on age and leukocyte count had prognostic significance (P=0.04 for overall comparison; 5-year EFS, 64+/-+/-8% (high risk) vs 83+/-+/-6% (standard risk)). This study illustrates the marked clinical heterogeneity among and within subgroups of infants or older children with ALL and specific 11q23 abnormalities, and identifies patients at particularly high risk of failure who may benefit from innovative therapy.     

Microscopic analysis and significance of vascular architectural complexity in renal cell carcinoma.

The objective of this study was to evaluate the utility of measuring microvessel fractal dimension (MFD) as a parameter of architectural microvascular complexity in localized renal cell carcinoma (RCC). Forty-nine patients with low-stage clear cell RCC were assessed in a 9-year follow-up retrospective study. Tumor vessels were visualized with the endothelial marker CD34. Tumor microvessel density (MVD) was measured by computerized morphometry. Fractal analysis of the RCC microvascular network was performed and the MFD was computed in each case. Correlation between tumor vascular parameters, histological grade, extent of tumor necrosis and patient survival were tested by uni- and multivariate analyses. A significant correlation was found between tumor grade and decreased survival (P = 0.04). The extent of macroscopic tumor necrosis also significantly correlated with poor prognosis (P = 0.0001). Survival analysis revealed a significantly higher MVD in patients who survived longer than 5 years as compared with those who died before the end of the 5-year follow-up period (MVD = 10.8 +/- 4.7% versus 6.4 +/- 3.7%; P = 0.03). MVD was also inversely associated with the extent of tumor necrosis (P = 0.03). Microvessel fractal dimension was significantly higher in low- as compared with high-grade tumors (1.55 +/- 0.11 versus 1.45 +/- 0.15; P = 0.03). Survival analysis revealed a significantly higher MFD in those who lived >5 years as compared with those who died earlier (1.56 +/- 0.11 versus 1.46 +/- 0.15; P = 0.02). The MFD was inversely associated with the extent of tumor necrosis (P = 0.01). Multivariate analysis revealed that the MFD was the only significant factor to correlate with tumor necrosis, and that tumor necrosis was the only independent predictor of patient survival. These results indicate that the analysis of MFD as a marker of tumor microvascular complexity may provide important prognostic information as well as novel insight into the biology of tumor angiogenesis.     

Evaluation of the relationship between the systemic inflammatory response and cancer-specific survival in patients with primary operable breast cancer

The relationship between the systemic inflammatory response (as evidenced by elevated C-reactive protein and lowered albumin concentrations), clinico-pathologic status and relapse-free, cancer-specific and overall survival was examined in patients with invasive primary operable breast cancer (n=300). The median follow-up of the survivors was 46 months. During this period, 37 patients relapsed and 25 died of their cancer. On multivariate analysis, only tumour size (P<0.05), albumin (P<0.01) and systemic treatment (P<0.0001) were significant independent predictors of relapse-free, cancer-specific and overall survival. Lower serum albumin concentrations (相似文献   

组织因子表达与胃癌微血管生成的关系及其临床意义

背景与目的组织因子(tissuefactor,TF)生理功能为凝血过程的启动者。近来发现TF参与多种恶性肿瘤微血管形成的过程。本研究旨在探讨胃癌组织中表达的组织因子与其微血管形成过程之间的关系和临床意义。方法应用免疫组织化学EnVisionTM法,检测了80例胃癌和20例正常胃组织标本中TF、VEGF(血管内皮生长因子)的表达情况和CD34单克隆抗体标记的MVD值(肿瘤微血管密度)。结果胃癌组织中TF和VEGF的阳性表达率分别为65.00%(52/80)和67.50%(54/80),MVD值为36.14±9.94;正常胃组织中TF和VEGF的阳性表达率分别为5.00%(1/20)和5.00%(1/20),MVD值为12.10±3.27。胃癌组织中TF的表达与VEGF的表达和MVD值之间均存在相关性(P<0.05),组织中TF表达越高,相应VEGF的表达越高,MVD值也越大。TF与患者的总生存期、TNM分期和肝脏转移状况有关。结论胃癌组织中异常表达增高的TF与胃癌微血管形成过程和患者预后有关。     

Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis.

Transplant outcome was analyzed in 150 patients with myelodysplastic syndrome (MDS) or acute myelogenous leukemia transformed from MDS (tAML) conditioned with nonmyeloablative or myeloablative regimens. A total of 38 patients received nonmyeloablative regimens of 2 Gy total body irradiation alone (n=2) or with fludarabine (n=36), 90mg/m2. A total of 112 patients received a myeloablative regimen of busulfan, 16mg/ kg (targeted to 800-900 ng/ml), and cyclophosphamide 120 mg/ kg. Nonmyeloablative patients were older (median age 62 vs 52 years, P<0.001), more frequently had progressed to tAML (53 vs 31%, P=0.06), had higher risk disease by the International Prognostic Scoring System (53 vs 30%, P=0.004), had higher transplant specific comorbidity indices (68 vs 42%, P=0.01) and more frequently had durable complete responses to induction chemotherapy (58 vs 14%). Three-year overall survival (27%/48% (P=0.56)), progression-free survival (28%/4 44%, (P=0.60)), and nonrelapse mortality (41%/34%, (P=0.94)) did not differ significantly between nonmyeloblative/myeloablative conditioning. Overall (HR=0.9, P=0.84) and progression-free survivals (HR=1, P=0.93) were similar for patients with chemotherapy-induced remissions irrespective of conditioning intensity. Graft vs leukemia effects may be more important than conditioning intensity in preventing progression in patients in chemotherapy-induced remissions at the time of transplantation. Randomized prospective studies are needed to further address the optimal choice of transplant conditioning intensity in myeloid neoplasms.     

Non-metastatic stage IV nasopharyngeal carcinoma patients: analysis of the pattern of relapse and survival.

BACKGROUND AND PURPOSE: The objective of this study is to analyze the mode of recurrence patterns and survival of our 96 non-metastatic stage IVA and IVB nasopharyngeal carcinoma (NPC) patients. PATIENTS AND METHODS: A total of 234 previously untreated, histologically confirmed non-metastatic NPC patients were treated in our department between 1993 and 2001. Among them 96 patients (41%) were staged as IVA or B disease. All patients were uniformly staged using the fifth edition of AJCC/UICC staging system. There were 76 male and 20 female patients. Their ages ranged from 9 to 72 years (median age: 43.5). Histopathological diagnosis was WHO 2 and 3 in 89 (93%) patients. All patients were treated with external radiotherapy and 77 out of 96 patients (80%) with stage IV disease received either concomitant or neoadjuvant cisplatin based combined chemotherapy regimens. Median follow-up time was 30 months (range: 4-101 months). RESULTS: At the time of this analysis, 60 (62%) patients were alive and 48 of them were free of disease. Local recurrence rate was found to be significantly higher in stage IVA patients (28 vs. 11%, P=0.02) and distant metastasis rate was significantly higher in stage IVB patients (40 vs. %8, P=0.0001). The 3 year overall (OS), disease free (DFS), loco regional relapse free (LRRFS) and distant metastasis free survival (DMFS) rates were 71, 74, 77 and 94% for stage IVA and 60, 46, 77 and 58% for stage IVB patients, respectively. Three year LRFS rates for stage IVA and IVB were 77 and 89%, respectively (P=0.1). Age older than 40 years was found to be statistically significant adverse prognostic factor both for OS (P=0.01) and LRRFS (P=0.005) in univariate analysis. Advanced N status was an unfavorable prognostic factor both for OS (P=0.03), DFS (P=0.0004) and DMFS (P=0.0003). DMFS was adversely affected by the presence of cranial nerve palsy at diagnosis (P=0.01), advanced T status (P=0.03) and advanced N status (P=0.0003). In univariate analysis treatment with chemotherapy was found to be an unfavorable prognostic factor for DMFS (P=0.02). According to the multivariate analysis, older age (>40 year of age) was a significant independent prognostic factor for OS (P=0.02), DFS (P=0.05) and LRRFS (P=0.01). Patients with advanced N status had worse OS (P=0.03), DFS (P<0.0001) and DMFS (P=0.07). Patients treated with chemotherapy as an adjuvant to radiotherapy had tended to have a better DFS (P=0.04). CONCLUSIONS: The local relapse was the major cause of failure in patients with stage IVA disease, and distant metastasis was the predominant treatment failure in stage IVB patients. While stage IVA patients may benefit more intensive local treatment strategies, stage IVB patients definitely need more systemic treatment.     

环氧合酶-2抑制剂塞来昔布对人肝癌HepG2裸小鼠移植瘤生长和肿瘤血管生成的抑制作用

背景与目的:有研究证实,环氧合酶-2(cyclooxygenase-2,COX-2)与肿瘤,特别是与消化系统肿瘤形成的关系较为密切,而其抑制剂则具有抗肿瘤作用。本研究探讨特异性抑制剂塞来昔布对人肝癌HepG2裸小鼠移植瘤生长和肿瘤血管生成的抑制作用。方法:将肝癌细胞HepG2种植至裸鼠背侧皮下,4天后开始用塞来昔布治疗,58天后处死。观测裸鼠移植瘤的体积和质量。并采用免疫组化和逆转录-聚合酶链反应法(RT-PCR)检测裸鼠移植瘤组织中COX-2、血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)、碱性成纤维生长因子(basicfibroblastgrowthfactor,bFGF)和血管生成素-2(angiopoientin-2,Ang-2)的表达,用免疫组化法检测微血管密度(microvesseldensity,MVD)。结果:治疗组切除的移植瘤平均体积和质量分别是(709.11±108.53)mm3和(2.63±0.34)g,对照组分别为(1417.55±69.50)mm3和(5.32±0.98)g,两组比较差异有显著性(P<0.01)。治疗组肿瘤增殖率为55.21%。②对照组COX-2、VEGF、bFGF、Ang-2的表达和MVD值分别是4.50±0.25、5.43±0.58、4.03±0.47、5.53±0.54和128.24±9.82,而在塞来昔布组分别是2.42±0.29、2.80±0.30、2.23±0.41、2.88±0.25和29.23±1.52。两组相比较,COX-2、VEGF、bFGF、Ang-2的表达和MVD值差异有显著性(P<0.01)。COX-2与VEGF、bFGF、Ang-2和MVD有明显的相关性(r分别为0.862、0.882、0.857,P分别<0.01)。结论:塞来昔布有效抑制了人肝癌细胞HepG2裸小鼠移植瘤的生长和血管生成,其作用途径是抑制了COX-2的表达。     

40岁以下青年人肺癌的临床病理特征和预后

目的　探讨 <4 0岁青年人肺癌的临床病理特征及预后 ,并与≥ 4 0岁的中老年人肺癌进行比较。方法　对 12 9例青年人肺癌 (青年组 )以及随机选择的 14 0例中老年人肺癌 (中老年组 )进行回顾性分析 ,比较两组临床病理特征和生存期。结果　青年组与中老年组相比 ,青年组女性患者比例高 (P =0 .0 37) ,平均症状持续时间长 (4 .7个月 ,P <0 .0 0 1) ,误诊率高 (6 5 .1% ,P <0 .0 0 1) ,平均误诊时间长 (5 .6个月 ,P <0 .0 0 1) ,以腺癌为主要病理类型 (5 4 .3% ,P <0 .0 0 1) ,癌细胞分化差 (6 9.5 % ,P <0 .0 0 1) ,诊断时晚期多 (74 .4 % ,P <0 .0 0 1) ,接受综合治疗的比例高 (94 .6 % ,P <0 .0 0 1) ,因远处转移而致治疗失败者的比例高 (6 4 .7% ,P =0 .0 2 )。两组总的中位生存期和 5年生存率差异无显著性 (P =0 .2 889) ,但Ⅰ期和Ⅱ期中 ,青年组中位生存期及 5年生存率优于中老年组 (P =0 .0 4 95 )。两组肿瘤家族史及吸烟史差异无显著性。结论　青年人肺癌的临床病理特征明显不同于中老年人肺癌 ,但生存期相似。将青年人肺癌定义为“青年型肺癌”有临床实际意义。     

Ovarian cancer in younger vs older women: a population-based analysis

To compare the clinico-pathologic prognostic factors and survival of younger vs older women diagnosed with epithelial ovarian cancer. Demographic, clinico-pathologic, treatment, and surgery information were obtained from patients with ovarian cancer from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001 and analysed using Kaplan-Meier estimates. Of 28 165 patients, 400 were <30 years (very young), 11 601 were 30-60 (young), and 16 164 were >60 (older) years of age. Of the very young, young, and older patients, 261 (65.3%), 4664 (40.2%), and 3643 (22.5%) had stage I-II disease, respectively (P<0.001). Across all stages, very young women had a significant survival advantage over the young and older groups with 5-year disease-specific survival estimates at 78.8% vs 58.8 and 35.3%, respectively (P<0.001). This survival difference between the age groups persists even after adjusting for race, stage, grade, and surgical treatment. Reproductive age (16-40 years) women with stage I-II epithelial ovarian cancer who received uterine-sparing procedures had similar survivals compared to those who underwent standard surgery (93.3% vs 91.5%, P=0.26). Younger women with epithelial ovarian cancer have a survival advantage compared to older patients.     

Retrospective analysis on treating nasopharyngeal carcinoma with accelerated fractionation (6 fractions per week) in comparison with conventional fractionation (5 fractions per week): report on 3-year tumor control and normal tissue toxicity.

BACKGROUND AND PURPOSE: To assess the therapeutic gain achieved by accelerated fractionation for non-keratinizing/undifferentiated nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: During January 1994 to October 1997, 325 patients were treated to a total dose of 66 Gy in 33-37 fractions: 167 (irradiated before mid-January 1996) with 5 daily fractions (CF) and subsequent 158 with 6 daily fractions (AF) per week. Their median treatment times were 46 and 39 days, respectively. Additional boost to parapharyngeal extension had been given to 181 and Cisplatin-based chemotherapy to 57 patients (24 concurrent with radiotherapy). RESULTS: The AF group had significantly higher progression-free rate than the CF group (74 vs. 63% at 3 years, P=0.02 by the log-rank test). However, the difference in disease-specific survival (86 vs. 80%, P=0.39) and overall survival (81 vs. 78%, P=0.9) did not reach statistical significance. Strongly significant improvement in local failure-free rate was achieved for patients with T3-4 tumors (87 vs. 62%, P<0.01). Multivariate analyses showed that fractionation was an independent significant factor for overall progression: hazard ratio=0.63, 95% confidence interval: 0.41-0.98, P=0.04. Among the 268 patients treated with radiotherapy alone, those treated by AF had significantly higher incidence of acute reaction grade > or=3 (72 vs. 13%, P<0.01). However, all patients completed the scheduled dose without excessive prolongation, and no significant increase in late complications was observed (20 vs. 15% at 3 years, P=0.19). CONCLUSIONS: The current analyses suggested that acceleration to 6 daily fractions per week could significantly improve the progression-free rate for NPC without excessive late toxicity. Improvement in local control was confined to T3-4 tumors.     

Microvessel Density (MVD) in Locally Advanced Breast Cancer

Background: The aim of this study was to evaluate microvessel density (MVD) by expression of CD31 andCLEC14A in core biopsies from previously untreated patients with locally advanced breast cancer (LABC) and assessits prognostic significance. Methods: MVD was evaluated in core needle biopsies (n = 92), collected prior to anytreatment, from patients who were diagnosed with locally advanced breast cancer (LABC). Immunohistochemistry forexpression of CD31 and CLEC14A were performed on these tumours. The median duration of follow-up was 9.3 years.The effect of prognostic factors on disease free survival (DFS) and overall survival (OS) was assessed using a Log ranktest and Cox regression model. Results: The clinical factors such as age, clinical nodal stage, stage and pathologicalnodal status were found to be significant in predicting overall survival by multivariate analysis (P<0.05). Out of 92, 52tumours had blood vessels expressing CD31, whereas in the remainder, there was no expression. The mean and medianMVD of CD31 in 92 tumours was 38 and 5.5 respectively, and it was not a significant factor for predicting disease freesurvival or overall survival. When we considered the tumours (n=52) which expressed CD31, patients who had veryhigh MVD (>100), had inferior progression free survival and overall survival (P=0.5). There was no expression ofCLEC14A in any of the core needle biopsies whereas it was expressed in specimens from mastectomy from the samepatient. Conclusion: This is the first report of MVD in LABC prior to any treatment. The results suggest angiogenesiscould be a prognostic factor in LABC.     

VEGF-A和VEGF-C在乳腺癌组织中的表达及其意义

背景与目的:VEGF家族都与血管生成相关,血管内皮生长因子-A(vascularendothelialgrowthfactorA,VEGF-A)和血管内皮生长因子-C(vascularendothelialgrowthfactorC,VEGF-C)与肿瘤的生长和转移关系密切。本研究探讨乳腺癌组织中VEGF-A、VEGF-C的表达与癌细胞增殖、微血管密度(microvesseldensity,MVD)和淋巴结转移的关系。方法:采用免疫组织化学方法观察98例乳腺癌组织中VEGF-A、VEGF-C、增殖细胞核抗原(proliferatingcellnuclearantigen,PCNA)、CD34的表达情况。结果:98例乳腺癌组织中,VEGF-A阳性率为85.7%(84/98),VEGF-C阳性率90.8%(89/98),两者在淋巴结转移组表达均高于未转移组,差异具有显著性(P<0.05)。PCNA的表达随着VEGF-A、VEGF-C表达强度增强,肿瘤细胞增殖活性也随之增强(r=0.432,P=0.000;r=0.294,P=0.001)。淋巴结转移组MVD值(64.26±26.40)明显高于未转移组(50.29±29.35)(P<0.05),且随着VEGF-A表达增强,MVD也随之增高(r=0.327,P<0.001),VEGF-C表达与MVD无相关性(r=0.123,P>0.05)。结论:VEGF-A主要介导了血管生成、细胞增殖和转移;VEGF-C促进乳腺癌细胞增殖,与血管密度无关,与淋巴结转移密切相关。     

Oestrogen receptor status, pathological complete response and prognosis in patients receiving neoadjuvant chemotherapy for early breast cancer

The aim of this study was to ascertain if oestrogen receptor (ER) status predicts for pathological complete response (pCR) to neoadjuvant chemotherapy in operable breast cancer, and the effects of pCR on survival. Using a single-institution database, 435 patients were identified, who received neoadjuvant chemotherapy for operable breast cancer and were eligible for the analysis. Patients whose tumours were ER negative were more likely to achieve a pCR than patients who were ER positive (21.6 vs 8.1%, P<0.001). Owing to a strong correlation between ER status and grade, these variables were not shown to be independent predictors of pCR. Overall survival (OS) was better in those patients who achieved a pCR compared to those who did not (5-year OS 91 vs 73%; P=0.02). This was still the case when only patients with ER-negative tumours were examined (5-year OS 90 vs 52%, P=0.005), but not in the subset of patients with ER-positive tumours (5-year OS 93 vs 79%; P=0.3). Therefore, patients with ER-negative tumours were found to be more likely to achieve a pCR to neoadjuvant chemotherapy than those with ER-positive tumours, and pathological response did not have prognostic significance in patients with ER-positive tumours.     

人肝癌组织中iNOS、VEGF的表达及微血管密度的病理意义

背景与目的:诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)和血管内皮生长因子(vascular endothelial growth factor,VEGF)被认为是诱导和调节肿瘤血管生成,进而影响肿瘤病理进展和预后的重要相关因子。本研究检测人肝细胞癌(hepatocellular carcinoma,HCC)及相应癌旁组织中iNOS、VEGF的表达,探讨其与血管生成的关系,为临床诊治HCC及判断其预后提供理论依据。方法:应用组织芯片技术,采用原位杂交和免疫组化法分析147例HCC组织及癌旁组织中iNOS、VEGF的表达,并用CD34标记免疫组化法检测微血管密度(microvessel density,MVD)。结果:iNOS、VEGF在癌旁组织中的阳性率分别为33.33%和40.82%,而在癌组织中的阳性率分别为86.39%和78.91%,癌组织与癌旁组织比较差异有显著性(P<0.01)。癌组织的MVD值为56.5±12.8,癌旁组织的MVD值为8.4±3.6,两者差异有显著性(P<0.01)。iNOS的表达与肿瘤大小、乙型肝炎表面抗原(HBsAg)相关(P<0.05),而与转移和肿瘤分化程度无关(P>0.05)。VEGF的表达及MVD值与肿瘤大小、转移相关(P<0.05),而与HBsAg和肿瘤分化程度无关(P>0.05)。在癌组织中MVD与VEGF、iNOS的表达呈正相关,VEGF和iNOS之间亦存在正相关关系(P<0.01)。结论:HCC中iNOS及VEGF的表达与肿瘤血管生成有关。癌组