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Immunohistochemical evaluation of the tumor neoangiogenesis as a prognostic factor for gastric cancers.

INTRODUCTION
The angiogenesis, the process by which new blood vessels are formed, plays an essential role in the survival of the malignant cells, in the local expansion and tumor invasion, as well as in the appearance of distant metastases.


MATERIAL AND METHODS
We evaluated the relation between MVD, the VEGF expression, the clinicopathologic factors and the survival in patients with gastric cancer. A prospective study has been carried out, regarding the evolution and aggressiveness of the gastric cancer, with a duration of 5 years, 61 patients that underwent a surgery for gastric cancer being included in the study. The immunohistochemical reactions for CD34 and VEGF were performed for all gastric cancers cases included in the study group.


RESULTS
MVD has shown in the gastric carcinomas an average value significantly higher in comparison to the normal mucosa (38.7 vs. 12.5, p<0.001 ES). In the intestinal type we have noticed a much lower average MVD than the average MVD in the diffuse type of gastric carcinomas (36.8 vs. 41.6) (p=0.02478 S). The anaplastic carcinoma and the signet ring cell carcinoma are detaching themselves as histological forms associated to an intense neoangiogenesis activity. The neoangiogenesis activity is correlated with: the histologic grade, the lymphovascular invasion, the level of extend, the lymph node metastasizing, the distant metastasizing and the TNM stage. The positive immunoreactions for VEGF are significantly more frequent in the gastric carcinomas, in comparison to the normal gastric mucosa (65.6% vs. 6.5%, p<0.001 ES). The immunoreactions to the VEGF protein were positive in 71.1% of the intestinal carcinomas, significantly more frequent in comparison to the diffuse type carcinomas (52.9%) (p=0.018178 S). Our results show a tight correlation between the histologic grade, the level of the tumor invasion and the VEGF expression.


CONCLUSIONS
Our results prove the major correlation between the VEGF expression and the 5-year survival rate of the patients with gastric cancer, the survival rate for the carcinomas with VEGF +~++ being significantly lower than for the VEGF negative ones (12.5% vs. 23.8%) (p=0.027983 S). Our study proves a tight correlation between the VEGF expression and the MVD (p=0.03986 S), these factors playing an important role in the tumoral biologic conduct, in the progression and the prognostic.