DOI QR코드

DOI QR Code

Microvessel Density as a Prognostic Factor in Ovarian Cancer: a Systematic Review and Meta-analysis

  • He, Lei (Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University) ;
  • Wang, Qiao (Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University) ;
  • Zhao, Xia (Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University)
  • Published : 2015.03.04

Abstract

Background: The prognostic value of microvessel density (MVD), reflecting angiogenesis, detected in ovarian cancer is currently controversial. Here we performed a meta-analysis of all relevant eligible studies. Materials and Methods: A comprehensive search of online PubMed, Medline, EMBASE and Sciencedirect was performed to identify all related articles. The search strategy was designed as 'microvessel density', 'ovarian cancer', 'ovarian neoplasm', 'CD34' and 'angiogenesis'. Results: The studies were categorized by author/year, number of patients, FIGO stage, histology, cutoff value for microvessel density, types of survival analysis, methods of hazard rations (HR) estimation, HR and its 95% confidence interval (CI). Combined hazard ratios suggested that high MVD was associated with poor overall survival (OS) and progression-free survival (PFS), with HR and 95% CIs of 1.84 (1.33-2.35) and 1.36 (1.06-1.66), respectively. Subgroup analysis showed that high MVD detected by CD34 was relevant for OS [HR=1.67 (1.36-2.35)], but not MVD detected with other antibodies [HR=2.11 (0.90-3.31)]. Another subgroup analysis indicated that high MVD in patients without pre-chemotherapy, but not with pre-chemotherapy, was associated with OS [HR=1.88(1.59-2.18 and HR=1.70 (-0.18-3.59)]. Conclusions: The OS and PFS with high MVD were significant poorer than with low MVD in ovarian cancer patients. However, high MVD detected by CD34 seems to be more associated with survival for patients without pre-chemotherapy.

Keywords

Microvessel density;survival;ovarian cancer;chemotherapy;meta-analysis;CD34

References

  1. Altman DG (2001). Systematic reviews of evaluations of prognostic variables. BMJ, 323, 224-8. https://doi.org/10.1136/bmj.323.7306.224
  2. Barraclough H, Simms L, Govindan R (2011). Biostatistics primer: what a clinician ought to know: hazard ratios. J Thorac Oncol, 6, 978-82. https://doi.org/10.1097/JTO.0b013e31821b10ab
  3. Bast RC, Jr., Hennessy B, Mills GB (2009). The biology of ovarian cancer: new opportunities for translation. Nat Rev Cancer, 9, 415-28. https://doi.org/10.1038/nrc2644
  4. Beecken WD, Fernandez A, Joussen AM, et al (2001). Effect of antiangiogenic therapy on slowly growing, poorly vascularized tumors in mice. J Natl Cancer Inst, 93, 382-7. https://doi.org/10.1093/jnci/93.5.382
  5. Cao F, Hu YW, Li P, et al (2013). Lymphangiogenic and angiogenic microvessel density in Chinese patients with gastric carcinoma: correlation with clinicopathologic parameters and prognosis. Asian Pac J Cancer Prev, 14, 4549-52. https://doi.org/10.7314/APJCP.2013.14.8.4549
  6. Carmeliet P (2000). Mechanisms of angiogenesis and arteriogenesis. Nature Med, 6, 389-95. https://doi.org/10.1038/74651
  7. Carmeliet P, Jain RK (2000). Angiogenesis in cancer and other diseases. Nature, 407, 249-57. https://doi.org/10.1038/35025220
  8. Chan JK, Magistris A, Loizzi V, et al (2005). Mast cell density, angiogenesis, blood clotting, and prognosis in women with advanced ovarian cancer. Gynecol Oncol, 99, 20-5. https://doi.org/10.1016/j.ygyno.2005.05.042
  9. Egger M, Zellweger-Zahner T, Schneider M, et al (1997). Language bias in randomised controlled trials published in English and German. Lancet, 350, 326-9. https://doi.org/10.1016/S0140-6736(97)02419-7
  10. Ferrero A, Dompe D, Ravarino N, et al (2011). Angiogenesis and molecular markers in advanced epithelial ovarian cancer: a retrospective study. Gynecol Oncol, 123, 301-7. https://doi.org/10.1016/j.ygyno.2011.07.026
  11. Folkman J (1971). Tumor angiogenesis: therapeutic implications. N Engl J Med, 285, 1182-6. https://doi.org/10.1056/NEJM197111182852108
  12. Fox SB, Leek RD, Smith K, et al (1994). Tumor angiogenesis in node-negative breast carcinomas-relationship with epidermal growth factor receptor, estrogen receptor, and survival. Breast Cancer Res Treat, 29, 109-16. https://doi.org/10.1007/BF00666186
  13. Gadducci A, Ferrero A, Cosio S, et al (2006). Intratumoral microvessel density in advanced epithelial ovarian cancer and its use as a prognostic variable. Anticancer Res, 26, 3925-32.
  14. Gadducci A, Viacava P, Cosio S, et al (2003). Intratumoral microvessel density, response to chemotherapy and clinical outcome of patients with advanced ovarian carcinoma. Anticancer Res, 23, 549-56.
  15. Gasparini G, Bonoldi E, Viale G, et al (1996). Prognostic and predictive value of tumour angiogenesis in ovarian carcinomas. Int J Cancer, 69, 205-11. https://doi.org/10.1002/(SICI)1097-0215(19960621)69:3<205::AID-IJC10>3.0.CO;2-6
  16. Goodheart MJ, Ritchie JM, Rose SL, et al (2005). The relationship of molecular markers of p53 function and angiogenesis to prognosis of stage I epithelial ovarian cancer. Clin Cancer Res, 11, 3733-42. https://doi.org/10.1158/1078-0432.CCR-04-0056
  17. Grimes DA, Schulz KF (2002). Bias and causal associations in observational research. Lancet, 359, 248-52. https://doi.org/10.1016/S0140-6736(02)07451-2
  18. Han ES, Burger RA, Darcy KM, et al (2010). Predictive and prognostic angiogenic markers in a gynecologic oncology group phase II trial of bevacizumab in recurrent and persistent ovarian or peritoneal cancer. Gynecol Oncol, 119, 484-90. https://doi.org/10.1016/j.ygyno.2010.08.016
  19. Hata K, Yoshida M, Maruyama R, et al (2002). Prognostic significance of ultrasound derived intratumoral peak systolic velocity in epithelial ovarian cancer. Ultrasound Obstet Gynecol, 20, 186-91. https://doi.org/10.1046/j.1469-0705.2002.00748.x
  20. Heimburg S, Oehler MK, Papadopoulos T, et al (1999). Prognostic relevance of the endothelial marker CD 34 in ovarian cancer. Anticancer Res, 19, 2527-9.
  21. Hlatky L, Hahnfeldt P, Folkman J (2002). Clinical application of antiangiogenic therapy: microvessel density, what it does and doesn't tell us. J Natl Cancer Inst, 94, 883-93. https://doi.org/10.1093/jnci/94.12.883
  22. Hollingsworth HC, Kohn EC, Steinberg SM, et al (1995). Tumor angiogenesis in advanced stage ovarian carcinoma. Am J Pathol, 147, 33-41.
  23. Ino K, Shibata K, Kajiyama H, et al (2006). Angiotensin II type 1 receptor expression in ovarian cancer and its correlation with tumour angiogenesis and patient survival. Br J Cancer, 94, 552-60. https://doi.org/10.1038/sj.bjc.6602961
  24. Labiche A, Elie N, Herlin P, et al (2009). Prognostic significance of tumour vascularisation on survival of patients with advanced ovarian carcinoma. Histol Histopathol, 24, 425-35.
  25. Leek RD (2001). The prognostic role of angiogenesis in breast cancer. Anticancer Res, 21, 4325-31.
  26. Li LN, Zhou X, Gu Y, et al (2013). Prognostic value of MMP-9 in ovarian cancer: a meta-analysis. Asian Pac J Cancer Prev, 14, 4107-13. https://doi.org/10.7314/APJCP.2013.14.7.4107
  27. Lin JY, Qin JB, Li XY, et al (2012). Diagnostic value of human epididymis protein 4 compared with mesothelin for ovarian cancer: a systematic review and meta-analysis. Asian Pac J Cancer Prev, 13, 5427-32. https://doi.org/10.7314/APJCP.2012.13.11.5427
  28. Liu P, Sun YL, Du J, et al (2012). CD105/Ki67 coexpression correlates with tumor progression and poor prognosis in epithelial ovarian cancer. Int J Gynecol Cancer, 22, 586-92. https://doi.org/10.1097/IGC.0b013e31823c36b8
  29. Muhammadnejad S, Muhammadnejad A, Haddadi M, et al (2013). Correlation of microvessel density with nuclear pleomorphism, mitotic count and vascular invasion in breast and prostate cancers at preclinical and clinical levels. Asian Pac J Cancer Prev, 14, 63-8. https://doi.org/10.7314/APJCP.2013.14.1.63
  30. Nakayama K, Kanzaki A, Takebayashi Y, et al (2001). Different features of angiogenesis between ovarian and breast carcinoma. Cancer Lett, 170, 161-7. https://doi.org/10.1016/S0304-3835(01)00588-2
  31. Obermair A, Wasicky R, Kaider A, et al (1999). Prognostic significance of tumor angiogenesis in epithelial ovarian cancer. Cancer Lett, 138, 175-82. https://doi.org/10.1016/S0304-3835(99)00005-1
  32. Ogawa S, Kaku T, Kobayashi H, et al (2002). Prognostic significance of microvessel density, vascular cuffing and vascular endothelial growth factor expression in ovarian carcinoma: a special review for clear cell adenocarcinoma. Cancer Lett, 176, 111-8. https://doi.org/10.1016/S0304-3835(01)00754-6
  33. Palmer JE, Sant Cassia LJ, Irwin CJ, et al (2007). Prognostic value of measurements of angiogenesis in serous carcinoma of the ovary. Int J Gynecol Pathol, 26, 395-403. https://doi.org/10.1097/pgp.0b013e318063bed7
  34. Parmar MK, Torri V, Stewart L (1998). Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med, 17, 2815-34. https://doi.org/10.1002/(SICI)1097-0258(19981230)17:24<2815::AID-SIM110>3.0.CO;2-8
  35. Peng HL, He L, Zhao X (2012). Association of reduced immunohistochemical expression of E-cadherin with a poor ovarian cancer prognosis - results of a meta-analysis. Asian Pac J Cancer Prev, 13, 2003-7. https://doi.org/10.7314/APJCP.2012.13.5.2003
  36. Qin Q, Sun Y, Fei M, et al (2012). Expression of putative stem marker nestin and CD133 in advanced serous ovarian cancer. Neoplasma, 59, 310-5. https://doi.org/10.4149/neo_2012_040
  37. Raspollini MR, Amunni G, Villanucci A, et al (2005). Microvessel density in ovarian carcinoma: computer image analysis in patients with shorter and longer survival. Int J Gynecol Cancer, 15, 844-9. https://doi.org/10.1111/j.1525-1438.2005.00146.x
  38. Raspollini MR, Amunni G, Villanucci A, et al (2004). Prognostic significance of microvessel density and vascular endothelial growth factor expression in advanced ovarian serous carcinoma. Int J Gynecol Cancer, 14, 815-23. https://doi.org/10.1111/j.1048-891X.2004.014514.x
  39. Risau W (1997). Mechanisms of angiogenesis. Nature, 386, 671-4. https://doi.org/10.1038/386671a0
  40. Rubatt JM, Darcy KM, Hutson A, et al (2009). Independent prognostic relevance of microvessel density in advanced epithelial ovarian cancer and associations between CD31, CD105, p53 status, and angiogenic marker expression: a gynecologic oncology group study. Gynecol Oncol, 112, 469-74. https://doi.org/10.1016/j.ygyno.2008.11.030
  41. Shen GH, Ghazizadeh M, Kawanami O, et al (2000). Prognostic significance of vascular endothelial growth factor expression in human ovarian carcinoma. Br J Cancer, 83, 196-203. https://doi.org/10.1054/bjoc.2000.1228
  42. Suhonen KA, Anttila MA, Sillanpaa SM, et al (2007). Quantification of angiogenesis by the Chalkley method and its prognostic significance in epithelial ovarian cancer. Eur J Cancer, 43, 1300-7. https://doi.org/10.1016/j.ejca.2007.03.007
  43. Suhonen KA, Anttila MA, Sillanpaa SM, et al (2007). Quantification of angiogenesis by the Chalkley method and its prognostic significance in epithelial ovarian cancer. Eur J Cancer, 43, 1300-7. https://doi.org/10.1016/j.ejca.2007.03.007
  44. Taskiran C, Erdem O, Onan A, et al (2006). The prognostic value of endoglin (CD105) expression in ovarian carcinoma. Int J Gynecol Cancer, 16, 1789-93. https://doi.org/10.1111/j.1525-1438.2006.00658.x
  45. Uzzan B, Nicolas P, Cucherat M, et al (2004). Microvessel density as a prognostic factor in women with breast cancer: a systematic review of the literature and meta-analysis. Cancer Res, 64, 2941-55. https://doi.org/10.1158/0008-5472.CAN-03-1957
  46. Weidner N, Folkman J, Pozza F, et al (1992). Tumor angiogenesis: a new significant and independent prognostic indicator in early-stage breast carcinoma. J Natl Cancer Inst, 84, 1875-87. https://doi.org/10.1093/jnci/84.24.1875
  47. Wesseling P, van der Laak JA, Link M, et al (1998). Quantitative analysis of microvascular changes in diffuse astrocytic neoplasms with increasing grade of malignancy. Hum Pathol, 29, 352-8. https://doi.org/10.1016/S0046-8177(98)90115-0
  48. Yancopoulos GD, Davis S, Gale NW, et al (2000). Vascular-specific growth factors and blood vessel formation. Nature, 407, 242-8. https://doi.org/10.1038/35025215
  49. Yancopoulos GD, Davis S, Gale NW, et al (2000). Vascular-specific growth factors and blood vessel formation. Nature, 407, 242-8. https://doi.org/10.1038/35025215

Cited by

  1. DDR1 enhances invasion and metastasis of gastric cancer via epithelial-mesenchymal transition vol.37, pp.9, 2016, https://doi.org/10.1007/s13277-016-5070-6
  2. Expression of a novel endothelial marker, C-type lectin 14A, in epithelial ovarian cancer and its prognostic significance vol.22, pp.1, 2017, https://doi.org/10.1007/s10147-016-1033-6
  3. Characterisation of tumour microvessel density during progression of high-grade serous ovarian cancer: clinico-pathological impact (an OCTIPS Consortium study). vol.119, pp.3, 2018, https://doi.org/10.1038/s41416-018-0157-z