Prognostic significance of vascular endothelial growth factor expression and microvessel density in esophageal squamous cell carcinoma: Comparison with positron emission tomography

Abstract

Background: This study investigated whether the expression of vascular endothelial growth factor (VEGF) in a primary tumor and the intratumoral microvessel density (MVD) were independent prognostic factors in patients with an esophageal squamous cell carcinoma (SCC) in comparison with positron emission tomography (PET) by using F-18-fluorodeoxyglucose (FDG) and stage. Methods: Fifty-one patients with a newly diagnosed esophageal SCC who underwent preoperative FDG-PET and esophagectomy with intent to cure were enrolled in this study. The VEGF expression level, the intratumoral MVD, and the Ki-67 labeling index were evaluated by using immunohistochemical staining. Only significant variables in the univariate survival analysis were examined by multivariate survival analysis with the Cox proportional hazards model. Result: Cancer-related deaths occurred in 17 of 51 patients during the follow-up. Univariate survival analysis showed that the pathologic stage, pNM, maximum standardized uptake value of the primary tumor, tumor length on PET, number of PET-positive lymph nodes, PET stage, Ki-67 labeling index, intratumoral MVD, and the presence of VEGF expression were significant prognostic predictors for the overall survival. Multivariate analysis revealed that the pathologic stage, number of PET-positive nodes (0, 1, 2, or >= 3), intratumoral MVD (cutoff, 60/mm(2)), and presence of VEGF expression were independent significant prognostic predictors for overall survival. Conclusion: In addition to the pathologic stage, the intratumoral MVD, the presence of VEGF expression, and the number of FDG-PET-positive nodes were independent prognostic predictors in patients with an esophageal SCC undergoing curative surgery.