Markers of angiogenesis in high-risk, early-stage cervical cancer: A Gynecologic Oncology Group study

ObjectivesTo determine whether markers of tumor angiogenesis were associated with progression-free survival (PFS) and overall survival (OS) in women with high-risk, early-stage cervical cancer treated on a phase III trial.MethodsOne hundred seventy-three tumor specimens were analyzed by semi-quantitative immunohistochemical (IHC) staining for vascular endothelial growth factor (VEGF, pro-angiogenesis factor), thrombospondin-1 (TSP-1, anti-angiogenesis factor), CD31 (non-specific endothelial marker), and CD105 (tumor-specific endothelial marker). Tumoral histoscores (HS) were calculated for VEGF using the formula: [% cells positive × (intensity + 1)]. TSP-1 specimens were categorized as negative or positive. CD31 and CD105 microvessel density (MVD) “hotspots” were counted in three 20× high-power fields. Associations between angiogenesis markers and survival were evaluated.ResultsTSP-1 expression was observed in 65% of cases while 66% expressed high VEGF (≥ 200), 34% exhibited high CD31 (CD31 ≥ 110) and 66% displayed high CD105 (CD105 ≥ 28). In univariate analyses CD31 MVD, but not tumor TSP-1, was associated with improved PFS (HR = 0.37; 95% CI = 0.18–0.76; p = 0.007) and OS (HR = 0.37; 95% CI = 0.17–0.79; p = 0.010). After adjusting for prognostic clinical covariates, high CD31 MVD, but not TSP-1, VEGF or CD105 MVD, was an independent prognostic factor for PFS (HR = 0.36; 95% CI = 0.17–0.75; p = 0.006) and OS (HR = 0.36; 95% CI = 0.17–0.79; p = 0.010).ConclusionsTumor angiogenesis measured by CD31 MVD is an independent prognostic factor for both PFS and OS in high-risk, early-stage cervical cancer. We hypothesize that this finding may be explained by improved treatment response in well-vascularized, well-oxygenated tumors.