Tumor necrosis correlates with angiogenesis and is a predictor of poor prognosis in malignant mesothelioma

Edwards, J. G., Swinson, D. E. B., Jones, J. L., Muller, S., Waller, D. A., & O'Byrne, Kenneth J. (2003) Tumor necrosis correlates with angiogenesis and is a predictor of poor prognosis in malignant mesothelioma. Chest, 124(5), pp. 1916-1923.

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Objectives: Malignant mesothelioma (MM) is a fatal tumor of increasing incidence related to asbestos exposure. Microscopic tumor necrosis (TN) is a poor prognostic factor in solid tumors, but it has not been characterized in MM. We wished to evaluate the incidence of TN in MM and its correlations with clinicopathologic factors, angiogenesis, and survival.

Methods: TN was graded in 171 routine formalin-fixed, paraffin-embedded hematoxylin-eosinstained tumor sections by two independent observers. Angiogenesis was assessed by the microvessel count (MVC) of CD34 immunostained sections. TN was correlated with survival by Kaplan-Meier and log-rank analysis, and stepwise, multivariate Cox models were used to compare TN with angiogenesis and established prognostic factors and prognostic scoring systems.

Results: TN was identified in 39 cases (22.8%) and correlated with low hemoglobin (p = 0.01), thrombocytosis (p = 0.04), and high MVC (p = 0.02). TN was a poor prognostic factor in univariate analysis (p = 0.008). Patients with TN had a median survival of 5.3 months vs 8.3 months in negative cases. Independent indicators of poor prognosis in multivariate analysis were nonepithelioid cell type (p = 0.0001), performance status > 0 (p = 0.007), and increasing MVC (p = 0.004) but not TN. TN contributed independently to the European Organisation for Research and Treatment of Cancer (EORTC) [p = 0.03] and to the Cancer and Leukemia Group B (CALGB) [p = 0.03] prognostic groups in respective multivariate Cox analyses.

Conclusions: TN correlates with angiogenesis and is a poor prognostic factor in MM. TN contributes to the EORTC and CALGB prognostic scoring systems.

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ID Code: 65047
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: Angiogenesis, Malignant mesothelioma, Necrosis, Prognosis, CD34 antigen, eosin, formaldehyde, hematoxylin, hemoglobin, paraffin, adult, aged, article, cancer grading, cancer research, cancer survival, cancer tissue, cell type, clinical article, controlled study, correlation analysis, epithelium cell, female, human, human tissue, immunohistochemistry, incidence, Kaplan Meier method, male, microvasculature, multivariate analysis, pathology, prediction, priority journal, rank sum test, scoring system, thrombocytosis, tumor necrosis, Humans, Mesothelioma, Middle Aged, Neovascularization, Pathologic, Pleural Neoplasms, Proportional Hazards Models, Survival Rate
DOI: 10.1378/chest.124.5.1916
ISSN: 0012-3692
Divisions: Current > Schools > School of Biomedical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2003 American College of Chest Physicians
Deposited On: 03 Dec 2013 06:46
Last Modified: 03 Dec 2013 07:07

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