Gastroenterology

Gastroenterology

Volume 125, Issue 4, October 2003, Pages 1094-1104
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Low microvessel density is an unfavorable histoprognostic factor in pancreatic endocrine tumors

https://doi.org/10.1016/S0016-5085(03)01198-3Get rights and content

Abstract

Background & Aims: In many malignant tumors, intratumoral microvascular density (MVD) has been suggested to be a prognostic parameter. We aimed to provide a quantitative evaluation of intratumoral microvascular density in a large series of resected endocrine tumors of the pancreas and to evaluate the potential prognostic significance of this parameter. Methods: Eighty-two tumors from 77 patients have been studied. MVD was evaluated by 2 observers after CD34 immunostaining and correlated with the following parameters: WHO classification, hormonal profile, tumor size, vascular endothelial growth factor expression, occurrence of metastasis, duration of survival. Results: MVD ranged from 5 to 92 vessels/field. MVD was significantly higher in well-differentiated benign endocrine tumors than in tumors of uncertain behavior and in carcinomas. No close correlation was found between MVD and the hormonal profile. MVD was significantly higher in tumors characterized by the following histoprognostic parameters: size <2 cm, proliferation index <2%, no evidence of metastasis. No close correlation was observed between MVD and VEGF expression. Finally, a MVD <30 vessels/field was associated with the occurrence of metastasis in tumors <2 cm and/or with a proliferation index <2% and with a significantly shorter survival after surgery. Conclusions: The quantitative analysis of microvessel density in pancreatic endocrine tumors may identify patients who, despite favorable conventional histoprognostic factors, are at risk of unfavorable evolution.

Section snippets

Study group

The study group comprised all patients submitted to surgical resection for an endocrine tumor of the pancreas at Hôpital Edouard Herriot between 1986 and 2001 and for whom both complete clinical information and tissue material of the primary pancreatic tumor were available. Seventy-seven patients fulfilled these criteria. Clinical data were analyzed and the available imaging data were reviewed. The following information was recorded for each patient: age, sex, location of the tumor,

Clinical characteristics of the study group

Seventy-seven patients were included in the study group. There were 37 male and 40 female. Mean age at resection was 48.3 years (range, 18–88 years). Nine patients had the MEN1 syndrome. Four patients, including 3 with MEN1 syndrome, had multiple tumors (2 tumors in 3 patients, 3 tumors in 1 patient).

Nineteen patients presented clinical evidence of a functional hormonal syndrome, related to the hypersecretion of insulin in 7 cases, glucagon in 8, vasoactive intestinal peptide in 1, gastrin in

Discussion

Our results show that, in endocrine tumors of the pancreas, intratumoral microvascular density is highly variable and suggest that this parameter may be of prognostic value: in our series, patients with tumors of low microvascular density are at higher risk of metastasis and present shorter survivals after surgical resection than patients presenting with tumors of high microvascular density.

In our experience, the intratumoral microvascular density of endocrine pancreatic tumors shows a very

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    Supported by grants from Ligue contre le Cancer (Comité de Saône et Loire), Région Rhône-Alpes (Programme Emergence), Société Nationale Française de Gastro-Entérologie (Fonds de Recherche), and Fondation pour la Recherche Médicale. Anne-Marie Marion-Audibert is a recipient of a grant from Fondation de France. Géraldine Gouysse was supported by a grant from Hospices Civils de Lyon (Appel d’Offres Recherche Clinique 1997).

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