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Conrad Notes
a timely medical meeting newsletter
COLORECTAL CANCER PROGNOSIS USING IMD EXAMINATION
P. Vermeulen, MD, Oncological Center, St Augustine Hospital-University of Antwerp, Belgium, found intratumor microvessel density (IMD) to predict 5-year survival of colorectal cancer (CRC) patients. A prospective study showed a lower 5-year survival rate in CRC patients with an increased IMD. The correlation seen in CRC tumors also occurs in adenocarcinoma of the breast. (See related reports of Chaplin and Dirix in this issue of Conrad Notes).
Selection of CRC patients Vermeulen's study on 245 CRC patients began in 1990 and ended in 1996. Only disease-specific patients participated including those with Dukes' D carcinoma requiring palliative surgery. Twenty-six percent of the patients had rectal cancer; there were 127 males and 118 females.
Measurement of IMD and p53-protein Vermeulen used CD-31 immunostaining to measure IMD by microscopic examination of 200 high power fields for "hot spots." A low IMD is less than and a high IMD is greater than the median of the population. DO7 and collagen IV staining helped estimate p53-protein expression.
Observed differences in IMD IMD increases significantly with age (p<0.01) and seems to be unrelated to the Dukes' classification groups of CRC. Study patients with a low IMD showed a 5-year survival rate of 71% compared with 61% for patients with a high IMD (p=0.004).
What about p53-protein? This protein, if abnormal, often leads to cancer. Vermeulen classified the study patients according to DO7 staining of tumor cell nuclei. Patients with <10% positive tumor nuclei showed a 5-year survival rate of 86%. The rate decreased to 44% in patients with >10% positive nuclei. Survival further decreased to 32% in the 61 study patients with a high IMD and >10% positive nuclei.
Comments Vermeulen's review of the published literature yielded no confirmatory but three negative retrospective reports on the possible prognostic value of IMD in CRC patients (Soclansky; Frank; and Takebazen). Therefore, another prospective study in CRC patients is needed.

The recent report of Fontaini et al (JNCI 1997;89:881-886) on non-small-cell lung carcinoma (NSCLC) patients lends indirect support to Vermeulen's findings. NSCLC patients with an increased IMD showed a significantly reduced survival rate.

For professional correspondence, please contact Dr. Vermeulen by E-mail at: angio.vermeulen@glo.be

Eugene A. Conrad

Presented at The European Cancer Conference (ECCO 9), September 14-18, 1997
Copyright © 1997 Conrad Group, Inc. All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078-2230 / November 1997
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