Περίληψη:
Several studies support an important role of angiogenesis in breast cancer growth and metastasis. The main objectives of the study were to investigate the immunohistochemical expression of vascular endothelial growth factor (VEGF) family ligands (VEGF-A and VEGF-C) and receptors (VEGFR1, VEGFR2 and VEGFR3) in breast cancer and their associations with clinicopathological parameters, cancer subtypes/subgroups and patient outcome. Formalin-fixed paraffin-embedded tumor tissue samples were collected from early-stage breast cancer patients treated with anthracycline-based chemotherapy within a randomized trial. Immunohistochemistry was performed on serial 2.5 μm thick tissue sections from tissue microarray blocks. High VEGF-A, VEGF-C, VEGFR1, VEGFR2 and VEGFR3 protein expression was observed in 11.8% (N = 87), 80.8% (N = 585), 28.1% (N = 202), 64.6% (N = 359) and 71.8% (N = 517) of the cases, respectively. Significant associations were observed among all proteins (all p-values <0.05), with the exception of the one between VEGF-C and VEGFR1 (chi-square test, p = 0.15). Tumors with high VEGF-A protein expression, as compared to tumors with low expression were more frequently ER/PgR-negative (33.3% vs. 20.8%, chi-square test, p = 0.009) and HER2-positive (44.8% vs. 20.6%, p<0.001). In addition, tumors with high VEGFR1 expression, were more frequently HER2-positive (32.8% vs. 19.6%, p<0.001), while tumors with high VEGFR3 expression were more frequently ER/PgR-negative (24.9% vs. 17.0%, p = 0.024) and HER2-positive (26.9% vs. 14.8%, p = 0.001). High VEGF-A and VEGF-C protein expression was associated with increased DFS in the entire cohort (HR = 0.57, 95% CI 0.36–0.92, Wald’s p = 0.020 and HR = 0.71, 95% CI 0.52–0.96, p = 0.025, respectively), as well as in specific subtypes/subgroups, such as HER2-positive (VEGF-A, HR = 0.32, 95% CI 0.14–0.74, p = 0.008) and triple-negative (VEGF-C, HR = 0.44, 95% CI 0.21–0.91, p = 0.027) patients. High vs. low VEGFR1 expression was an unfavorable factor for DFS in triple-negative patients (HR = 2.74, 95% CI 1.26–5.98, p = 0.011), whereas the opposite was observed among the ER/PgR-positive patients (HR = 0.69, 95% CI 0.48–0.98, p = 0.041). Regarding OS, high VEGF-C protein expression was associated with increased OS in the entire cohort (HR = 0.64, 95% CI 0.46–0.89, Wald’s p = 0.008), as well as in in specific subtypes/subgroups, such as ER/PgR-negative (HR = 0.37, 95% CI 0.20–0.71, p = 0.003) and triple-negative (HR = 0.42, 95% CI 0.19–0.90, p = 0.026) patients. In conclusion, high expression of angiogenesis-related proteins is associated with adverse clinicopathological parameters in early-stage breast cancer patients and may be surrogate markers of biologically distinct subgroups of ER/PgR-negative or triple-negative tumors with superior outcome. Further validation of our findings in independent cohorts is needed. © 2018 Goussia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Συγγραφείς:
Goussia, A.
Simou, N.
Zagouri, F.
Manousou, K.
Lazaridis, G.
Gogas, H.
Koutras, A.
Sotiropoulou, M.
Pentheroudakis, G.
Bafaloukos, D.
Markopoulos, C.
Patsea, H.
Christodoulou, C.
Papakostas, P.
Zaramboukas, T.
Samantas, E.
Kosmidis, P.
Venizelos, V.
Karanikiotis, C.
Papatsibas, G.
Xepapadakis, G.
Kalogeras, K.T.
Bamia, C.
Dimopoulos, M.-A.
Malamou-Mitsi, V.
Fountzilas, G.
Batistatou, A.
Λέξεις-κλειδιά:
anthracycline; cyclophosphamide; epirubicin; exemestane; fluorouracil; methotrexate; paclitaxel; tamoxifen; vasculotropin A; vasculotropin C; vasculotropin receptor 1; vasculotropin receptor 2; vasculotropin receptor 3; FLT4 protein, human; KDR protein, human; vasculotropin A; vasculotropin C; vasculotropin receptor 2; vasculotropin receptor 3; VEGFA protein, human, adult; aged; Article; breast cancer; cancer chemotherapy; cancer radiotherapy; cancer staging; cancer tissue; controlled study; disease free survival; female; human; human tissue; immunohistochemistry; major clinical study; outcome assessment; overall survival; partial mastectomy; prognosis; protein expression; radical mastectomy; randomized controlled trial (topic); tissue microarray; breast; breast tumor; clinical trial; metabolism; middle aged; mortality; neovascularization (pathology); pathology; phase 3 clinical trial; proportional hazards model; randomized controlled trial; young adult, Adult; Aged; Breast; Breast Neoplasms; Female; Humans; Middle Aged; Neovascularization, Pathologic; Prognosis; Proportional Hazards Models; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor C; Vascular Endothelial Growth Factor Receptor-2; Vascular Endothelial Growth Factor Receptor-3; Young Adult
