The Value of Vascular Endothelial Growth Foctor Expression as a Prognostic Indicator in Renal Cell Caricinoma

Lee, Keon Cheol; Yoon, Duck Ki

Abstract

PURPOSE: We evaluated if VEGF (Vascular Endothelial Growth Factor)-immunoreactivity is associated with tumor stage or grade in RCC (renal cell carcinoma), and specifically, if it could serve as a prognostic i ndicator in terms of survival.
MATERIALS AND METHODS
Histologic samples of 54 patients in whom radical nephrectomy due to RCC (clear cell type exclusively) from January 1995 to July 1999 were included in this study. VEGF-immunoreactivity was classified as 0 to 3+ according to the ratio of VEGF-positive cells in randomly selected multiple tumor areas. Histologic differentiation was classified according to Fuhrmann's classification and staging was made with TNM classification.
RESULTS
The correlation between grade and VEGF-positivity was statistically significant using chi-square analysis. Among the 3 patients with grade I, showed 2, 1, 0 for VEGF 1+, 2+, 3+ respectively. In grade II the cases were 11, 7, 3 respectively. In grade III the cases were 3, 10, 11, and in grade IV the cases were 1, 2, 3 respectively. The correlation between stage and VEGF-positivity didn't show statistical significance. The survival rate for VEGF during the period was 100%, 90%, 76.5% for VEGF 1+, 2+, 3+ respectively. The survival rate for grade was 100%, 100%, 83.3%, 66.7% for grade I, II, III, IV respectively. The survival rate for stage was 95.2%, 85.7%, 87.5%, 66.7% FOR STAGE I, II, III, IV respectively. In the same grade, survival rate decreased apparently according to the increase of VEGF-positivity. For example, in the same grade III, the survival rae was 100%, 90%, 72.7% for VEGF 1+, 2+, 3+ respectively.
CONCLUSIONS
The results of this study is that VEGF is correlated with tumor grade and the higher VEGF expression, the lower the survival rate, so we can predict the prognosis by VEGF immunohistochemical staining for supplement of grading system. VEGF alone can be a good predictor for survival, and importantly in the same grade, we can differentiate patient's prognosis with VEGF.