Tumor angiogenesis: A new significant and independent prognostic indicator in early-stage breast carcinoma

Noel Weidner, Judah Folkman, Franco Pozza, Pierantonio Bevilacqua, Elizabeth N. Allred, Dan H. Moore, Salvatore Meli, Giampietro Gasparini

Research output: Contribution to journalArticlepeer-review


Background: Axillary lymph node status has been the most important prognostic factor in operable breast carcinoma, but it does not fully account for the varied disease outcome. More accurate prognostic indicators would help in selection of patients at high risk for disease recurrence and death who are candidates for systemic adjuvant therapy. Our recent findings indicated that microvessel density (count or grade) in invasive breast carcinoma (a measure of tumor angiogenesis) is associated with metastasis and thus may be a prognostic indicator. Purpose: This study was designed to further define the relationship of microvessel density with overall and relapse-free survival and with other reported prognostic indicators in breast carcinoma. Methods: In a prospective, blinded study of 165 consecutive patients, the microvessels within primary invasive breast carcinoma were highlighted by immunocytochemical staining to detect factor VIH-related antigen. Using light microscopy, we counted microvessels per 200× field in the most active areas of neovascularization and graded microvessel density. These findings were correlated, by univariate and multivariate analyses, with overall find relapse-free survival, axillary node status, and other prognostic indicators (median follow-up, 51 months). Results: There was a highly significant (P≤-001) association of microvessel density with overall survival and relapse-free survival in all patients, including node-negative and node-positive subsets. All patients with breast carcinomas having more than 100 microvessels per 200× field experienced tumor recurrence within 33 months of diagnosis, compared with less than 5% of the patients with breast carcinoma having 33 or fewer microvessels per 200× field. Moreover, microvessel density was the only statistically significant predictor of overall survival among node-negative women (P

Original languageEnglish
Pages (from-to)1875-1887
Number of pages13
JournalJournal of the National Cancer Institute
Issue number24
Publication statusPublished - Dec 16 1992

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Statistics, Probability and Uncertainty
  • Applied Mathematics
  • Physiology (medical)
  • Radiology Nuclear Medicine and imaging


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