title: Hypoxia-inducible factor-1alpha is associated with risk of aggressive behavior and tumor angiogenesis in gastrointestinal stromal tumor.
abstract: BACKGROUND
  The objective of this study was to evaluate the relationship of HIF-1alpha expression and tumor angiogenesis, recurrence/distant metastasis, and its value in the prediction of aggressive behavior of gastrointestinal stromal tumor (GIST).
  
  
  METHODS
  Paraffin-embedded specimens from 62 patients with GIST were divided into two groups, low risk (n = 31) and high risk (n = 31) according to the tumor size, mitotic count and proliferating cell nuclear antigen (PCNA) index. We investigated the expression of the HIF-1alpha and analyzed correlation with tumor angiogenesis monitored by expression of vascular endothelial growth factor (VEGF) and tumor microvessel density using immunohistochemical staining. The data were analyzed with chi(2) test or Fisher's exact test and multivariate test.
  
  
  RESULTS
  There were statistically significant differences between high risk (29/31; 93.5%) and low risk (8/31; 25.8%) of GIST in high expression of HIF-1alpha (P<0.0001). In addition, the incidence of recurrence/distant metastasis was significantly higher in cases of high HIF-1alpha expression (12/35; 34.3%) than in cases of low HIF-1alpha expression (1/24; 4.2%)(P = 0.009). Moreover, high VEGF expression (37/43; 86.0%) and microvessel density (30/32; 93.8%) were significantly higher in high HIF-1alpha expression tumors than in low-expression tumors (P < 0.0001).
  
  
  CONCLUSIONS
  Our findings suggest that HIF-1alpha may play an important role in aggressive behavior and tumor angiogenesis in GIST. In addition, high expression of HIF-1alpha was significantly correlated with tumor recurrence/distant metastasis, so it may provide an ancillary prognostic factor for GIST.
authors.affiliation: Department of Pathology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung City 807, Taiwan.
authors.forename: Wan-Tzu
authors.initials: WT
authors.lastname: Chen
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Huang
authors.forename: Ming-Tsang
authors.initials: MT
authors.lastname: Wu
authors.forename: Sheau-Fang
authors.initials: SF
authors.lastname: Yang
authors.forename: Yue-Chiu
authors.initials: YC
authors.lastname: Su
authors.forename: Chee-Yin
authors.initials: CY
authors.lastname: Chai
mesh_terms: D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000098:blood supply* / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D007150:Immunohistochemistry; D007414:Intestinal Neoplasms / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology*; D011379:Prognosis; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis; D012306:Risk; D013274:Stomach Neoplasms / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D014157:Transcription Factors / Q000096:biosynthesis*; D042442:Vascular Endothelial Growth Factors / Q000096:biosynthesis
chemical_list: C497442:HIF1A protein, human; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D018809:Proliferating Cell Nuclear Antigen; D014157:Transcription Factors; D042442:Vascular Endothelial Growth Factors