VEGF expression predicts survival in patients with peritoneal surface metastases from mucinous adenocarcinoma of the appendix and colon.
BACKGROUND
High levels of vascular endothelial growth factor (VEGF) in ovarian cancer metastases are associated with a worse prognosis in patients treated with chemotherapy. VEGF-directed therapy improves survival for those with metastatic colorectal cancer. Patients with mucinous adenocarcinomas metastatic to the peritoneal surfaces can be treated with cytoreductive surgery, and both tumor grade and cytoreduction status are prognostic. We hypothesized that angiogenic indices may be prognostic in patients undergoing cytoreductive surgery for mucinous adenocarcinoma of the appendix and colon.


METHODS
Cytoreductive cases from a 5-year period from the University of Cincinnati peritoneal malignancy database were reviewed. CD 34 counts (blood vessels) and VEGF expression was evaluated by means of immunohistochemistry on specimens from patients undergoing cytoreductive surgery and intraperitoneal hyperthermic perfusion (IPHP) for mucinous adenocarcinoma.


RESULTS
A total of 26 males and 9 females, with a mean age of 50 years, underwent cytoreductive surgery and IPHP for mucinous adenocarcinoma of appendiceal (n = 32) or colonic (n = 3) origin. With a mean follow-up of 18 months (range 1-63 months), 23 had disease recurrence and 12 were alive without recurrence. The mean survival was 19 months (range 1-63 months). CD34 counts did not correlate with recurrence or survival; however, average VEGF counts correlated with survival (P = 0.017), and, for patients with recurrence, this correlation was stronger (P = 0.002).


CONCLUSIONS
These results suggest that markers of tumor angiogenesis may predict survival in patients with peritoneal surface metastases from mucinous adenocarcinoma. These findings provoke the hypothesis that antiangiogenic therapies may be effective in patients with this devastating disease.
Division of Surgical Oncology, Department of Surgery, University of Cincinnati Medical Center, 234 Goodman St., ML #0772, Cincinnati, Ohio 45219, USA.
Jocelyn M
JM
Logan-Collins
Andrew M
AM
Lowy
Toni M
TM
Robinson-Smith
Seena
S
Kumar
Jeffrey J
JJ
Sussman
Laura E
LE
James
Syed A
SA
Ahmad
D002288:Adenocarcinoma, Mucinous / Q000378:metabolism* / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D001063:Appendiceal Neoplasms / Q000473:pathology* / Q000628:therapy*; D014408:Biomarkers, Tumor / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000378:metabolism* / Q000556:secondary / Q000628:therapy*; D011237:Predictive Value of Tests; D016019:Survival Analysis; D042461:Vascular Endothelial Growth Factor A / Q000096:biosynthesis*
D014408:Biomarkers, Tumor; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A