title: Complexity of tumor vasculature in clear cell renal cell carcinoma.
abstract: Clear cell renal cell carcinoma (CCRCC) is a highly vascularized cancer resistant to conventional chemotherapy and radiotherapy. Antiangiogenic therapy has achieved some effectiveness against this unique malignancy. The complexity of the tumor vasculature in CCRCC has led to differences in correlating tumor microvessel density with patient prognosis. The authors' recent findings demonstrated that there were at least 2 major categories of tumor vessels in CCRCC-namely, undifferentiated and differentiated-correlating with patient prognosis in contrasting ways, with higher undifferentiated vessel density indicating poorer prognosis, and higher differentiated vessel density correlating with better prognosis. Furthermore, the presence of pericytes supporting the differentiated vessels varied in CCRCC. The distributions of pericyte coverage and differentiated vessels in CCRCC were uneven. The tumor margin had a higher pericyte coverage rate for differentiated vessels than did the inner tumor area. The uneven distributions of pericyte coverage and differentiated vessels in CCRCC prompted the authors to revisit the mechanism of tumor central necrosis, which was also known to be a prognostic indicator for CCRCC. The discrepancy of prognostic correlation between protein and messenger RNA levels of vascular endothelial growth factor in CCRCC was discussed. The complexity of the tumor vasculature in CCRCC also led the authors to begin to re-evaluate the therapeutic effects of antiangiogenic agents for each type of tumor vessel, which will in turn significantly broaden understanding of tumor angiogenesis and improve therapeutic effect.
authors.affiliation: The State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China. qianchn@mail.sysu.edu.cn
authors.forename: Chao-Nan
authors.initials: CN
authors.lastname: Qian
authors.forename: Dan
authors.initials: D
authors.lastname: Huang
authors.forename: Bill
authors.initials: B
authors.lastname: Wondergem
authors.forename: Bin Tean
authors.initials: BT
authors.lastname: Teh
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000098:blood supply* / Q000188:drug therapy; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply* / Q000139:chemically induced / Q000188:drug therapy; D009336:Necrosis / Q000473:pathology; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D020286:Pericytes / Q000502:physiology; D011379:Prognosis; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A