title: The relationship of vascular endothelial growth factor and coagulation factor (fibrin and fibrinogen) expression in clear cell renal cell carcinoma.
abstract: OBJECTIVE
  To investigate the relationship between angiogenesis and coagulation markers in tumor tissues of primary renal cell carcinoma (RCC). Tumors stimulate angiogenesis and activate the coagulation cascade. The importance of the interplay between these pathways for RCC is unknown.
  
  
  METHODS
  In all, 69 clear cell RCC specimens were analyzed by immunohistochemical staining applied to tissue microarrays. The expression of vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1alpha, fibrinogen and fibrin, and microvessel density were visually analyzed. Finally, staining patterns were related to clinical variables and survival.
  
  
  RESULTS
  The VEGF expression was detected in 100% of tumors, with 68% showing a high expression, whereas hypoxia-inducible factor-1alpha staining was low (only 26% had a moderate to high staining). Fibrinogen was expressed adjacent to the tumor cells in 26% of cases, whereas in 84% it was expressed around the blood vessels. In 30% of tumors, expression of fibrin was detected. High tumor VEGF expression correlated with high fibrin staining (P = .05). From a multivariate analysis, microvessel density (P = .033) and fibrinogen adjacent to tumor cells (P = .046) were independent factors related to VEGF expression.
  
  
  CONCLUSIONS
  In this study, we found clinical evidence for the permeability activity of VEGF as reflected by extravascular fibrinogen expression adjacent to tumor cells in the extracellular matrix. In addition, VEGF and fibrin expression were associated, indicative for concomitant activation of the coagulation cascade and angiogenesis in RCC. Taken together, these data indicate that activation of angiogenesis and coagulation are related in RCC.
authors.affiliation: Department of Medical Oncology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Henk M W
authors.initials: HM
authors.lastname: Verheul
authors.forename: Karen
authors.initials: K
authors.lastname: van Erp
authors.forename: Marjolein Y V
authors.initials: MY
authors.lastname: Homs
authors.forename: G S
authors.initials: GS
authors.lastname: Yoon
authors.forename: Petra
authors.initials: P
authors.lastname: van der Groep
authors.forename: Craig
authors.initials: C
authors.lastname: Rogers
authors.forename: Donna E
authors.initials: DE
authors.lastname: Hansel
authors.forename: George J
authors.initials: GJ
authors.lastname: Netto
authors.forename: Roberto
authors.initials: R
authors.lastname: Pili
mesh_terms: D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D002292:Carcinoma, Renal Cell / Q000097:blood / Q000098:blood supply / Q000378:metabolism*; D005337:Fibrin / Q000096:biosynthesis*; D005340:Fibrinogen / Q000096:biosynthesis*; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood / Q000098:blood supply / Q000378:metabolism*; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D012189:Retrospective Studies; D014407:Tumor Cells, Cultured; D042461:Vascular Endothelial Growth Factor A / Q000096:biosynthesis*
chemical_list: D042461:Vascular Endothelial Growth Factor A; D005337:Fibrin; D005340:Fibrinogen