title: Vasculogenic mimicry: a new prognostic sign of human osteosarcoma.
abstract: Vasculogenic mimicry (VM), a formation of nonendothelial microvascular channels, has been generally recognized as a new pattern of neovascularization in aggressive malignancies. However, whether VM is present and clinically significant in osteosarcoma remains unknown. We identified VM by CD34/periodic acid-Schiff double staining of osteosarcoma specimens before chemotherapy and investigated its prognostic implications. Tumors were also immunohistochemically stained for focal adhesion kinase (FAK) and migration inducing gene 7 (Mig-7) to determine whether these markers are associated with the occurrence of VM. VM was found in 15 of 66 osteoblastic-type osteosarcoma samples (22.7%), and the incidence of VM did not differ with respect to patient sex, age, tumor size, tumor site, surgical type, or histologic response to preoperative chemotherapy. However, Kaplan-Meier survival analysis determined that the presence of VM and the tumor necrosis rate after preoperative chemotherapy are associated with both the overall survival (P = .011 and P = .040, respectively) and metastasis-free survival (P = .002 and P = .045, respectively). Furthermore, Cox proportional hazards analysis showed that the presence of VM and the histologic response to preoperative chemotherapy were independent indicators for both poor overall survival (P = .007 and P = .024, respectively) and poor metastasis-free survival (P = .002 and P = .027, respectively). The expression level of FAK and Mig-7 were higher in the VM group than the non-VM group (P = .017 and P = .021, respectively). These results demonstrate the presence of VM in osteoblastic osteosarcoma and suggest that VM is an unfavorable prognostic factor with FAK and Mig-7 expressions as a potential mechanism of VM formation in osteosarcoma.
authors.affiliation: Department of Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou City 213003, Jiangsu Province, People's Republic of China.
authors.forename: Ke
authors.initials: K
authors.lastname: Ren
authors.affiliation: Laboratory of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing City 210028, Jiangsu Province, People's Republic of China.
authors.forename: Nan
authors.initials: N
authors.lastname: Yao
authors.affiliation: Department of Orthopedics, Wuhu Second People's Hospital, Wuhu City 241000, Anhui Province, People's Republic of China.
authors.forename: Guangye
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Tian
authors.affiliation: Jinling Hospital, Department of Pathology, Nanjing University, School of Medicine, Nanjing City 210002, Jiangsu Province, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Ma
authors.affiliation: Jinling Hospital, Department of Orthopedics, Nanjing University, School of Medicine, Nanjing City 210002, Jiangsu Province, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou City 213003, Jiangsu Province, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Laboratory of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing City 210028, Jiangsu Province, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Jinling Hospital, Department of Orthopedics, Nanjing University, School of Medicine, Nanjing City 210002, Jiangsu Province, People's Republic of China.
authors.forename: Xing
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Jinling Hospital, Department of Orthopedics, Nanjing University, School of Medicine, Nanjing City 210002, Jiangsu Province, People's Republic of China.
authors.forename: Guangxin
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Jinling Hospital, Department of Orthopedics, Nanjing University, School of Medicine, Nanjing City 210002, Jiangsu Province, People's Republic of China.
authors.forename: Sujia
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou City 213003, Jiangsu Province, People's Republic of China. Electronic address: xiaoliangsun@sohu.com.
authors.forename: Xiaoliang
authors.initials: X
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000401:mortality / Q000473:pathology*; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D055815:Young Adult
keywords: Focal adhesion kinase; Migration inducting gene-7; Osteosarcoma; Survival; Vasculogenic mimicry