title: Colorectal polypoid lesions and expression of vascular endothelial growth factor in a consecutive series of endoscopic and surgical patients.
abstract: Colorectal cancer incidence in patients undergoing screening protocols is decreasing because of the higher rate of discovered preneoplastic colonic lesions; however, adenomatous polyps may not always be removable endoscopically and surgery may still be necessary. The aim of this study was to assess the vascular endothelial growth factor expression in the different steps of colorectal carcinogenesis to explore its potential role as a marker of malignancy in polypoid lesions. A total of 92 subjects with colonic adenoma or cancer who underwent screening colonoscopy or surgery were prospectively enrolled. Real-time reverse transcription polymerase chain reaction for VEGF-A messenger RNA expression and immunohistochemistry for VEGF-A were performed. Immunoassays for VEGF-A, VEGF-C, VEGFR-1, VEGFR-2, and VEGFR-3 were also performed. Non-parametric statistics, receiver operating characteristic curve analysis, and logistic multiple regression analysis were used. VEGF-A messenger RNA expression was higher in patients with high-grade dysplasia or colorectal cancer than in those with low-grade dysplasia adenomas (p = 0.01). At immunohistochemistry, VEGF-A expression was significantly higher in colorectal cancer patients compared to dysplastic adenomas (p < 0.001), and the accuracy of VEGF-A expression for prediction of malignancy was 91.7 (95% confidence interval = 78.7-97.9). VEGF-C protein expression was lower in colorectal cancer patients than in simple adenomas (p = 0.02). VEGF-A levels were directly correlated to polyp size (rho = 0.73, p = 0.0062). Multivariate analysis demonstrated that malignancy and polyp size were independent predictors of VEGF-A mucosal levels. This study demonstrated that the VEGF-A expression changes along the colorectal carcinogenesis pathway showing a neat step up at the passage from high-grade dysplasia to invasive cancer. This feature might potentially be useful to stratify colorectal polyps in different risks of progression classes. Moreover, the high level of VEGF-A expression predicted the presence of lymphovascular invasion with good accuracy.
authors.affiliation: 1 Department of Surgery, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Ruffolo
authors.affiliation: 2 Pathology Unit, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Toffolatti
authors.affiliation: 2 Pathology Unit, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Canal
authors.affiliation: 3 Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
authors.forename: Andromachi
authors.initials: A
authors.lastname: Kotsafti
authors.affiliation: 1 Department of Surgery, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pagura
authors.affiliation: 1 Department of Surgery, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Pozza
authors.affiliation: 2 Pathology Unit, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Campo Dell'Orto
authors.affiliation: 4 Gastroenterology Unit (IV), Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferrara
authors.affiliation: 1 Department of Surgery, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Massani
authors.affiliation: 2 Pathology Unit, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Dei Tos
authors.affiliation: 3 Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Castoro
authors.affiliation: 1 Department of Surgery, Cà Foncello Regional Hospital, Treviso, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Bassi
authors.affiliation: 3 Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D063646:Carcinogenesis / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000235:genetics / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012333:RNA, Messenger / Q000096:biosynthesis / Q000235:genetics; D042461:Vascular Endothelial Growth Factor A / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D012333:RNA, Messenger; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A
keywords: Colorectal cancer; colorectal malignant polyps; vascular endothelial growth factor