Measurement of Neovascularization Is an Independent Prognosticator of Survival in Node-negative Breast Cancer Patients with Long-Term Follow-Up

We measured neovascularization, epidermal growth factor receptor, and c-erbB-2 expression in a consecutive series of 233 surgically resected axillary lymph node-negative breast cancer patients with a long-term follow-up to define the usefulness of these parameters as independent prognostic indicators of overall survival (OAS). Microvessel count (MVC), as a measure of neovascularization, was determined using a monoclonal antibody against human factor VIII-related antigen. The median MVC of 20 (range, 4–76) was used as a cutoff value for discriminating between low and high vascularized tumors. Epidermal growth factor receptor and c- erb B-2 expression were evaluated by immunohistochemistry. Tumors were considered positive if >10% of the cells showed specific membrane staining. OAS curves were estimated by the Kaplan-Meier method. The indepen-dent prognostic effect of each variable was determined with the Cox proportional hazards model. High MVC ( P = 0.04), high nuclear grade ( P = 0.005), and high S-phase ( P = 0.02) significantly affected OAS at univariate analysis. In a Cox multivariate analysis, the characteristics with an independent prognostic effect on OAS were: MVC (relative hazard, 2.12; 95% confidence interval, 1.18–3.81; P = 0.01) and nuclear grade (relative hazard, 2.83; 95% confidence interval, 1.12–7.17; P = 0.01). These results demonstrate that quantification of neovascularization adds useful independent prognostic information on survival in node-negative breast cancer patients with long-term follow-up.