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Abstract
The process of angiogenesis is the result of an unbalance among pro-and anti-angiogenic factors produced from both the tumor and the normal cells. The evaluation of tumour angiogenesis has been proposed to be an independent prognostic marker for many solid tumours (breast, prostate, lung, head and neck cancers). It is still controversial in laryngeal cancer and has its supporters and opponents (Nishida et al., 2006).
Microvessel density (MVD) has been established as a reliable and reproducible approach to the assessment of angiogenesis. One of the most common methods used in analyzing vascular density is immunohistochemical staining of CD34, a specific immunohistochemical marker for endothelial cells (Sasano and Suzuki 2005) and was used in the current study. MVD has been extensively studied and has been reported to be positively related to tumor grade or not; related to stage of the tumor in laryngeal cancer or not; related to tumor size; but probably not related to tumor metastases. (Tizinia et al., 2005)
The purpose of the present study was to investigate the significance of angiogenesis in squamous cell carcinoma of the larynx, as assessed by microvessel density, in correlation with the clinical and prognostic parameters.
We included forty patients with LSCC all planned for partial or total larygectomy and ten controls with MAPLs. They were clinically and pathologically evaluated. The degree of angiogenesis was measured by using immunohistochemical staining for CD 34 to assess MVD. All patients were followed up for detection of recurrence in one year. Recurrent patients were reassessed for their MVD.
Twenty four cases were presented with glottic carcinoma, fifteen cases were presented with supraglottic carcinoma and only one case was presented as subglottic carcinoma.
Our results showed a significant correlation between the degree of vascularity expressed in MVD and regional lymph nodal metastasis. Also, it showed a significant correlation between the degree of vascularity and both the pathalogical grading of the tumour and its laryngeal site. A highly statistically significant difference was found between the initial MVD and the MVD after recurrence in the recurrent cases.
MVD was posivitely correlated to the T stage of the tumour but didn’t reach a statistically significant difference.
Also, we found that the degree of angiogenesis of LSCC was not correlated with recurrent disease, a finding that is in line with those of previous studies. This finding should trigger more studies to identify other prognostic factors.
No correlation was found between the degree of angiogenesis and the pathological variant.
In conclusion, there is controversy in our study as regards the value of MVD as a prognostic factor of SCC of the larynx as there were significant correlations with nodal metastases, site and with pathological grade but no relation with T staging and recurrence.