Wenquan Wang, Liang Liu, HuaxiangXu, Chuntao Wu, Jinfeng Xiang, 

Yaqi Wang, Jin Xu, Chen Liu, JiangLong, Quanxing Ni, Xianjun Yu

Department of Pancreatic and Hepatobiliary Surgery,Fudan University Shanghai Cancer Center, Pancreatic Cancer Institute

Objective:Microvessel density (MVD) as anangiogenesis predictor is inefficient per se in cancer prognosis. We evaluatedprognostic values of combining intratumoral alpha-smooth muscle actin (α-SMA)-positivestromal cell density and MVD after curative resection in hypervascularhepatocellular carcinoma (HCC) and hypovascular pancreatic cancer (PC). Method:Tissue microarrays were constructed from tumors of 305 HCC and 57 PCpatients who underwent curative resection and analyzed for α-SMA and CD34expression by immunostaining. Prognostic values of these two proteins and otherclinicopathological features were examined. Result: Both low α-SMAdensity and high MVD-CD34 were associated in HCC with the presence ofintrahepatic metastasis and microvascular invasion, and they were related tolymph node involvement and microvascular invasion in PC (P<0.05). Although CD34 alone, but not α-SMA, was an independentprognostic factor for overall survival and recurrence-free survival, thecombination of low α-SMA and high CD34 was a predictor of worst prognosis forboth types of tumors and had a better power to predict patient death and earlyrecurrence (P<0.01). Furthermore,the results show that distribution of most of the α-SMA-positive cells andvascular endothelial cells overlap, showing major colocalization on vascularwalls. Conclusion: Poor microvessel integrity, as indicated by high MVD,together with low perivascular α-SMA-positive cell coverage is associated withearly recurrence, unfavorable metastasis, and short survival after tumorresection. This finding highlights the significance of vascular quality intumor progression, which provides an optimized complement to vascular quantityin prognosis of postoperative patients.

Key Words: microvessel density  hepatoc microvessel integrity