Tumor angiogenesis in stage IB cervical cancer: Correlation of microvessel density with survival

Objective: Because angiogenesis is considered essential for tumor growth and the development of metastasis, we assessed the correlation of microvessel density with overall survival in patients with clinical stage IB carcinoma of the uterine cervix. Study Design: Histologic slides were immunostained for factor VIII-related antigen. Microvessel density was determined within each tumor by enumeration under a light microscope at 200x magnification and an examination area of 0.25 mm2. The Cox proportional hazards model was used for multivariate analysis. Results: In 166 patients with stage IB cervical cancer the 5-year survival was as follows: 89.7% in 102 patients whose tumors had a microvessel density ≤20/field, and 63.0% in 64 patients whose tumors had a microvessel density >20/field (log rank p<0.0001). In the multivariate Cox model microvessel density, lymph node involvement, tumor size, and the application of radiation therapy remained independent prognostic factors for survival, whereas lymphatic vascular space involvement failed to retain a significant value. Conclusion: High microvessel density adversely influences patientsʹ survival in clinical stage IB cervical cancer and identifies patients with negative nodes at risk for relapse.