Tumor angiogenesis as a predictor of recurrence and survival in patients with node-negative colon cancer

Ann Surg. 1995 Dec;222(6):695-9. doi: 10.1097/00000658-199512000-00002.


Objective: The authors' objective was to quantitatively assess angiogenesis or neovascularity within node-negative colon cancers and to determine if increased angiogenesis correlated with higher recurrence and lower survival rates.

Summary background data: Neovascularization promotes rapid tumor growth by facilitating nutrient and metabolite exchange. Recent work with breast and nonsmall cell lung cancers has shown that low angiogenic activity imparts a lower risk of recurrence and metastasis. Although adjuvant therapy is beneficial for patients with node-positive colon cancers, no such benefit has been demonstrated for patients with node-negative lesions. Nevertheless, up to 30% of this latter group will experience recurrence. We sought to identify a subset of patients with node-negative colon cancers at high risk for recurrence who might benefit from such therapy.

Methods: One hundred five node-negative colon cancers were immunostained for endothelial cell factor VIII-related antigen. Blood vessels within three microscopic fields at 100X magnification were counted, the mean calculated, and an angiogenesis score assigned. A subjective angiogenesis grade (1-4) was assigned after each slide was surveyed in its entirety. Score and grade were then assessed with respect to cancer recurrence and patient survival.

Results: Mean patient age was 71 years (range, 41-90 years) and mean tumor size, 5.6 cm (range, 2-12 cm). Mean follow-up was 6.5 years; mean angiogenesis score, 27.9 (range, 4-50); and mean grade, 2.0 (range, 1-4). Patients living 5 years had significantly lower angiogenesis scores than did nonsurvivors (22.8 vs. 43.2, p = 0.0004). Each 10-vessel increase in score imparted a 2.0-fold greater hazard of death and a 2.7-fold greater hazard of recurrence. The probability of surviving 5 years is estimated by: [formula: see text] and the probability of recurrence is estimated by: [formula: see text]

Conclusions: Angiogenesis within colon cancer is an important predictor of tumor behavior and may identify patients at higher risk for recurrence and early death.

MeSH terms

  • Adenocarcinoma / blood supply*
  • Adenocarcinoma / mortality*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / secondary
  • Aged
  • Colonic Neoplasms / blood supply*
  • Colonic Neoplasms / mortality*
  • Colonic Neoplasms / pathology
  • Endothelium, Vascular / chemistry
  • Female
  • Humans
  • Immunoenzyme Techniques
  • Lymphatic Metastasis
  • Male
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local / epidemiology*
  • Neovascularization, Pathologic / pathology*
  • Prognosis
  • Risk Factors
  • Survival Analysis
  • Time Factors
  • von Willebrand Factor / analysis


  • von Willebrand Factor