Contrast Study On Renal Cell Carcinoma Vascularization With Mean Color Vessel Density And Pathologic Microvessel Density

Objective: To compare an in vivo angiogenesis parameter-Mean color vessel density (MCVD) generated from color power angiography (CPA) with Microvessel density (MVD) derived from immunohistochemistry for assessment of renal cell carcinoma vessels. The vessel endothelial cell (VEC) was stained with anti-CD34 monoclonal antibody and anti-factor-Ⅷ related antigen (F8RA) polyclonal antibody to search the better marker of microvessels in RCCs. The MVDs of the better sensitive marker were compared with MCVDs in RCCs. The aims were to analyze the characteristics of blood supply, explore the vessels pathologic basis of CPA, investigate the advantage and disadvantage of CPA in detecting and quantitating tumor vessels, evaluate the clinical value in metastasis and prognosis preoperatively in RCCs.Material and Methods: Between March 2001 and November 2002, 38 RCCs were examined with ultrasonography preoperatively. At first, the size, profile, location, distance between the tumor center and the skin surface, relationship with surrounding and status of lymphnode metastasis and venous emboli of RCCs were recorded with B-mode ultrasound. Second, the blood flows in RCCs were displayed with CPA and graded intoⅠ～Ⅲ according to the blood flow distribution and degree of blood supply richness. Then the best image of CPA were captured and stored to the computer for later quantitative analysis. MCVD was calculated using computer soft ware. All the slices of tumor tissue specimens excised operatively were stained with CD34 and A-F8RA. MVD were calculated respectively. These results were analyzed statistically combined with Robson clinical stages of RCCs in the study.Results: ⑴ Immunohistochemically, the membrane and plasma of the VEC in cancerous tissue of 38 RCCs were positively stained with CD34 and A-F8RA. The microvessels were shown irregular profile, uneven distribution and littery arrange. The mean MVD of each were 60.00±31.47/400× and 25.82±12.48/400×. ⑵ The MVDs stained with CD34 in the three clinical stages were 59.65±32.69/400×, 66.35±33.71/400× and 49.58±27.14/400×; the MVDs stained with A-F8RA in the three clinical stages were 27.91±14.07/400×, 27.00±13.06/400× and 21.53±9.43/400×. There was no significant correlation between MVD and clinical stages (p>0.05). ⑶ In the 38 RCCs, 7(18.4%) of 38 were displayed as CPAⅠwith only dot-like blood flow signals in the tumors; 21(55.3%) cases were Ⅱ with regular strip, branch-shaped blood flow signals in tumor orarch-shaped vessels around it and small branches extending into; 10(26.3%) cases were Ⅲ, displaying as irregular dendritic blood flow signals in tumor and big surrounding vessels in peritumor with branches extending into. Mean MVDs of the three grades were 68.52±45.04/400×, 54.09±28.16/400× and 64.45±29.00/400× respectively. There were no associations between groups (p>0.05). ⑷ In the 38 RCCs, MCVD and MVD showed rank correlation (r=0.344, p≤0.05). ⑸ The mean MCVDs in the three clinical stages were 0.1962±0.1120,0.2302±0.1557,0.2069±0.0972。There was no significant correlation between MCVD and clinical stages (p>0.05). Conclusions: ⑴ In immunohistochemistry, the method stained with CD34 was more sensitive than that with A-F8RA .It could show smaller and immature microvessels and even single endothelial cell. So it could stain the VEC of neoangiogenesis in RCCs better. Thus, in the second part of this study, MVD stained with CD34 was used to compare with the new parameter MCVD of CPA. ⑵ CPA can display the blood supply and distribution in the tumors sensitively, but the half-quantitive analysis of tumor vessels- the grades have no association with MVD of RCCs statistically. So it could not be the prognostic index of RCCs. ⑶ The quantitative analysis of tumor vessels in RCCs - MCVD can reflect the cancerous neoangiogenesis indirectly and be the prognostic index to evaluate RCCs. It can alsoreflect the global blood supply of RCCs better than MVD. ⑷ MCVD, as a new index for the quantification of...