Skip to main content
Top
Published in: World Journal of Surgical Oncology 1/2008

Open Access 01-12-2008 | Research

Neoangiogenesis in early cervical cancer: Correlation between color Doppler findings and risk factors. A prospective observational study

Authors: Matias Jurado, Rosendo Galván, Rafael Martinez-Monge, Jesús Mazaira, Juan Luis Alcazar

Published in: World Journal of Surgical Oncology | Issue 1/2008

Login to get access

Abstract

Background

The aim of the present article was to evaluate whether angiogenic parameters as assessed by transvaginal color Doppler ultrasound (TVCD) may predict those prognostic factors related to recurrence.

Methods

A total of 27 patients (mean age: 51.3 years, range: 29 to 85) with histologically proven early stage invasive cervical cancer were evaluated by TVCD prior to surgery. Subjective assessment of the amount of vessels within the tumor (scanty-moderate or abundant) and pulsatility index (PI) were recorded. All patients underwent radical hysterectomy and pelvic lymph node dissection. Postoperative treatment (RT or chemoradiotherapy) was given according to risk factors (positive lymph nodes, parametrial and vaginal margin involvement, depth stromal invasion, lymph-vascular space involvement)

Results

Tumors with "abundant" vascularization were significantly associated with pelvic lymph node metastases, depth stromal invasion > 10 mm, lymph-vascular space involvement, tumor diameter > 17.5 mm, and parametrial involvement. Postoperative treatment was significantly more frequent in patients with "abundant" vascularization (OR: 20.8, 95% CIs: 2 to 211). The presence of scanty-moderate vascularization with a PI < 0.82 or abundant vascularization with either PI > 0.82 or PI < 0.82 was associated with high-risk group in 94.4% of the cases (OR: 21.2, 95% CI: 1.9 to 236.0)

Conclusion

The results are consistent with a relationship between tumor angiogenesis and prognostic factors for recurrence in early cervical cancer. "Abundant" vascularization and PI < 0.82 may be related to postoperative treatment due to risk factors.
Appendix
Available only for authorised users
Literature
1.
go back to reference Carmeliet P, Jain RK: Angiogenesis in cancer and other diseases. Nature. 2000, 407: 249-257. 10.1038/35025220.CrossRefPubMed Carmeliet P, Jain RK: Angiogenesis in cancer and other diseases. Nature. 2000, 407: 249-257. 10.1038/35025220.CrossRefPubMed
2.
go back to reference Wiggins DL, Granai CO, Steinhoff MM, Calabresi P: Tumor angiogenesis as a prognostic factor in cervical carcinoma. Gynecol Oncol. 1995, 56: 353-356. 10.1006/gyno.1995.1062.CrossRefPubMed Wiggins DL, Granai CO, Steinhoff MM, Calabresi P: Tumor angiogenesis as a prognostic factor in cervical carcinoma. Gynecol Oncol. 1995, 56: 353-356. 10.1006/gyno.1995.1062.CrossRefPubMed
3.
go back to reference Schlenger K, Hockel M, Mitze M, Schäffer U, Weikel W, Knapstein PG, Lambert A: Tumor vascularity – a novel prognostic factor in advanced cervical carcinoma. Gynecol Oncol. 1995, 59: 57-66. 10.1006/gyno.1995.1268.CrossRefPubMed Schlenger K, Hockel M, Mitze M, Schäffer U, Weikel W, Knapstein PG, Lambert A: Tumor vascularity – a novel prognostic factor in advanced cervical carcinoma. Gynecol Oncol. 1995, 59: 57-66. 10.1006/gyno.1995.1268.CrossRefPubMed
4.
go back to reference Tjalma W, Van Mark E, Weyler J, Dirix L, Van Daele A, Goovaerts G, Albertyn G, van Dam P: Quantification and prognostic relevance of angiogenic parameters in invasive cervical cancer. Br J Cancer. 1998, 78: 170-174.PubMedCentralCrossRefPubMed Tjalma W, Van Mark E, Weyler J, Dirix L, Van Daele A, Goovaerts G, Albertyn G, van Dam P: Quantification and prognostic relevance of angiogenic parameters in invasive cervical cancer. Br J Cancer. 1998, 78: 170-174.PubMedCentralCrossRefPubMed
5.
go back to reference Cosgrove D: Angiogenesis imaging-ultrasound. Br J Radiol. 2003, 76: 43-S49. 10.1259/bjr/86364648.CrossRef Cosgrove D: Angiogenesis imaging-ultrasound. Br J Radiol. 2003, 76: 43-S49. 10.1259/bjr/86364648.CrossRef
6.
go back to reference Fleischer AC, Nierman KJ, Donnelly EF, Yankeelov TE, Canniff KM, Hallahan DE, Rothenberg ME: Sonogrphic depiction of microvessel perfusion. J Ultrasound Med. 2004, 23: 1499-1506.PubMed Fleischer AC, Nierman KJ, Donnelly EF, Yankeelov TE, Canniff KM, Hallahan DE, Rothenberg ME: Sonogrphic depiction of microvessel perfusion. J Ultrasound Med. 2004, 23: 1499-1506.PubMed
7.
go back to reference Foster FS, Burns PN, Simpson DH, Wilson SR, Christopher DA, Goertz DE: Ultrasound of the visualization and quantification of tumor microcirculation. Cancer Metastasis Rev. 2000, 19: 131-138. 10.1023/A:1026541510549.CrossRefPubMed Foster FS, Burns PN, Simpson DH, Wilson SR, Christopher DA, Goertz DE: Ultrasound of the visualization and quantification of tumor microcirculation. Cancer Metastasis Rev. 2000, 19: 131-138. 10.1023/A:1026541510549.CrossRefPubMed
8.
go back to reference Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C: Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997, 350: 535-540. 10.1016/S0140-6736(97)02250-2.CrossRefPubMed Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C: Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997, 350: 535-540. 10.1016/S0140-6736(97)02250-2.CrossRefPubMed
9.
go back to reference Delgado G, Bundy BN, Fowler WC, Stehman FB, Sevin B, Creasman WT, Major F, DiSaia P, Zaino R: A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1989, 35: 314-320. 10.1016/0090-8258(89)90070-X.CrossRefPubMed Delgado G, Bundy BN, Fowler WC, Stehman FB, Sevin B, Creasman WT, Major F, DiSaia P, Zaino R: A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1989, 35: 314-320. 10.1016/0090-8258(89)90070-X.CrossRefPubMed
10.
go back to reference Samlal RA, Velden van der J, Ten Kate FJ, Schilthuis MS, Hart AA, Lammes FB: Surgical pathologic factors that predict recurrence in stage I b and II a cervical carcinoma patients with negative pelvic lymph nodes. Cancer. 1997, 80: 1234-1240. 10.1002/(SICI)1097-0142(19971001)80:7<1234::AID-CNCR6>3.0.CO;2-K.CrossRefPubMed Samlal RA, Velden van der J, Ten Kate FJ, Schilthuis MS, Hart AA, Lammes FB: Surgical pathologic factors that predict recurrence in stage I b and II a cervical carcinoma patients with negative pelvic lymph nodes. Cancer. 1997, 80: 1234-1240. 10.1002/(SICI)1097-0142(19971001)80:7<1234::AID-CNCR6>3.0.CO;2-K.CrossRefPubMed
11.
go back to reference Singh N, Arif S: Histopathologic parameters of prognosis in cervical cancer – a review. Int J Gynecol Cancer. 2004, 14: 741-750. 10.1111/j.1048-891X.2004.014504.x.CrossRefPubMed Singh N, Arif S: Histopathologic parameters of prognosis in cervical cancer – a review. Int J Gynecol Cancer. 2004, 14: 741-750. 10.1111/j.1048-891X.2004.014504.x.CrossRefPubMed
12.
go back to reference Inoue T, Okumura M: Prognostic significance of parametrial extension in patients with cervical carcinoma stages I b, II a and II b: A study of 628 cases treated by radical hysterectolmy and lymphadenectomy with and without postoperative radiation. Cancer. 1984, 54: 1714-1719. 10.1002/1097-0142(19841015)54:8<1714::AID-CNCR2820540838>3.0.CO;2-S.CrossRefPubMed Inoue T, Okumura M: Prognostic significance of parametrial extension in patients with cervical carcinoma stages I b, II a and II b: A study of 628 cases treated by radical hysterectolmy and lymphadenectomy with and without postoperative radiation. Cancer. 1984, 54: 1714-1719. 10.1002/1097-0142(19841015)54:8<1714::AID-CNCR2820540838>3.0.CO;2-S.CrossRefPubMed
13.
go back to reference Kamura T, Tsukamoto N, Tsuruchi N, Saito T, Matsuyama T, Akazawa K, Nakano H: Multivariate analysis of the histopathologic prognostic factors of cervical cancer in patients undergoing radical hysterectomy. Cancer. 1992, 69: 181-186. 10.1002/1097-0142(19920101)69:1<181::AID-CNCR2820690130>3.0.CO;2-B.CrossRefPubMed Kamura T, Tsukamoto N, Tsuruchi N, Saito T, Matsuyama T, Akazawa K, Nakano H: Multivariate analysis of the histopathologic prognostic factors of cervical cancer in patients undergoing radical hysterectomy. Cancer. 1992, 69: 181-186. 10.1002/1097-0142(19920101)69:1<181::AID-CNCR2820690130>3.0.CO;2-B.CrossRefPubMed
14.
go back to reference Estape RE, Angioli R, Madrigal M, Janicek M, Gomez C, Penalver M, Averette H: Close vaginal margins as a prognostic factor after radical hysterectomy. Gynecol Oncol. 1998, 68: 229-232. 10.1006/gyno.1998.4960.CrossRefPubMed Estape RE, Angioli R, Madrigal M, Janicek M, Gomez C, Penalver M, Averette H: Close vaginal margins as a prognostic factor after radical hysterectomy. Gynecol Oncol. 1998, 68: 229-232. 10.1006/gyno.1998.4960.CrossRefPubMed
15.
go back to reference Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, Zaino RJ: A phase III randomized trial of postoperative pelvic irradiation in stage Ib cervical carcinoma with poor prognostic features: follow-up of a Gynecologic Oncology group study. Int J Radiat Oncology Biol Phys. 2006, 65: 169-176. 10.1016/j.ijrobp.2005.10.019.CrossRef Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, Zaino RJ: A phase III randomized trial of postoperative pelvic irradiation in stage Ib cervical carcinoma with poor prognostic features: follow-up of a Gynecologic Oncology group study. Int J Radiat Oncology Biol Phys. 2006, 65: 169-176. 10.1016/j.ijrobp.2005.10.019.CrossRef
16.
go back to reference Peters WA, Liu PY, Barrett RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W, Alberts DS: Concurrent chemotherapy and pelvic radiation therapy compared with radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000, 18: 1606-1613.PubMed Peters WA, Liu PY, Barrett RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W, Alberts DS: Concurrent chemotherapy and pelvic radiation therapy compared with radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000, 18: 1606-1613.PubMed
17.
go back to reference Landoni F, Maneo A, Cormio G, Perego P, Milani R, Caruso O, Mangioni C: Class II versus class III radical hysterectomy in stage Ib-IIa cervical cancer: a prospective randomized study. Gynecol Oncol. 2001, 80: 3-12. 10.1006/gyno.2000.6010.CrossRefPubMed Landoni F, Maneo A, Cormio G, Perego P, Milani R, Caruso O, Mangioni C: Class II versus class III radical hysterectomy in stage Ib-IIa cervical cancer: a prospective randomized study. Gynecol Oncol. 2001, 80: 3-12. 10.1006/gyno.2000.6010.CrossRefPubMed
18.
go back to reference Inoue T, Morita K: The prognostic significance of number of positive nodes in cervical carcinoma stages Ib, IIa, and IIb. Cancer. 1990, 65: 1923-1927. 10.1002/1097-0142(19900501)65:9<1923::AID-CNCR2820650909>3.0.CO;2-M.CrossRefPubMed Inoue T, Morita K: The prognostic significance of number of positive nodes in cervical carcinoma stages Ib, IIa, and IIb. Cancer. 1990, 65: 1923-1927. 10.1002/1097-0142(19900501)65:9<1923::AID-CNCR2820650909>3.0.CO;2-M.CrossRefPubMed
19.
go back to reference Delgado G, Bundy BN, Zaino R, Stehman FB, Sevin B, Creasman WT, Major F, DiSaia P, Zaino R: A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol. 1989, 35: 314-320. 10.1016/0090-8258(89)90070-X.CrossRefPubMed Delgado G, Bundy BN, Zaino R, Stehman FB, Sevin B, Creasman WT, Major F, DiSaia P, Zaino R: A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol. 1989, 35: 314-320. 10.1016/0090-8258(89)90070-X.CrossRefPubMed
20.
go back to reference Larsson G, Alm P, Gullberg B, Grundsell H: Prognostic factors in early invasive carcinoma of the uterine cervix: a clinical, histopathologic, and statistical analysis of 343 cases. Am J Obstet Gynecol. 1983, 146: 145-153.CrossRefPubMed Larsson G, Alm P, Gullberg B, Grundsell H: Prognostic factors in early invasive carcinoma of the uterine cervix: a clinical, histopathologic, and statistical analysis of 343 cases. Am J Obstet Gynecol. 1983, 146: 145-153.CrossRefPubMed
21.
go back to reference Hsieh CY, Wu CC, Chen TM, Chen CA, Chen CL, Wang JF, Chang CF, Hsieh FJ: Clinical significance of intratumoral blood flow in cervical carcinoma assessed by color Doppler ultrasound. Cancer. 1995, 75: 2518-2522. 10.1002/1097-0142(19950515)75:10<2518::AID-CNCR2820751018>3.0.CO;2-A.CrossRefPubMed Hsieh CY, Wu CC, Chen TM, Chen CA, Chen CL, Wang JF, Chang CF, Hsieh FJ: Clinical significance of intratumoral blood flow in cervical carcinoma assessed by color Doppler ultrasound. Cancer. 1995, 75: 2518-2522. 10.1002/1097-0142(19950515)75:10<2518::AID-CNCR2820751018>3.0.CO;2-A.CrossRefPubMed
22.
go back to reference Tepper R, Zalel Y, Altaras M, Ben-Baruch G, Beyth Y: Transvaginal color Doppler ultrasound in the assessment of invasive cervical carcinoma. Gynecol Oncol. 1996, 60: 26-29. 10.1006/gyno.1996.0006.CrossRefPubMed Tepper R, Zalel Y, Altaras M, Ben-Baruch G, Beyth Y: Transvaginal color Doppler ultrasound in the assessment of invasive cervical carcinoma. Gynecol Oncol. 1996, 60: 26-29. 10.1006/gyno.1996.0006.CrossRefPubMed
23.
go back to reference Alcazar JL, Jurado M: Transvaginal color Doppler for predicting pathological response to preoperative chemoradiation in locally advanced cervical carcinoma: a prliminary study. Ultrasound Med Biol. 1999, 25: 1041-1045. 10.1016/S0301-5629(99)00063-0.CrossRefPubMed Alcazar JL, Jurado M: Transvaginal color Doppler for predicting pathological response to preoperative chemoradiation in locally advanced cervical carcinoma: a prliminary study. Ultrasound Med Biol. 1999, 25: 1041-1045. 10.1016/S0301-5629(99)00063-0.CrossRefPubMed
24.
go back to reference Wu YC, Yuan CC, Hung JH, Chao KC, Yen MS, Ng HT: Power Doppler angiographic appearance and blood flow velocity waveforms in invasive cervical carcinoma. Gynecol Oncol. 2000, 79: 181-186. 10.1006/gyno.2000.5889.CrossRefPubMed Wu YC, Yuan CC, Hung JH, Chao KC, Yen MS, Ng HT: Power Doppler angiographic appearance and blood flow velocity waveforms in invasive cervical carcinoma. Gynecol Oncol. 2000, 79: 181-186. 10.1006/gyno.2000.5889.CrossRefPubMed
25.
go back to reference Cheng WF, Lee CN, Chu JS, Chen CA, Chen TM, Shau WY, Hsieh CY, Hsieh FJ: Vascularity index as a novel parameter for the in vivo assessment of angiogenesis in patients with cervical carcinoma. Cancer. 1999, 85 (3): 615-617. 10.1002/(SICI)1097-0142(19990201)85:3<651::AID-CNCR15>3.0.CO;2-9.CrossRef Cheng WF, Lee CN, Chu JS, Chen CA, Chen TM, Shau WY, Hsieh CY, Hsieh FJ: Vascularity index as a novel parameter for the in vivo assessment of angiogenesis in patients with cervical carcinoma. Cancer. 1999, 85 (3): 615-617. 10.1002/(SICI)1097-0142(19990201)85:3<651::AID-CNCR15>3.0.CO;2-9.CrossRef
26.
go back to reference Cheng WF, Wei LH, Su YN, Cheng SP, Chu JS, Lee CN: The possible use of color flow Doppler in planning treatment in early invasive carcinoma of the cervix. Br J Obstet Gynaecol. 1999, 106 (11): 1137-1342.CrossRefPubMed Cheng WF, Wei LH, Su YN, Cheng SP, Chu JS, Lee CN: The possible use of color flow Doppler in planning treatment in early invasive carcinoma of the cervix. Br J Obstet Gynaecol. 1999, 106 (11): 1137-1342.CrossRefPubMed
27.
go back to reference Hsu KF, SU JM, Huang SC, Cheng YM, Kang CY, Shen MR, Chang FM, Chou CY: Three-dimensional power-Doppler imaging of early-stage cervical cancer. Ultrasound Obstet Gynecol. 2004, 24: 664-671. 10.1002/uog.1756.CrossRefPubMed Hsu KF, SU JM, Huang SC, Cheng YM, Kang CY, Shen MR, Chang FM, Chou CY: Three-dimensional power-Doppler imaging of early-stage cervical cancer. Ultrasound Obstet Gynecol. 2004, 24: 664-671. 10.1002/uog.1756.CrossRefPubMed
28.
go back to reference Testa AC, Ferrandina G, Distefano M, Fruscella E, Mansueto D, Basso D, Salutari V, Scambia G: Color Doppler velocimetry and three-dimensional color power angiography of cervical carcinoma. Ultrasound Obstet Gynecol. 2004, 24: 445-452. 10.1002/uog.1703.CrossRefPubMed Testa AC, Ferrandina G, Distefano M, Fruscella E, Mansueto D, Basso D, Salutari V, Scambia G: Color Doppler velocimetry and three-dimensional color power angiography of cervical carcinoma. Ultrasound Obstet Gynecol. 2004, 24: 445-452. 10.1002/uog.1703.CrossRefPubMed
29.
go back to reference Alcázar JL: Transvaginal color Doppler in the assessment of cervical cancer. Cancer Ther. 2005, 3: 139-146. Alcázar JL: Transvaginal color Doppler in the assessment of cervical cancer. Cancer Ther. 2005, 3: 139-146.
Metadata
Title
Neoangiogenesis in early cervical cancer: Correlation between color Doppler findings and risk factors. A prospective observational study
Authors
Matias Jurado
Rosendo Galván
Rafael Martinez-Monge
Jesús Mazaira
Juan Luis Alcazar
Publication date
01-12-2008
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2008
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-6-126

Other articles of this Issue 1/2008

World Journal of Surgical Oncology 1/2008 Go to the issue