Vascular endothelial growth factor expression and survival in node positive breast cancer patients treated with adjuvant therapy

Abstract

653 Background: Vascular endothelial growth factor (VEGF) expression may affect tumor angiogenesis, with most studies finding worse survival associated with VEGF positivity. Methods: An immunohistochemical analysis for VEGF expression was performed on a cohort of 125 primary breast cancer patients diagnosed between 1989 and 1998 with 4 or more positive axillary lymph nodes, treated with adjuvant therapy. Patients were followed via registry for treatment, recurrence, and vital status current as of 2003. VEGF immunostaining, using the C1 clone on deparaffinized, formalin fixed tissue, was scored via a semi-quantitative system based on the intensity of immunostaining signal. Correlations were measured with factors associated with better and worse outcomes such as tumor size, number of positive lymph nodes, estrogen/progesterone receptor status, and HER-2/neu over expression. Log rank test for survival differences by VEGF status were calculated using Kaplan Meier plots. Results: 37% of the sample tested positive (2+) for VEGF (n=46). Fifty seven percent of the cases were over 50 years of age, 65% had 4–9 positive lymph nodes and 35%>=10, and median follow up was six years. VEGF positive patients had worse breast cancer survival (log rank test = 8.93, p = .003), overall survival (log rank test = 7.54, p = .006), and relapse free survival (log rank test = 5.61, p = .018). Patients who had 4–9 versus 10 or more positive lymph nodes, were estrogen receptor positive, or were HER-2/neu negative had significantly worse disease specific survival if they were VEGF positive. ER+/VEGF+ patients had significantly worse survival that ER+/VEGF- patients. Conclusions: In this study high levels of expression of VEGF were associated with significantly worse survival in breast cancer patients, even in subgroups expected to have a better prognosis. No significant financial relationships to disclose.