Clinical, immunohistochemical and biological study of prognostic factors for oral squamous cell carcinomas

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Tumor angiogenesis is necessary for tumor progression. Many studied have demonstrated that greater numbers of tumor vessels increase the chance for tumor cells to enter circulation, and newly formed tumor vessels are more easily invaded than normal vessels. Vascular endothelial growth factor (VEGF) is one of the important angiogenic factors highly specific for endothelium. Many recent studies showed a positive correlations between VEGF expression, tumor microvascular density (MVD) and patient outcome. In this study, we investigated correlations between MVD, VEGF expression, circulating carcinoma cells in peripheral blood and lymph node and distant metastasis.VEGF expression and MVD were examined by immunohistochemical staining in 43 patients with oral squamous cell carcinomas. The incidence of lymph node metastasis with high-MVD patients were significantly higher than those with low-MVD patients (82% vs 17%). The analysis of the relation between MVD in the tumor areas and VEGF expression showed a strong statistical association between MVD and VEGF expression. The MVD in the patients with VEGF-positive tumors was higher than in those with VEGF-negative tumors (73% vs 15%). A higher VEGF expression was significantly associated with nodal metastatic involvement. Thus, according to examination of VEGF expression, we can able to predict the probability of lymph node metastases and outcome of patients with oral carcinoma. Furthermore, our study disclosed that the detection rate of circulating carcinoma cells in the peripheral blood clearly increased with MVD and lymph node metastasis. The results of this study clearly show that the detection of circulating carcinoma cells in the peripheral blood may be a powerful marker for predicting tumor relapse after radical surgery.