The Value Of Tumor Angiogenesis Activity For Stratification Of Hcc Patients

The study aimed to evaluate whether the identification of angiogenesis factors improves the system of clinical classification and allows for choice of more appropriate candidates for surgery. The cohort study covered 180 patients. Ninety two of them underwent radical treatment: 48 liver resection, 44 liver transplantation. Eighty eight patients were selected for palliative treatment. Endothelial progenitor cells in the blood were assessed with a flow cytometer, serum VEGF concentration was measured by ELISA. HCC samples were examined for morphologic characteristics and stained for VEGF and VEGFR concentration within tumor tissue. Patients were followed up to 3 years after the surgery. With the use of the multivariate analysis model we identified the angiogenesis factors that are significant for the appropriate stratification of candidate for the radical treatment (P-value < 0.05). Patients considered as eligible for the radical surgical treatment had lower levels of angiogenesis factors than those chosen for the palliative care (P < 0.001). The optimal cutoff identified for the rate of circulating EPCs, serum VEGF level, and tumor VEGF concentration was 47.08%, 327.2 pg/mL and 83.16 morphometric units, respectively. In 30% of patients undergoing surgery HCC recurred within 3 years. The preoperative level of angiogenesis factors exceeded the value of the cutoff in all of them (P < 0.001). The multivariate analysis showed an increased EPCs level as the strongest independent factor indicating tumor unfavorable biology and the possibility of relapse after surgery (Odds Ratio = 15.5, P < 0.001). We conclude that the assessment of angiogenesis factors improves the clinical evaluation and allows for more accurate stratification of patients for surgery.