Prognostic evaluation of the microvascular network in myelodysplastic syndromes

• Published in: Leukemia Vol. 15; no. 9; pp. 1369 - 1376
• Main Authors: KORKOLOPOULOU, P, APOSTOLIDOU, E, PAVLOPOULOS, P. M, KAVANTZAS, N, VYNIOU, N, THYMARA, I, TERPOS, E, PATSOURIS, E, YATAGANAS, X, DAVARIS, P
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01-09-2001; Nature Publishing Group
• Subjects: Acute Disease; Acute myeloid leukemia; Adult; Aged; Aged, 80 and over; Angiogenesis; Area; Biological and medical sciences; Blast cells; Chronic myelomonocytic leukemia; Coagulation factors; Disease-Free Survival; Disorders; Factor VIII - analysis; Female; Hematologic and hematopoietic diseases; Humans; Image analysis; Image processing; Leukemia; Leukemia, Myeloid - pathology; Leukemia, Myelomonocytic, Chronic - pathology; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical prognosis; Medical sciences; Microcirculation - pathology; Microvasculature; Middle Aged; Myelodysplastic syndrome; Myelodysplastic syndromes; Myelodysplastic Syndromes - pathology; Myelomonocytic leukemia; Neovascularization, Pathologic - pathology; Parameters; Pathogenesis; Prognosis; Quantitation; Refractory anemia; Shape factor; Survival; Vascularization; Human; Immunohistochemistry; Prognosis; Factor VIII; Exploration; Malignant hemopathy; Myelodysplastic syndrome; Pathology; Angiogenesis; Microcirculation; Distribution; Network; Neovascularization; Predictive factor; Morphometry; Quantitative analysis
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/sj.leu.2402220

Considering the recently stated suggestion of neovascularization being implicated in myelodysplastic syndromes (MDS) pathogenesis, we evaluated multiple morphometric microvascular characteristics in MDS, in relation to clinicopathologic factors and prognosis. Trephines from 50 newly diagnosed MDS patients were immunostained for factor VIII and compared to those from 20 controls, 10 chronic myelomonocytic leukemia (CMML) and 12 acute myeloid leukemia (AML) patients. Quantitation of microvessel density (MVD), area, total vascular area (TVA), major and minor axis length, perimeter, compactness, shape factor, Feret diameter, and the number of branching vessels was performed by image analysis. Overall, the MDS group had significantly higher MVD, TVA, minor axis and shape factor values and significantly lower compactness than the control group. AML was characterized by increased vascularity compared to MDS and CMML, as well as by the presence of flattened microvessels (lower values of shape factor). Hypercellular MDS showed higher MVD. RA/RARS displayed larger caliber vessels than RAEB, which explains the favorable prognostic effect of increased size-related parameters on progression and/or survival. Moreover, decreased compactness and MVD were independent predictors of longer progression-free survival. It is concluded that angiogenesis is involved in the conversion of normal marrow to MDS and ultimately to AML and that disease progression within MDS is accompanied by qualitative alterations of the microvascular network. Furthermore, size-related parameters affect survival, while shape-related parameters and MVD are more influential with regard to progression-free survival.