Prognostic value of von Willebrand factor, CD34, CD31, and vascular endothelial growth factor expression in women with uterine leiomyosarcomas

Background and Objectives To compare uterine leiomyosarcomas (LMS) and leiomyomas (LM) with normal myometrium in terms of microvessel density (MVD), and to correlate this parameter with vascular endothelial growth factor (VEGF) expression and clinical/pathological parameters. Methods An immunohistochemical technique, using antibodies against von Willebrand factor (FvW), CD34, CD31, and VEGF, was applied to formalin‐fixed paraffin‐embedded samples of 32 normal myometria, 32 uterine LM, and 12 LMS. MVD was calculated by a digital image analyzer. Results Using anti‐FvW, mean ± SD MVD in myometrium, LM, and LMS was 107.0 ± 53.6, 66.2 ± 55.4, and 64.4 ± 44.2, respectively (P = 0.001). MVD was lower in LMS (P = 0.021) and in LM (P = 0.0004) than in normal myometrium. Using anti‐CD34, mean ± SD MVD in myometrium, LM, and LMS was 187.6 ± 91.2, 106.1 ± 55.5, and 114.2 ± 98.8, respectively (P = 0.001). MVD was lower in LMS (P = 0.012) and LM (P = 0.0004) than in normal myometrium. No such differences were found using anti‐CD31 and anti‐VEGF. No correlation was found between MVD and VEGF expression. In women with uterine LMS, low MVD (assessed with anti‐FvW) correlated with recurrence (P = 0.04) and poor overall survival (P = 0.03). Conclusions Uterine smooth muscle tumors exhibit a lower MVD than normal myometrium, as assessed using anti‐FvW or anti‐CD34 antibodies. A reduced MVD, as assessed by FvW staining, has prognostic value in uterine LMS. J. Surg. Oncol. 2004;86:84–90. © 2004 Wiley‐Liss, Inc.