Angiogenesis and Survival in Patients with Myelodysplastic Syndrome
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Angiogenesis has been implicated in the pathogenesis and prognosis of myelodysplastic syndrome (MDS). In this study, we investigated the relationship between microvessel density (MVD), vascular endothelial growth factor (VEGF) expression, common morphological and clinical factors, and survival in patients with MDS. We examined the MVD of paraffin-embedded bone marrow sections from 70 MDS patients and 31 controls. VEGF expression was determined in 50 patients and 20 controls. The median MVD in MDS patients was significantly higher than that in controls (p = 0.025), whereas there was no difference in VEGF expression between MDS patients and controls. In univariate analysis, increased MVD was associated with a shorter survival time (p = 0.023). However, in multivariate analysis, MVD was not an independent predictor of survival. The VEGF expression did not influence survival in univariate analysis. Survival was independently influenced by platelet count (p = 0.0073), cytogenetic risk category (p = 0.022), and transfusion dependence (p = 0.0073). Neither MVD nor VEGF expression were predictors for progression to acute myeloid leukemia in univariate analysis. Progression to acute myeloid leukemia was independently influenced only by the cytogenetic risk category (p = 0.022). This study confirmed increased MVD in MDS. It does not support an independent prognostic role of angiogenesis in MDS.
KeywordsMyelodysplastic syndrome Angiogenesis Microvessel density VEGF Survival Prognosis
Atypical localization of immature progenitor cells
Acute myeloid leukemia
Acute myeloid leukemia with myelodysplasia-related changes
chronic myelomonocytic leukemia
hematoxylin and eosin
International Prognostic Scoring System
Refractory anemia with excess blasts
Refractory anemia with excess blasts in transformation
Refractory anemia with ringed sideroblasts
Refractory cytopenia with multilineage dysplasia
Refractory cytopenia with unilineage dysplasia
Vascular endothelial growth factor
World Health Organization
WHO classification-based prognostic scoring system
We wish to thank Dusan Pejin and Nada Vuckovic for their support.
Contributors: All authors have actively participated to the study and approved the manuscript. Aleksandar Savic designed the research, collected patient information, analyzed and interpreted the data, and wrote the manuscript. Vesna Cemerikic-Martinovic contributed control patients, reviewed bone marrow histology. Sinisa Dovat provided critical revisions. Borivoje Sekulic and Vanja Kvrgic collected patient information. Ivana Urosevic and Nebojsa Rajic collected patient information, and contributed patients. Stevan Popovic contributed patients.
Conflicts of interest statement
There are no conflicts of interests to disclose.
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