Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2016; 22(23): 5422-5429
Published online Jun 21, 2016. doi: 10.3748/wjg.v22.i23.5422
Endocan-expressing microvessel density as a prognostic factor for survival in human gastric cancer
Yuan Chang, Wei Niu, Pei-Long Lian, Xian-Qiang Wang, Zhi-Xin Meng, Yi Liu, Rui Zhao
Yuan Chang, Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
Wei Niu, Pei-Long Lian, Zhi-Xin Meng, Yi Liu, Rui Zhao, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Xian-Qiang Wang, Department of Pediatric surgery, the PLA General Hospital, Beijing 100853, China
Author contributions: Chang Y designed the research and drafted and revised the paper; Niu W, Lian PL and Wang XQ performed the research; Meng ZX and Liu Y searched the literature and analyzed the data; and Zhao R revised the paper and approved the final version.
Supported by National Natural Science Foundation of China, No. 81302123.
Institutional review board statement: The study was reviewed and approved by Qilu Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rui Zhao, PhD, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, No. 107 Wenxi Road, Jinan 250012, Shandong Province, China. zhr4722@163.com
Telephone: +86-531-82166651 Fax: +86-531-82169243
Received: March 13, 2016
Peer-review started: March 13, 2016
First decision: March 31, 2016
Revised: April 12, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 21, 2016

AIM: To investigate the expression of endocan in tumour vessels and the relationships between endocan and the expression of vascular endothelial growth factor (VEGF) and prognosis in gastric cancer.

METHODS: This study included 142 patients with confirmed gastric cancer in a single cancer centre between 2008 and 2009. Clinicopathologic features were determined, and an immunohistochemical analysis of endocan-expressing microvessel density (MVD) (endocan-MVD), VEGF and vascular endothelial growth factor receptor 2 (VEGFR2) was performed. Potential relationships between endocan-MVD and clinicopathological variables were assessed using a Student’s t-test or an analysis of variance test. Spearman’s rank correlation was applied to evaluate the relationship between endocan-MVD and the expression of VEGF/VEGFR2. Long-term survival of these patients was analysed using univariate and multivariate analyses.

RESULTS: Positive staining of endocan was observed in most of the gastric cancer tissues (108/142) and in fewer of the normal gastric tissues. Endocan-MVD was not associated with gender or histological type (P > 0.05), while endocan-MVD was associated with tumour size, Borrmann type, tumour differentiation, tumour invasion, lymph node metastasis and TNM stage (P < 0.05). According to the Spearman’s rank correlation analysis, endocan-MVD had a positive correlation with VEGF (r = 0.167, P = 0.047) and VEGFR2 (r = 0.410, P = 0.000). The univariate analysis with a log-rank test indicated that the patients with a high level of endocan-MVD had a significantly poorer overall survival rate than those with a low level of endocan-MVD (17.9% vs 64.0%, P = 0.000). The multivariate analysis showed that a high level of endocan-MVD was a valuable prognostic factor.

CONCLUSION: Endocan-MVD significantly correlates with the expression of VEGF and VEGFR2 and is a valuable prognostic factor for survival in human gastric cancer.

Keywords: Endocan, Microvessel density, Vascular endothelial growth factor, Gastric cancer, Survival

Core tip: Angiogenesis plays an important role in the progression of gastric cancer. In the present study, we first found that endocan-expressing microvessel density (MVD) (endocan-MVD) had a positive correlation with vascular endothelial growth factor (VEGF) and VEGFR2 in gastric cancer tissues. Patients with a high level of endocan-MVD had a significantly poorer overall survival rate than those with a low level of endocan-MVD. Based on our research, we suggest that endocan-MVD may act as a valuable prognostic factor for survival in patients with gastric cancer.