Cheng Si-Hang, Liu Jia-Ming, Liu Qin-Yu, Luo De-Yi, Liao Bang-Hua, Li Hong, Wang Kun-Jie
Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China.
Int J Clin Exp Pathol. 2014 Aug 15;7(9):5855-63. eCollection 2014.
Microvessel density (MVD), an indicator of angiogenesis, has been proposed to predict prognosis of patients with renal cell carcinoma (RCC), but its ability to predict survival of patients with RCC remains controversial. The present study sought to address this question rigorously by systematically reviewing the literature on MVD and RCC prognosis. We identified relevant studies in PubMed, EMBASE and the Cochrane Library, and two reviewers independently assessed study quality and extracted relevant data to compare survival based on MVD stratification in patients with RCC. We identified 15 studies that satisfied the inclusion criteria; eight studies assessed MVD in surgical samples by immunohistochemistry to label factor VIII; four studies, by immunohistochemistry to label CD34; two studies, CD31; and one study, CD105. Survival meta-analysis was performed using data pooled from 10 studies: five based on factor VIII, two based on CD34, two based on CD31 and one based on CD105. The overall survival hazard ratio describing the relationship between MVD and survival in all 10 pooled studies was 0.964 (95% CI: 0.873-1.065), while the individual hazard ratios for pooled studies based on factor VIII were 1.673 (95% CI: 0.860-3.252); CD34, 0.903 (95% CI: 0.853-0.956); and CD31, 0.926 (95% CI: 0.868-0.989). The corresponding result for the sole trial based on CD105 was 0.1759 (95% CI: 0.036-0.856). These findings suggest that MVD is not reliably associated with survival time of patients with RCC, which may reflect the need to take into account whether the microvasculature is differentiated or not. MVD as currently calculated may not be an ideal prognostic factor for patients with RCC.
微血管密度（MVD）作为血管生成的一个指标，已被提出用于预测肾细胞癌（RCC）患者的预后，但其预测RCC患者生存率的能力仍存在争议。本研究旨在通过系统回顾关于MVD和RCC预后的文献来严格解决这个问题。我们在PubMed、EMBASE和Cochrane图书馆中识别相关研究，两名 reviewers 独立评估研究质量并提取相关数据，以比较基于RCC患者MVD分层的生存率。我们识别出15项符合纳入标准的研究；8项研究通过免疫组织化学对手术样本中的MVD进行评估，以标记因子VIII；4项研究通过免疫组织化学标记CD34；2项研究标记CD31；1项研究标记CD105。使用从10项研究中汇总的数据进行生存meta分析：5项基于因子VIII，2项基于CD34，2项基于CD31，1项基于CD105。在所有10项汇总研究中描述MVD与生存之间关系的总生存风险比为0.964（95%CI：0.873 - 1.065），而基于因子VIII的汇总研究的个体风险比为1.673（95%CI：0.860 - 3.252）；CD34为0.903（95%CI：0.853 - 0.956）；CD31为0.926（95%CI：0.868 - 0.989）。基于CD105的唯一试验的相应结果为0.1759（95%CI：0.036 - 0.856）。这些发现表明，MVD与RCC患者的生存时间并无可靠关联，这可能反映出需要考虑微血管是否分化。目前计算的MVD可能不是RCC患者的理想预后因素。
