High Expression of Galectin-1, VEGF and Increased Microvessel Density Are Associated with MELF Pattern in Stage I-III Endometrioid Endometrial Adenocarcinoma

Background: In this study, we investigate the expression of markets of angiogenesis and microvessel density (MVD) in cases of microcys- tic, elongated and fragmented (MELF) pattern, with its prognostic role in the survival of endometrioid endometrial adenocarcinomas (EA) patients. Methods: In this study, 100 cases of EA, 49 cases with MELF pattern and 51 without, were in immunohistochemically stained for galectin-1, vascular endothelial growth factor (VEGF), and MVD. Morphometry and statistical (univariate and multivariate) analyses were performed to assess overall survival (OS) and disease-free survival. Results: The expression of VEGF (p<.001) and galectin-1 (p< .001), as well as MVD area (p<.001) and number of vessels/mm(2) (p<.050), were significantly higher in the +MELF pattern group compared to the -MELF group. A low negative correlation between MELF-pattern and the number of days of survival (p <.001, r = -0.47) was also found. A low positive correlation of MELF-pattern with galectin-1 expression (p< .001, r=0.39), area of vessels/mm 2 (p<.001, r=0.36), outcome of EA (p<.001, r=0.42) and VEGF expression (p<.001, r=0.39) suggests potential pathological relevance of these factors in the prognosis of EA. A univariate survival analysis indicated a role for all parameters of survival. Multivariate Cox proportional hazard regression analysis revealed that only area of vessels/mm 2 (hazard ratio [HR], 1.018; 95% confidence interval [CI] 1.002 to 1.033), galectin-1 (HR, 1.049; 95% CI, 1.025 to 1.074) and VEGF (HR, 1.049; 95% CI, 1.022 to 1.077) play key roles in OS. Conclusions: This study reports an increase in MVD, VEGF and galectin-1 expression in EA with MELF pattern and suggests that MELF pattern, along with the angiogenic profile, may be a prognostic factor in EA.