VEGF Expression in lesions of Patients with Colorectal Peritoneal
Metastases is Correlated to Survival
E.M.V. de Cuba, I.H.J.T de Hingh*, R.Kwakman, P.M. Delis-van Diemen**, R. Bouwe**, H.J. Bonjer, G.A. Meijer**,
E.A. te Velde
Dept. of Surgical Oncology, VU University Medical Center Amsterdam
* Dept. of Surgery, Catharina Ziekenhuis Eindhoven
** Tumor Profiling Unit Dept. of Pathology, VU University Medical Center
Aim: High levels of Vascular Endothelial Growth Factor (VEGF) are associated with a
worse prognosis in colorectal cancer (CRC). Anti-VEGF therapies are known to improve
the survival in hematogenously disseminated CRC. CRC patients presenting with
peritoneal metastases (PM) can be curatively treated with cytoreductive surgery (CRS)
and HIPEC. It is not known whether these patients also benefit from treatment with antiVEGF treatment. We aim to investigate the levels of expression of VEGF in peritoneal
deposits and its prognostic value in HIPEC patients.
Materials and Methods: From 2007 to 2010 from the Catherina Hospital Eindhoven all
consecutive patients undergoing CRS & HIPEC were investigated for VEGF expression.
Patients surviving less than 12 months post-treatment were categorized as short
survivors and patients surviving more than 12 months as long survivors. These two
groups were compared for VEGF expression using the Chi-square test. VEGF expression
was assessed in selected sections of peritoneal metastases by immunohistochemistry on
formalin-fixed paraffin embedded tissue. The intensity of the staining was scored as
negative, weak, moderate and strong.
Results: A total of 49 patients (22 male and 27 female) that underwent CRS&HIPEC for
colon carcinoma (n=44) and rectal carcinoma (n=5) were included. The median age was
62 years (range 31-77) and median follow-up was 18 months (range 1-51). Of these
patients, 34 survived > 12 months (69%). Moderate to strong VEGF expression was
observed in 35 out of 38 successfully analysed cases (92%). Univariate analysis showed
that high VEGF correlates with a survival of less than twelve months (p=0,02).
Conclusions: Higher VEGF expression was correlated with a survival of less than twelve
months in this group of patients undergoing CRS&HIPEC. The use of anti-VEGF, i.e.
Bevacuzimab, in patients undergoing CRS&HIPEC might be of additional clinical value.