Vascular endothelial growth factor as a potential prognosticator in
Ewing Sarcoma: a tertiary care cancer center experience from India
Abstract
Introduction: Vascular endothelial growth factor (VEGF)is an angiogenic
marker and implicated in carcinogenesis and prognostication of cancers.
However its prognostic potential in a rare cancer-Ewing’s sarcoma merits
exploration. Methods: Histopathologically confirmed consecutive ES cases
registered at our institute from 2014 to 2018 were analysed.
Immunohistochemical staining for VEGF was performed on tumour tissues
and they were further classified based on VEGF intensity. Results: There
were 105 patients including 53 non-metastatic and 52 metastatic. VEGF
immunostaining in non-metastatic and metastatic cohort was negative in
20 (37.7%) and 21 (40.4%), mildly positive in 13 (24.5%) and 9
(17.3%) cases, moderately positive in 14 (26.4%) and 16 (30.8%), and
was intensely positive in 6 (11.3%) and 7 (13.5%) patients,
respectively. VEGF immunoexpression up to 25% was seen in 14 (13.3%)
and 10 (9.5%) patients within the non-metastatic and metastatic cohort,
respectively. The median EFS and OS for the entire cohort were 26.4
(95% CI 17.6-NA) and 32.5 (21.3-NA) months, respectively. Metaststatic
ES patients having either VEGF immunostaining in >25%
tumor cells or moderate /strong immunostaining were found to inferior
EFS and OS [p= 0.017, HR-0.153; p=0.013, HR-0.109
respectively].Additionally, treatment-naïve, compliant and
non-metastatic patients had superior EFS (p=0.000, 0.000, 0.020, 0.022
respectively) and OS (p=0.000, 0.000, 0.006, 0.041 respectively).
Conclusion: VEGF expression and intensity were found as independent
negative prognostic marker in Ewing sarcoma .This may translate to
therapeutic relevance but needs validation in the subsequent, larger
prospective studies.