Expression of platelet-derived endothelial cell growth factor/thymidine phosphorylase in human gallbladder lesions

Immunohistochemical study of microvessel density, CD44 (standard form), p53 protein and c-erbB2 in gallbladder carcinoma

BACKGROUND

The purpose of the present study was to investigate microvessel density (MVD), and the expression of CD44 adhesion molecule, p53 protein and c-erbB2 in gallbladder carcinoma, and their relation to histological grade and tumor invasiveness.

METHODS

Immunohistochemical staining with antibodies against factor VIIIRAg, CD44 standard form (CD44s), p53 protein and c-erbB2 was performed on paraffin sections from 33 cases of gallbladder carcinoma.

RESULTS

Significant increase of MVD with increasing depth of invasion (P < 0.02) was observed. No association of MVD with histological differentiation, CD44s, p53 and c-erbB2 protein expression was found. The expression of p53 protein was significantly higher in deeply invasive tumors (P = 0.028) and in moderately and poorly differentiated carcinomas (P < 0.05). The CD44s expression was higher in well-differentiated carcinomas (P < 0.05). c-erbB2 expression was found in 30.4% of tumors studied, but did not relate to any other parameters.

CONCLUSION

Microvessel density and p53 protein expression increase progressively with increasing tumor invasiveness in gallbladder carcinomas. Microvessel density, p53 protein, CD44s, and perhaps c-erbB2 expression may be implicated in gallbladder carcinoma evolution.

Phase II study of capecitabine plus cisplatin as first-line chemotherapy in advanced biliary cancer

BACKGROUND

A phase II study was conducted to assess the efficacy and tolerability of substituting capecitabine for 5-fluorouracil in combination with cisplatin in patients with advanced biliary cancer.

PATIENTS AND METHODS

Patients with previously untreated metastatic or unresectable measurable biliary adenocarcinoma received oral capecitabine 1250 mg/m(2) twice daily on days 1-14, and intravenous cisplatin 60 mg/m(2) on day 1. This cycle was repeated every 21 days.

RESULTS

Forty-two patients were enrolled in this study. Of these, 38 were assessable for efficacy and 41 were assessable for safety. A median of three cycles of treatment (range one to eight) were administered. One patient achieved a complete response, and eight had partial responses, giving an overall response rate of 21.4% in the intention-to-treat population (95% confidence interval 9.1% to 33.9%). The median response duration was 5.1 months. The median time to progression and median overall survival were 3.7 and 9.1 months, respectively. The most common grade 3/4 adverse events were neutropenia (20% of patients), vomiting (12%), diarrhea (7%) and stomatitis (5%). There were no treatment-related deaths.

CONCLUSIONS

The combination of capecitabine and cisplatin has promising antitumor activity and is well tolerated in patients with advanced biliary cancer.

Thymidine phosphorylase expression in gallbladder adenocarcinomas

The expression of thymidine phosphorylase (TP), a potent chemotactic factor for endothelial cells, was studied in 60 adenocarcinomas of the gallbladder, by use of immunohistochemical techniques. Results on patterns of TP expression were correlated with angiogenesis (anti-CD31), histopathological variables, and patient survival. TP was frequently expressed in tumor cells, stromal cells, tumor-associated macrophages, and lymphocytes of gallbladder adenocarcinomas. The expression was mixed nuclear/cytoplasmic. However, only nuclear TP (TPnuc) expression by tumor cells was correlated with increased angiogenic activity. High angiogenesis, assessed as microvessel density (MVD), was the most significant prognostic factor. The subgroup of patients with TPnuc and medium/high MVD had the worst prognosis as evaluated by the survival curves. Furthermore, CD31+ lymphocytes, frequently seen in carcinomas with high-fibroblastic TP reactivity, were connected with an improved survival. It is concluded that angiogenesis, as verified by multivariate analysis, is the most important prognostic factor in gallbladder carcinomas. In these tumors, high histologic grade and low CD31+ lymphocytic infiltration are also independent predictors of poor prognosis. TP is associated with an aggressive phenotype apparently because of its anglogenic activity. Therapeutic strategies targeting TP may be of value in patients overexpressing this enzyme.