Angiogenic Index as a Measure of Angiogenesis in Prostate Cancer and Its Correlation with Gleason Grade and Score

Abstract

Introduction: Microvessel density, as a measure of angiogenesis, predicts prognosis in prostate cancer. Angiogenic Index (AI, numerical value of angiogenesis) minimises the possible variation concerning the width of the microscopic field, stromal epithelial relations and cellular tumour size. Aim: To study AI in prostate cancer and its correlation with Gleason Grade (GG) and Gleason Score (GS). Materials and Methods: The present cross-sectional, study was done at Postgraduate Department of Pathology, Sarojini Naidu Medical College, Agra, India, from September 2019 to December 2020. Twenty five histopathologically confirmed prostate adenocarcinoma specimens from radical prostatectomy, Transurethral Resection of Prostate (TURP), and needle biopsy were included in the study. These cases were categorised according to Gleason Grade (GG); Gleason Score (GS) was assigned to each case. The GSs were simplified into three groups: low (GS 2-6), intermediate (GS 7) and high-grade (GS 8-10). Immunohistochemical {Cluster Differentiation (CD) 31} blood vessel staining was done to calculate AI. Statistical significance was determined by Unpaired t-test. Results: All the cases were males with age range from 55 to 76 years (mean age was 65.48±5.62 years). Mean AI was 13.74, 83.76, 163.27, 299.12 for the GG1, GG3, GG4, GG5 respectively. Mean AI was 29.72, 82.67, 129.15, 186.65, 191.93, 307.34 for GS 2, 6, 7, 8, 9, 10 respectively. Comparing GG among themselves, statistically significant difference in AI was found between GG3 vs GG4 (p-value=0.0056, r-value=0.5269). Difference was also statistically significant between GG3 vs GG5 (p-value=0.000011, r-value=0.8030) and GG4 vs GG5 (p-value=0.0036, r-value=0.5806). In all scores combined, the mean AI was 56.20 for low-grade (GS 2-6), 129.15 for intermediate-grade (GS 7), 247.35 for high-grade (GS 8-10). Statistically significant difference was found in between AI (p-value<0.05) in all Gleason scores. Conclusion: Positive correlation was observed between AI, GG and GS in prostatic adenocarcinoma. AI may be of immense value to predict prognosis of prostatic adenocarcinoma.