Study On The Expression Of VEGF, MMP-9 And Recurrent Factors Of Sacral Chordoma

Objective: To study the expression levels of VEGF, MMP-9 in sacral chordoma and investigate their contribution to the angiogenesis and the correlation between their expression levels, in order to provide sufficient evidences for anti-angiogenesis therapy for sacral chordoma.Methods: 36 sacral chordoma tissues and 8 normal tissues nearby tumor were resected from the patients with sacral chordoma who have accepted surgical treatment from 1993 to 2008 in our hospital. Immunohistochemical method was performed to estimate the expression of VEGF, MMP-9 and CD34 (represent MVD). Statistical analysis was performed to analyze the difference of expression level between tumor tissues and normal tissues nearby tumor, and the correlations among VEGF, MMP-9 and MVD.Results: There was a significant difference between the mean MVD in sacral chordomas (13.617±6.110) and normal tissues nearby tumor (8.70±3.055) (P<0.05). The VEGF-positive rate was 77.8% (28/36) in sacral chordomas and 25% (2/8) in normal tissues nearby tumor. The MMP-9-positive rate was 69.4% (25/36) in sacral chordomas and 12.5% (1/8) in normal tissues nearby tumor. In statistical analysis, there was a significant difference between the expression levels of VEGF and MMP-9 in sacral chordomas and normal tissues nearby tumor (P<0.05). The mean MVD of the VEGF-positive group and VEGF-negative group was 14.914±6.073 and 9.075±3.759 respectively, the difference was significant (P<0.05). The mean MVD in the MMP-9-positive group and MMP-9-negative group was 15.504±5.836 and 9.327±4.450 respectively, the difference was significant (P<0.05). In 36 sacral chordomas, the mean score of VEGF was 3.694±1.697, and the mean score of MMP-9 was 3.33±1.490. In Pearson linear correlation, there was a significant correlativity between the expression of VEGF and MMP-9 in sacral chordoma (P<0.05).Conclusion: Angiogenesis in sacral chordoma is abundant. VEGF and MMP-9 maybe positively regulate the angiogenesis in sacral chordoma. VEGF and MMP-9 has synergistic effect in the angiogenesis of sacral chordoma. It suggests that some specific drugs which inhibit VEGF, MMP-9 or their receptor may have a good therapeutic effectiveness for sacral chordoma.Objective: To investigate recurrent factors of sacral chordoma after surgical therapy retrospectively, in order to provide theoretic foundation for an improvement of continuous disease-free survival time (CDFS).Methods: This retrospective study included 28 patients with sacral chordoma who underwent initial operation from 1993 to 2008 in our hospital. The data of gender, age, tumor size, tumor location, surgical type, and the expression of VEGF and MMP-9 was reviewed. CDFS was calculated according the Kaplan-Meier method and statistical analysis was performed using Log-Rank test.Results: The mean follow-up time was 76.2 months. At the final follow-up, 13 of 28 patients (46.4%) developed local recurrences, the average recurrence time was 35.9 months. CDFS was found significantly longer in patients whose tumor highest level at or below S3 compared to above S3 (median: 53 versus 20 months, P<0.05). The median CDFS in intralesional surgery group was 35 months, marginal surgery group was 42 months and wide surgery group was 70.5 months. Statistic analysis showed that surgical type was the most valuable indicator of CDFS (P<0.05). CDFS was also found significantly longer in MMP-9 negative expression group than MMP-9 positive expression group (median: 75 versus 26 months, P<0.05). CDFS was not found significant difference between different age group, sex group, tumor size group, and VEGF expression group (P>0.05).Conclusion: The high level of tumor involvement, incomplete excision, and positive expression of MMP-9 will probably lead to shorter CDFS. Expression of VEGF was not correlate with the recurrence of sacral chordoma. Resects the tumor completely with a wide surgical margins may provide a better prognosis for these patients. Overexpression of MMP-9 can be used as possible prognostic indications of the recurrence of sacral chordoma.