EJSO 2002; 28: 637±644 doi:10.1053/ejso.2002.1307, available online at http://www.idealibrary.com on 1 Prognostic significance of intratumoural microvessel density (IMD) in resected pancreatic and ampullary cancers to standard histopathological variables and survival A. W. Khan*, A. P. Dhillon², R. Hutchins³, A. Abraham*, S. R. Shah*, S. Snooks³ and B. R. Davidson* *University Department of Surgery, ²University Department of Histopathology, Royal Free & University College Medical School, University College London, UK and ³Department of Surgery, King George's Hospital, Ilford, UK Aim: Angiogenesis is required for tumour growth. Its evaluation, by intratumoural microvessel density (IMD), has prognostic significance in many solid tumours. There is controversy regarding its use in pancreatic cancer and little is known about its role in ampullary tumours. The aim is to study IMD as a prognostic marker in resected ductal adenocarcinomas of head of pancreas and cancers of the ampullary region. Methods: Forty-seven patients (23 pancreatic and 24 ampullary, mean age 62.0 years) surviving a potentially curative (R0/R1) resection were analysed. Paraffin-embedded sections of these tumours were immunohistochemically stained for CD-34 and IMD was determined (magnification 6 200). This was correlated with histopathological data and survival using Cox's multivariate analysis. Results: Mean survival for the pancreatic cancer group was 18.4 months (SE  2.7) and 81.2 months (SE  9.9) for the ampullary cancer group. In the pancreatic cancer group, IMD was found to have independent prognostic significance to survival on multivariate analysis (P  0.002, Hazard Ratio (HR) 13.60) along with microscopic resection margin involvement (P  0.003, HR 15.18). For ampullary cancers, IMD was higher in those with lymph node metastasis (P  0.02, Mann±Whitney U-test). Conclusion: IMD in resected pancreatic cancers correlates with survival. # 2002 Elsevier Science Ltd. All rights reserved. Key words: tumour angiogenesis; intratumoral microvessel density; pancreatic cancer; ampullary cancer pancreaticoduodenectomy. INTRODUCTION Angiogenesis is an integral part of the cascade of biological events leading to tumour growth beyond 1±2 mm. 1 One of the more objective methods of measuring tumour angiogenesis is by recording intratumoural microvessel density (IMD). 2 It has been shown that microvessel density measured in histological sections by immuno-histochemical techniques is repre- sentative of whole tumour vascularity. 3 Studies on many solid tumours including breast, lung and bladder cancer have indicated that increased IMD is associated with regional and distant spread and in many studies it has been correlated with survival. 2,4,5 The influence of IMD on prognosis in resected pancreatic ductal adenocarcinoma has produced con- flicting data. 6,7 The prognostic significance of IMD in ampullary adenocarcinoma has not been evaluated. Pancreatic cancer has a 5-year survival post curative resection of 10%, 8 and is poorly responsive to chemotherapy. 9 A good index of prognosis in resected 0748±7983/02/$35.00 # 2002 Elsevier Science Ltd. All rights reserved. Part of this work was presented at the International Hepato-Pancreatic Biliary Association meeting, 26 May 2000, Australia. Correspondence to: Brian R. Davidson, Professor of Surgery, Royal Free & University College Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Tel: 44 020 7830 2757; Fax: 44 020 7830 2688.