Vascular endothelial growth factor, platelet-derived endothelial cell growth factor and angiogenesis in non-small-cell lung cancer

High microvessel density, an indirect measure of angiogenesis, has been shown to correlate with increased tumour size, lymph node involvement and poor prognosis in non-small-cell lung cancer (NSCLC). Tumour cell vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) expression correlate with angiogenesis and a poor outcome in this disease. In a retrospective study VEGF and PD-ECGF expression and microvessel density were evaluated immunohistochemically in surgically resected specimens (T1-3, N0-2) from 223 patients with operable NSCLC using the VG1, P-GF.44C and JC70 monoclonal antibodies respectively. High VEGF immunoreactivity was seen in 104 (46.6%) and PD-ECGF in 72 (32.3%) cases and both were associated with high vascular grade tumours (P= 0.009 and P= 0.05 respectively). Linear regression analysis revealed a weak positive correlation between VEGF and PD-ECGF expression in cancer cells (r= 0.21; P = 0.002). Co-expression of VEGF and PD-ECGF was not associated with a higher microvessel density than VEGF or PD-ECGF only expressing tumours. Furthermore a proportion of high vascular grade tumours expressed neither growth factor. Univariate analysis revealed tumour size, nodal status, microvessel density and VEGF and PD-ECGF expression as significant prognostic factors. Tumour size (P < 0.02) and microvessel density (P < 0.04) remained significant on multivariate analysis. In conclusion, VEGF and PD-ECGF are important angiogenic growth factors and have prognostic significance in NSCLC. Furthermore the study underlines the prognostic significance of microvessel density in operable NSCLC.     

Cyclin D1和p16在青年妇女早期子宫颈鳞癌诊断中的表达及意义

目的探讨Cyclin D1、p16在青年妇女子宫颈上皮内瘤变（cervical intraepithelial neoplasia CIN）及子宫颈早期鳞状上皮癌中的表达意义。方法观察Cyclin D1、p16在CINⅠ级40例、CINⅡ及CINⅢ级各20例、早期浸润癌30例的免疫组织化学表达,设立30例正常子宫颈及慢性炎性反应子宫颈上皮作对照组。结果Cyclin D1、p16在正常子宫颈组织中低表达,在CINⅡ~Ⅲ级组和早期浸润癌组中表达升高,且有递增的趋势（P〈0.01）。Cyclin D1在正常子宫颈组与CINⅠ组,CINⅡ组与子宫颈癌组之间比较差异有统计学意义（P〈0.05）。p16在正常子宫颈组和CINⅡ组相比差异有统计学意义（P〈0.05）。CINⅠ级组中p16表达亦较低,与子宫颈癌组相比差异有统计学意义（P〈0.05）。在早期浸润癌中Cyclin D1与p16的表达无明显相关性（P〉0.05）。结论Cyclin D1和p16与CIN及癌变有密切关系,可作为恶性转化的指标之一。     

Thymidine phosphorylase expression in tumor stroma of uterine cervical carcinomas: histological features and microvessel density

Immunohistochemical staining was performed on 91 cases of uterine neoplasm in order to determine if expression of platelet-derived endothelial cell growth factor/thymidine phosphorylase (TP) correlates with tumor microvessel density (MVD) and histological parameters of uterine carcinomas in tumor cells and in tumor stroma. The sample group consisted of 72 primary invasive squamous cell carcinomas of the cervix (ISC) and 19 cervical intraepithelial neoplasms (CIN) of the uterus. In ISC of the cervix, TP expression in tumor stroma showed a significant correlation with a non-keratinizing histological subtype (P < 0.001) and with an infiltrating invasive pattern (P < 0.001). However, in tumor cells the TP expression showed a higher correlation with a keratinizing histological subtypes (P = 0.009). MVD was significantly higher (P = 0.002) in tumors showing high TP expression in stroma than in tumors with low expression. These findings suggest that the TP expression in stromal cells, rather than in tumor cells, may play a role in promoting microvessel growth in cervical squamous cell carcinoma, and angiogenesis may also have an association with tumor cell invasion.     

血小板衍生内皮细胞生长因子在胃癌和胃癌前病变中的表达及意义

目的：分析胃癌和胃癌前病变组织中血小板衍生内皮细胞生长因子（thymidine phosphorylase/platelet-derived endothelial cell growth factor, TP/PD-ECGF）表达、微血管密度（microvessel density MVD）和血小板（PLT）计数的变化.方法：收集有详细临床资料,并有外周血血小板计数资料的归档病理切片标本117例,分别作TP/PD-ECGF、MVD（应用CD34染色）免疫组化染色和PLT计数.结果：正常胃黏膜、肠上皮化生、不典型增生和肠型胃癌组织中TP/PD-ECGF表达阳性率分别为25%、34.88%、65.71%和92.95%,各组间差异有统计学意义.117例不同胃组织中TP/PD-ECGF表达积分与MVD具有相关性（r=0.441,P=0.000）,TP/PD-ECGF表达阳性组与阴性组的MVD差异有统计学意义,P＜0.01.胃不典型增生组织TP/PD-ECGF表达阳性组与阴性组的MVD差异有统计学意义,P＜0.05.对MVD行4组不同胃组织间的两两比较显示,除肠上皮化生组与不典型增生组之间差异无统计学意义外（P＞0.05）,其余组间比较均有统计学意义.血小板计数在正常胃黏膜组与肠型胃癌组之间差异有统计学意义,P＜0.01.结论：胃癌和胃癌前病变中存在TP/PD-ECGF表达增加和MVD增多.伴随TP/PD-ECGF表达增加,MVD也随之增加.血小板在胃癌的形成中也起到一定作用.     

Clinical significance of angiogenic factor expression at the deepest invasive site of advanced colorectal carcinoma

Tumor angiogenesis is a complicated process for which the mechanisms remain unclear. The aim of this study was to elucidate the clinical significance of several angiogenic factor expression as a predictor of the invasive/metastatic potential and of the prognosis of advanced colorectal carcinoma (CRC) in relation to their intratumoral histologic heterogeneity. One hundred fifty two patients who had undergone surgical resection for advanced CRC entered this study. PD-ECGF, VEGF, and VEGF-C were examined immunohistochemically with antibodies 1C6-203, A-20, and C-20, respectively. Tumor microvessel density (MVD) was determined immunohistochemically with anti-CD34 antibody. Expression of PD-ECGF, of VEGF, and of VEGF-C at the deepest invasive site were detected in 77 (50.7%), 62 (30.8%), and 71 (46.7%) of the 152 lesions, respectively. PD-ECGF, VEGF, and VEGF-C expression at the deepest invasive site in lesions with liver metastasis (77, 67, and 70%) was significantly higher than that in those without liver metastasis (44, 34, and 41%). In cases with curative surgery, patients with PD-ECGF, VEGF, and VEGF-C expression at the deepest invasive site had a significantly poorer prognosis than those without PD-ECGF, VEGF, and VEGF-C expression at the deepest invasive site. PD-ECGF, VEGF, and VEGF-C expression at the deepest invasive site correlated significantly with MVD. Multivariate analysis with logistic regression for 5-year survival in patients with curative surgery showed that lymph node metastasis and VEGF expression were significant risk factors. Expression of PD-ECGF, VEGF, and VEGF-C was correlated significantly with metastatic potential and prognosis in relation to MVD. Of the several angiogenic factors, VEGF expression at the deepest invasive site of tumor was the most statistically significant indicator of prognosis in advanced CRC.     

Expression of vascular endothelial growth factor in patients with testicular germ cell tumors as an indicator of metastatic disease

BACKGROUND: Angiogenesis is essential for tumor growth and metastasis. Vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP)/platelet-derived endothelial cell growth factor (PD-ECGF) are involved in increased angiogenic activity and disease progression in solid tumors. However, there is no information regarding the association of these angiogenic factors with clinicopathologic findings in testicular germ cell tumors (GCTs). METHODS: The authors examined the expression of VEGF and TP as well as microvessel density in GCTs and their association with clinicopathologic findings. Expression of VEGF and TP and microvessel density were examined immunohistochemically in 80 GCTs, including 33 seminomas (25 tumors with organ-confined disease and 8 with metastasis) and 47 nonseminomatous testicular GCTs (NSGCTs) (20 tumors with organ-confined disease and 27 with metastasis). Expression of VEGF also was examined in four GCTs and one nonneoplastic testis by immunoblotting. RESULTS: VEGF protein was expressed more highly in GCTs compared with nonneoplastic testes. VEGF expression in GCTs was correlated significantly with microvessel count (P < 0.001). Both VEGF expression and microvessel count were correlated with metastasis in seminoma (P = 0.008 and P < 0.001, respectively), but only VEGF expression was identified as statistically significant by multiple regression analysis (P = 0.006). Conversely, four variables (VEGF expression, microvessel count, the presence of venous invasion, and the presence of embryonal carcinoma elements in the primary tumor) were correlated with metastasis in NSGCT (P < 0.001, P < 0.001, P = 0.004, and P = 0.029, respectively). However, multiple regression analysis revealed that only VEGF expression and microvessel count were significant factors for metastasis (P < 0.007 and P < 0.001, respectively). In contrast, high levels of TP were observed in infiltrating cells, but not in the majority of cancer cells. CONCLUSIONS: The findings of the current study suggest that VEGF expression is involved in tumor development, angiogenesis, and metastasis in GCT.     

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

The aim of this study was to investigate the expression of platelet-derived endothelial growth factor (PD-ECGF) in human gallbladder carcinomas to elucidate its role in angiogenesis and tumour progression. To this end, 56 archival surgical specimens of gallbladder lesions were examined for PD-ECGF/thymidine phosphorylase (TP) expression by immunohistochemistry and the PD-ECGF/TP protein level was assessed in five fresh specimens of gallbladder carcinoma by enzyme-linked immunosorbent assay (ELISA). Hyperplastic epithelial cells and adenoma cells showed no or faint staining with PD-ECGF/TP. Out of 43 gallbladder carcinomas, 27 (63%) showed moderate to strong immunoreactivity in the cytoplasm and nuclei of the tumour cells. PD-ECGF/TP immunoreactivity in stromal infiltrating cells was detected in 43% (3/7) hyperplasias, 17% (1/6) adenomas and 86% (37/43) carcinomas. PD-ECGF/TP protein levels in carcinoma tissues were higher than those in corresponding normal mucosa. PD-ECGF/TP expression did not correlate with angiogenesis, but significantly correlated with depth of invasion, lymph node metastasis, and tumour stage. These results overall suggest that PD-ECGF/TP produced by both cancer cells and infiltrating cells is associated with tumour progression in human gallbladder carcinoma.     

Platelet-derived endothelial cell growth factor is not implicated in progression of cervical cancer

We examined the expression of platelet-derived endothelial cell growth factor (PD-ECGF) mRNAs in 47 invasive cervical cancer tissues by semi-quantitative RT-PCR and addressed its association with clinicopathological features including microvessel density. Squamous cell carcinomas expressed higher levels of PD-ECGF mRNA than non-squamous cell carcinomas (P=0.014). We found no association between FIGO stage and levels of PD-ECGF mRNA. A subset of 31 patients with stage Ib-II cervical cancer underwent radical hysterectomy and pelvic lymphadenectomy. There were no significant differences in PD-ECGF mRNA levels with respect to tumor size, degree of stromal invasion, lymphvascular space involvement, parametrial involvement, vaginal involvement or lymph node metastasis among these patients. There was no correlation between microvessel density and the levels of PD-ECGF mRNA. These findings suggest that PD-ECGF expression is not associated with progression and metastasis of cervical cancer.     

Angiogenic switch occurs during the precancerous stage of human esophageal squamous cell carcinoma

We previously reported that vascular endothelial growth factor (VEGF) expression correlates with vessel density in human esophageal squamous cell carcinomas. However, tumor angiogenesis is not controlled simply by the presence of VEGF, and is likely regulated by several angiogenic factors produced by tumor and host cells. The goal of the present study was to determine the angiogenic profile of precancerous and cancerous lesions of the esophagus. Expression of mRNAs for VEGF, platelet derived endothelial cell growth factor (PD-ECGF), basic fibroblast growth factor (bFGF), and interleukin (IL)-8 was examined in six esophageal carcinoma cell lines and fresh biopsy specimens from 16 patients with invasive esophageal carcinoma by RT-PCR. Immunohistochemical analyses with antibodies against VEGF, PD-ECGF, bFGF, and IL-8 were performed on archival specimens of 60 normal esophageal mucosa, 11 dysplasias and 49 carcinomas of the esophagus. Microvessels were stained with anti-CD34 antibody and quantified by counting the number of vessels in a x200 field in the most vascularized areas of the tumor. Esophageal carcinoma cell lines and tumor tissues expressed mRNAs for one or more these angiogenic factors at various levels. An initial increase in vessel density and enhanced expression of PD-ECGF and VEGF were observed in dysplastic epithelium. Vessel density was significantly higher in more advanced lesions. bFGF and IL-8 were not expressed in dysplasias and mucosal carcinomas, but expression was increased in late stage squamous cell carcinoma. These findings suggest that the angiogenic switch is a very early event in the development of invasive carcinoma. Several different angiogenic factors produced by tumor cells and host cells may regulate angiogenesis during different steps of esophageal carcinogenesis.     

Topographic study of cervical condyloma and intraepithelial neoplasia

In this study of 101 cervical conization specimens, the location and the size of condyloma and intraepithelial neoplasia (dysplasia and carcinoma in situ) were mapped using the last endocervical gland as the marker for the original squamocolumnar junction. Condylomatous changes were identified in 85% of cervices affected by the intraepithelial neoplasia, and were in direct contact with 68% of intraepithelial neoplasms. The proximal location of intraepithelial neoplasia in relation to the condyloma can be explained by the occurrence of neoplasia just proximal to the condyloma and subsequent expansion of neoplasia towards the cervical canal. This study adds topographic evidence linking cervical condyloma to the development of intraepithelial neoplasia.     

宫颈鳞癌组织与细胞系中血管紧张素Ⅱ-1型受体的表达及其临床意义

目的探讨血管紧张素Ⅱ-1型受体（AT1R）在宫颈鳞癌组织及细胞系中的表达及临床意义。方法（1）应用半定量RT-PCR方法,检测石蜡包埋组织中AT1R mRNA的表达,其中宫颈鳞癌组织35例,宫颈上皮内瘤变（CIN）组织15例,正常宫颈组织15例,2株宫颈鳞癌细胞系Siha、C33a;免疫组化技术检测其AT1R蛋白的表达,并分析AT1R基因的表达与宫颈癌临床病理参数的关系。（2）血管紧张素Ⅱ（AngⅡ）以不同浓度分组共培养鳞癌细胞,应用MTT比色法检测AngⅡ对Siha、C33a细胞的促增殖作用;应用ELISA实验方法检测AngⅡ对Siha、C33a细胞表达血管内皮生长因子（VEGF）的影响,并观察ATIR拮抗剂颉沙坦（valsatan）对AngⅡ的抑制效应。结果（1）AT1R mRNA在2株宫颈鳞癌细胞中高表达,在宫颈鳞癌组织中的阳性表达率及平均相对表达量（77．1％, 0．3863±0．041）均明显高于CIN组（40．0％,0．0768±0．035）和正常宫颈组（0．0％,0;P〈0．01）; AT1R蛋白在宫颈鳞癌组织中的阴性、弱、中、强表达依次为0、23％、23％和54％,与CIN和正常宫颈组织相比,其表达水平显著上调（P〈0．01）;并且AT1R mRNA和蛋白的高表达与宫颈鳞癌组织分级有关（P〈0．05）,而与临床分期及盆腔淋巴结转移无关（P〉0．05）。（2）AngⅡ在10^-9～10^-8mol／L水平对Siha、C33a细胞有明显的促增殖作用;在10^-8mol／L水平可上调Siha、C33a细胞VEGF的表达,而valsatan可明显下调AngⅡ促细胞分泌VEGF的作用（P〈0．01）。结论AngⅡ及AT1R表达增高可能通过促进肿瘤细胞的无限增殖,并上调肿瘤细胞VEGF的表达以促进肿瘤血管生成;拮抗AT1R有可能为宫颈癌的治疗提供新的选择。     

Increased expression of platelet-derived endothelial cell growth factor in human hepatocellular carcinomas correlated with high Edmondson grades and portal vein tumor thrombosis.

Platelet-derived endothelial cell growth factor (PD-ECGF), identical to thymidine phosphorylase, has been reported as an angiogenic factor in human malignancies. However, the role of PD-ECGF in human hepatocellular carcinoma (HCC) is still unconfirmed. Herein, we studied the expression of PD-ECGF in 27 human HCC cases by immunohistochemistry, to clarify the relationship to tumor angiogenesis. The immunoreaction of PD-ECGF in HCC cells was scored in both the staining percentage and intensity. CD34, an endothelial cell marker, was used to evaluate the intratumoral microvessel density (IMVD). PD-ECGF expression was noted in carcinoma cells in 14 (51.9%) of 27 HCCs. In these cases, the carcinoma cells showed heterogeneous staining in both the nucleus and cytoplasm. Tumor-associated stroma cells and infiltrating lymphocytes were also stained. Kupffer cells in non-tumor areas were strongly positive. Statistically, the expression of PD-ECGF increased in HCC specimens with high Edmondson grades (III-IV) or portal vein tumor thrombosis (PVTT) (P<0.05). Additionally, the IMVD of PD-ECGF-positive HCC specimens (136.071+/-31.008, mean +/- SD) was higher than that of the PD-ECGF-negative HCC specimens (61.077+/-15.795) (P<0.05). These findings may suggest that PD-ECGF is one of the angiogenic factors in human HCCs. Furthermore, with the increasing expression of PD-ECGF, HCC cells show poor differentiation and invasive behavior.     

Tissue factor expression, angiogenesis, and thrombosis in pancreatic cancer.

PURPOSE: Hemostatic activation is common in pancreatic cancer and may be linked to angiogenesis and venous thromboembolism. We investigated expression of tissue factor (TF), the prime initiator of coagulation, in noninvasive and invasive pancreatic neoplasia. We correlated TF expression with vascular endothelial growth factor (VEGF) expression, microvessel density, and venous thromboembolism in resected pancreatic cancer. EXPERIMENTAL DESIGN: Tissue cores from a tri-institutional retrospective series of patients were used to build tissue microarrays. TF expression was graded semiquantitatively using immunohistochemistry in normal pancreas (n=10), intraductal papillary mucinous neoplasms (n=70), pancreatic intraepithelial neoplasia (n=40), and resected or metastatic pancreatic adenocarcinomas (n=130). RESULTS: TF expression was observed in a majority of noninvasive and invasive pancreatic neoplasia, including 77% of pancreatic intraepithelial neoplasias, 91% of intraductal papillary mucinous neoplasms, and 89% of pancreatic cancers, but not in normal pancreas. Sixty-six of 122 resected pancreatic cancers (54%) were found to have high TF expression (defined as grade >or=2, the median score). Carcinomas with high TF expression were more likely to also express VEGF (80% versus 27% with low TF expression, P<0.0001) and had a higher median MVD (8 versus 5 per tissue core with low TF expression, P=0.01). Pancreatic cancer patients with high TF expression had a venous thromboembolism rate of 26.3% compared with 4.5% in patients with low TF expression (P=0.04). CONCLUSIONS: TF expression occurs early in pancreatic neoplastic transformation and is associated with VEGF expression, increased microvessel density, and possibly clinical venous thromboembolism in pancreatic cancer. Prospective studies evaluating the role of TF in pancreatic cancer outcomes are warranted.     

Cell-mediated immunity to encephalitogenic factor (MMI test) in women with cervical dysplasia and carcinoma in situ: the effects of serum.

Lymphocyte sensitivity to encephalitogenic factor (EF) was measured with the macrophage migration inhibition (MMI) test in 60 women with dysplasia or carcinoma in situ of the cervix, in 10 women with invasive cervical carcinoma, and in 20 women with a variety of benign gynaecological conditions. Significant migration inhibition with EF (P less than 0.01) was seen with lymphocytes taken from 7/13 (54%) women with mild and/or moderate dysplasia, from 22/47 (47%) women with severe dysplasia and/or carcinoma in situ, from 6/10 (60%) women with invasive cervical carcinoma and from 3/20 (15%) women with benign gynaecological conditions. Autologous serum was seen to abrogate EF-mediated migration inhibition in 3/4 sensitized women with mild and/or moderate dysplasia, in 5/7 sensitized women with severe dysplasia and/or csrcinoma in situ and in 2/3 sensitized women with invasive cervical carcinoma. Autologous serum from 2 sensitized women with benign gynaecological conditions did not abrogate the response of their lymphocytes to EF.     

Monocyte chemoattractant protein-1 expression correlates with macrophage infiltration and tumor vascularity in human gastric carcinomas

The purpose of this study was to investigate the role of interactions between tumor cells and macrophages during angiogenesis in human gastric carcinomas. Macrophage infiltration into tumors and monocyte chemoattractant protein-1 (MCP-1) expression was assessed in 72 archival specimens of gastric carcinoma for comparison with tumor vascularity. The mRNA expression of MCP-1 was examined by RT-PCR in 6 gastric carcinoma cell lines and in fresh biopsy specimens from 18 patients. Immunolocalization of representative angiogenic factors, vascular endothelial growth factor (VEGF), and platelet-derived endothelial cell growth factor (PD-ECGF) was also done. MCP-1 expression in tumor cells increased with the depth of tumor invasion (Tis 9.5%, T1 19.4%, T2-4 60.0%), as did microvessel density and macrophage infiltration. Macrophage counts correlated with vessel counts, and both were significantly higher in MCP-1-positive than in negative tumors. Of the 6 gastric carcinoma cell lines, 2 constitutively expressed MCP-1 mRNA. In 6 (33.3%) of 18 biopsy samples, MCP-1 mRNA was expressed at higher levels in tumor tissues than in normal mucosa. VEGF protein was expressed by gastric carcinoma cells, whereas PD-ECGF protein was expressed mainly by stromal mononuclear cells. MCP-1 expression correlated significantly with VEGF but not PD-ECGF expression in gastric carcinomas. These results suggest that MCP-1 produced by human gastric carcinoma cells plays a role in angiogenesis via macrophage recruitment and activation.     

TP/PD-ECGF表达与血小板增多在胃癌中的意义

目的:研究血小板衍化内皮细胞生长因子(TP/PD-ECGF)在胃癌中的表达及血小板增多情况,并对其与胃癌患者临床病理特征和预后的关系进行探讨。方法:采用免疫组化EnVision两步法检测107例胃癌组织中TP/PD-ECGF的表达,记录血小板增多情况,并分析二者与胃癌患者临床病理特征及预后的关系。结果:胃癌患者中TP/PD-ECGF阳性表达率为71.0%,与血小板增多呈正相关(P<0.01)。TP/PD-ECGF表达、血小板增多与肿瘤分期、淋巴结转移、远处转移及分化程度呈正相关。TP/PD-ECGF阳性与阴性表达患者3年、5年总生存率分别为69.04%、18.12%和88.87%、75.20%,二者差异有统计学意义(P=0.0383);3年、5年无进展生存率分别为64.87%、17.92%和82.73%、35.00%,二者差异有统计学意义(P=0.0350)。Cox比例风险模型多因素分析显示,肿瘤分期、淋巴结转移、远处转移、TP/PD-ECGF及血小板增多均是影响胃癌预后独立的危险因素。结论:TP/PD-ECGF表达与血小板增多呈正相关,二者与胃癌生长和浸润转移关系密切,可作为胃癌独立的预后因素。     

Modulation of neoangiogenesis in bronchial preneoplastic lesions.

We have previously demonstrated that vascular count significantly increases in the preneoplastic lesions of the bronchial tree, starting from very low levels in the normal epithelium to a significantly higher number of microvessels in moderate dysplastic lesions and in situ carcinomas. Vascular endothelial growth factor (VEGF) protein expression has shown to be strictly associated with neovascularization both in human cancer and in various type of preinvasive lesions. A number of studies have demonstrated that mutant p53 is involved in the regulation of angiogenesis, and immunohistochemical detection of the p53 protein is associated with p53 gene mutations. In this study we looked for possible correlation between p53 protein detection, VEGF expression and vascular count in a series of preneoplastic and neoplastic lesions of the bronchial tree in order to investigate the angiogenic pattern and its genetic control in the early steps of bronchial cancer development. Twenty-four retrospective bronchial lesions with different grades of dysplasia and a case of normal bronchial epithelium were analysed. Surgical specimens removed from patients either confirmed, or suspect for lung carcinoma were stained immunohistochemically for CD34, VEGF, and p53. There were significant increases in microvascular density (MVD), VEGF, and p53 expression from normal bronchial epithelium through moderate dysplasia to in situ carcinoma to invasive cancer and these factors were significantly associated with moderate dysplastic lesions. A statistically significant difference was observed in MVD between hyperplastic-metaplastic, moderate dysplastic lesions and in situ carcinoma. A similar pattern was also observed for VEGF and p53 protein expression but no significant difference was observed between moderate dysplastic lesions and in situ carcinoma with regard to VEGF protein expression. The association between MVD, VEGF expression, p53 mutations and preinvasive lesions of the bronchial tree suggests that neoangiogenesis is early in non-small cell lung cancer (NSCLC) development and that p53 may have an important role in promoting angiogenesis in this human model of carcinogenesis.