食管癌患者治疗前S-VEGF表达水平与临床因素的关系

Clinical Significance of S-VEGF in Patients with Esophageal Cancer

目的以无进展生存率为主要观察指标,探讨食管癌患者血清血管内皮生长因子(S- VEGF)表达水平与临床因素间的关系及其对预后影响。方法按入组条件共收治了89例食管癌患者,其中手术治疗46例,同期放化疗43例,同时选取30名健康人作为对照。手术采用食管病变切除术加区域淋巴结清扫术；同期放化疗的放疗剂量为60 Gy,照射方式采用常规分割方案；同期化疗方案为顺铂+氟尿嘧啶,分别在放疗开始的第1、29天进行。所有患者在治疗前取血清标本,应用S-VEGF定量试剂盒进行酶联免疫吸附试验。结果食管癌组治疗前S-VEGF表达水平明显高于正常对照组,分别为(475．93±44．76)、(294．20±23．40)pg/ml,差异有统计学意义(t=2．35,P=0．020)。S-VEGF表达水平受T分期和临床分期影响。Ⅰ+Ⅱ期和Ⅲ+Ⅳ期的1年无进展生存率分别为71%、29%(x^2 =10．12,P=0．002)。S-VEGF表达水平＜475 pg/ml和≥475 pg/ml的1年无进展生存率分别为66%、24%(x^2=12．31,P=0．000)。Cox回归分析结果表明S-VEGF表达水平也是影响预后的因素。结论治疗前食管癌患者S-VEGF表达水平明显高于健康人,S-VEGF表达水平受临床分期影响。食管癌患者治疗前S-VEGF表达水平影响患者预后,有可能作为一个独立预后指标。

Objective The purpose of this study was to investigate the clinical sign/ficance of serum vascular endothehal growth factor （S-VEGF） in patients of esophageal squamous cell carcinoma with the end-point of progress-free survival rate. Methods Sera from 89 patients with esophageal squamous carcinoma, who presented and treated with concurrent chemoradiotherapy or surgical resection in Cancer Center of Sun Yat-Sen University from December 2002 to May 2004, were sampled at the time of pre-treatment. 30 cases of health individuals without any evidence of disease were selected as control group. For patients with surgical resection were performed with esophagectomy and extended lymphadenectonly. For patients with concurrent cbemoradiotherapy comprised of cisplatin and 5-fluorouracil. The radiotherapy dose of 2 Gy per day was initiated on Day 1 of chemotherapy and continued daily for 5 days per week for 6 weeks, for a total dose of 60 Gy. Two courses of chemotherapy were given during radiotherapy at 6-week intervals. The serum vascular endothelial growth factor （ SVEGF） levels were measured with a solid phase enzyme Human VEGF Immunoassay EIISA kit. The end point of this study was progress-free survival, and time was calculated from the date of diagnosis to date of relapse or last follow evaluation. Results S-VEGF level of patients with esophageal squamous cell carcinoma was significantly higher than that of healthy controls （475.93 ± 44.76 pg/ml vs. 294.20 ± 23.40 pg/ml; P = 0.020）. S-VEGF levels in patients with Stage Ⅲ and Stage Ⅳ disease were significantly higher than those in patients with Stage Ⅰ and Stage Ⅱ disease. The 1-year progress-free survival rate of high S-VEGF group （ ≥ 475 pg/ml） was significantly lower than that of the low S-VEGF group（ 〈 475 pg/ml） （ 24% vs. 66% ; P = 0.0（104）. The 1-year progress-free survival rate of the patients with Stage Ⅰ and Stage Ⅱ disease was significantly higher than that of patients with Stage m and Stage Ⅳ disease （71% vs. 29% ; P = 0. 0015）. The variables were assessed by multivariate analysis using the Cox proportional hazards model, and the results revealed that the clinical stage and the S-VEGT were first and second independent prognosis factor, respectively. Conclusions In the current study, a high S-VEGF was found to be associated with tumor progression, poor treatment response, and poor survival in patients with squamous cell carcinoma of the esophagus.