同期放化疗对食管癌患者血清血管内皮生长因子表达水平的影响——附43例临床资料分析

Effect of Concurrent Chemoradiotherapy on Serum Vascular Endothelial Growth Factor in Esophageal Squamous Cell Carcinoma Patients——A Report of 43 Cases

背景与目的:食管癌患者的预后,除与临床分期有关外,还与血清血管内皮生长因子(serumvascularendothelialgrowthfactor,S-VEGF)的表达水平有关。本研究采用酶联反应吸附试验,探讨食管癌患者同期放化疗对血清中VEGF表达水平的影响及其与预后的关系。方法:收集自2002年12月～2004年1月期间就诊于中山大学肿瘤医院进行同期放化疗,符合入组条件的食管鳞癌患者;血清标本分别在治疗前和治疗结束后1个月抽取,同时选取性别、年龄比例相当的健康人血清作为对照组。采用酶联免疫吸附试验测定S-VEGF表达水平。放射治疗采用常规分割方案进行,放疗剂量60～64Gy,分别在放疗过程中的第1～2天和第29～30天给予顺铂+氟尿嘧啶方案化疗。比较食管癌患者组和正常人组之间S-VEGF表达水平有无差异。以无肿瘤进展生存率为指标,观察治疗前和治疗后,食管癌患者S-VEGF表达水平的变化情况及其与无进展生存率的关系。结果:食管癌患者治疗前、治疗后1个月的S-VEGF表达水平均高于和健康对照组,分别为(516.27±67.89)ng/L、(347.19±35.42)ng/L和(294.20±23.40)ng/L(P<0.01、P=0.002)。同期放化疗显著降低S-VEGF的表达(P<0.01)。完全缓解(CR)患者和部分缓解(PR)+进展(PD)的患者治疗前S-VEGF表达水平分别为(345.82±76.29)ng/L和(669.37±99.04)ng/L(P=0.020)。根据治疗前后S-VEGF表达的动态变化进行分组,即S-VEGF治疗前、治疗后水平>516.27ng/L、>347.19ng/L组(A组),>516.27ng/L、<347.19ng/L组(B组),<516.27ng/L、>347.19ng/L组(C组),<516.27ng/L、<347.19ng/L组(D组),则A、B、C、D四组的1年无肿瘤进展率分别为0%、17%、57%、72%(P=0.005)。结论:食管癌患者S-VEGF的表达水平明显高于健康人;同期放化疗能够降低食管癌患者S-VEGF的表达;治疗前和治疗后S-VEGF的变化情况有可能成为一个判断患者预后参考指标。

BACKGROUND ＆ OBJECTIVE. The prognosis of esophageal cancer is not only affected by TNM stage but also by the level of serum vascular endothelial growth factor （S-VEGF）. This study was to investigate the effect of concurrent chemoradiotherapy on S-VEGF in esophageal squamous cell carcinoma （ESCC）, and to explore the correlation of S-VEGF to the prognosis of ESCC. METHODS. Serum samples were obtained from ESCC patients, treated with concurrent chemoradiotherapy in Cancer Center of Sun Yat-sen University from Dec. 2002 to May 2004, before treatment and 1 month after treatment. The serum samples from sex- and age-matched healthy donors were used as controls. Two courses of chemotherapy, comprised of cisplatin and 5-fluorouracil, were given during radiotherapy at 4-week intervals. S-VEGF level was measured by ELISA. The changes of S- VEGF level before and after treatment were observed, and its correlation to progress-freely survival rate of ESCC patients was analyzed. RESULTS. S- VEGF level was significantly higher in ESCC patients before and 1 month after treatment than in healthy controls [（516.27±67.89） ng/L and （347.19± 35.42） ng/L vs. （294.20±23.40） ng/L, P〈0.01, P=0.002]; concurrent chemoradiotherapy significantly reduced S-VEGF level （P〈0.01）. S-VEGF level before treatment was significantly lower in the patients achieved complete remission than in those achieved partial remission or had progressive disease [（345.82±76.29） ng/L vs. （669.37±99.04） ng/L, P = 0.020]. The 1-year progress-freely survival rate was 0 in the patients with S- VEGF level of 〉 516.27 ng/L before treatment and 〉347.19 ng/L after treatment, 17% in the patients with S-VEGF level of 〉 516.27 ng/L and 〈 347.19 ng/L, respectively, 57% in the patients with S-VEGF level of 〈 516.27 ng/L and 〉347.19 ng/L, respectively, and 72% in the patients with S-VEGF level of 〈 516.27 ng/L and 〈347.19 ng/L, respectively （P= 0.005）. CONCLUSIONS： S-VEGF level is higher in ESCC patients than in healthy control. Concurrent chemoradiotherapy could reduce S-VEGF level in ESCC. The changes of S-VEGF level before and after treatment may provide prognostic information for ESCC patients.