血管内皮生长因子对小细胞肺癌诊治的应用价值研究

The clinical value of vascular endothelial growth factor in patients with small cell lung cancer

背景与目的血管内皮生长因子(VEGF)与肿瘤的发生、发展和转移关系密切,而小细胞肺癌(SCLC)患者预后差,转移早,生存期短。本研究拟探讨VEGF在SCLC中发生、发展的作用及其对SCLC患者诊治的临床意义和预后价值。方法酶联免疫吸附方法检测未经任何治疗的SCLC患者、良性肺部疾病患者及健康对照血清VEGF浓度和SCLC患者血清前胃泌素释放肽(ProGRP)的浓度,放射免疫分析方法检测血清神经元特异烯醇化酶(NSE)的浓度。结果SCLC患者血清VEGF浓度较健康对照及良性肺部疾病患者高,差异有统计学意义(P<0.05),而且SCLC患者血清VEGF的浓度与患者的临床分期有明显的相关性(P<0.05)。以血清VEGF的平均浓度489.1ng/L作为临界值,诊断SCLC的灵敏度和特异度分别是32.8%和95.7%。SCLC患者血清VEGF与血清NSE、ProGRP的水平无明显的相关性(r分别为0.221、0.217,P值均>0.05)。血清VEGF与血清NSE、ProGRP及三者的联合检测SCLC阳性率分别为54.1%、73.8%和78.7%。单变量生存分析和多变量生存分析SCLC患者血清VEGF水平与生存期的关系,结果显示低水平组的平均生存期比高水平组显著延长(P<0.05)。结论SCLC患者血清VEGF浓度与其生存期有明显的相关性,可以作为SCLC患者的一个预后因子。由于血清VEGF酶联免疫吸附试验方法学的特点,可以考虑作为SCLC肿瘤标志物的一辅助实验。

Background and objective It is well-known that vascular endothelial growth factor （VEGF） relates to the oncogenesis and development and metastasis of cancer, and patients with small cell lung cancer （SCLC） often have poor prognosis, earlier metastasis and shorter survival. This study is designed to investigate the effect of VEGF on the oncogenesis and development of SCLC and the clinical significance and prognostic value of VEGF in patients with SCLC. Methods Serum VEGF level and pro-gastrin releasing peptide （ProGRP） level were measured using enzyme-linked immunosorhent assay （ELISA） in patients with SCLC hefore treatment and patients with benign lung diseases and in healthy persons, and serum neuron specific enolase （NSE） levels measured using radioimmunoassay. Results There were significant difference of serum VEGF level between the patients with SCLC and the patients with benign lung diseases and healthy persons （P〈0.05）. Taking the mean concentration of serum VEGF as a cut-off, patients were divided into high VEGF （〉489.1 ng/L） and low VEGF （≤489.1 ng/L） groups, and the sensitivity and the specificity were 32.8% and 95.7% respectively. It was shown that the serum levels of VEGF in patients with SCLC didn＇t correlate with clinical features including age, gender, performance status and treatment, but correlated with disease staging （P〈0.05）. High VEGF level was found more frequently in patients with extensive disease of SCLC than in those with limited disease （P〈0.05）. The correlations weren＇t found between serum VEGF level and NSE level, ProGRP level in patients with SCLC （r=0. 221, P〉0.05; r=0. 217, P〉0.05）. However, the positive rate of diagnosising SCLC was 54.1% by the determinant of serum VEGF allied serum NSE, 73.8% by the determinant of serum VEGF allied serum ProGRP and 78. 7 % by the determinant of serum VEGF allied se