治疗前外周血血管内皮抑素浓度与局部晚期鼻咽癌治疗后远处转移的关系

Correlation of Pretreatment Serum Level of Endostatin to Posttreatment Distant Metastasis in Patients with Advanced Nasopharyngeal Carcinoma

背景与目的:远处转移是局部晚期鼻咽癌治疗失败的主要原因之一。有研究提示血清血管内皮抑素(endostatin)浓度与肿瘤的复发及转移等密切相关。本研究通过检测患者外周血血管内皮抑素浓度,探讨其与局部晚期鼻咽癌患者治疗后远处转移的关系。方法:用酶联免疫吸附法(ELISA)测定218例初治局部晚期(A92分期Ⅲ121例、Ⅳa97例)患者及20例健康人外周血血管内皮抑素的浓度,并分析外周血血管内皮抑素浓度与患者性别﹑T分期、N分期及治疗后远处转移及局部区域复发的关系。结果:局部晚期鼻咽癌的外周血血管内皮抑素浓度中位值显著高于健康对照组(P<0.001)。以187.50μg/L为截点将218例患者分为两组,低浓度组(≤187.5μg/L)和高浓度组(>187.5μg/L)。经使用log-rank法双侧检验可见,两组2年无区域局部复发率﹑2年无进展生存率﹑2年总生存率差异无显著性(P>0.05);两组2年无转移生存率差异有显著性(P=0.034)。多因素分析显示:治疗前外周血血管内皮抑素浓度(95%可信区间,1.039～3.696,P=0.03)是局部晚期鼻咽癌治疗后远处转移的可能影响因素。结论:治疗前外周血血管内皮抑素浓度与局部晚期鼻咽癌治疗后远处转移有关,可作为局部晚期鼻咽癌治疗后远处转移的预测指标之一。

BACKGROUND ＆ OBJECTIVE： Distant metastasis is the main failure of advanced nasopharyngeal carcinoma （NPC） after treatment. Endostatin is a strong prognostic factor of many tumors. This study was to evaluate the correlation of pretreatment serum endostatin level to posttreatment distant metastasis in patients with advanced NPC, METHODS： The serum concentration of endostatin in 218 advanced NPC patients （122 at stage Ⅲ and 96 at stage Ⅳ） before and after treatment, and in 20 healthy subjects was detected by ELISA. The correlations of serum endostatin level to patients＇ sex, T stage, N stage, distant metastasis and local relapse after treatment were analyzed, RESULTS： The median serum concentration of endostatin was significantly higher in NPC patients than in controls （149.75 μg/L vs. 31.00 μg/L, P〈0.05）, Using the concentration of 187.50 μg/L as a break point, the patients were divided into low concentration group （≤187.50 μg/L） and high concentration group （〉187.50 μg/L）, No significant differences were detected in 2-year local relapse-free survival rate （P=0.963）, progression-free survival rate （P=0.063） and overall survival rate （P=0.381） between low concentration group and high concentration group, while the 2- year distant metastasis-free survival rate was significantly lower in low concentration group than in high concentration group （79.0% vs. 85.8%,P= 0.034）. Multivariate analysis revealed that serum endostatin concentration of more than 187.50 μg/L before treatment may predict the distant metastasis of local advanced NPC after treatment （95% confidence interval=1.039-3.696, P=0.03）. CONCLUSION： High level of serum endostatin before treatment may predict distant metastasis of advanced NPC patients after treatment.