肝细胞癌介入栓塞前后血管内皮生长因子和内皮抑素的变化与预后的关系

Changes of VEGF and endostatin after transcatheter arterial chemoembolization and prognosis in patients with hepatocellular carcinoma

目的 探讨肝细胞癌患者肝动脉化疗栓塞术（TACE）前后血管内皮生长因子（VEGF）和内皮抑素（ES）变化规律与预后的关系.方法 酶联免疫吸附试验（ELISA）法检测患者TACE术前及术后1周血清VEGF和ES水平.结果 肿瘤直径≥5 cm的患者,ES在治疗前后分别为（43.35±9.80）ng/ml、（48.35±10.89）ng/ml;VEGF分别为（310.23±64.31）ng/ml、（369.10±60.11）ng/ml.肿瘤伴有门静脉癌栓的患者ES在治疗前后分别为（54.28±8.78）ng/ml、（50.28±7.51）ng/ml;VEGF分别为（331.26±63.38）ng/ml、（400.29±60.98）ng/ml.VEGF和ES水平与肿瘤大小、门静脉癌栓以及临床分期密切相关（P＜0.05）.肝细胞癌患者临床分期越晚,TACE前、后VEGF和ES水平均越高.晚期肝癌患者VEGF/ES比值明显高于早期患者.VEGF/ES比值越低生存时间越长.结论 VEGF、ES、VEGF/ES比值可作为预测肝细胞癌治疗效果的指标.

Objective To study the relationship between the change in serum levels of vascular endothelial growth factor（VEGF） and endostatin （ES） after trascatheter arterial chemoembolization （TACE） and the prognosis of patients with liver carcinoma. Methods Serum VEGF and endostatin levels were measured by enzyme-linked immunoassay in 120 patients with hepatocellular carcinoma before and a week after TACE.Results Among patients with large （diameter ≥5 cm） tumors , the serum levels of ES and VEGF before and after TACE are 43.35 （ ±9.80）,48.35 （ ± 10.89）, 310.23 （±64.31） ,and 369.10 （ ±60. 11） ng/ml respectively. Among patients with portal vein tumor thrombus, the corresponding figures are 54.28 （±8.78 ）,50.28 （±7.51）, 331.26 （±63.38） and 400.29 （±60.98） ng/ml. The levels of VEGF and ES were significantly related to the presence of portal vein tumor thrombus, the clinicopathological grade and size of the tumor（P ＜0.05 ）. Patients with a higher grade tumor were more likely to have elevated levels of VEGF and ES.So are patients with more advanced stage tumors. In addition, higher levels of VEGF and ES in serum are associated with worse survival. Conclusion Elevated serum VEGF and endostatin levels in patients with hepatocellular carcinoma are closely correlated with the grade and size of the tumor, and the presence of portal vein tumor thrombus. Serum VEGF and ES level may be used for predicting the biological behavior, invasion, metastasis and prognosis of hepatocellular carcinoma.