食管癌患者放化疗中病理反应与血清VEGF变化的关系及其对疗效和预后的影响

Relation between tumor pathologic response to concurrent chemo-radiotherapy and changes of serum VEGF level and its influence on the efficacy and prognosis in patients with esophageal carcinoma

目的观察食管癌同期放化疗中肿瘤组织病理反应与血清血管内皮生长因子（VEGF）表达水平的相关性及其对疗效和预后的影响。方法46例年龄≤75岁，KPS评分≥80，首次治疗的食管癌患者，同期行放化疗。放化疗前及放化疗第4周胃镜活检，放化疗前、放化疗第4周及放疗结束后1周作食管x射线钡剂造影，检测血清中VEGF表达水平，分析肿瘤组织病理反应与血清VEGF表达水平的相关性及两者对疗效和预后的影响。结果治疗后重度反应组、中度反应组和轻度反应组中分别有18例（85．7％）、7例（53．8％）及6例（50．0％）患者的血清VEGF水平较治疗前下降，3组比较差异有统计学意义（χ2=6．072，P〈0．05）。重度反应组、中度反应组、轻度反应组近期疗效有效率分别为90．5％、38．5％、33．3％，3组比较差异有统计学意义（χ2=14．289，P〈0．05）；重度反应组与轻度反应组总生存期（OS）差异无统计学意义。治疗后血清VEGF水平下降及上升的患者中，分别有22人（71．0％）、6人（40．0％）近期疗效评价为有效，两组比较差异有统计学意义（χ2=4．070，P〈0．05）。结论放化疗过程中的病理反应程度与血清VEGF水平变化可预测食管癌患者的治疗疗效，监测治疗中病理反应和VEGF水平变化对临床个体化治疗有指导意义。

Objective To observe the relation between pathologic tumor response to concurrent chemo-radiotherapy and the serum VEGF level, and to explore its corresponding influence on the efficacy and prognosis in patients with esophageal carcinoma. Methods Totally 46 cases of patients with esophageal cancer who received concurrent chemo-radiotherapy were enrolled. The gastroscopy and pathologic examination were conducted before and 4 weeks afterwards. Meanwhile, the serum VEGF level and X-ray barium of esophageal image were measured before, 4 weeks later and after the radiotherapy. The relation between the tumor pathologic response and the changes of the serum VEGF level and its influence on the efficacy and prognosis were analyzed. Results There were 18 cases （85.7%） , 7 cases （53.8%） and 6 cases （50.0%） whose serum VEGF level dropped in the severe, moderate and mild group, respectively, and significant differences among these groups（χ2 = 6. 072, P 〈0. 05）. There were 19 cases （90. 5% ）, 5 cases （38.5%） and 4 cases （33.3%） whose response measured as effective in the severe, moderate and mild group, respectively, and significant differences among these groups （χ2 = 14. 289,P 〈 0.05） ）. The 2-year survival rates of the severe, there was no statistically difference between the severe and mild group on OS. There were 22 cases （71.0%） , 6 cases（40.0% ） and 4 cases （33.3%） whose response measured as effective in the serum VEGF level drop and increase group, respectively, and significant differences between these groups （χ2 = 14. 289, P 〈 0.05 ） ）. Conclusions The tumor pathologic response during chemo-radiotherapy and the changes of the serum VEGF lever may predict thecurative effect of chemo-radiotherapy in the patients with esophageal cancer. To monitor the tumor pathologic response and the changes of the serum VEGF levels may be valuable for individualized treatment for esophageal cancer patients.