外周血VEGF预测晚期卵巢癌患者新辅助化疗满意减瘤效果

Effect of the vascular endothelial growth factor level in peripheral blood of patients with advanced ovarian cancer after neoadjuvant chemotherapy treatment for predicting their tumor reduction satisfaction

目的:探讨外周血血管内皮细胞生长因子(VEGF)预测新辅助化疗晚期卵巢癌患者满意减瘤的临床价值.方法:收集2017年1月-2018年3月本院收治的新辅助化疗晚期卵巢癌患者110例,均接受以铂类药物为主的新辅助化疗2个疗程,再行肿瘤细胞减灭术(NACT-IDS)术,术后20d行至少6个疗程化疗.依据NACT-IDS术后残留肿瘤病灶大小将患者分为减瘤满意组及减瘤不满意组,根据术前外周血VEGF均值将患者分为VEGF≤151pg/ml组和>151pg/ml组,根据术前术后外周血VEGF下降百分比均值将患者分为≤82%组和>82%组,比较不同组别患者NACT-IDS减瘤满意、术后5年生存时间.结果:减瘤不满意组术前外周血VEGF水平(199.96±15.43pg/ml)高于减瘤满意组(145.78±15.37pg/ml),外周血VEGF下降百分比(79.98±5.17)%低于减瘤满意组(84.45±5.49)%;外周血VEGF≤151g/ml患者中减瘤满意率(97.4%)高于VEGF>151pg/ml患者中减瘤满意率(54.5%),外周血VEGF下降>82%患者中减瘤满意率(95.5%)高于VEGF下降≤82%(38.1%)(均P<0.05).影响晚期卵巢癌减瘤满意度的因素为术前VEGF高和VEGF下降百分比低(均P<0.05).接受随访至少5年,110例中生存35例,死亡65例,死亡率59.1%,死亡原因均为卵巢癌复发.术前外周血VEGF≤151g/ml患者中位生存时间(>60月)高于VEGF>151pg/ml患者(43月)(P<0.05).外周血VEGF下降百分比≤82%与VEGF>82%患者中位生存时间(51.8月、52.3月)无差异(P>0.05).结论:外周血VEGF可用于预测新辅助化疗晚期卵巢癌患者减瘤满意及5年生存情况.

Objective:To investigate the clinical value of the vascular endothelial growth factor(VEGF)level in peripheral blood of patients with advanced ovarian cancer after ncoadjuvant chemotherapy treatment(NACT)for predicting their tumor reduction satisfaction.Methods:110 patients with advanced ovarian cancer who had been treated with ncoadjuvant chemotherapy from January 2017 to March 2018 were collected.All patients had received 2 courses of ncoad-juvant chemotherapy,mainly platinum drugs,and then given cytoreductive surgery and 20 days chemotherapy for least 6 courses after surgery.All patients were divided into group A1(patients with tumor reduction satisfaction)and A2(patients without tumor reduction satisfaction)based on the size of residual tumor lesions after surgery,the patients were divided into group B1(patients with VEGF level<151 pg/ml)and group B2(patients with VEGF lcvcl>51 pg/ml)based on the preoperative VEGF level in peripheral blood of the patients,and the patients were divided into group Cl(patients with the percentage decrease of VEGF level<82%)and group C2(patients with the percentage decrease of VEGF lcvcl>82%)based on the percentage of VEGF level in peripheral blood decrease after surgery.Results:The preoperative VEGF level in peripheral blood(199.96±15.43 pg/ml)of the patients in group A2 was significantly higher than that(145.78±15.37 pg/ml)of the patients in group A1,and the percentage of decrease of the VEGF lcvcl(79.98±5.17%)in peripheral blood of the patients in group A2 was significantly lower than that(84.45±5.49%)of the patients in group Al.The satisfaction rate of tumor rcduction(97.4%)of the patients in group B1 was significantly higher than that(54.5%)of the patients in group B2,and the satisfaction rate of tumor reduction(95.5%)of the pa-tients in group C2 was significantly higher than that(38.1%)of the patients in group Cl(all P<0.05).The influencing Actors of the tumor reduction satisfaction of the patients with advanced ovarian cancer were the high preoperative VEGF level and the low postoperative percentage of the VEGF level decreased(P<0.05).These patients were followed up for at least 5 years,35 cases survived and 65 cases died,with a mortality rate of 59.1%.The cause of death of all the patients was the ovarian cancer recurrence.The median survival time of the patients in group B1(2>60 months)was significantly higher than that(43 months)of the patients in group B2(P<0.05).There was no significant difference in the median survival time(51.8 months vs.52.3 months)of the patients between group Cl and group C2(P>0.05).Conclusion:The VEGF level in peripheral blood of the patients with advanced ovarian cancer after NACT can be used to predict their satisfactory tumor reduction and 5-ycar survival situation.