【摘要】 目的:探讨食管癌患者血清VEGF表达的临床意义。方法:89例食管癌患者,其中实施手术治疗46例(食管病变切除术加区域淋巴结清除术),同期放化疗43例(放疗剂量60Gy,常规分割;化疗方案DDP+5-FU,分别在放疗开始的第1天和第29天进行),失访3例均为手术组患者;同时选取30名健康人作为对照。所有患者在治疗前抽取血清标本,酶联免疫吸附试验测定血清VEGF。结果:食管癌患者组治疗前的血清VEGF表达水平[(475·93±44·76)ng/L]明显高于正常对照组[(294·20±23·40)ng/L],P=0·020。血清VEGF表达水平受T分期和临床分期的影响。Ⅰ+Ⅱ和Ⅲ+Ⅳ的1年无进展生存率分别为71%和29%,P=0·0015。血清VEGF表达水平<475ng/L和≥475ng/L的1年无进展生存率分别为66%和24%,P=0·0004。COX比例风险模型因素分析结果表明,临床分期和血清VEGF表达水平是影响预后的独立因素。结论:食管癌患者治疗前血清VEGF的表达水平影响患者的预后,有可能作为一个独立预后指标,但在疾病诊断和判断临近器官是否受侵上难于肯定其实际的应用价值。更多还原

【Abstract】 OBJECTIVE: To investigate the clinical significance of serum vascular endothelial growth factor (S-VEGF) in esophageal squamous cell carcinoma with the end-point of progress-free survival rate. METHODS:Sera from 89 patients with esophageal squamous carcinoma,who presented and treated with concurrent chemoradiotherapy or surgical resection in Cancer Center of Sun Yat-Sen University from December 2002 to May 2004,were sampled at pre-treatment. Thirty cases of health individuals without any evidence of disease were selected as a control group. Patients with surgical resection were performed with esophagectomy and extended lymphadenectomy. Patients with concurrent chemoradiotherapy comprised of cisplatin and 5-fluorouracil. The radiotherapy with 2 Gy per day was initiated on the first day of chemotherapy and continued daily for 5 days per week for 6 weeks, at a total dose of 60 Gy. Two courses of chemotherapy were given during radiotherapy at 6-week intervals. The serum vascular endothelial growth factor (S-VEGF) levels were measured with a solid phase enzyme Human VEGF Immunoassay ELISA kit. The end point of this study was progress-free survival,and the time was calculated from the date of diagnosis to date of relapse or last follow evaluation. RESULTS:S-VEGF level of patients with esophageal squamous cell carcinoma[(475.93±44.76) ng/L] was significantly higher than that of healthy controls[(294.20±23.40) ng/L],P=0.020. S-VEGF levels in patients with Stage Ⅲ and Stage Ⅳ disease were significantly higher than those in patients with Stage Ⅰ and Stage Ⅱ disease. The 1-year progress-free survival rate of high S-VEGF group (≥475 ng/L, 24%) was significantly lower than that of the low S-VEGF group (<475 ng/L, 66%),P=0.000 4. The 1-year progress-free survival rate of the patients with Stage Ⅰ and Stage Ⅱ(71%) disease was significantly higher than that of patients with Stage Ⅲ and Stage Ⅳ disease (29%),P=0.001 5. The variables were assessed by multivariate analysis using the Cox proportional hazards model,and the results revealed that the clinical stage and the S-VEGF were first and second independent prognosis factor,respectively. CONCLUSION: It suggests that high S-VEGF is associated with tumor progression,poor treatment response,and poor survival in patients with esophageal cancer.更多还原