晚期胃癌VEGF表达对化疗方案选择的影响

目的研究晚期胃癌组织中血管内皮生长因子(VEGF)表达,探讨VEGF表达与化疗方案治疗患者生存的关系。方法选择1999年11月至2005年6月在本院治疗的Ⅳ期胃癌患者60例。胃癌组织病理蜡块切片,免疫组化方法检测其中VEGF蛋白表达情况并进行评分。Kaplan-Meier方法分析VEGF表达与无进展生存时间(PFS)、总生存时间(OS)的关系。结果在60例已行FOLFOX或PLF方案治疗的胃癌患者标本中,40例(免疫组化评分3分)VEGF阳性(66.67%),远离肿瘤的正常胃组织3例呈弱阳性(5.00%),近癌旁组织阳性11例(18.33%),与癌组织比较有统计学差异(P0.01)。60例中,VEGF的表达对治疗效果的相对危险度分别为1.612,95%CI=0.375~6.930,P=0.521。生存分析显示20例VEGF阴性的患者PFS为(208.88±65.71)d,95%CI=80.10~337.67。40例阳性患者的PFS为(146.97±11.99)d,95%CI=123.46~170.48,P=0.643。OS为(439.98±46.18)d,95%CI=349.47~530.48,P=0.567。分析PLF组和FOLFOX组PSF、OS差异无统计学意义,但分层分析显示40例VEGF表达阳性中,两组的OS统计学有意义。结论VEGF在晚期胃癌组织中表达与治疗后的生存期有关,可能影响治疗方案的选择。

Survival analysis:expression of vascular endothelial growth factor affection

Objective To detect the expression of VEGF in Ⅳ stage gastric carcinoma and to explore the correlation between VEGF and life span after chemotherapy protocols. Methods Sixty samples from Ⅳ stage gastric carcinoma patients treated with FOLFOX or PLF plan were selected. The expression of VEGF was determined by immunohistochemical analysis. Kaplan-Meier survival analysis was taken for the relation among VEGF, progression-free survival（PFS） or overall survival（OS）. Results The expression of VEGF was detected in 40 of 60 gastric carcinoma（66.67%）, which was significantly higher than those in normal gastric mucosa（3/60, 5.00%） and the tissue beside carcinoma（11, 18.33%）, P〈0.01. The odds ratio of VEGF was 1.612, 95% confidence interval（CI）： 0.375-6.930, P=-0.521. In VEGF negative paitents（n=20）, the PFS was （208.88± 65.71） d, 95% CI=80.10-337.67. OS was （337.10 ± 55.77） d, 95% CI=267.78-486.40. In VEGF positive paitents, the PFS was （146.97 ± 11.99） d, 95% CI=123.46-170.48, P=-0.643; OS was （439.98 ± 46.18 ）d,95% CI =349.47-530.48,P=-0.567. To all the paitents, PFS and OS was not significantly different between PLF and FOLFOX group. However, further analysis showed there was significant difference with OS in PLF and FOLFOX group. Conclusion VEGF expression is related to life span of gastric carcinoma paitents during advanced stage, which maybe affect therapeutic choice for advanced gastric carcinoma.