乳腺癌患者治疗前后血清VEGF水平变化及其临床意义

目的探讨乳腺癌手术和术后治疗对患者血清血管内皮细胞生长因子（VEGF）水平的影响，以及血清VEGF水平与治疗疗效和预后的关系。方法采用酶联免疫吸附法（ELISA）检测44例乳腺癌患者术前1d、术后第1、3、7、30、120d的血清VEGF水平；采用免疫组化LSAB法检测乳腺癌组织中雌激素受体（ER）、孕激素受体（PR）、雌激素调节蛋白（PS2）、原癌基因C-erbB-2的蛋白表达水平。结果术后第1d血清VEGF水平较术前明显降低（P〈0．001）；术后第3、7d较术前和术后第1d明显升高（P〈0．001）；术后30d下降，接近术前水平（P〉0．05）。44例乳腺癌患者中，有15例术后120d血清VEGF水平明显高于术前和术后第1d（VEGF升高组，P〈0．01），有29例明显低于术前和术后第1d（VEGF降低组，P〈0．01），两组病例术前和术后1、3、7、30d的血清VEGF水平差异无统计学意义。VEGF升高组ER表达明显低于降低组（P〈0．01），而C-erbB-2表达明显高于降低组（P〈0．01），升高组中淋巴结阳性率高，且临床分期晚的患者较多。结论乳腺癌外科手术切除与术后辅助治疗可明显降低患者血清VEGF水平；患者血清VEGF水平与其治疗疗效和预后密切相关，可作为乳腺癌患者治疗疗效和预后判断监测的重要指标之一。

Change and Clinic Significance of Serum VEGF Level before and after Breast Cancer Patients Treated

Objective To investigate the effect of breast cancer operation and post-operation therapy on the vascular endothelial growth factor (VEGF) serum level of patients with breast cancer, and the correlation between the VEGF serum level and the treatment effect with disease prognosis. Methods By ELISA method, the serum VEGF levels in 44 patients with invasive ductal breast cancer were measured on 1 day before operation, on day 1, 3, 7, 30 and 120 after the resection operation. The proteins of VEGF, ER, PR, PS_2 and C-erbB-2 were evaluated by immunohistochemistry LSAB method. Results Compared with serum level before operation, the VEGF level on day 1 after surgery decreased significantly (P<0.001).The VEGF serum levels on post-operation day 3 and 7 increased obviously, much higher than preoperative level and that on post-operation day 1 (P<0.001). The VEGF level almost returned to preoperative level by 30 days after operation. In the 44 patients with breast cancer, there were 29 patients whose VEGF levels on day 120 were much lower than preoperative levels and that on post-operation day 1 (VEGF decrease group, P<0.01), but 15 patients showing the opposite change (VEGF increase group, P<0.01). The VEGF level difference between the two groups could be found statistically on day 120 after operation (P<0.01), but no difference on post-operation day 1, 3, 7 and 30. The median levels of lower ER and higher C-erbB-2 expression were showed in VEGF increase group's patients than in VEGF decrease group's patients. There were the high lymph nodes positive rate and late clinical stage in VEGF increase group's patients. Conclusions The surgical operation with other therapy can significantly decrease the VEGF serum level in patients with breast cancer. There is a close correlation between serum VEGF level and treatment effect with disease prognosis.The VEGF serum level may be one of important indexes in monitor forecast of therapy efficiency and disease prognosis.