肿瘤切除和术后复发对乳腺癌患者血管生成平衡的影响

目的观察乳腺癌患者血清血管内皮生长因子（VEGF）和内皮细胞抑制素（ES）浓度比值在手术前、后及复发时的变化，探讨肿瘤切除和术后复发对体内血管生成平衡的可能影响。方法分别采用竞争性酶联免疫试验和ELISA法测定59例乳腺痛患者手术前、后和复发时血清VEGF及ES水平，计算VEGF／ES比值，片与30例乳腺良性肿瘤和59例正常对照组比较。结果（1）手术前乳腺癌患者血清VEGF和ES水平与两对照组相比均显著增高（P〈0．005），VEGF／ES比值为9．1；手术后3周时，血清VEGF水平明显下降，而ES仍保持在较高状态，VEGF／ES比值下降至3．3。（2）复发患者术后VEGF／ES比值与术前相比也有所下降（10．3 vs 7．4），但一旦疾病复发时VEGF水平又急剧上升，VEGF／ES比值升至14．2。多因素分析显示，术后VEGF／ES比值是影响乳腺癌患者复发转移率的一个独立因素。结论乳腺癌肿瘤切除可影响患者体内血清VEGF—ES间平衡，监测VEGF／ES比值对患者预后评估有一定的辅助意义。

Effect of tumor surgery and postoperative relapse on angiogenesis balance in breast cancer

Objective To observe the serum VEGF/ES ratios before and after operation and at clinical relapse in patients with breast cancer, and to discuss the potential effect of tumor surgery and postoperative relapse on the angiogenesis balance. Methods The serum VEGF and ES levels of 59 cases of breast cancer before and after operation and at clinical relapse were determined using competitive enzyme immunoassays and ELISA, (respectively), and compared with the results of 30 cases of benign breast tumors and 59 cases of normal (controls). Results (1) Preoperatively, the serum ES and VEGF levels of breast cancer patients were (significantly) elevated, as compared to the other 2 groups, and the VEGF/ES ratio was 9.1. Postoperatively, at 3 weeks, VEGF level decreased significantly and ES remained at a high level. The VEGF/ES ratio was (3.3). (2)At the time of clinical relapse, serum VEGF level was followed by marked elevation, and the VEGF/ES ratio increased up to 14.2. Multivariate analyses showed that the postoperative VEGF/ES ratio was an independent factor related to the postoperative recurrence of breast cancer. Conclusions Breast cancer surgery may affect the balance between serum VEGF and ES, and the determination of VEGF/ES ratio can have auxiliary value in the assessment of prognosis of breast cancer patients.