Sharma A, Greenman J, Sharp D M, Walker L G, Monson J R T
Academic Surgical Unit, Cancer Division, University of Hull, UK.
Psychooncology. 2008 Jan;17(1):66-73. doi: 10.1002/pon.1191.
Vascular endothelial growth factor (VEGF) and psychosocial factors have both been shown to have independent prognostic value in colorectal cancer. Recently, an association between VEGF and psychosocial factors has been reported in patients with ovarian cancer.
A consecutive series of eligible patients undergoing elective resection for colorectal cancer were invited to participate. Standardized measures of various aspects of quality of life (QoL) were administered 5-12 days before surgery, and again 6-8 weeks after the operation, blood samples were obtained at the same times. Solid phase ELISA was used for VEGF-A analysis using serum samples. Correlations and multiple regression analysis were used to examine the relationship between VEGF and psychosocial factors.
One hundred and four patients with colorectal cancer were recruited. Seventy (67%) were male and the mean age was 67.6 years.A significant positive correlation was found between preoperative VEGF level and preoperative depression (r=0.227, p=0.03). Preoperative VEGF was negatively correlated with preoperative cancer-related concerns (r=-0.273, p=0.009) and positive affectivity (r=-0.219, p=0.05). Linear regression using TNM stage as a covariate showed that cancer-related concerns were an independent predictor of preoperative VEGF levels (p=0.02). Preoperative cancer-related concerns and global QoL were negatively correlated with postoperative VEGF (r=-0.381, p=0.001, r=-0.264, p=0.005), whereas preoperative depression correlated positively with postoperative VEGF (r=0.333, p=0.003). Linear regression analysis showed that preoperative HADS depression (p=0.005) and cancer-related concerns (p=0.002) were independent predictors of postoperative VEGF levels. Postoperative VEGF was significantly correlated with postoperative anxiety (r=0.249, p=0.02), depression (r=0.289, p=0.01), and functional well-being (r=-0.242, p=0.03). Linear regression analysis showed that postoperative anxiety (p=0.048), depression (p=0.013) and functional well-being (p=0.046) independently predicted postoperative VEGF-A levels.
Various psychosocial factors, particularly cancer-related concerns and depression, appear to be related to preoperative and postoperative VEGF level in patients with newly diagnosed colorectal cancer. However, the clinical significance of these findings needs to be addressed in longitudinal follow-up studies of recurrence and survival. Future prognostic studies involving VEGF and related cytokines should assess psychosocial variables at various time points and include these in a multivariate analysis of outcomes.
血管内皮生长因子（VEGF）和社会心理因素在结直肠癌中均显示出独立的预后价值。最近，在卵巢癌患者中报道了VEGF与社会心理因素之间的关联。
邀请一系列连续接受择期结直肠癌切除术的符合条件的患者参与。在手术前5 - 12天进行生活质量（QoL）各个方面的标准化测量，术后6 - 8周再次测量，同时采集血样。使用固相ELISA法对血清样本进行VEGF - A分析。采用相关性和多元回归分析来研究VEGF与社会心理因素之间的关系。
招募了104例结直肠癌患者。70例（67%）为男性，平均年龄为67.6岁。术前VEGF水平与术前抑郁之间存在显著正相关（r = 0.227，p = 0.03）。术前VEGF与术前癌症相关担忧（r = - 0.273，p = 0.009）和积极情感（r = - 0.219，p = 0.05）呈负相关。以TNM分期作为协变量的线性回归分析表明，癌症相关担忧是术前VEGF水平的独立预测因子（p = 0.02）。术前癌症相关担忧和总体生活质量与术后VEGF呈负相关（r = - 0.381，p = 0.001，r = - 0.264，p = 0.005），而术前抑郁与术后VEGF呈正相关（r = 0.333，p = 0.003）。线性回归分析表明，术前医院焦虑抑郁量表（HADS）抑郁评分（p = 0.005）和癌症相关担忧（p = 0.002）是术后VEGF水平的独立预测因子。术后VEGF与术后焦虑（r = 0.249，p = 0.02）、抑郁（r = 0.289，p = 0.01）和功能健康状况（r = - 0.242，p = 0.03）显著相关。线性回归分析表明，术后焦虑（p = 0.048）、抑郁（p = 0.013）和功能健康状况（p = 0.046）独立预测术后VEGF - A水平。
各种社会心理因素，特别是癌症相关担忧和抑郁，似乎与新诊断的结直肠癌患者术前和术后的VEGF水平有关。然而，这些发现的临床意义需要在复发和生存的纵向随访研究中加以探讨。未来涉及VEGF和相关细胞因子的预后研究应在不同时间点评估社会心理变量，并将其纳入结局的多变量分析中。
