Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2011 Aug;27(8):314-22. doi: 10.1016/j.kjms.2011.03.008. Epub 2011 May 8.
Vascular endothelial growth factor (VEGF), angiopoietin-2, and endostatin have been reported to be related with angiogenesis of hepatocellular carcinoma (HCC). The potential feasibility of serial serum VEGF-A, angiopoietin-2, and endostatin measurements in cirrhotic patients with HCC treated by transcatheter arterial chemoembolization (TACE) was investigated. VEGF-A, angiopoietin-2, and endostatin serum level were determined by enzyme-linked immunosorbent assay 1 day before and 7 days after TACE in 40 patients. Then they were followed up for 3 months. The results showed that TACE could cause significant increase of VEGF-A (p < 0.01) and angiopoietin-2 (p = 0.01); whereas there was no significant change of endostatin (p > 0.1). Twenty-five patients with rapid growth of HCC within 3 months after TACE had higher proportion of American Joint Committee on Cancer HCC staging >II and higher increase of VEGF-A after TACE than 15 patients without rapid growth (all p < 0.05). Stepwise logistic regression analysis revealed that VEGF-A >16.7 pg/mL 7 days after TACE selected by receiver operating characteristic curve analysis (p < 0.05) was the only independent predictor for rapid growth of HCC (odds ratio 6.33, 95% confidence interval: upper 26, lower 1.54, p < 0.05; sensitivity 76%, specificity 66.7%, accuracy 72.5%, positive predictive level 79.2%, negative predictive level 62.5%, p < 0.01). In conclusion, significant increases of serum level VEGF-A and angiopoietin-2 after TACE have been demonstrated from this study. Therefore, serial VEGF-A level 1 day before and 7 days after TACE may be used to predict rapid HCC growth.
血管内皮生长因子（VEGF）、血管生成素-2 和内皮抑素已被报道与肝细胞癌（HCC）的血管生成有关。本研究旨在探讨经导管动脉化疗栓塞（TACE）治疗的 HCC 肝硬化患者血清 VEGF-A、血管生成素-2 和内皮抑素的连续检测的潜在可行性。40 例患者在 TACE 前 1 天和 TACE 后 7 天，采用酶联免疫吸附试验（ELISA）法检测血清 VEGF-A、血管生成素-2 和内皮抑素水平，然后进行 3 个月的随访。结果显示，TACE 可显著增加 VEGF-A（p<0.01）和血管生成素-2（p=0.01），但内皮抑素无明显变化（p>0.1）。25 例 TACE 后 3 个月内 HCC 快速生长的患者中，美国癌症联合委员会（AJCC）肝癌分期>Ⅱ期的比例更高，TACE 后 VEGF-A 的增加幅度也更高，与 15 例无快速生长的患者相比，差异均有统计学意义（均 p<0.05）。逐步逻辑回归分析显示，TACE 后 7 天 VEGF-A>16.7 pg/ml 是 HCC 快速生长的唯一独立预测因子（优势比 6.33，95%可信区间：上限 26，下限 1.54，p<0.05；敏感性 76%，特异性 66.7%，准确性 72.5%，阳性预测值 79.2%，阴性预测值 62.5%，p<0.01）。综上所述，本研究表明 TACE 后血清 VEGF-A 和血管生成素-2 水平显著升高。因此，TACE 前后 1 天和 7 天的 VEGF-A 连续水平可能用于预测 HCC 的快速生长。
