血清内皮抑素水平升高与晚期鼻咽癌患者的不良预后相关。
Elevated serum endostatin levels are associated with poor survival in patients with advanced-stage nasopharyngeal carcinoma.
机构信息
State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
出版信息
Clin Oncol (R Coll Radiol). 2013 May;25(5):308-17. doi: 10.1016/j.clon.2012.11.009. Epub 2013 Jan 3.
AIMS
To evaluate the prognostic value of serum endostatin levels in patients with advanced-stage nasopharyngeal carcinoma (NPC).
MATERIALS AND METHODS
Between August 2003 and March 2005, 218 patients with advanced-stage NPC were enrolled in this study, including 70 patients in the training cohort and 148 in the validation cohort. The pre-treatment serum endostatin and vascular endothelial growth factor (VEGF) levels were measured using competitive enzyme immunoassays. For the normal control, serums samples from 20 healthy individuals were also collected.
RESULTS
Serum endostatin levels in the patients with advanced-stage NPC were significantly higher than those of controls, but VEGF levels were similar in the two groups. Univariate analysis revealed significant differences between the high and low endostatin level groups regarding 5 year overall survival (63.9% versus 90.5%; P = 0.003), progression-free survival (PFS) (50.2% versus 79.3%; P = 0.003) and distant metastasis-free survival (DMFS) (59.1% versus 85.3%; P = 0.01) in the training cohort. Using the same cut-off value generated from the training cohort, there were also significant unfavourable correlations between serum endostatin levels and overall survival (P = 0.001), PFS (P = 0.001) and DMFS (P = 0.002) in the second independent validation cohort. Multivariate analysis using the entire group (n = 218) revealed that the serum endostatin level was an independent unfavourable prognostic factor for overall survival (hazard ratio 4.8; 95% confidence interval 2.48-9.23; P < 0.0001), PFS (hazard ratio 3.44; 95% confidence interval 2.06-5.74; P < 0.0001) and DMFS (hazard ratio 3.65; 95% confidence interval 1.92-6.94; P < 0.0001) in patients with advanced-stage NPC. No associations were observed between the outcomes and the serum VEGF levels in patients with advanced-stage NPC.
CONCLUSIONS
High endostatin levels are associated with poor survival and this knowledge may improve the risk stratification of patients with advanced-stage NPC.
目的
评估晚期鼻咽癌（NPC）患者血清内皮抑素水平的预后价值。
材料与方法
本研究纳入了 218 例晚期 NPC 患者，包括训练队列中的 70 例和验证队列中的 148 例。采用竞争酶免疫分析法检测患者治疗前血清内皮抑素和血管内皮生长因子（VEGF）水平。正常对照组为 20 例健康个体的血清样本。
结果
晚期 NPC 患者血清内皮抑素水平明显高于对照组，但两组 VEGF 水平相似。单因素分析显示，高、低内皮抑素水平组 5 年总生存率（63.9%比 90.5%；P=0.003）、无进展生存率（PFS）（50.2%比 79.3%；P=0.003）和无远处转移生存率（DMFS）（59.1%比 85.3%；P=0.01）存在显著差异。采用训练队列生成的相同临界值，在第二个独立验证队列中，血清内皮抑素水平与总生存率（P=0.001）、PFS（P=0.001）和 DMFS（P=0.002）也存在显著的负相关关系。采用整个研究人群（n=218）的多因素分析显示，血清内皮抑素水平是晚期 NPC 患者总生存（危险比 4.8；95%置信区间 2.48-9.23；P<0.0001）、PFS（危险比 3.44；95%置信区间 2.06-5.74；P<0.0001）和 DMFS（危险比 3.65；95%置信区间 1.92-6.94；P<0.0001）的独立不良预后因素。晚期 NPC 患者的血清 VEGF 水平与结局之间无相关性。
结论
高内皮抑素水平与生存不良相关，这一知识可能有助于提高晚期 NPC 患者的风险分层。
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