Abstract
Angiogenesis is important in malignant pleural effusion (MPE) formation and it is regulated by a number of pro- and anti-angiogenic cytokines. The purpose of this study was to evaluate the prognostic value of angiogenic factor vascular endothelial growth factor (VEGF) and angiogenesis inhibitor endostatin in lung cancer patients with MPE, and investigate the relationship between these two kinds of agent. Using enzyme-linked immunoadsorbent assay, the concentrations of VEGF and endostatin were measured in pleural effusions (PE) and serum from a total of 70 lung cancer patients with MPE and 20 patients with tuberculosis. Compared to patients with tuberculosis, the levels of VEGF and endostatin in both PE and serum were significantly higher in patients with lung cancer. There were statistically significant correlations between VEGF levels in PE and serum (r=0.696, <0.001), endostatin levels in PE and serum (r=0.310, p=0.022), and VEGF and endostatin levels in PE (r=0.287, p=0.019). Cox multivariate analysis revealed that elevated pleural VEGF and endostatin levels and serum endostatin level were independent predictors of shorter overall survival. Both pro- and anti-angiogenic factors are likely contributors to PE formation. Our results suggest that the levels of VEGF and endostatin in PE, together with endostatin in serum, may be potential prognostic parameters for lung cancer patients with MPE.
Highlights
Lung cancer is the leading cause of cancer-related death in the world
We investigated an important angiogenic factor, vascular endothelial growth factor (VEGF) and a potent antiangiogenic factor, endostatin in patients with tuberculosis and MPEassociated lung cancer and showed that their levels in pleural effusions (PE) and serum were significantly higher in patients with lung cancer than those in patients with tuberculosis
In our multivariate analysis, VEGF and endostatin in PE, and serum endostatin were revealed as independent prognostic parameters of lung cancer patients with malignant pleural effusion (MPE)
Summary
15% of lung cancer patients have malignant pleural effusion (MPE) at the time of initial diagnosis and 50% develop MPE later in the course of their disease (Memon et al, 1981). Angiogenesis is regulated by a number of angiogenic and antiangiogenic cytokines.Vascular endothelial growth factor (VEGF) is an important mediator of angiogenesis and vascular permeability.It stimulates capillary formation and has specific mitogenic and chemotactic effects on vascular endothelial cells (Zebrowski et al, 1999). Previous research has investigated pleural angiogenic factors and angiogenesis inhibitors determinations play a role in the diagnosis (Sack et al, 2005; Zhou et al, 2009; Koniari et al, 2011; Zhang et al, 2012), and VEGF has been reported to be correlated with a poor prognosis. In the present study, We focused on these pro- and antiangiogenic factors to determine the links between them and the possible role in the clinical outcomes of patient survival
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