Abstract
BackgroundElevated preoperative plasma levels of the angiogenesis-related marker VEGF have been associated with worse oncological outcomes in various malignancies. ObjectiveTo investigate the predictive/prognostic role of VEGF in patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC). Design, setting, and participantsVEGF plasma levels were measured preoperatively in 1036 patients with UCB who underwent RC. Outcome measurements and statistical analysisThe correlation between plasma VEGF levels and pathological and survival outcomes was assessed using logistic regression and Cox regression analyses. Discrimination was assessed using the concordance index (C index). The clinical net benefit was evaluated using decision curve analysis (DCA). Results and limitationsPatients with higher pretreatment plasma VEGF levels had poorer recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) according to log-rank tests (all p < 0.001). Higher VEGF levels were not independently associated with higher risk of lymph node metastasis, ≥pT3 disease, or non–organ-confined disease (all p > 0.05). Preoperative plasma VEGF levels were independently associated with RFS, CSS, and OS in preoperative and postoperative multivariable models. However, in all cases the C index increased by <0.02 and there was no improvement in net benefit on DCA. A limitation is that none of the patients received current elements of standard of care such as neoadjuvant chemotherapy. ConclusionsElevated plasma VEGF levels were associated with features of biologically and clinically aggressive disease such as worse survival outcomes among patients with UCB treated with RC. However, VEGF appears to have relatively limited incremental additive value in clinical use. Further study of VEGF for UCB prognostication is warranted before routine use in clinical algorithms. Patient summaryCurrently available models for predicting outcomes in bladder cancer are less than optimal. A protein called vascular endothelial growth factor (VEGF), which is a marker of the formation of blood vessels (angiogenesis), may have a role in predicting survival outcomes in bladder cancer.
Highlights
Elevated plasma vascular endothelial growth factor (VEGF) levels were associated with features of biologically and clinically aggressive disease such as worse survival outcomes among patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC)
Radical cystectomy (RC) with lymph node dissection is the standard treatment for very high-risk non–muscleinvasive and muscle-invasive urothelial carcinoma of the bladder (UCB) [1,2]
This is the first study to investigate the predictive and prognostic value of plasma VEGF levels in patients with UCB treated with RC
Summary
Radical cystectomy (RC) with lymph node dissection is the standard treatment for very high-risk non–muscleinvasive and muscle-invasive urothelial carcinoma of the bladder (UCB) [1,2]. Various clinical and pathological factors have been explored to improve risk stratification for patients with UCB and identify those who might benefit from intensified perioperative systemic therapy [4–6]. Preoperative biomarkers that capture the biological and clinical potential of each tumor must be identified to improve risk stratification for patients with UCB [9–11]. Elevated preoperative plasma levels of the angiogenesis-related marker VEGF have been associated with worse oncological outcomes in various malignancies. Objective: To investigate the predictive/prognostic role of VEGF in patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC). Conclusions: Elevated plasma VEGF levels were associated with features of biologically and clinically aggressive disease such as worse survival outcomes among patients with UCB treated with RC. A protein called vascular endothelial growth factor (VEGF), which is a marker of the formation of blood vessels (angiogenesis), may have a role in predicting survival outcomes in bladder cancer
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.