Abstract
Purpose.
The purpose of this study was to determine whether serum vascular endothelial growth factor (sโVEGF) levels at the time of diagnosis correlate with any known tumor variables and overall survival in patients with advanced laryngeal squamous cell carcinoma. Comparisons with a cohort of normal healthy controls were also performed to determine the potential usefulness of sโVEGF as a screening tool.
Experimental Design.
Serum from patients enrolled in the VA Laryngeal Cooperative Study #258 (n = 183), as well as normal healthy controls (n = 40) was used in this analysis. Quantitative enzymeโlinked immunosorbent assays (ELISA) for VEGF were performed in duplicate on each serum sample. Demographic and survival data were available for each patient enrolled in the study. Univariate analyses, multivariate Cox regression analyses, and KaplanโMeier survival analysis were used.
Results.
The mean serum concentration of sโVEGF for the healthy control group was 47.83 ยฑ 0.13 pg/mL. For all patients enrolled in the VA Cooperative Study, regardless of treatment group, the mean sโVEGF level was 317.22 ยฑ 25.46 pg/mL. The patients randomly assigned to the surgical arm (n = 97) had a mean value of 315.44 ยฑ 30.44 pg/mL. Those randomly assigned to the induction chemotherapy arm (n = 86) had a mean sโVEGF level of 319.22 ยฑ 42.11 pg/mL. Serum VEGF levels were significantly elevated in patients with laryngeal carcinoma compared with healthy controls (p < .001). The serum VEGF levels in each arm of the trial were also elevated versus the healthy controls (p < .001, surgery arm plus radiotherapy; p < .001, chemotherapy plus radiotherapy). In a univariate analysis, elevated sโVEGF correlated with poor Karnofsky performance status for all patients with advanced laryngeal carcinoma (p < .008). High sโVEGF levels also correlated with a poor performance score in patients on the chemotherapy arm of the VA Laryngeal Trial (p < .004). Elevated sโVEGF levels in the surgical plus radiotherapy arm correlated with nodeโpositive disease (p = .047) and supraglottic location of the tumor (p = .022). In a multivariate analysis using all known tumor variables and sโVEGF levels, elevated sโVEGF levels and infiltrating growth pattern correlated with decreased survival for all evaluated patients with advanced laryngeal carcinoma (p = .065, and p = .018, respectively).
Conclusions.
Serum VEGF levels are significantly elevated in patients with advanced laryngeal carcinoma versus healthy controls. Elevated pretreatment sโVEGF levels tended to indicate a more aggressive disease state and a poorer overall survival in advanced laryngeal carcinoma. ยฉ 2002 Wiley Periodicals, Inc. Head Neck 24: 1004โ1011, 2002