血浆VEGF水平检测在NSCLC患者中的临床意义

发布时间：2018-05-30 05:13

  本文选题：非小细胞肺癌 + 血浆血管内皮生长因子　； 参考：《皖南医学院》2017年硕士论文

【摘要】：目的:肺癌是全球范围内患病率和病死率最高的恶性肿瘤之一,尽管当代医学发展迅速,然而如何提高早期肺癌的诊疗技术,能否寻找到一种方法或生物标志物更好地评估治疗反应和预测疾病进展,怎样才能更好地管理肺癌患者。本文就上述问题作一探讨。方法:我们研究了49名确诊的、主要是未经治疗的原发性非小细胞肺癌(NSCLC)的患者,并收集10名对照组的资料(主要包括:诊断、癌胚抗原、细胞角蛋白19片段等)。49名NSCLC患者接受以铂剂为主的一线化疗。然后分别在第1周期化疗前、第3周期化疗前和第5周期化疗前采集并量化血浆血管内皮生长因子(VEGF)水平,根据评估结果进行相关分析。结果:我们观察到:(1)肺腺癌患者血浆VEGF水平高于肺鳞癌,P0.05;(2)血浆VEGF水平作为肺腺癌、肺鳞癌生物标志物的受试者工作特征曲线(ROC曲线)下面积(AUC)分别是0.910、0.723,95%置信区间(CI)分别为0.813-1.000、0.537-0.909,各自敏感度为76%、87.5%,各自特异度为90%、50%,且P均0.05;(3)第3次化疗前、第5次化疗前评估时,缓解期、稳定期、进展期的血浆VEGF水平是不同的,P0.05;(4)第3次化疗前、第5次化疗前血浆VEGF水平反应疾病进展的AUC分别为0.857、0.856,各自敏感度为88.9%、77.8%,特异度为73.3%、83.3%,95%CI分别为0.735-0.980、0.729-0.983,P=0.001;(5)对于治疗反应方面,血浆VEGF水平评估治疗反应良好,第3次化疗前、第5次化疗前的AUC分别为0.218,0.146;血浆VEGF水平评估治疗反应欠佳,第3次化疗前、第5次化疗前的AUC分别为0.782、0.854;95%CI分别为0.617-0.947,0.730-0.978,且敏感度很高,达90%以上,P均0.05。结论:血浆VEGF作为中晚期NSCLC特异性的生物标志物有潜在价值,在一线化疗过程中监测血浆VEGF水平,能在早期阶段识别哪些患者可能存在治疗反应欠佳或者是有疾病进展,这对我们是否需要更换治疗方案提供重要信息,有助于个体化治疗,对中晚期非小细胞肺癌的患者有更好的管理。
[Abstract]:Objective: lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world. Despite the rapid development of modern medicine, how to improve the diagnosis and treatment of early lung cancer, Can we find a better method or biomarker to evaluate the therapeutic response and predict the progress of the disease, and how to better manage the lung cancer patients. This paper discusses the above problems. Methods: we studied 49 patients with untreated primary non-small cell lung cancer (NSCLC) and 10 controls (including diagnosis, carcinoembryonic antigen, carcinoembryonic antigen). A total of 49 NSCLC patients with cytokeratin 19 fragment were treated with platinum-based first-line chemotherapy. Then before the first cycle of chemotherapy, before the third cycle of chemotherapy and before the fifth cycle of chemotherapy, the plasma levels of vascular endothelial growth factor (VEGF) were collected and quantified, and the correlation analysis was carried out according to the evaluation results. Results: we observed that the plasma VEGF level of lung adenocarcinoma was higher than that of lung squamous cell carcinoma (P0.05 / 2) the plasma VEGF level was regarded as lung adenocarcinoma. The area under the operating characteristic curve (ROC curve) of patients with lung squamous cell carcinoma (ROC curve) was 0.91010 / 0.72395% confidence interval (CI) 0.813-1.000 / 0.537-0.909, respectively. The sensitivity of the two groups was 760.87.5%, and the specificity of each part was 90% (P 0.053) before the third chemotherapy, when the fifth time of chemotherapy was evaluated, The plasma VEGF levels in remission, stable and advanced stages were different (P0.05 / 4) before the third time of chemotherapy, before the fifth time of chemotherapy, the levels of plasma VEGF were 0.8570.8056, respectively, the sensitivity was 88.97.88.The specificity was 73.395CI (0.735-0.980,0.729-983P0. 001Ci, respectively) in response to the treatment, the plasma VEGF level was 0.857-0.856, and the specificity was 83.395CI (0.735-0.980) before the third time of chemotherapy, and before the fifth time of chemotherapy, the level of plasma VEGF reflected the progression of the disease, and the specificity was 0.735-0.980 (0.729-983P = 0.001), respectively. The response of plasma VEGF was good, the AUC before the 5th chemotherapy was 0.2180.146, the plasma VEGF level was poor, before the 3rd chemotherapy, the AUC before the 5th chemotherapy was 0.617-0.9470.730-0.978, and the AUC before the 5th chemotherapy was 0.617-0.9470.730-0.978. More than 90% (P < 0.05). Conclusion: plasma VEGF has potential value as a specific biomarker of NSCLC in middle and late stage. Monitoring plasma VEGF level during first-line chemotherapy can identify which patients may have poor therapeutic response or disease progression in the early stage. This provides important information on whether or not we need to change treatment protocols, contribute to individualized treatment and better manage patients with advanced non-small cell lung cancer (NSCLC).
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

【参考文献】

相关期刊论文 前10条

1 丁旭青;韩玉培;杨鲲鹏;;VEGF-C、VEGFR-3在NSCLC中的表达与淋巴转移[J];河南外科学杂志;2016年06期

2 王X;何娜萍;吴琼;向满林;易斌;;血管内皮生长因子在肺癌中的临床应用价值[J];检验医学;2016年09期

3 王永莎;范娟;傅少志;丁瑞麟;;阿帕替尼联合紫杉醇不同时序给药治疗肺癌的实验[J];肿瘤防治研究;2016年07期

4 李旭;张翠翠;谭红叶;陈锦波;;甲磺酸阿帕替尼片治疗晚期非小细胞肺癌的临床效果观察[J];中国生化药物杂志;2016年02期

5 石远凯;孙燕;于金明;丁翠敏;王子平;王长利;王东;王存德;王征;王孟昭;支修益;卢铀;冯继锋;刘云鹏;刘晓晴;刘巍;伍钢;李小梅;李凯;李恩孝;李薇;陈公琰;陈正堂;余萍;吴宁;吴密璐;肖文华;张力;张沂平;张树才;杨树军;宋霞;林冬梅;罗荣城;单莉;周彩存;周宗玫;赵琼;胡成平;胡毅;郭其森;常建华;黄诚;曾tD;韩宝惠;韩晓红;郏博;韩颖;黄昱;;中国晚期原发性肺癌诊治专家共识(2016年版)[J];中国肺癌杂志;2016年01期

6 王丹平;束军;沈继龙;袁杰清;;PEDF与VEGF检测在非小细胞肺癌诊断中的应用探讨[J];医学与哲学(B);2015年09期

7 孟谊;杨杨;樊祥山;钱晓萍;刘宝瑞;王立峰;;VEGF、EGFR的表达与非小细胞肺癌生物学行为的相关性[J];现代肿瘤医学;2015年05期

8 王颖轶;陈书长;;STAT5、VEGF和EGFR在非小细胞肺癌中表达的相关研究[J];现代肿瘤医学;2014年04期

9 杨晋;;64排螺旋CT与血清肿瘤标志物联合检测在肺癌诊断中的价值[J];中国煤炭工业医学杂志;2014年03期

10 何全利;吴艳艳;鲁之中;刘伟;;五种血清肿瘤标志物联合检测对肺癌的临床诊断价值[J];中国临床研究;2014年02期

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