Elevation of serum level of vascular endothelial growth factor as a new predictor of recurrence and disease progression in patients with superficial urothelial cancer

Objectives. To determine whether the serum vascular endothelial growth factor (VEGF) level in patients with urothelial cancer could be used as a predictor of recurrence and disease progression. Methods. Serum levels of VEGF in 51 healthy controls and 135 patients with urothelial cancer (81 superficial and 54 invasive cancers) were measured using a sandwich enzyme immunoassay, and the results were analyzed with respect to several clinicopathologic factors. Results. Significant differences in the serum VEGF level were observed between healthy controls and patients with superficial urothelial cancer (34 +/- 12 pg/mL versus 49 +/- 27 pg/mL, P < 0.001) and between healthy controls and patients with invasive cancer (34 +/- 12 pg/mL versus 51 rt 35 pg/mL, P < 0.001), whereas there was no significant difference in the serum VEGF level between superficial and invasive cancers (49 +/- 27 pg/mL versus 51 +/- 35 pg/mL, P = 0.31). Among patients with superficial cancer, the disease-free survival rate of patients with elevated serum levels of VEGF was significantly lower than that of patients with normal levels (P < 0.05). The progression-free survival rate of superficial cancer patients with elevated serum levels of VEGF was also significantly lower than that of patients with normal levels (P < 0.01). In addition, Cox's multivariate analysis revealed that the elevation of serum VEGF level was strongly associated with disease-free survival and progression-free survival in patients with superficial cancer (P < 0.05). Conclusions. The results of this study suggest that the elevation of serum VEGF level could be used as a new independent predictor of recurrence and disease progression in patients with superficial urothelial cancer. (C) 1999, Elsevier Science Inc. All rights reserved.